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Pulp and Periradicular Microbiology
Pulp and Periradicular Microbiology
FACULTY OF DENTISTRY
ENDODONTIC DEPARTMENT
PREPARED FOR :
SUBMITTED BY :
TASNEEM SAFI
2017
I. PATHWAYS OF PULP AND PERIRADICULAR INFECTION:
- Bacteria was found to be the main cause of pulp and periradicular infection.
Kakehashi et al 1965, made an experiment on 2 groups of rats; germ free and normal
microbial flora rats. Pulp exposures in rat teeth were left exposed to saliva. Pulp
necrosis and periapical pathosis.(abscesses) developed only in rats with normal oral
flora. So there is a direct role of bacteria in initiation of these pathosis.
Organisms that infect root canals enter as planktonjc form which is free floating
single micro-organism cells in an aqueous environment inside root canal which can
cause infection.
Then they form aggregates which are grouping of microorganisms of same species
and coaggregates which are grouping of microorganisms of different species.
Bacteria then, adhere to dentin surface, colonize and multiplay to form biofilms .
Sessile biofilms are aggregates of one or more species of bacteria in polysaccharide
matrix that synthesize and attach the microorganism to a solid surface (e.g tooth
surface).
-Infection in root canal:
Infection depends on :
Host resistance
-Selection of species inside root canal depends on oxygen tension, pH, nutrient
avaliable, virulence and microbial interaction (synergism / antagonism) and host
defence.
1. Bacterial biofilm:
Microbial biofilms are resistant to antimicrobial agents and can not be removed by
mechanical preparation alone, inside bioflims micro-organisms have synergistic effect
or antagonistic effect on other microorganisms. So bioflims protect microorganisms
inside it. So it is one of the causes of endodontic failures. Therefore, it should be
eliminated to assure endodontic success.
a) Fimbrie (pilli) which allow adherence of bacteria to surfaces and allow aggregation
and conjugation.
- Some vesicles are secreted that have the same structure as parent micro-
organisms.They will bind to antibodies produced thus protecting their parent micro-
organsins.
- Some vesicles contain enzymes and toxins allow bacterial adhesion, and cause
heamagglutination, hemolysis proteolytic action.
b) Enzymes that aid in the spread of organisms in host tissue. They cause direct
damage by degrading components of the extracellular matrix of the connective tissue.
c) Endotoxins
Composed of Lipopolysaccharide (Lipid A portion) which is component of outer
membrane of Gram -ye bacteria only. It is released after micro-organisms death, It
activates complement system,cause fever, shock and bone resorption. It increases in
symptomatic cases.
d) Exotoxin
Composed of polypeptide which is produced in cytoplasm of Gram+ve bacteria
mainly,also gram-ve. It is secreted by living micro-organisms. One of exotoxins is
Leukotoxin which creates small holes on leukocyte membrane causing cell lysis.
IV. BACTRIAL IDENTIFICATION TECHNIQUE :
Microorganisms identification can be done with culturing technique or with the more
recent moleculer methods.
When to culture?
Technique:
After access preparations samples are taken by sterile paper points and placed in
transport
media that support growth of both aerobic and anerobic microorganisms.
Media used may be enriched blood agar or broth media (fluid thioglycolate or
chopped meat broth) for facultative and fastidious anerobic micro-organisms.
** Molecular Methods:
1.Intraradicular:
a) Primary infectjon: the first microorganisms which invade and Colonize necrotic
pulp. They are mixed polymicrobial infection mainly anerobic and Some facultative
microorganisms, with increase in obligate anerobes especially gm-ye bacteria Each
root canal contains about 5-8 different Species
By PCR, micro-organisms identified from infected canals were mainly:
* Bacteroidetes:
Black Pigmented Bacteroids (BPB) increase in acute infection, symptomatic cases and
flare ups.
I) Asaccharolytic Bacteroides:
Porphyrotnonas(EfldOd0fltaIis Gingivaiis)
II) Sacchirolytic Bacteroides:
2.Extraradicular infection:
Infection in per radicular area may be caused by:
o Intrardicular infection that extends to periapical area. e.g. acute apical abscess
caused by necrotic pulp, which need endodontic treatment. It contains
microorganisms similar to their intraradicular source, but with increase in Gram
–ve anerobic bactereia of bacteroids as Prevotella (den icolla, intermedia,
nigrcscens) and Porphyromonas (endodontalis, gingivalis)
Or
It has been well established that bacteria play a definite role in the development
of pulpitis
1. Isolation and barrier techniques: gloves, glasses, masks, shields, hand washing,
rubber dam.
REFERENCES :
Ingle IL, Bakland LK,. Baumgartner JC. Ingle’s Endodontics 6.6 ed. BC Decker Inc., 2008.
Hargreaves KH , Cohen S. Cohen’s Pathways of the pulp. 10th ed. Mosby El Sevier, 2011.