endodontic microbiology
TRANSCRIPT
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ENDODONTIC MICROBIOLOGYSARANG SURESH HOTCHANDANI
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▪ The PURPOSE OF ENDODONTIC TREATMENT is to;
Eradicate the occurring infection
Prevent the microbes from infecting the root canal or peri radicular tissue.
▪ Endodontic infections usually develop after pulpal necrosis or in those cases in which pulp was removed for treatment.
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▪ Apical periodontitis is inflammatory disease of microbial origin caused by infection of root canal.
▪ Bacteria are major microorganisms involved in etiology of apical periodontitis.
▪ APICAL PERIODONTITIS DEVELOPS WHEN FIGHT B/W HOST DEFENSE AND ROOT CANAL BACTERIA OCCURS WHICH RESULT IN INFLAMMATION OF PERIAPICAL AREA.
▪ After death of pulp, host defense is lost, then after this, bacteria in root canal form biofilms (similar to dental caries) which in result damage the periapical area.
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ROUTES OF ROOT CANAL INFECTION▪ Normally, dentine & pulp
are sterile and is covered by enamel & cementum which prevent the entry of microorganisms.
▪ Microorganisms can reach the pulp when these protective coverings (enamel & cementum) are lost due to following reasons.
▪ Microbes which can damage the pulp and can lead to apical periodontitis comes from following sources;
▪ Oral cavity
▪ Periodontium
▪ Systemic root
▪ Bacteria reach at pulp through following routes;
▪ Dentinal tubules
▪ Lateral or apical foramina
▪ Systemic roots
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▪ Bacterial invasion of dentinal tubules occurs more rapidly in non – vital teeth than in vital teeth.
▪ But if the dentine thickness is very small, permeability to microbes is increased because of larger diameter of tubules near the pulp.
▪ In non-vital pulp above mentioned things does not occur & necrotic pulp is best environment for bacteria.
▪ EFFECTS OF VITALITY OF PULP;
▪ Outward movement of fluid in exposed dentinal fluid prevent the diffusion of microbes.
▪ Tubular contents also decrease the dentinal permeability to microbes;
▪ Collage
▪ Crystals
▪ Host defense molecules
▪ Antibodies
▪ Dentinal sclerosis, reparative or reactionary, smear layer also prevents the diffusion of microbes.
▪ These effects are produced only when the pulp is vital.
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DIRECT PULP EXPOSURES
It is most noticeable route of
endodontic infection.
Caries (most common)
Trauma
Restorative procedures
Scaling & root planning
Attrition or abrasion
Naturally absent
Congenital anomalies
• Dens invaginates
• Dens evaginatus
• Palatal groove defects
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PERIODONTAL DISEASE
▪ Microbes in subgingival biofilms reach the pulp thorough
▪ Dentinal tubules
▪ Lateral, apical or furcation canals.
▪ Pulp necrosis due to periodontal disease develop only when periodontal pocket reaches the apical foramina which damages the vessels penetrating through apical foramina.
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ANACHORESIS
▪ It is a process by which microorganisms are transmitted in the blood or lymph to an area of tissue damage.
▪There is no clear evidence that this process cause root canal infection.
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MICROBIOTA OF ENDODONTIC INFECTION
CLASSIFICATION OF ENDODONTIC INFECTION
▪ Extra radicular infection
▪ Intra radicular infection
▪ Primary infection
▪ Secondary infection
▪ Persistent infection
•Asymptomatic apical periodontitis
•Dialister invisnus
•Bacteroids.
•Symptomatic Apical Periodontitis
• Treponema Denticola
•Acute Apical Abscess
•Porphyromonas Endodonticalis,
• Treponema Denticola
The different types of
endodontic diseases contain different types of
microbes.
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PRIMARY INTRA RADICULAR INFECTION (VIRGIN INFECTION)
▪These are those microorganisms which initially invade & colonize the necrotic pulp tissue.
▪ These organisms may be those which initially infected the pulp and resulted in inflammation & then necrosis. OR these organisms may be late comers which arrive as soon as pulp necrosis.
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PRIMARY INTRA RADICULAR INFECTION (VIRGIN INFECTION)
▪ Primary infection is caused by mixed group of bacteria; gram +ve, gram -ve & others.
