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Niazi SA, Bakhsh A. Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:931. [PMID: 35888650 PMCID: PMC9319780 DOI: 10.3390/medicina58070931] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
The 'Focal Infection Era in Dentistry' in the late 19th and early 20th century resulted in widespread implementation of tooth extraction and limited the progress of endodontics. The theory proposed that bacteria and toxins entrapped in dentinal tubules could disseminate systemically to remote body parts, resulting in many types of degenerative systemic diseases. This theory was eventually refuted due to anecdotal evidence. However, lately there has been increased interest in investigating whether endodontic disease could have an impact on general health. There are reviews that have previously been carried out on this subject, but as new data have emerged since then, this review aims to appraise the available literature investigating the dynamic associations between apical periodontitis, endodontic treatment, and systemic health. The available evidence regarding focal infection theory, bacteraemia and inflammatory markers was appraised. The review also collated the available research arguing the associations of apical periodontitis with cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome and autoimmune disorders, along with the effect of statins and immunomodulators on apical periodontitis prevalence and endodontic treatment prognosis. There is emerging evidence that bacteraemia and low-grade systemic inflammation associated with apical periodontitis may negatively impact systemic health, e.g., development of cardiovascular diseases, adverse pregnancy outcomes, and diabetic metabolic dyscontrol. However, there is limited information supporting the effect of diabetes mellitus or autoimmune disorders on the prevalence and prognosis post endodontic treatment. Furthermore, convincing evidence supports that successful root canal treatment has a beneficial impact on systemic health by reducing the inflammatory burden, thereby dismissing the misconceptions of focal infection theory. Although compelling evidence regarding the association between apical periodontitis and systemic health is present, further high-quality research is required to support and establish the benefits of endodontic treatment on systemic health.
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Affiliation(s)
- Sadia Ambreen Niazi
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy’s Dental Hospital, King’s College London, London SE1 9RT, UK
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah 24381, Saudi Arabia;
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Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 2015; 27:419-40. [PMID: 24982315 DOI: 10.1128/cmr.00092-13] [Citation(s) in RCA: 411] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Propionibacterium acnes is known primarily as a skin commensal. However, it can present as an opportunistic pathogen via bacterial seeding to cause invasive infections such as implant-associated infections. These infections have gained more attention due to improved diagnostic procedures, such as sonication of explanted foreign materials and prolonged cultivation time of up to 14 days for periprosthetic biopsy specimens, and improved molecular methods, such as broad-range 16S rRNA gene PCR. Implant-associated infections caused by P. acnes are most often described for shoulder prosthetic joint infections as well as cerebrovascular shunt infections, fibrosis of breast implants, and infections of cardiovascular devices. P. acnes causes disease through a number of virulence factors, such as biofilm formation. P. acnes is highly susceptible to a wide range of antibiotics, including beta-lactams, quinolones, clindamycin, and rifampin, although resistance to clindamycin is increasing. Treatment requires a combination of surgery and a prolonged antibiotic treatment regimen to successfully eliminate the remaining bacteria. Most authors suggest a course of 3 to 6 months of antibiotic treatment, including 2 to 6 weeks of intravenous treatment with a beta-lactam. While recently reported data showed a good efficacy of rifampin against P. acnes biofilms, prospective, randomized, controlled studies are needed to confirm evidence for combination treatment with rifampin, as has been performed for staphylococcal implant-associated infections.
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Examination of a Culturable Microbial Population from the Gastrointestinal Tract of the Wood-Eating Loricariid Catfish Panaque nigrolineatus. DIVERSITY-BASEL 2013. [DOI: 10.3390/d5030641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Perry A, Lambert P. Propionibacterium acnes: infection beyond the skin. Expert Rev Anti Infect Ther 2012; 9:1149-56. [PMID: 22114965 DOI: 10.1586/eri.11.137] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Propionibacterium acnes is a Gram-positive bacterium that forms part of the normal flora of the skin, oral cavity, large intestine, the conjunctiva and the external ear canal. Although primarily recognized for its role in acne, P. acnes is an opportunistic pathogen, causing a range of postoperative and device-related infections. These include infections of the bones and joints, mouth, eye and brain. Device-related infections include those of joint prostheses, shunts and prosthetic heart valves. P. acnes may play a role in other conditions, including inflammation of the prostate leading to cancer, SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, sarcoidosis and sciatica. If an active role in these conditions is established there are major implications for diagnosis, treatment and protection. Genome sequencing of the organism has provided an insight into the pathogenic potential and virulence of P. acnes.
