Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

Relaciones endoperiodontales: una frontera transitable / Endoperiodontal relationships: a passable border

La existencia de una íntima conexión entre el conducto radicular y el ligamento periodontal, ha dado lugar a lo que se conoce como relaciones endoperiodontales. Esto se debe a la presencia de varias vías anatómicas de comunicación entre ambas entidades: el foramen apical, los forámenes laterales pertenecientes a conductos accesorios y conductillos dentinarios en zonas de ausencia del cemento dentario protector. Los microorganismos y sus agentes tóxicos tienen la capacidad de afectar ambos tejidos en esa interrelación física y biológica. El diagnóstico diferencial entre enfermedad endodóntica y periodontal es de vital importancia para la elección del tratamiento y el pronóstico a distancia.

The intimate connection between the root canal and theperiodontal ligament generates a concept that is known asendo-periodontal relationships. This is due to the presence ofseveral anatomical communications between them: apical foramen,lateral foramina and dentinal tubules denuded of theircementum coverage. Microorganisms and their toxic agentscan affect both tissues due to this physical and biological interrelation.Proper differential between endodontic and periodontaletiology is vital to the accurate choice of treatment andfor the long term prognosis.

Investigations of the prevalence and virulence of Candida albicans in periodontal and endodontic lesions in diabetic and normoglycemic patients

Abstract Pulpal and periodontal tissues have similar microbiota that allows cross-contamination between the pulp and periodontal tissues. Objective The aim of this study was to investigate the prevalence of isolated Candida albicans from periodontal endodontic lesions in diabetic and normoglycemic patients, and the fungi's virulence in different atmospheric conditions. Material and Methods A case-control study was conducted on 15 patients with type 2 diabetes mellitus (G1) and 15 non-diabetics (G2) with periodontal endodontic lesions. Samples of root canals and periodontal pockets were plated on CHROMagar for later identification by polymerase chain reaction (PCR) and virulence test. Results C. albicans was identified in 79.2% and 20.8% of the 60 samples collected from diabetic and normoglycemic patients, respectively. Of the 30 samples collected from periodontal pockets, 13 showed a positive culture for C. albicans, with 77% belonging to G1 and 23% to G2. Of the 11 positive samples from root canals, 82% were from G1 and 18% from G2. Production of proteinase presented a precipitation zone Pz<0.63 of 100% in G1 and 72% in G2, in redox and negative (Pz=1), under anaerobic conditions in both groups. Hydrophobicity of the strains from G1 indicated 16.4% with low, 19.3% with moderate, and 64.3% with high hydrophobicity in redox. In G2, 42.2% had low, 39.8% had moderate, 18% had high hydrophobicity in redox. In anaerobic conditions, G1 showed 15.2% with low, 12.8% with moderate, and 72% with high hydrophobicity; in G2, 33.6% had low, 28.8% had moderate, and 37.6% had high hydrophobicity. There was statistical difference in the number of positive cultures between G1 and G2 (p<0.05) with predominance in G1. There was statistical difference for all virulence factors, except hemolysis (p=0.001). Conclusions Candida albicans was isolated more frequently and had higher virulence in diabetic patients.

Fluido intersticial en estadios clínicos de patología periapical crónica / Crevicular fluid in clinical stages of chronic periapical pathology

Se intentó correlacionar el momento evolutivo de la patología periapical crónica (PPC) de origen pulpar, mediante la valoración cuantitativa de fluido intersticial. En 88 pacientes se introdujo un cono de papel No.30 hasta 1 mm. del extremo apical en las piezas dentarias afectadas, inmediatamente después de la apertura del conducto radicular. Mediante un higrómetro electrónico se obtuvo la cantidad relativa de líquido embebido en el cono de papel. Los valores se dividieron en cuatro estadios. 1: estado de equilibrio, promedio 5,44; 2: estado inflamación leve, promedio 21,29; 3: estado inflamación moderada, promedio 42,73; 4: estado inflamación severa, promedio 98,71. La cantidad de fluido intersticial varía cuantitativamente de acuerdo con el momento evolutivo de la PPC, pudiendo ser proporcional a la gravedad de la lesión

Avaliaçäo comparativa entre o quadro clínico e histopatológico de pacientes acometidos por afecçöes pulpares / Comparative evaluation between clinical and histopatological aspects on patientes with pulp affections

As agreçöes ao órgäo dentário desencadeiam reaçäo pulpar acompanhada por alteraçöes morfológicas variáveis. A resposta pulpar consiste normalmente numa reaçäo inflamatória, proporcional ao grau de agressäo e duraçäo do agente causador. A pulpite pode ser considerada crônica ou aguda, conforme as alteraçöes vasculares e os tipos de células envolvidas. Pode atingir porçöes da poupa ou sua totalidade. As afecçöes da polpa apresentam características clínicas próprias de cada fase, principalmente no que se refere à sensibilidade. Três dentes molares humanos que apresentam lesäo cariosa em diferentes estágios de evoluçäo foram utilizados em nosso protocolo. Foi realizada uma avaliaçäo clínica dos sinais e sintomas decorrente dos dentes afetados, os quais era indicados para exodontia. Posteriormente, os pacientes sofreram exodontia dos dentes afetados, e em seguida os espécimes foram submetidos a processamento para avaliaçäo histológica e comparaçäo com o quadro clínico do paciente. Foi observado um padräo reacional com grande variabilidade individual, onde o diagnóstico histopatológico nem sempre corresponde à gravidade do quadro clínico