▪ Composed of 10 – 30 bacterial species & 103 – 108 bacterial cells per canal.
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PERSISTENT & SECONDARY ENDODONTIC INFECTIONS.
▪ Persistent endodontic infections; these are those microbes which survive in root canal after intra canal antimicrobial procedures.
▪ Secondary Endodontic Infection; these are those microbes which occupy the root canal during or after professional intervention of root canal (RCT).
▪ They can be oral or non-oral bacteria depending on source.
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•Loss or leakage of restorative material.
•Tooth fracture.
•Opened teeth for drainage of abscess.
SOURCE OF MICROBES BETWEEN
APPOINTMENTS
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Gram Positive Bacteria are Most Common Persistent Bacteria.
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E. faecalis facultative anaerobic gram positive
coccus (30 – 90% cases) &
Candida infections (3 – 18%
cases) are found more commonly in root canal
treated teeth in post treatment apical
periodontitis (Secondary Intra Radicular)
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EXTRA RADICULAR INFECTIONS
▪Extra radicular infections are characterized by, microbial invasion & proliferation in the inflamed peri radiculartissue as a result of intra radicular infections.
▪The most common form of extra radicular infection is acute apical abscess.
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EXTRA RADICULAR INFECTION CAN BE CAUSED BY INTRA RADICULAR BACTERIA OR BACTERIA FROM OUTER SIDE.
▪ Those extra radicular infections which are caused by intra radicular bacteria are treated easily by RCT.
▪Example; Sinus Tract
▪ If the extra radicular infection which are caused by outer side are treated only by Endodontic Surgery.
▪Example; Actinomycosis
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SYMPTOMATIC INFECTIONS
▪ Occurrence and intensity of symptoms is due to interaction of following factors with each other;
▪ Difference in virulence ability among strains of same species
▪ The number of occurring species & interaction among them
▪ The number of bacterial cells (load)
▪ Environmental factors which regulate the expression of virulence factor of microbes
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ECOLOGY OF ENDODONTIC MICROBIOTA
▪ Necrotic root canal is a fertile environment for bacterial growth.
▪ It gives bacteria a moist, warm, nutritious & anaerobic environment which is protected from host defense due to absence of microcirculation in necrotic pulp.
▪ The ecologic factors which affect the composition of microbes in necrotic root canal include;
▪ Oxygen tension & redox potential
▪ Type & amount of available nutrients
▪ Bacterial interactions
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OXYGEN TENSION & REDOX POTENTIAL
▪Different bacterial species dominate at different stages of the infectious process.
▪ In initial phases of pulpal infectious process;
▪ Facultative bacteria predominate
▪During pulp necrosis & consumption by facultative bacteria, oxygen is reduced in root canal so;
▪ Obligate anaerobes predominate here
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AVAILABLE NUTRIENTS UTILIZED BY BACTERIA IN ROOT CANAL
The necrotic pulp tissue
Proteins & glycol proteins from tissue fluid
Components of saliva
Products of metabolism of other bacteria
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INTERACTION WITH OTHER SPECIES IN ROOT CANAL
▪Positive interaction enhances the survival capacity & quantity of interacting bacteria;
▪Mutualism, Commensalism
▪Negative interaction decreases the quantity of bacteria;
▪ Example; Competition & Antagonism
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APICAL PERIODONTITIS AS A BIOFILM RELATED DISEASE
▪Bacteria in root canal may exist in one of two patterns;
▪Planktonic cells (unattached free floating cells)
▪ Easily eliminated with instrumentation & irrigation.
▪ Formation of biofilm that adheres to walls of root canal. (DOMINANT PATTERN IN APICAL PERIODONTITIS)
▪ More difficult to eradicate & require special therapeutic approaches.
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APICAL PERIODONTITIS AS A BIOFILM RELATED DISEASE
▪ So, it means apical periodontitis is also biofilm induced oral disease like caries & marginal periodontitis.
▪ Definition of Biofilm: sessile, multicellular microbial community characterized by cells that are firmly attached to a surface and trapped in self – produce matrix.
▪ Advantages of Biofilm:
▪ Good communication among species
▪ Metabolic cooperation
▪ Protection against exogenous threats
▪ Pathogenic effect on the host
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