To the Editor.—In his interesting interchange with Dr. Kaplan on the prophylaxis of bacteremia associated with dental manipulation,1 and in his paper which sparked the interchange,2 Dr. Speck poses the alternative of systemic antibiotics or no prophylaxis. He reports that blood cultures taken five minutes after aggressive prophylactic cleansing of teeth were negative in all of 32 children studied by him, and concludes that whereas bacteremia following dental manipulation may be common in adults, it is not so in children. Hence he provides no antibiotic cover in children with heart disease prior to such manipulation (except for extractions). His explanation for the distinction between adults and children is that periodontal disease involving the gingiva is widespread among adults, but is generally not found in pediatric patients. The diseased gingiva, presumably, is the primary source of the bacteremia following dental manipulation.
Dr. Kaplan cites evidence to the effect