Bacteria on the tongue could cause ‘serious infections’ in the heart

Children's Oral Health

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There are billions of bacteria in the mouth, some of which reside exclusively on the tongue. Occasionally, these enter the blood through ulcers or other openings in the gums, allowing the entry of various circulating bacteria into the blood. Once in the systemic circulation, bacteria can prove fatal it if travels to the wrong places. This is because the body risks contracting serious infections.

Tongue scraping is advocated as an oral hygiene practice for the prevention of cavities and bad breath, which it does by reducing bacteria count in the mouth.

In fact, some literature states the practice is marginally more effective than the use of toothbrushes in managing halitosis (bad breath).

In some patients with vulnerable heart valves, the practice may carry a hidden risk of bacteraemia.

“The practice of tongue scraping […] has not been well studied, and both the magnitude and frequency of bacteraemia may be greater than with routine brushing,” explains a report by the Centers for Disease Control and Prevention (CDC).


The practice most closely related to a risk of bacteraemia is tooth extraction, however.

Neil Sikka, a dentist at Bupa Dental Central, explained: “In most cases, small numbers of bacteria are removed from the bloodstream by the immune system.

“This can lead to serious infections around the body including in the brain, heart and joints.”

Harmful levels of bacteria in the mouth typically manifest as gum disease first, but a great number of people ignore their symptoms.

When an inoculum of bacteria enters the bloodstream, however, some sites in the body may be more prone to inflammation.

“Bacteria are most likely to collect on artificial materials in the body. This would include prosthetic joints, heart valves and catheters,” explained Mr Sikka.

“For many years it was accepted practice when performing certain dental procedures on patients with prosthetic replacements and those at increased risk, that preventive antibiotics should be administered.

“However, following research in 2008, NICE (National Institute of Clinical Excellence) issued guidance […] stating that preventive antibiotics are not routinely recommended for dental treatment in at-risk patients.

“Under normal circumstances, healthy patients receiving dental treatment are at very low risk of developing bacteremia.”

Figures suggest that the incidence of bacteremia in adults ranges from zero percent to 100 percent for tooth extractions, and from zero to 57 percent for toothbrushing.

The risk of bacteremia from other practices like tongue scraping have yet to be quantified, but some case reports suggest it may be worth considering.

In 2007, the CDC reported on the case of a 59-year-old female who developed endocarditis two months after purchasing a plastic tongue scraper.

Endocarditis, which refers to “life-threatening” inflammation of the heart valves, is not a known complication of tongue scraping.

The patient’s doctors, however, proposed that she may have developed infective endocarditis as a “consequence” of bacteremia from the patient’s use of a tongue scraper.

It was also suggested that the use of tongue scrapers may not be “prudent” in people with abnormal cardiac valves.

Though literature supporting this link is scarce, research suggests the use of antiseptic mouthwash could significantly lower the risk of bacteremia.

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