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Endodontic Microbiology
Endodontic Microbiology
LNDCDCN1IC MICkC8ICLCG
ur. 8aef Sherlf
LecLure CuLllne
lnLroducLlon
orLals of enLry for mlcroorganlsms
Mlcroblal vlrulence and paLhogenlclLy
rlmary endodonLlc lnfecLlons
Mlcroblology of perlradlcular endodonLlc lnfecLlons
Mlcroblology of rooL canal fallures
LndodonLlc abscesses and cellullLls
ldenLlflcaLlon of bacLerla
Pow Lo combaL mlcrobes ln 8C1
Introduct|on
3- Lnzymes
Lnzymes produced by bacLerla have numerous acLlvlLles llke:
Lhey help ln spread of lnfecLlon,neuLrallzaLlon of lmmunoglobulln and Lhe
complemenL componenL.Mn leucocuLes release hydrolyLlc enzymes
whlch degeneraLe and lyse Lo form purulenL exudaLes and have
adverse effecLs on Lhe surroundlng Llssues.
4- laLLy aclds
varlous shorL chaln faLLy aclds llke proplonlc acld, buLyrlc acld are produced
by aneroblc bacLerla. 1hey cause neuLrophlllc chemoLaxls,
degranulaLlon, phagocyLosls, and sLlmulaLe lnLerleukln-1 producLlon
whlch furLher causes bone resorpLlon and perlradlcular dlsease.
3- polyamlnes
1hese are blologlcally acLlve chemlcals found ln Lhe lnfecLed canals.
Some of polyamlnes such as cadaverlne, puLresclne, spermldlne help ln
regulaLlon of Lhe cell growLh, regeneraLlon of Llssues and modulaLlon
of lnflammaLlon.
6- Capsules
CLher vlrulenL facLors llke capsules presenL ln gram negaLlve black
plgmenLed bacLerla, enable Lhem Lo avold phagocyLosls.
7- llll
llll may play an lmporLanL role ln aLLachmenL of bacLerla Lo surfaces and
lnLeracLlon wlLh oLher bacLerla.
3
M|crob|a| echosystem of the root cana|
Slnce many years, varlous researches have been publlshed regardlng Lhe
mlcroblal flora of Lhe rooL canals, normal and lnfecLed.
8uL over pasL 3-10 years, dlfference ln flora has been reporLed because of
lmproved Lechnology ln sampllng, culLurlng Lechnlques, culLure medla
as well as more advanced Lechnology regardlng lsolaLlon and
ldenLlflcaLlon of mlcroorganlsms.
MosL commonly gram poslLlve organlsms are found ln Lhe rooL canals,
buL gram negaLlve and obllgaLe anaerobes have been found ln rooL canals.
usuallay Lhe mlcrobes whlch can survlve ln envlronmenL of low oxygen
Lenslon are found ln rooL canals. usuallay Lhe mlcrobes whlch can
survlve ln envlronmenL of low oxygen Lenslon and can survlve Lhe
rlgors of llmlLed pabulums are found ln rooL canals.
varleLy of mlcroorganlsms enLer Lhe rooL canal sysLem Lhrough varlous
porLals of enLry buL only Lhose whlch flL for survlval ln such
envlronmenL do survlve.
1ypes of bacter|a |ns|de the root cana|
MosL commonly seen bacLerla ln rooL canals ls sLrepLococcl ,
oLhers can be:
sLaphylococcus,
gram negaLlve and
anaeroblc bacLerla.
8acLerlal mlx ln necroLlc pulps
ln necrot|c pu|p, a mlx of bacLerlal specles ls found.
necroLlc pulp space acLs as a reservolr
ln necroLlc pulp, Lhere ls:
- lack of clrculaLlon wlLh
- compromlsed hosL defense mechanlsm,
Lhls makes pulp as a reservolr for lnvadlng mlcrobes.
ln necroLlc pulps,
- Llssue flulds and dlslnLegraLed cells,
- low oxygen Lenslon and
- bacLerlal lnLeracLlons
are Lhe maln facLors whlch deLermlne whlch bacLerla wlll predomlnaLe.
