title: The association between dental health and procedures and developing shunt infections in pediatric patients.
abstract: OBJECTIVE
  Cerebrospinal fluid-diverting shunts are often complicated by bacterial infections. Dental procedures are known to cause transient bacteremia that could potentially spread hematogenously to these implanted devices. No literature currently exists to inform practitioners as to the need for prophylactic antibiotics for patients who possess these implants. The authors performed a retrospective study to assess whether dental procedures and poor oral health were associated with a higher likelihood of developing CSF-diverting shunt infections.
  
  
  METHODS
  Neurosurgical and pediatric dental records from January 2007 to December 2012 were reviewed for shunt surgeries and dental encounters. Indications for shunt surgery and infection rates were recorded. Dental records were reviewed for several markers of overall dental health, such as a DMFT (decayed, missing, and filled teeth) score and a gingival health/oral hygiene score. The association between these scores and the incidence of shunt infections were studied. Moreover, the relationship between the incidence of shunt infections and the timing and invasiveness of preceding dental encounters were analyzed.
  
  
  RESULTS
  A total of 100 pediatric patients were included in our study, for a total of 204 shunt surgeries. Twenty-one shunt infections were noted during the 6-year study period. Five of these shunts infections occurred within 3 months of a dental procedure. The odds ratio (OR) of developing a shunt infection within 3 months of a dental procedure was 0.98 (95% confidence interval [CI] 0.27-3.01), and was not statistically significant. The OR of developing a shunt infection after a high-risk dental procedure compared with a low-risk dental procedure was 1.32 (95% CI 0.02-16.29), and was not statistically significant. There was no significant association between measures of dental health, such as DMFT and gingival health score, and the likelihood of developing a shunt infection. The ORs for these 2 scores were 0.51 (95% CI 0.04-4.96) and 1.58 (95% CI 0.03-20.06), respectively. The study was limited by sample size.
  
  
  CONCLUSIONS
  Dental health status and the number and type of dental procedures performed do not appear to confer a higher risk of developing a CSF-diverting shunt infection in this pediatric population.
authors.affiliation: Department of General Internal Medicine, Keck Hospital of University of Southern California;
authors.forename: Alan A
authors.initials: AA
authors.lastname: Moazzam
authors.forename: Ernest
authors.initials: E
authors.lastname: Nehrer
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Da Silva
authors.forename: José C
authors.initials: JC
authors.lastname: Polido
authors.forename: Anush
authors.initials: A
authors.lastname: Arakelyan
authors.forename: Mina
authors.initials: M
authors.lastname: Habibian
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D005260:Female; D005882:Gingival Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D009909:Oral Health; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D009057:Stomatognathic Diseases / Q000601:surgery*
keywords: CHLA = Children's Hospital of Los Angeles; CI = confidence interval; DMFT = decayed, missing, and filled teeth; OR = odds ratio; dental procedures; pediatric shunts; shunt infection; ventriculoperitoneal shunts