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Affiliation(s)
- Alexandra Perry
- Eurofins Agroscience Services Ltd, Slade Lane, Wilson, Melbourne, Derbyshire, DE73 8AG, UK
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5
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Rafferty B, Jönsson D, Kalachikov S, Demmer RT, Nowygrod R, Elkind MS, Bush H, Kozarov E. Impact of monocytic cells on recovery of uncultivable bacteria from atherosclerotic lesions. J Intern Med 2011; 270:273-80. [PMID: 21366733 PMCID: PMC3133811 DOI: 10.1111/j.1365-2796.2011.02373.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Epidemiological evidence suggests that infections may contribute to atherogenesis. However, with the exception of Chlamydophila pneumoniae, cultivable bacteria have not been recovered from atherosclerotic lesions. Therefore, we aimed at developing an approach to recover uncultivable bacteria from atherectomy tissues. METHODS We cultured homogenates from atherectomy specimens from seven nonseptic patients undergoing surgery for arterial obstruction either alone or together with THP-1 monocyte-like cells. We performed 16S rDNA analysis, biochemical tests, random amplification of polymorphic DNA PCR analysis, quantitative polymerase chain reaction (qPCR) and immunohistofluorescence to identify the cultivated bacteria. Wilcoxon signed-rank tests were used to determine whether THP-1 treatment yielded a higher number of isolates than did the untreated controls. RESULTS We recovered more bacteria from cocultures of atherectomy specimens with THP-1 cells than atherectomy specimens cultured alone. On average, tissue homogenates incubated with THP-1 cells versus control yielded 124 vs. 22 colony-forming units, a median of 140 vs. 7, respectively (P = 0.02). We recovered 872 isolates of limited number of species, including Propionibacterium acnes, Staphylococcus epidermidis and Streptococcus infantis and the fastidious anaerobe Porphyromonas gingivalis, and confirmed its presence in tissue using double immunofluorescence imaging. qPCR demonstrated the presence of ≥3.5 × 10(3) P. gingivalis genomes per gram of atheromatous tissue. CONCLUSIONS These results indicate that viable previously uncultivable bacterial species are present within atheromas. Our results suggest revisiting the hypothesis that infections may have a causative role in atherosclerotic inflammation and have implications for research regarding novel diagnostics and treatments for cardiovascular disease.
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Affiliation(s)
- Brian Rafferty
- Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Daniel Jönsson
- Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Sergey Kalachikov
- Columbia Genome Center, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Ryan T. Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Roman Nowygrod
- Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Mitchell S.V. Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
| | - Harry Bush
- Department of Surgery, Weill Cornell Medical College, 445 East 69th Street, New York, NY 10021, USA
| | - Emil Kozarov
- Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University Medical Center, 630 West 168 Street, New York, NY 10032
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Eribe ERK, Hofstad T, Olsen I. Enzymatic/Biochemical and Cellular Fatty Acid Analyses of Leptotrichia Isolates. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/089106002320644311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Emenike Ribs K. Eribe
- From the 1Dental Faculty, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Tor Hofstad
- Department of Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway
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Lyons JA, Bemis DA, Bryant MJ, Kania SA, Abd-Eldaim M, Newman SJ. Isolation of Propionibacterium Acnes from a Case of Placentitis and Abortion in a Cow. J Vet Diagn Invest 2009; 21:274-277. [DOI: 10.1177/104063870902100220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
On the basis of the scarcity of reports in the veterinary literature, it appears that Propionibacterium spp. are rarely associated with disease or isolated from cattle tissues. Recently, Propionibacterium spp. has been associated with multifocal abscessation in cattle. This report describes a case of necrosuppurative placentitis and abortion in an adult Holstein cow. Numerous colonies of small, pleomorphic, Gram-positive, rod-shaped bacteria were observed within the fibrin lattice associated with placental lesions and within the fetal atelectatic lung. Propionibacterium acnes was isolated in high numbers from the placenta, fetal lung, and stomach contents. To the authors' knowledge, this is the first report of placentitis associated with propionibacteria in a cow.
