Endodontic microbiology

Endodiontics

1. Endodontic Microbiology ANJALI SAVITA MDS I DEPT OF CONSERVATIVE AND ENDODONTICS

2. Contents Introduction Mechanisms of Microbial Pathogenicity Microbial Ecology and the Root Canal Ecosystem Routes of canal infection Endodontic microbiota Types of endodontic infections Biofilm and bacterial interaction Bacterial treatment measures Conclusion References

3. INTRODUCTION Microorganisms cause virtually all pathoses of the pulp and the periradicular tissues. To effectively treat endodontic infections, clinicians must recognize the cause and effect of microbial invasion on the dental pulp space and the surrounding periradicular tissues.

4. Mechanisms of Microbial Pathogenicity and Virulence Factors

5. Bacterial cell and its structural components that can act as virulence factors.

6. Bacterial virulence factors

7. Microbial Ecology And Root Canal Ecosystem

8. NUTRIENT SUPPLY TO MICROBES

9. ROUTES OF ROOT CANAL INFECTION

10. Correlation With Pathoses And Treatment

11. Endodontic Microbiota

12. Gram Positive

13. Gram Negative

14. Types Of Endodontic Infections Intraradicular Infections Extraradicular Infection

15. Primary Intrardicular Infection

16. Bacteria Involved In Primary Intraradicular Infection Gram Negative Gram Positive

17. BACTEROIDS

18. Fusobacterium Nucleatum

19. Spirochete

20. Secondary Intraradicular Infections

21. Bacteria Involved In Secondary Intraradicular Infection

22. Persistant Intraradicular Infection

23. E . Faecalis

24. Virulence factors of E. Faecalis

25. Why E. feacalis can survive in root filled teeth?

26. Fungi

27. Extraradicular infections

28. Biofilm And Bacterial Interaction Definition

29. According to kishen There are four distinct stages in development of biofilm Formation of a conditioning layer Planktonic bacterial cell attachment Detachment (seeding dispersal) Bacterial growth and biofilm expansion.

30. The biofilm has following attributes that makes it resistance to clinical

31. Quorum sensing is mediated by low molecular weight molecules- autoinducers Qs leads to Exchange of genetic materials between species Antibiotic resistance Nutrient breakdown Xenobiotic metabolism Coordinated behaviour of biofilm

32. Endodontic biofilms help bacteria to survive because

33. Classification Of Endodontic Biofilm

34. Bacterial Treatment Measure

35. Irrigants Saline Sodium hypochlorite(NaOCl) CHX Hydrogen peroxide ( Citric acid EDTA   Sonic and ultrasonic devices can improve irrigant effect

36. ICM Formocresol PCP &CPC Glutaraldehyde Cresatin Thymol The current IC Medicament of choice is Ca (OH)2

37. DRAINAGE Drainage removes these irritants & improves local circulation.

38. Adjunctive Antibiotic therapy

39. Prophylactic Antibiotics for Medically Compromised Patients Prior to surgical procedures gum & mucosa should be disinfected with: Chlorhexidine or iodine-glycerin

40. Medically compromised patients at great risk of bacteremia include: Medically compromised patients at risk of bacteremia must receive a regimen of antibiotics that follows the recommendations of American Heart Association (AHA)

41. Antibiotics Fever 38°c Malaise Trismus Diffuse swelling Cellulitis Signs & symptoms of systemic Involvement & spread infection Alone or in combination Antibiotics should be continued for 2 to 3 days after disappearance of signs & symptoms.

42. Selection of an Antibiotic Regimen

43. Culturing

44. Conclusion Microbes seeking to establish in the root canal must leave the nutritionally rich and diverse environment of the oral cavity, breach enamel, invade dentine, overwhelm the immune response of the pulp and settle in the remaining necrotic tissue within the root canal. During that time they have to compete in a limited space with other microbes for the available nutrition. The bacterial community profiles in treated cases vary from individual to individual, indicating that distinct bacterial combinations can play a role in treatment failure.

