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Course: ENDO511
20/12/2015
ENDODONTIC MICROBIOLOGY
ROLE OF BACTERIA IN PULP AND PA PATHOSIS
Kakahashi 65 demonstrated presence of bacteria is necessary to
produce pulpal necrosis and periapical inflammation.
Moller 81 demonstrated non-infected necrotic pulp tissue did not
produce inflammatory reactions in periapical tissues.
TERMINOLOGY
- Colonization: the establishment of bacteria or other
microorganism in a living host.
- Infection: damage the host and produce clinical signs and
symptoms.
- Pathogenicity: the capacity of organisms to produce disease
within a particular host.
- Virulence: the degree of pathogenicity in a host under defined
circumstance.
- Planktonic cells: free floating bacterial cells
- Sessile cells: bacterial cells present in groups of coaggregates
(cells with distinct morphologies) OR aggregates (cells with the
same morphology)
- Biofilm: sessile multicellular microbial community characterized
by cells that are firmly attached to a surface and enmeshed in a
self-produced matrix of extracellular polymeric substance (EPS),
usually polysaccharide.
- Strict anaerobes: function at low oxidation-reduction potential
and grow only in the absence of oxygen, but they vary in their
sensitivity to oxygen.
- Obligate anaerobic bacteria: they can grow in the presence of
oxygen, but they derive most of their energy from anaerobic
energy pathways.
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Course: ENDO511
20/12/2015
Caries
Trauma and restoration leakage
Anachoreasis
Periodontal disease
Dental Caries:
A. Facultative gram +ve bacteria
- Propionibacterium
- Eubacterium, arachnia
- Lactobacilli, bifidobavcterium
- Actinomyces
B. Some of gram ve
- Bacteroides
The most common pathway to the root canal system for microbes.
When the tooth is intact, enamel and dentin protect it against invasion
of the pulp space. As caries approaches the pulp, reparative dentin is
laid down to avert exposure, but this rarely can prevent microbial entry
without caries excavation.
DENTINAL TUBULES
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Course: ENDO511
20/12/2015
PERIODONTAL DISEASE
-
Accessory canal
Furcation canal
Lateral canal
Apical foramen
Exposed dentinal tubule
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Course: ENDO511
20/12/2015
Mechanism of Action
Bacterial attachment, prevention
of bacterial phagocytosis
Capsule, exopolysaccharide, Bacterial attachment, prevention
glycocalyx
of
bacterial
phagocytosis,
protection from complement and
immune system
Peptidoglycan,
muramyl Immunodilation,
induction
of
peptides
inflammatory mediators
Endotoxin
Activation
of
inflammatory
response, activation of cytokine
production, induction of bone
resorption
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Course: ENDO511
Proteolytic
enzymes:
collagenase,
gelatinase,
hyaluronidase,
fibrolysin,
immunoglobulin
proteases.
H2S
and
volatile
sulfur
compunds
Inorganic acids: butyric acid,
propionic acid
Superoxide dismutase
20/12/2015
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Course: ENDO511
20/12/2015
FUNGI
- Fungi are eukaryotic microorganisms that may colonize the oral
cavity, especially candida species, but they have been only
occasionally detected in primary Intraradicular infections.
- Reported C. albicans in 21% of samples from primarily infected
canals.
VIRUSES
- Because viruses require viable host cells to infect and replicate
themselves, they cannot thrive in the root canal with necrotic
pulp.
- Viruses have been reported to occur in the root canal only in
noninflamed vital pulps of patients infected with the human
immunodeficiency virus.
- Human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV)
have been detected in apical periodontitis lesions.
ENDODONTIC INFECTION
Intraradicular
Extraradicular
- Primary
- Secondary
- Persistent
PRIMARY ENDODONTIC INFECTIONS
- Primary infections are caused by microorganisms that initially
invade and colonize the necrotic tissue.
- Primary infections are characterized by a mixed clostridium
composed of 10-30 species per canal.
- The number of bacterial cells in an infected canals varies from
103-108 cells.
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Course: ENDO511
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P.
P.
P.
P.
intermedia
nigrescence
tannerae
multisaccharivorax
Porphyromonas
1. P. endodontalis
2. P. gingivalis
They seem to play an important role in the etiology of both acute and
chronic apical periodontitis, cases with purulent discharge and 51% of
symptomatic cases
SECONDARY ENDODONTIC INFECTION
Microorganisms not the primary cause of infection, but have been
introduced into the root canal during or after root canal treatment
There is increased risk of adverse outcome of the endodontic
treatment.
- Create both excellent apical and coronal seal
- Prevent bacterial nutrient regain in to the canal
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Course: ENDO511
20/12/2015
EXTRARADICULAR INFECTION
Microbial invasion and proliferation in inflamed periradicular tissue. It
can be dependent (sequel of Intraradicular infection acute apical
abscess) so can be successful (actinomycosis) where surgery is must.
BIOFILMS
Defined as a sessile multicellular microbial community characterized
by cells that are firmly attached to a surface and enmeshed in a selfproduced matrix of extracellular polymeric substance (EPS) usually
polysaccharide
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Course: ENDO511
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BENEFITS:
-
INFECTION CONTROL
Standard of care for infection control
Endodontic treatment or extraction
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