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Affiliation(s)
| | | | | | | | - Mohamed Abd-Eldaim
- Departments of Comparative Medicine
- College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; and the Virology Department, College of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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McDowell A, Perry AL, Lambert PA, Patrick S. A new phylogenetic group of Propionibacterium acnes. J Med Microbiol 2008; 57:218-224. [PMID: 18201989 DOI: 10.1099/jmm.0.47489-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Immunofluorescence microscopy-based identification of presumptive Propionibacterium acnes isolates, using the P. acnes-specific mAb QUBPa3, revealed five organisms with an atypical cellular morphology. Unlike the coryneform morphology seen with P. acnes types I and II, these isolates exhibited long slender filaments (which formed large tangled aggregates) not previously described in P. acnes. No reaction with mAbs that label P. acnes types IA (QUBPa1) and II (QUBPa2) was observed. Nucleotide sequencing of the 16S rRNA gene (1484 bp) revealed the isolates to have between 99.8 and 99.9 % identity to the 16S rRNA gene of the P. acnes type IA, IB and II strains NCTC 737, KPA171202 and NCTC 10390, respectively. Analysis of the recA housekeeping gene (1047 bp) did reveal, however, a greater number of conserved nucleotide polymorphisms between the sequences from these isolates and those from NCTC 737 (98.9 % identity), KPA171202 (98.9 % identity) and NCTC 10390 (99.1 % identity). Phylogenetic investigations demonstrated that the isolates belong to a novel recA cluster or lineage distinct from P. acnes types I and II. We now propose this new grouping as P. acnes type III. The prevalence and clinical importance of this novel recA lineage amongst isolates of P. acnes remains to be determined.
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Affiliation(s)
- Andrew McDowell
- School of Medicine and Dentistry, Queen's University, Belfast BT12 6BN, UK
| | - Alexandra L Perry
- Pharmaceutical and Biological Sciences, School of Life and Heath Sciences, Aston University, Birmingham B4 7ET, UK
| | - Peter A Lambert
- Pharmaceutical and Biological Sciences, School of Life and Heath Sciences, Aston University, Birmingham B4 7ET, UK
| | - Sheila Patrick
- School of Medicine and Dentistry, Queen's University, Belfast BT12 6BN, UK
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Debelian GJ, Eribe ER, Olsen I, Tronstad L. Ribotyping of bacteria from root canal and blood of patients receiving endodontic therapy. Anaerobe 2007; 3:237-43. [PMID: 16887597 DOI: 10.1006/anae.1997.0108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/1997] [Accepted: 05/25/1997] [Indexed: 11/22/2022]
Abstract
DNA restriction patterns and corresponding ribotypes of 26 bacterial isolates (Propionibacterium acnes, Peptostreptococcus prevotii, Fusobacterium nucleatum, Prevotella intermedia, Prevotella nigrescens, Actinomyces israelii, Streptococcus intermedius, and Streptococcus sanguis) recovered from patients with infected root canals and their peripheral blood, collected during and after endodontic therapy, were examined. Eleven additional reference strains including type strains were also examined. Purified DNA was digested with BglI,EcoRI, and HindIII. Hybridization was carried out with a digoxigenin-labeled cDNA probe obtained by reverse transcription of Escherichia coli 16S + 23S rRNA. Ribotypes of the bacteria recovered from root canal and blood showed identical characteristics within the patients, and differed between the patients. The results were confirmed when the similarity coefficient (S(AB)) of the ribotypes from the isolates were assessed by the Dendron computer-assisted system. These results suggested that the bacteria isolated from the blood originated from the root canal.
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Affiliation(s)
- G J Debelian
- Division of Endodontics, University of Oslo, Oslo, Norway.
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Brincat M, Savarrio L, Saunders W. Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required? Int Endod J 2006; 39:671-82. [PMID: 16916356 DOI: 10.1111/j.1365-2591.2006.01124.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this review is to evaluate the evidence implicating nonsurgical endodontic procedures in inducing infective endocarditis (IE). The literature is reviewed and findings about dental procedures that elicit bacteraemia [in particular root canal treatment (RCT)], sequelae of bacteraemia, relationship between IE and RCT and variation between antibiotic prophylaxis (AP) guidelines are highlighted. At present, there is still significant debate as to which dental procedures require chemoprophylaxis and what antibiotic regimen should be prescribed. Currently, there are insufficient primary data to know whether AP is effective or ineffective against IE. Practitioners are bound by current guidelines and medico-legal considerations. Thus, the profession requires clear, uniform guidelines that are evidence-based.
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Affiliation(s)
- M Brincat
- Department of Periodontology, Glasgow Dental Hospital and School, Glasgow, UK.
