Focal Infection, Bacteremias, Anachoresis and the Hollow Tube Theory 2010

Objectives and Goals

  • be able to describe and discuss the "Theory of Focal Infection"
  • understand the consequences of a bacteremia and be intimately familiar with the appropriate prophylactic antibiotic regimen.
  • be able to describe and discuss the "Hollow Tube Theory"
  • be able to describe and discuss the phenomenon of anachoresis.

All Read: Ingle's Endodontics 6th edition.  2008 pp 221-223

Focal Infection and Bacteremia

Rosenow EC.  The relation of dental infection to systemic disease. Dental Cosmos 1917;59:485.

Okell CC, Elliot SD.  Bacteremia and oral sepsis with special reference to   the etiology of subacute endocarditis.  Lancet 1935;2:869.

Fish EW.  Bone infection.  JADA 1939;26(5):691-712.

Grossman LI.  Focal infection: are oral foci of infection related to systemic disease?  DCNA 1960;4:749.

Bender IB, Seltzer S, Yermish M.  The incidence of bacteremia in   endodontic manipulation. Oral Surg 1960;13(3):353-360.

Baumgartner JC, Heggers JP, Harrison JW.  The incidence of bacteremias related to endodontic procedures I. Non-surgical      endodontics.  JEndodon 1976;2(5):135-140.

Baumgartner JC, Heggers JP, Harrison JW.  Incidence of bacteremias related to endodontic procedures. II Surgical endodontics.  JEndodon 1977;3(10):399-404.

Williams DG.  The dangers of root canal therapy.  Alternatives 1994;5(8):57-60.

Debelian GJ, Olsen I, Tronstad L.  Bacteremia in conjunction with endodontic therapy.  Endod Dent Traumatol 1995;11:142-149.

Mattila, K.J. et al. Age, Dental Infections and Coronary Heart Disease. J    Dent Res 79:(2)756-760, 2000

Niederman R, Joshipura K. Cause célébre: oral health and heart disease. Evidence-Based Dentistry 2000;2:59-60.

ADA. Antibiotic prophylaxis for dental patients with total joint replacements. JADA 2003;134(July):895-899.

Savarrio L, Mackenzie D, Riggio M, Saunders WP, Bagg J. Detection of bacteraemias during non-surgical root canal treatment. J Dent. 2005;33:293-303.

Joshipura KJ, Pitiphat W, Hung H-C, Willett WC, Colditz GA, Douglass CW. Pulpal inflammation and incidence of coronary heart disease. J Endod. 2006;32(2):99-103.

Caplan DJ, Chasen JB, Krall EA, Cai J, Kang S, Garcia RI, et al. Lesions of endodontic origin and risk of coronary heart disease. J Dent Res. 2006;85(11):996-1000.

Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc. 2007;138:458-74.

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. J Am Dent Assoc. 2007;138:739-60.

AAOS. Information statement- Antibiotic prophylaxis for bacteremia in patients with joint replacements.  2009   

Hollow Tube Theory

Rickert UG, Dixon CM.  The controlling of root surgery. Trans Eighth Int Dent Congress 1931.

Goldman M, Pearson AH.  A preliminary investigation of the "hollow tube" theory in endodontics: studies with neotetrazolium.  J Oral Ther       Pharmacol 1965;1:618-626.

Torneck CD.  Reaction of rat connective tissue to polyethylene tubeimplants. Part I.  Oral Surg 1966;21:379.

Torneck CD.  Reaction of rat connective tissue to polyethylene tubeimplants. Part 2. Oral Surg 1967;24(5):674-683.


Gier RE, Mitchel DF.  Anachoretic effect of pulpitis.  J Dent Res 1968;47:564.

Allard, U. et al. Experimental infections with S. aureus, S. sanguis, P. aeruginosa, and B. fragilis in the jaws of dogs. Oral Surg 48:454-462 1979.

Delivanis PD, Snowden RB, Doyle RJ.  Localization of blood-borne bacteria in instrumented unfilled root canals.  Oral Surg 1981; 52 (4):430-432.

Delivanis PD, Fan VSC.  The localization of blood-borne bacteria ininstrumented unfilled and over-instrumented canals.  J Endodon 1984:10(11):521-524.