6
1he growLh of one bacLerlal specles may be dependanL on Lhe oLher
bacLerlal specles whlch supplles Lhe essenLlal neuLrlenLs.ln Lhe slmllar
way anLagonlsLlc relaLlonshlp may occur ln bacLerla,
l.e. byproducLs of some bacLerlal specles may klll or reLard Lhe growLh of
oLher specles.
ln oLher words, some byproducLs can acL elLher as nuLrlenL or as Loxln
dependlng on bacLerlal specles.
We can summarlze Lhe followlng relaLlons beLween organlsms lsolaLed from
rooL canals:
1- mlxed lnfecLlons are more common Lhan slngle lnfecLlon.
2- ulp conLalns flora almosL slmllar Lo LhaL of Lhe oral cavlLy.
3- ApproxlmaLely 23 of lsolaLed organlsms are anaerobes.
4- Crganlsms lsolaLed from-flare-up cases as well as- asympLomaLlc cases
are almosL slmllar.
3- varlous researchers have ldenLlfled wlde varleLy of mlcroorganlsms ln
Lhe rooL canals whlch ls parLlally relaLed Lo personal lnLeresL and
culLure Lechnlques used by Lhem.
A rooL canal conLalnlng necroLlc pulp becomes a selecLlve hablLaL LhaL
allows some specles of bacLerla Lo grow ln preference Lo oLhers.
1he nuLrlenLs provlded by Lhe breakdown producLs of a necroLlc pulp,
Llssue fluld and serum from surroundlng Llssues along wlLh
low oxygen Lenslon, and bacLerlal by-producLs supporL Lhe growLh of
selecLed mlcroorganlsms.
1he coronal porLlon of a rooL canal may harbor organlsms dlfferenL from
Lhose ln Lhe aplcal porLlon.
Some specles of black-plgmenLed bacLerla, epLosLrepLococcl,
lusobacLerlum and AcLlnomyces specles have been found relaLed Lo
cllnlcal slgns and sympLoms.
8uL because of polymlcroblal naLure of Lhe endodonLlc lnfecLlons, no
absoluLe correlaLlon has been found beLween bacLerlal specles and
severlLy of endodonLlc lnfecLlons.
7
1he paLhogenlclLy of bacLerolds ls malnly relaLed Lo Lhe presence of
llpopolysacharldes and pepLldoglycans.
1hese :
1- lnduce hormones llke cyLoklnlns whlch play an lmporLanL role ln
lnflammaLlon.
2- SLlmulaLe 8-lymphocyLes.
3- AcLlvaLe compllmenL cascade.
4- Lnhance producLlon of varlous paln medlaLors llke bradyklnl, hlsLamlne,
and prosLaglandlns.
3- LS once released ( as endoLoxlns ) causes blologlcal effecLs lncludlng
lnflammaLlon and bone resorpLlon.
M|crob|o|ogy of per|rad|cu|ar endodont|c |nfect|ons
Cnce a necroLlc pulp ls lnfecLed, Lhe rooL canal sysLem becomes a
sLorehouse of mlcroorganlsms. AL Lhe aplcal foramen and aL Lhe rooL
ends of lnfecLed canal, plaque llke blofllms have been found.
LxLraradlcular bacLerla are usually assoclaLed wlLh
acuLe sympLoms, Lhe presence of a slnus LracL,
an lnfecLed cysL, or ln cases noL respondlng Lo endodonLlc LreaLmenL.
8oLh acuLe and chronlc perlradlcular abscesses are polymlcroblal lnfecLlons
wlLh large numbers of bacLerla.
erlaplcal lnflammaLory leslons conLaln macrophages, lymphocyLes, ( 1-cells
and 8-cells ), plasma cells and neuLrophlls. 1helr funcLlon ls Lo prevenL
mlcroorganlsms from lnvadlng perlradlcular Llssues.