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Eldeniz AU, Erdemir A, Hadimli HH, Belli S, Erganis O. Assessment of antibacterial activity of EndoREZ. ACTA ACUST UNITED AC 2006; 102:119-26. [PMID: 16831684 DOI: 10.1016/j.tripleo.2005.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 11/08/2004] [Accepted: 06/12/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this in vitro study was to evaluate antibacterial activity of a new resin based sealer, EndoREZ in comparison with 5 other sealers: AH 26, Diaket, Sultan, Apexit, and RoekoSeal. STUDY DESIGN The effect of 6 different sealers on the growth of 3 bacteria (Enterococcus faecalis, Staphylococcus aureus, and Pseudomonas aeruginosa) was measured using the agar diffusion test (ADT) and direct contact test (DCT). For ADT, 200 microL bacterial suspensions were spread on agar plates and freshly mixed sealers were applied to uniform wells punched in the agar. The zones of inhibition of bacterial growth were measured at 24 hours, 48 hours, 7 days, and 10 days. For DCT, 2 sets of sealers were prepared: fresh and 24-hour samples. Fresh samples were used within 20 minutes of mixing time while 24-hour samples were allowed to set in a humid atmosphere at 37 degrees C for 24 hours before testing. Sealers were mixed and placed on the walls of microtiter plate wells and 10-microL bacterial suspensions were allowed to directly contact the sealers for 1 hour. Fresh media were added and 15 microL were transferred from this plate to another plate containing fresh medium (215 microL). Bacterial growth of this last plate was then measured using spectrophotometer every hour over 16 hours. RESULTS ADT results indicated that EndoREZ, Apexit, and RoekoSeal did not show any antibacterial activity. In DCT results, AH 26 and Sultan were potent bacterial growth inhibitors. CONCLUSION EndoREZ is not as potent a bacterial growth inhibitor as Sultan and AH 26.
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Affiliation(s)
- Ayce Unverdi Eldeniz
- Department of Endodontics, Faculty of Dentistry, University of Selcuk, Konya, Turkey.
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12
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Chu FCS, Tsang CSP, Chow TW, Samaranayake LP. Identification of Cultivable Microorganisms from Primary Endodontic Infections with Exposed and Unexposed Pulp Space. J Endod 2005; 31:424-9. [PMID: 15917680 DOI: 10.1097/01.don.0000148149.27636.9c] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was aimed at comparing the cultivable microorganisms in canals with periapical radiolucencies with exposed and unexposed pulp space. Microbiological samples were taken and analyzed from 45 canals with exposed pulp space, and 43 canals with unexposed pulp space. The canal contents were analyzed by aerobic/anaerobic culture, and conventional identification techniques. There were 211 isolates of bacteria belonging to 28 genera and 55 species recovered from exposed canals. In the unexposed group, 185 isolates of bacteria were recovered, of which 54 species of 28 genera were identified. Among the four most common genera, Prevotella was significantly more common in the exposed group (51/211 in the exposed group versus 30/185 in the unexposed group) (p = 0.049), while there were no differences in prevalence of Actinomyces, Peptostreptococcus, and Campylobacter between two groups of canals. In addition, Fusobacterium nucleatum and Propionibacterium acne were significantly more common in the unexposed canals (p = 0.047 and p = 0.0051, respectively). Similarity in bacterial species in these two groups suggests that pulp space exposure may not be a significant factor in determining the type of bacteria present in infected canals.
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Affiliation(s)
- Frederick C S Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Valanne S, McDowell A, Ramage G, Tunney MM, Einarsson GG, O'Hagan S, Wisdom GB, Fairley D, Bhatia A, Maisonneuve JF, Lodes M, Persing DH, Patrick S. CAMP factor homologues in Propionibacterium acnes: a new protein family differentially expressed by types I and II. Microbiology (Reading) 2005; 151:1369-1379. [PMID: 15870447 DOI: 10.1099/mic.0.27788-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Analysis of the draft genome sequence of the opportunistic pathogenPropionibacterium acnestype strain NCTC 737 (=ATCC 6919) revealed five genes with sequence identity to the co-haemolytic Christie–Atkins–Munch-Peterson (CAMP) factor ofStreptococcus agalactiae. The predicted molecular masses for the expressed proteins ranged from 28 to 30 kDa. The genes were present in each of the three recently identifiedrecA-based phylogenetic groupings ofP. acnes(IA, IB and II), as assessed by PCR amplification. Conserved differences in CAMP factor gene sequences between these three groups were also consistent with their previous phylogenetic designations. All type IA, IB and II isolates were positive for the co-haemolytic reaction on sheep blood agar. Immunoblotting and silver staining of SDS-PAGE gels, however, revealed differential protein expression of CAMP factors amongst the different groups. Type IB and II isolates produced an abundance of CAMP factor 1, detectable by specific antibody labelling and silver staining of SDS-PAGE gels. In contrast, abundant CAMP factor production was lacking in type IA isolates, although larger amounts of CAMP factor 2 were detectable by immunoblotting compared with type II isolates. While the potential role of the abundant CAMP factor 1 in host colonization or virulence remains to be determined, it should be noted that the type strain ofP. acnesused in much of the published literature is a type IA isolate and is, therefore, lacking in this attribute.