45. References Kenneth M. Hargreaves, Stephen Cohen. Cohen’s Pathways of the Pulp. 10th edition. Elsevier, Mosby.2011 Ingle, Bakland , Baumgartner. Ingle’s Endodontics 6. BC Decker. 2008 Sabeti M, Slots J: Herpesviral -bacterial coinfection in periapical pathosis. J Endod 30:69, 2004 Siqueira JF, Jr, Rôças IN: Polymerase chain reaction-based analysis of microorganisms associated with failed endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:85, 2004. Sakamoto M, Siqueira JF, Jr, Rôças IN, Benno Y: Molecular analysis of the root canal microbiota associated with endodontic treatment failures. Oral Microbiol Immunol 23:275–281, 2008.

46. Zoletti GO, Siqueira JF, Jr, Santos KR: Identification of Enterococcus faecalis in root-filled teeth with or without periradicular lesions by culture-dependent and –independent approaches. J Endod 32:722, 2006. Rôças IN, Hulsmann M, Siqueira JF, Jr: Microorganisms in root canal-treated teeth from a German population. J Endod 34:926, 2008. Rôças IN, Siqueira JF, Jr, Aboim MC, Rosado AS: Denaturing gradient gel electrophoresis analysis of bacterial communities associated with failed endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:741, 2004. Kaufman B, Spangberg L, Barry J, Fouad AF: Enterococcus spp. in endodontically treated teeth with and without periradicular lesions. J Endod 31:851, 2005. Aruna Kanaparthy , Rosaiah Kanaparthy:Biofilms-The Unforgiving Film in Dentistry (Clinical Endodontic Biofilms) . Dentistry 2012, 2:7 Adalberto R. Vieira, Jose F. Siqueira, Domenico Ricucci . Dentinal Tubule Infection as the Cause of Recurrent Disease and Late Endodontic Treatment Failure: A Case Report. JOE — Volume 38, Number 2, February 2012

47. Abou-Rass M, Bogen G(1998) Microorganisms in closed periapical lesions. International Endodontic Journal, 1 :39-47 Baumgartner JC, Falkler WA(1991) Bacteria in the apical 5 mm of infected root canals. Journal of Endodontics, 17:380–383. Bogen G, Slots J(1999) Black-pigmented anaerobic rods in closed periapical lesions. International Endodontic Journal, 3:204-10. Cohen S, Burns RC (2002) Pathways of the pulp, ed 8. Harcourt Asia Co., India,: 457-500. Cruse WP, Bellizzi R (1980) A historic review of endodontics, 1689–1963, part 1. Jornal of Endodontics, 6: 495–499.

48. Dymock, D; Weightman , A J; Scully, C; Wade, W G (1996) Molecular analysis of microflora associated with dentoalveolar abscesses. Journal of Clinical Microbiology, 34 : 537-542 Goumas PD, Naxakis SS, Papavasiliou DA, Moschovakis ED, Tsintsos SJ, Skoutelis A (1997) Periapical abscesses: causal bacteria and antibiotic sensitivity. : Journal of Chemotherapy, 6:415-9. G. Sundqvist & David Figdor (2003) Life as an endodontic pathogen, Ecological differences between the untreated and root-filled root canals. Endodontic Topics, 6: 3–28. Haapasalo M, Ranta K, Ranta H (1987) Mixed anaerobic periapical infection with sinus tract. Endodontics & dental traumatology, 3; 83-5. HedmanWJ (1951) An investigation into residual periapical infection after pulp therapy. Oral Surgery Oral Medicine Oral Pathology, 4 : 1173-9.

49. Henderson B, Wilson M (1998) Commensal communism and the oral cavity. Journal of Dental Research, 77 : 1674–1683. Hirshberg A, Tsesis I, Metzger Z, Kaplan I, Aviv T. Israel (2003) Periapical actinomycosis: A clinicopathologic study. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontics, 95:614-20. Iwu C, Wallace T (1990) The microbiology of periapical granuloma. Oral Surgery Oral Medicine Oral Pathology, 69: 502-5. Jansen H-J, van der Hoeven JS (1997) Protein degradation by Prevotella intermedia and Actinomyces meyeri supports the growth of non- proteincleaving oral bacteria in serum. Journal of Clinical Periodontology, 24: 346– 353. Jansen H-J, van der Hoeven JS, Walji S, Goertz JH, Bakkeren JA (1996) The importance of immunoglobulin breakdown supporting the growth of bacteria in oral abscesses. Journal of Clinical Periodontology, 23: 717–723. Kiryu T, Hoshino E, Iwaku M (1994) Bacteria invading periapical cementum. Bacteria invading periapical cementum. Journal of Endodontics,4:169-72