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Grant32
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When is bacterial infection irreversible?
Once it hits the pulp
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How do bacteria invade the pulp?
Bacteria advance through the dentinal tubules
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What are some portals of entry for bacteria to the pulp?
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where are the microbes located in endodontic infections?
- Resorption lacunae
- periodontal plaque
- necrotic pulp tissue (major site)
- Dentinal tubules
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What is the etiologic agent of pulpal infection and periradicular lesion formation?
Bacteria
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What caused necrosis of the pulp?
The severance of blood supply (no metabolic activity)
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What do all teeth with periapical osteitis have?
- They all harbor bacteria.
- No bacteria were isolated from teeth without it
- Most samples had more than one bacterial strain
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which bacteria are prevalent in pulpal infection?
- Obligate anaerobic bacteriaFusobacterium, Bacteroides, Peptococcus, Peptostreptococcus
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When does a periapical immune response occur?
- When the infection overwhelms pulpal defenses and destroys the pulp tissue
- The periapical respnse is the second line of defense
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What causes a periapical lesion?
The accumulation of inflammatory cells and bone destruction
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Which bacteria are associated with caries? Deep caries?
- Streptococcus mutansStreptococcus sobrinusActinomyces
- Deep:
mostly strict anaerobes
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What did the necrotic dental pulp study of 1976 show?
- 1. Most samples had more than one bacterial strain
- 2. Predominance of obligate anaerobic bacteriafusobacterium, bacteroides, eubacterium, peptostreptococcus
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What is the root canal flora of noncarious but necrotic teeth with a diseased apex?
- It is dominated (90%+) by obligate anaerobesfusobacterium, porphyromonas, prevotella, eubacterium
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What is the microbial composition of carious teeth with necrotic pulp and diseased periapex?
It is less dominated (<70%) by strict anaerobes
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What are some species of polymicrobial endodontic infections?
- 1. Porphyromonas, black-pigmented (gingivalis, endodontalis)
- 2. Prevotella, black-pigmented (denticolla, intermedia, nigrescenst)
- 3.Prevotella, non-pigmented (buccae)
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Can fungi be present at the foramen of a root canal with a periapical granuloma?
Yes
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Possible nutritional relationships between bacteria inthe root canal
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What is the active component of Lipopolysaccharide (LPS) implicated in bacterial virulence?
Lipid A is the active component. It also has an O-specific chain
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How can you maximize endodontic prognosis?
By eliminating the microorganisms from infected root canals
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What is the core concept of endodontic treatment?
chemomechanical debridement and biomechanical preparation, followed by an obturation of the root canal system
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How do we treat vital pulp?
with a pulpectomy
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How do we treat necrotic pulp?
We treat by disrupting the microbial ecosystem by bacterial removal, as well as their byproducts and substate, from the canal system
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What do you do for emergency treatment of necrotic pulp?
- Multifaceted approach
- 1. Debridement of pulp space
- 2. Drainage of canal or soft tissue
- 3. Pharmacotherapeutics
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What do you do during an average endo treatment?
- 1. endo access
- 2. Determine working length
- 3. disinfect root canal
- 4. intracanal medication
- 5. place root filling
- 6. restoration
- 7. observation and follow up
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Tooth and rubber dam disinfection materials
- 1. 30% H202
- 2. 5% iodine tincture or .5% CHX
- 3. 6% Sodium Hypochlorite
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Root canal irrigants/disinfectants
Sodium hypochloride, Chlorhexidine
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Removal of smear layer compounds
- Irrigate with distilled water, then..
- Citric Acid, EDTA, MTAD
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What do you use to medicate between appointments? What does it do?
- calcium hydroxideHydrolyzes lipid moiety of bacterial LPS, alters properties
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What usually happens to periapical lesions after treatment is complete?
The lesions absolve through repair and regeneration
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Which has a higher success rate after RCT, + or - cultures?
- cultures (88.6%) have more than + (75%)
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What complicates the success of root canal therapies?
- The presence of bacteria can greatly affect the sucess
- The micro flora of failed RCT is different from untreated teeth
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What is the most commonly recovered bacteria in failed root canals?
Enterococcus faecalis
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Which factors of microbes have a negative impact on prognosis of treatment?
- Infection at time of root filingSize of preperative periapical lesion
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Which medical condition reduces the success of endo treatment?
Diabtes
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