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Affiliation(s)
- Susanna Valanne
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - Andrew McDowell
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - Gordon Ramage
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - Michael M Tunney
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - Gisli G Einarsson
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - Seamus O'Hagan
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
| | - G Brian Wisdom
- School of Biology and Biochemistry, Medical Biology Centre, 97 Lisburn Road, Queen's University, Belfast BT9 7BL, UK
| | - Derek Fairley
- QUESTOR Centre, Queen's University, David Keir Building, Stranmillis Road, Belfast BT9 5AG, UK
| | - Ajay Bhatia
- Corixa Corporation, Infectious Disease Institute, Seattle, WA 98104, USA
| | | | - Michael Lodes
- Corixa Corporation, Infectious Disease Institute, Seattle, WA 98104, USA
| | - David H Persing
- Corixa Corporation, Infectious Disease Institute, Seattle, WA 98104, USA
| | - Sheila Patrick
- Department of Microbiology and Immunobiology, School of Medicine, Queen's University, Grosvenor Road, Belfast BT12 6BN, UK
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Savarrio L, Mackenzie D, Riggio M, Saunders WP, Bagg J. Detection of bacteraemias during non-surgicalroot canal treatment. J Dent 2005; 33:293-303. [PMID: 15781137 DOI: 10.1016/j.jdent.2004.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 09/01/2004] [Accepted: 09/16/2004] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Some dental procedures initiate a bacteraemia. In certain compromised patients, this bacteraemia may lead to distant site infections, most notably infective endocarditis. OBJECTIVE To investigate whether a detectable bacteraemia was produced during non-surgical root canal therapy. METHODS Thirty patients receiving non-surgical root canal therapy were studied. Three blood samples were taken per patient: pre-operatively, peri-operatively and post-operatively. In addition, a paper point sample was collected from the root canal. The blood samples were cultured by pour plate and blood bottle methods. The isolated organisms were identified by standard techniques. Blood samples were analysed for the presence of bacterial DNA by the polymerase chain reaction (PCR). In two cases where the same species of organism was identified in the root canal and the bloodstream, the isolates were typed by pulsed field gel electrophoresis (PFGE). RESULTS By conventional culturing, a detectable bacteraemia was present in 9 (30%) of the 30 patients who had no positive pre-operative control blood sample. In 7 (23.3%) patients, the same species of organism was identified in both the bloodstream and in the paper point sample from the root canal system. Overall, PCR gave lower detection rates compared with conventional culture, with 10 of 90 (11%) of the blood samples displaying bacterial DNA. PFGE typing was undertaken for two pairs of culture isolates from blood and paper points; these were found to be genetically identical. CONCLUSIONS Non-surgical root canal treatment may invoke a detectable bacteraemia.
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Affiliation(s)
- L Savarrio
- Department of Adult Dental Care (Level 6), University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
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Ferreira FBA, Ferreira AL, Gomes BPFA, Souza-Filho FJ. Resolution of persistent periapical infection by endodontic surgery. Int Endod J 2004; 37:61-9. [PMID: 14870760 DOI: 10.1111/j.1365-2591.2004.00753.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. SUMMARY The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.
