Root canal treatment and apical periodontitis: What can be learned from observational studies?

Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review

Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.

Periapical status and prevalence of endodontic treatment in institutionalized elderly

The aim of this study was to determine the prevalence and frequency of apical periodontitis and root fillings in 450 institutionalized Brazilian elderly. The teeth with apical periodontitis were assessed using the Periapical Index (PAI) score. A total of 942 teeth were evaluated in 98 subjects (57 females and 41 males) with mean age of 74 years. The observed frequency of total edentulous subjects was high (76%) in this population. A total of 126 teeth showed root fillings, of these only 46 (36.5%) were scored as having adequate quality. Apical periodontitis was found in 114 teeth (12.1%) in 42 (42.9%) subjects. 80 (70.2%) inadequate root-filled teeth showed apical periodontitis. There was a significant correlation between the presence of periapical pathology and inadequate root-filled teeth. Inadequate root-filled teeth were associated with an increased prevalence of apical periodontitis in these subjects. This fact may result in increased endodontic retreatment needs for this population.

Influence of increased patient age on longitudinal outcomes of root canal treatment: a systematic review

OBJECTIVES

To conduct a systematic review of longitudinal endodontic outcomes in elders.

BACKGROUND

Negative opinions about the prognosis of non-surgical root canal treatment (NSRCT) in elders affect decisions made by patients and dentists. Patient, caregiver and dentist attitudes and behaviours may interact to decrease the provision of NSRCT. Critical examination of the available evidence through systematic review could provide objective data to assist patients, caregivers, healthcare providers and third-party payers in making decisions about the efficacy of NSRCT in elders and provide a robust foundation for the health promotion of NSRCT in elders.

METHODS

Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane CENTRAL. Title lists were scanned, and abstracts read to determine utility; articles meeting inclusion/exclusion criteria were analysed. Data were extracted and compiled into a table of evidence.

RESULTS

Defined searching produced 3605 titles; 24 articles were included, nine prospective and 15 retrospective. Overall study quality was good. Patient samples mostly represented modern populations from countries with very high human development indices. Over 17 430 teeth were included. Meta-analysis was not attempted due to heterogeneity in reporting. All 24 included papers demonstrated that increased patient age did not decrease the success or survival rates of NSRCT.

CONCLUSIONS

This systematic review of longitudinal NSRCT outcomes demonstrated that increased patient age did not decrease the success of NSRCT. Patient age is not a prognostic factor for NSRCT. Age should not be considered by dentists or patients when making NSRCT decisions.

Effect of vanadium chloroperoxidase on Enterococcus faecalis biofilms

INTRODUCTION

The aim of this study was to explore the antimicrobial effect of vanadium chloroperoxidase (VCPO) reaction products on Enterococcus faecalis biofilms of 4 different strains.

METHODS

Twenty-four-hour biofilms of E. faecalis strains V583, ER5/1, E2, and OS-16 were incubated in mixtures with VCPO, halide (either bromide or chloride), and hydrogen peroxide. The antibacterial efficacy was assessed by colony-forming unit counts.

RESULTS

The VCPO reaction products had a similar efficacy in reducing the viability of the 4 strains of E. faecalis (94%; range, 87%-100%). Bromide as the halogen of choice was more effective on E. faecalis strains E2 and OS-16, as compared with chloride (Mann-Whitney U test; P < .05). Despite different quantities of produced biofilms by the 4 strains, VCPO treatment was similarly effective toward all strains (Kruskal-Wallis test; P < .05).

CONCLUSIONS

VCPO treatment results in an antimicrobial effect toward in vitro E. faecalis biofilms and might provide an addition to current endodontic treatment, possibly as an antimicrobial dressing.