8oLh Lhe pulp and perlradlcular lnflammaLory Llssues have been shown Lo
produce cellular and humoral responses Lo Lhe mlcroorganlsms.
WhaL does mlcroblal lnvaslon produce?
Mlcroblal lnvaslon of perlradlcular Llssues resulLs ln producLlon of an
abscess or cellullLls. whlch presenLs Lhe slgns and sympLoms because
of speclflc and non-speclflc lnflammaLlon.
SLudles have shown LhaL polymlcroblal lnfecLlons are found ln boLh acuLe
and chronlc sLages of perlradlcular lnfecLlons.ln many asympLomaLlc
paLlenLs wlLh chronlc lnfecLlon, slnus LracLs have also been found
lL has been seen LhaL slnus LracLs are assoclaLed wlLh chronlc perlradlcular
abscesses LhaL always encompass a polymlcroblal lnfecLlon.
8
1hey are relaLlvely asympLomaLlc because Lhe slnus LracL provldes a
paLhway for dralnage.
lnvaslon of perlradlcualr Llssues ls relaLed Lo Lhe vlrulence of Lhe
mlcroorganlsms and Lhe hosL's reslsLance.
erlaplcal lnflammaLory leslons are dynamlc lnflammaLory evenLs and may
conLaln an abscess wlLh bacLerla,- a cysL and surroundlng
lnflammaLory Llssue slmulLaneously.
lL ls seen LhaL Lhe mosL common cause of perslsLanL perlraldcular lnfecLlons
ls lncompleLe debrldemenL of Lhe rooL canal sysLem.
lmporLance of seallng . 1herefore a Lhree dlmenslonal seallng of Lhe
rooL canal sysLem ls necessary for resoluLlon of perlaplcal paLhologles.
M|crob||ogy of root cana| fa||ures
1he lack of perlradlcular heallng followlng rooL canal LreaLmenL seems Lo be
relaLed Lo Lhe perslsLence of mlcroorganlsms ln Lhe rooL canal sysLem.
1hls would appear Lo be relaLed Lo an lnablllLy Lo effecLlvely shape, clean,
and seal Lhe compleLe rooL canal sysLem.
8acter|a |n treated & untreated cases d|ffer
lnLeresLlngly, Lhe mlcroflora culLured from prevlously fllled rooL canals wlLh
perslsLenL aplcal leslons dlffer slgnlflcanLly from Lhe mlcrobes ln
unLreaLed necroLlc canals. 8esearches have shown LhaL mlcroblology of
unLreaLed canals ls dlfferenL from prevlously obLuraLed canals.
8acLerla lsolaLed from canals prevlously fllled buL sLlll assoclaLed wlLh
radlographlc leslons Lend Lo have more fuculLaLlve bacLerla raLher Lhan
sLrlcL anaerobes.
lnsLead of havlng approxlmaLely equal amounLs of gram-negaLlve gram-
poslLlve bacLerla, Lhe bacLerla lsolaLed from prevlously obLuraLed
- culLlvable sLralns of malnly gram one Lo Lwo canals Lend Lo have only
poslLlve bacLerla.
ln several sLudles, prevlously fllled canals had a relaLlve lncrease ln Lhe
presence of otetococcos foecolls.
9
1he presence of bacLerla ln all of Lhe falled rooL canals supporLs Lhe
asserLlon LhaL Lhe vasL ma[orlLy of endodonLlc LreaLmenL fallures are
caused by lnLraradlcular lnfecLlons.
1he exLenL of endodonLlc lnfecLlons beyond Lhe rooL canal sysLem ls relaLed
Lo:
- vlrulence of bacLerla,
- hosL reslsLance, and
- assoclaLed anaLomy.
lnfecLlons may locallze or conLlnue Lo spread.
An abscess ls a cavlLy of purulenL exudaLes conslsLlng prlmarlly of:
bacLerla,
bacLerlal byproducLs,
lnflammaLory cells,
lysed cells, and Lhelr conLenLs.