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Affiliation(s)
- F B A Ferreira
- Endodontic Unit, Piracicaba Dental School, State University of Campinas, SP, Brazil
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17
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18
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Siqueira JF, Rôças IN, Favieri A, Oliveira JC, Santos KR. Polymerase chain reaction detection of Treponema denticola in endodontic infections within root canals. Int Endod J 2001; 34:280-4. [PMID: 11482139 DOI: 10.1046/j.1365-2591.2001.00382.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM A 16S rDNA-based polymerase chain reaction (PCR) method was used to detect the occurrence of Treponema denticola in root canals. METHODOLOGY Samples were collected from 54 single-rooted teeth having carious lesions and necrotic pulps. DNA extracted from the samples was amplified using the PCR assay, which yielded a specific fragment of T. denticola 16S rDNA. RESULTS T. denticola was detected in 10 of 29 asymptomatic cases (34.5%), eight of 15 root canals that were tender to percussion (53.3%), and five of 10 teeth with acute periradicular abscess (50%). In general, T. denticola was found in 23 of 54 cases (42.6%). CONCLUSIONS Findings suggest that T. denticola can be involved in the pathogenesis of periradicular lesions of endodontic origin.
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Affiliation(s)
- J F Siqueira
- Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil.
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Longman LP, Preston AJ, Martin MV, Wilson NH. Endodontics in the adult patient: the role of antibiotics. J Dent 2000; 28:539-48. [PMID: 11082521 DOI: 10.1016/s0300-5712(00)00048-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to review the published work on the indications and efficacy for antibiotics in endodontic therapy. DATA SOURCES Published works in the medical and dental literature. STUDY SELECTION Evaluation of published clinical trials in endodontic and other pertinent literature. CONCLUSIONS Antibiotics are not routinely indicated in the practice of endodontics. Therapeutic antibiotics may be required as an adjunct to operative treatment when there is pyrexia and/or gross local swelling; they are only rarely indicated in the absence of operative intervention. Prophylactic antibiotics may be required for certain patients who are susceptible to serious infective sequaelae.
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Affiliation(s)
- L P Longman
- Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK.
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Bate AL, Ma JK, Pitt Ford TR. Detection of bacterial virulence genes associated with infective endocarditis in infected root canals. Int Endod J 2000; 33:194-203. [PMID: 11307435 DOI: 10.1046/j.1365-2591.1999.00299.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to examine whether bacteria associated with root canals possess genes that might predispose to bacterial colonization of the endocardium. METHODOLOGY Oligonucleotides were designed from DNA sequences encoding the functional binding regions of streptococcal fibronectin-binding protein (FnBP) and staphylococcal fibrinogen-binding protein (FgBP). The specificity and cross-reactivity of the oligonucleotide primers were investigated; streptococcal primers were tested for recognition of FnBP genes in other strains of streptococci, and the staphylococcal primers for detection of FgBP from other staphylococci. Interspecies specificity of these primers was also investigated. In a pilot clinical study, the pulp chambers of 16 nonvital teeth without sinus tracts, were opened aseptically. Root canal samples were collected, along with samples from the gingival sulcus and anterior nares. From these samples DNA was extracted, subjected to polymerase chain reaction (PCR) and analysed by agarose gel electrophoresis. RESULTS Using the streptococcal FnBP primers, PCR bands were amplified from eight root canal samples, eight gingival samples and three nasal samples. With the staphylococcal primers, PCR bands were amplified from seven root canals, 11 gingival and nine nasal samples. This study showed that PCR could be used to detect bacteria in root canals that possess genes with homology to functional regions of those encoding FnBP or FgBP. CONCLUSIONS If bacteria in root canals possess FnBP or FgBP, they may have the potential to cause infective endocarditis.
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Affiliation(s)
- A L Bate
- Department of Conservative Dentistry, GKT Dental Institute, King's College, University of London, London, UK
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Abstract
REVIEW The focal infection theory was prominent in the medical literature during the early 1900s and curtailed the progress of endodontics. This theory proposed that microorganisms, or their toxins, arising from a focus of circumscribed infection within a tissue could disseminate systemically, resulting in the initiation or exacerbation of systemic illness or the damage of a distant tissue site. For example, during the focal infection era rheumatoid arthritis (RA) was identified as having a close relationship with dental health. The theory was eventually discredited because there was only anecdotal evidence to support its claims and few scientifically controlled studies. There has been a renewed interest in the influence that foci of infection within the oral tissues may have on general health. Some current research suggests a possible relationship between dental health and cardiovascular disease and published case reports have cited dental sources as causes for several systemic illnesses. Improved laboratory procedures employing sophisticated molecular biological techniques and enhanced culturing techniques have allowed researchers to confirm that bacteria recovered from the peripheral blood during root canal treatment originated in the root canal. It has been suggested that the bacteraemia, or the associated bacterial endotoxins, subsequent to root canal treatment, may cause potential systemic complications. Further research is required, however, using current sampling and laboratory methods from scientifically controlled population groups to determine if a significant relationship between general health and periradicular infection exists.