Tziafas D.  Experimental bacterial anachoresis in dog dental pulps capped with calcium hydroxide.  J Endodon 1989;15(12):591-595.


Meinig, G.  Root Canal Cover-up.  second edition, 1994.   (interesting book you all should read at some point)

Hunter, W.  The role of sepsis and antisepsis in medicine.  Lancet 1911;1:79.

Hunter, W.  The role of sepsis and antisepsis in medicine.  Dent Cosmos 1918;60:585.

Appleton JLT.  Bacteriologic control of the treatment of periapical infections.  Dental Items of Interest 1927;49:589-597.

Blaney JR.  The problem of the pulpless tooth as seen by clinical and laboratory investigation.  J  Dent Res 1930;10:425.

Coolidge ED.  The status of pulpless teeth as interpreted by tissue tolerance and repair following root canal filling.  JADA 1933;21:1669

Bartels HA.  The bacteriologist's view of focal infection.  NY St Dent J 1953;19:199.

Oartel JS.  Focal infection:evidence of the mechanism.  DCNA 1960;4:739.

Bender IB.  Dental procedures in patients with rheumatic heart disease.  Oral Surg 1963;16:466.

Dubrow H.  A method of treating non-vital with radiolucent periapical areas.  NY St Dent J 1964;30:155.

Phillips J.  Connective tissue response to hollow  polyethylene tube implants.  J Can Dent Assoc 1967;33(2);59.

Kennedy GDC, Simpson MS.  The hollow tube controversy.  Brit Endod Soc 1969;3(2):25.

Ehrmann EH.  Are dead teeth a health hazard? Med J Aust 1972;2:378.

Ehrmann EH.  Focal infection-the endodontic point of view.  Oral Surg 1977;44(4):628.

Hunter N.  Focal infection in perspective.  Oral Surg 1977:44(4):626

Wenger JS, Tsaknis PJ, del Rio CE, Ayer WA.  The effects of partially filled polyethylene tube jimplants in rats.  Oral Surg 1978;46(1):88.

Shepherd JP.  Osteomyelitis of the tibia following dento-alveolar abscess.  Brit Dent J 1978;145:267.

Ingham Hr.  Abscesses of the frontal lobe of the brain secondary to covert dental sepsis.  Lancet 1978;2:497.

Baumgartner JC, Plack WF.  Dental treatment and management of a patient with a heart valve.  JADA 1982;104:181.

Torabinejad M, Theofilopoulos AN, Ketering JD, Bakland LK.  Quantitation of circulating immune complexes, immunoglobulins G and M, and C3 complement component in patients with large periapical lesions.  Oral Surg 1983; 55:186.

Guntheroth WG.  How important are dental procedures as a cause of infective endocarditis.  Amer J Cardiol 1984;54:797.

Jaspers MT. Little JW.  Infective endocarditis; a review and update.  Oral Surg 1984;57:606. 

Griffin MR.  Infective endocarditis: Olmstead County, Minnesota 1950 to 1981.  JAMA 1985;254:1199.

Leviner E.  Development of resistant oral viridans streptococci after administration of prophylactic antibiotics: time management in the dental treatment of patients susceptible to infective endocarditis.  Oral Surg 1987;64:417.

Baltch AL.  Bacteremia in patients undergoing oral procedures: study following parenteral antimicrobial prophylaxis as recommentde by the American Heart Associaton.  Arch Intern Med 1988;148:1084.

King RC.  Bacteremia following intraoral suture removal.  Oral Surg 1988;65:23.

Dajani AS, Bisno AL, Chung KJ, Durack DT, Freed M, Gerber MA, et al. Prevention of bacterial endocarditis:  Recommendations by the American Heart Association. J Am Dent Assoc. 1990;64(22):2919-22.

Little JW. Antibiotic prophylaxis for prevention of bacterial endocarditis and infectious major joint prostheses. Oral Surg. 1992;2(III):93-101.

Beeson PB. Fashions in pathogenic concepts during the present centruy: autointoxication, focal infection, psychosomatic disease, and autoimmunity. Perspect Biol Med. 1992;36:13-23

Hall G, Hedstrom SA, Heindahl A, Nord CE. Prophylactic administration of ;enicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis. 1993;17(2):188-94.