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Affiliation(s)
- C A Murray
- University of Glasgow Dental School, Glasgow, UK
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Weiss EI, Shalhav M, Fuss Z. Assessment of antibacterial activity of endodontic sealers by a direct contact test. ENDODONTICS & DENTAL TRAUMATOLOGY 1996; 12:179-84. [PMID: 9028181 DOI: 10.1111/j.1600-9657.1996.tb00511.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is recognized that endodontic success depends on bacterial elimination from the root and root canal system. Antibacterial activity of endodontic sealers can improve the success rate of endodontic treatment, provided the physical properties are not compromised. The aim of this study was to evaluate the antimicrobial properties of two endodontic sealers (AH26 and Endoflas) using a direct contact test (DCT) which was designed for this purpose. The DCT is based on measuring the effect of close contact between test bacteria and the tested material on the kinetics of bacterial outgrowth using a temperature controlled microplate spectrophotometer (THERMOmax). For comparison, the agar diffusion test (ADT) was performed for both materials. The results of the DCT showed that Endoflas was a significantly more potent bacterial growth inhibitor than AH26, whereas when assessed with the ADT, AH26 was capable of producing a larger inhibition zone than Endoflas. The DCT, by being quantitative and virtually independent of solubility and diffusion, was found more suitable to assay solid surfaces. The results demonstrated the added value of DCT in the study of the antimicrobial properties of endodontic sealers.
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Affiliation(s)
- E I Weiss
- Section of Operative Dentistry, Maurice and Gaoriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel
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Dahle UR, Tronstad L, Olsen I. Characterization of new periodontal and endodontic isolates of spirochetes. Eur J Oral Sci 1996; 104:41-7. [PMID: 8653496 DOI: 10.1111/j.1600-0722.1996.tb00044.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Gas chromatographic analysis of cellular fatty acids (CFA), biochemical reactions, electrophoresis of soluble cellular proteins, as well as immunodiffusion were used to discriminate between 16 fresh spirochete isolates from periodontal and endodontic infections. CFA patterns were compared by the Hewlett Packard MIDI library to all available reference strains, and results of the biochemical tests were compared to VPI's records for treponemal strains. The electrophoretograms of soluble proteins of the fresh isolates were compared to those of previously well described strains of Treponema denticola, T. pectinovorum, T. vincentii, T. socranskii subsp. socranskii, T. socranskii subsp. paredis, T. socranskii subsp. buccale, and T. socranskii 04. Immunodiffusion was carried out by using adsorbed polyclonal rabbit antibodies to representative strains of the species mentioned. These methods separated most clinical strains from approved species strains, suggesting that new species had been isolated.
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Affiliation(s)
- U R Dahle
- Department of Oral Biology, Dental Faculty, University of Oslo, Norway.
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Debelian GJ, Olsen I, Tronstad L. Systemic diseases caused by oral microorganisms. ENDODONTICS & DENTAL TRAUMATOLOGY 1994; 10:57-65. [PMID: 8062808 DOI: 10.1111/j.1600-9657.1994.tb00061.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Human endodontic and periodontal infections are associated with complex microfloras in which approximately 150, (in apical periodontitis) and 350 (in marginal periodontitis) bacterial species have been encountered. These infections are predominantly anaerobic, with gram-negative rods being the most common isolates. The anatomic closeness of this microflora to the bloodstream can facilitate bacteremia and systemic spread of bacterial by-products and immunocomplexes. A variety of clinical procedures such as tooth extraction, periodontal and endodontic treatment, may cause translocation of microorganisms from the oral cavity to the bloodstream. The microorganisms that gain entrance to the blood circulate throughout the body, but are usually eliminated by the host (reticuloendothelial system) within minutes. However, in patients with ineffective heart valves or vascular diseases, bacteremia can be a potential danger, leading most commonly to infective endocarditis and myocardial or cerebral infarction. Other forms of systemic diseases such as brain abscesses, hematological infections and implant infections have also been related to oral microorganisms.
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Affiliation(s)
- G J Debelian
- Division of Endodontics, University of Oslo, Norway
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