Debelian GF, Olsen I, Tronstad L. Systemic diseases caused by oral microorganisms. Endod Dent Traumatol. 1994;10(2):57-65.

Reams GJ, Baumgartner JC, Kulild JC. Practical application of infection control in endodontics. J Endod. 1995;21(5):281-4.

Lacassin F, al e. Procedures associated with infective endocarditis in adults: a case control study. Eru Heart J. 1995;16:1968-74.

Wahl MJ. Myths of dental-induced prosthetic joint infections. Clin Infect Dis. 1995;20:1420-5.

Durack DT. Prevention of infective endocarditis. N Engl J Med. 1995;332(1):38-44.

Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996;67:1103-13.

Beck J, Garcia R, Heiss G, Vohomes PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol. 1996;67:1123.

Pallasch TJ, Slots J. Antibiotic prophylaxis for the medically compromised patient. Periodontology 2000. 1996;10:107-38.

Hall G, Nord CE, Heimdahl A. Elimination of bacteremia after dental extraction: comparison of erythromycin and clindamycin for prophylaxis of infective endocarditis. J Antimicrob Chemother. 1996;37(4):783-95.

Dajani AS, Taubert K, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis. J Am Dent Assoc. 1997;277(22):1794-801.

Cockerill FRI, al e. Analysis of 281,797 consecutive blood cultures performed over an eight-year perios: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis. 1997;24:403-18.

Advisory Statement: antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 1997;128:1004-8.

Durack DT. Antibiotics for prevention of endocarditis during dentistry: time to scale back? Ann Intern Med. 1998;129(10):829-31.

Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, et al. Dental and cardiac risk factors for infective endocarditis A population-based, case-control study. Ann Int Med. 1998;129(10):761-9.

Periodontology AAo. Periodontal disease as a potential risk factor for systemic diseases. J Periodontol. 1998;69:841-50.

Gibbons RV. Germs, Dr. Billings, and the theory of focal infection. Clin Infect Dis. 1998;27:627-33.

Bert F, Bariou-Lancelin M, Lambert-Zechovsky N. Clinical significance of bacteremia involving the 'Streptococcus milleri' group: 51 cases and review. Clin Infect Dis. 1998;27:385-7.

Roberts GJ. Dentists are innocent! 'Everyday' bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. Pediat Cardiol. 1999;20:317-25.

Jostes JL. Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an overview. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:483.

[29]      Pallasch T, Wahl M. The focal infection theory:  appraisal and reappraisal. Calif Dent Assoc J. 2000;28(3):194-200.

Pallasch T, Slots J. Oral Microorganisms and cardiovascular disease. Calif Dent Assoc J. 2000;28(3):204-14.

Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. J Am Med Assoc. 2000;284(11):1406-10.

Moles DR, Silva IDS. Causes, associations and evaluating evidence; can we trust what we read? Evidence-Based Dentistry. 2000;2:75-8.

Murray CA, Saunders WP. Root cnal treatment and general health: a review of the leterature. Int Endod J. 2000;33:1-18.

Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Examining the link between coronary heart disease and the elimination of chronic dental infections. J Am Dent Assoc. 2001;132:883-9.

Fouad AF, Barry J, Caimano M, Clawson M, Zhu Q, Carver R, et al. PCR-based identification of bacteria associated with endodontic infections. J Clin Microbiol. 2002;40:3223-31.

Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Pre-existing cardiovascular disease and periodontitis: a follow-up. J Dent Res. 2002;81:186-91.

Kulacz R, Levy TE. The roots of disease: Xlibris Corporation 2002.

Joshipura KJ, Douglas CW. Oral and  cardiovascular disease associations do not call for extraction of teeth. J Evidence Based Dent Prac. 2002;2:261-6.

ADA. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(July):895-9.

Pallasch TJ, Wahl MJ. Focal infection: new age or ancient history? Endod Topics. 2003;4:32-45.

Pallasch TJ. Antibiotic prophylaxis. Endod Topics. 2003;4:46-59.

Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal-systemic disease associations in the presence of smoking - causal or coincidental. Periodontology 2000. 2005;30:51-60.