The effect of a chemomechanical protocol to eliminate microorganisms from pulpectomized primary teeth: three case reports

Introduction: Description of the bacterial community before and after chemomechanical preparation (CP) with the removal of a smear layer (SL) in pulpectomized primary teeth has been little reported. Objective: These case reports describe the presence of total microorganisms and Enterococcus faecalis in root canals of primary incisors before and after CP with SL removal. Case Reports: Microbiological samples were collected from the root canals of three children (3.66±0.58 years old) with necrosis (n=2) and irreversible pulpal inflammation (n=1) in maxillary primary incisors. After teeth isolation with a rubber dam and antisepsis of the operative field, the sample collections were performed with sterile absorbent paper cones before and after the CP, which included irrigation with 2.5% sodium hypochlorite followed by 6% citric acid to remove the SL. The collected samples were analysed immediately at the end of the clinical procedures. The plates were incubated anaerobically for 48 hours at 37°C. The results were expressed as colony forming units (CFU)/mL. Results: Two of the three teeth showed total microorganisms before the CP. One incisor had no microorganisms in the initial collection. No CFU was counted in the samples collected after CP. Moreover, E. faecalis was not observed any time, either before or after the CP. Conclusions: E. faecalis was not detected in any sample, yet two of the three root canals had microorganisms before CP. In cases where microorganisms were initially found, 100% elimination was observed after the applied protocol.

Introdução: A descrição da comunidade bacteriana antes e após o preparo químico-mecânico (PQM) com remoção da smear layer (SL) em dentes decíduos pulpectomizados tem sido pouco relatada. Objetivo: Esses relatos de casos descrevem a presença de microrganismos totais e Enterococcus faecalis em canais radiculares de incisivos decíduos antes e após PQM com remoção de SL. Relatos dos Casos: Amostras microbiológicas foram coletadas do canal radicular de três crianças (3,66 ± 0,58 anos) com necrose (n = 2) e inflamação pulpar irreversível (n= 1) em incisivos decíduos superiores. Após o isolamento dos dentes com dique de borracha e antissepsia do campo operatório, as coletas das amostras foram realizadas com cones de papel absorvente estéril antes e após o PQM, que incluiu irrigação com hipoclorito de sódio 2,5% seguido de ácido cítrico 6% para retirada do SL. As amostras coletadas foram analisadas imediatamente ao final dos procedimentos clínicos. As placas foram incubadas em anaerobiose durante 48 horas a 37°C. Os resultados foram expressos em unidades formadoras de colônias (UFC)/mL. Resultados: Dois dos três dentes apresentaram microrganismos totais antes do PQM. Um incisivo não apresentava microrganismos na coleta inicial. Nenhuma UFC foi contada nas amostras coletadas após o PQM. Além disso, o E. faecalis não foi observado nenhum momento, nem antes, nem depois do PQM. Conclusão: Não foi detectado E. faecalis em nenhuma amostra, porém dois dos três canais radiculares apresentavam microrganismos antes do PQM. Nos casos em que foram encontrados microrganismos inicialmente, observou-se 100% de eliminação após o protocolo aplicado.

Identificación del complejo rojo en la necrosis pulpar abierta y cerrada con técnicas moleculares / Red complex identification in exposed and unexposed necrotic pulp with molecular techniques

Objetivo: identificar el complejo rojo periodontal, formado por Porphyromonas gingivalis, Treponema denticola y Tannerella forsythia, en la infección endodóntica primaria de necrosis pulpar, con cámara abierta y cerrada, utilizando técnicas de reacción en cadena de la polimerasa. Materiales y métodos: se realizó la toma para reacción en cadena de la polimerasa en 27 dientes con necrosis pulpar, 13 con cámara pulpar abierta y 14 con cámara cerrada. Resultados: en las muestras de necrosis abierta se identificaron P. gingivalis en un 92 por ciento, T. denticola en un 76 por ciento, T. forsythia en un 76 por ciento y el complejo rojo en un 61 por ciento. Las tomas de necrosis cerrada mostraron P. gingivalis en un 78 por ciento y T. denticola en un 57 por ciento; no se identificaron T. forsythia ni el complejo rojo. El análisis estadístico evidenció diferencias significativas entre los dos grupos (P<0,05). Conclusión: el sinergismo de las tres bacterias que forman el complejo rojo agravaría la patogénesis de la infección endodóntica y permitiría relacionar la microbiología endodóntica con la microbiología de periodontitis crónica.

Identificación de microorganismos por reacción en cadena de la polimerasa en necrosis pulpar y periodontitis apical / Identification of microorganisms by polymerase chain reaction in pulp necrosis and apical periodontitis

Objetivos: identificar, mediante la técnica de reacción en cadena de la polimerasa, diez especies bacterianas procedentes de conductos radiculares necróticos, así como analizar su asociación con signos y síntomas de la periodontitis apical (dolor, exudado y movilidad), dentro de un área geográfica específica, Santiago de Compostela (noroeste de España). Métodos: se realizó un estudio descriptivo, en un plazo de recogida de muestras de un año. Se extrajeron 43 muestras de los conductos radiculares necróticos, a razón de una muestra por pacientes, quienes fueron examinados previamente para determinar la presencia de periodontitis apical radiográfica, de la cual fueron descritos sus signos y síntomas. Se utilizaron puntas de papel absorbentes estériles y se procedió a extraer de dichas muestras el ADN por medio de la técnica del fenol-cloroformo. El producto se amplificó por medio de la reacción en cadena de la polimerasa, usando cebadores específicos para diez microorganismos. El resultado se visualizó por medio de electroforesis, utilizando un transiluminador UV. Los resultados se analizaron estadísticamente, para así establecer qué microorganismos estaban presentes de forma individual y cuáles se presentaron formando asociaciones como el llamado red complex, en relación con los signos y síntomas presentes en la periodontitis apical. Resultados: Fusobacterium nucleatum fue el microorganismo con presencia de forma individual más frecuente (83,72 por ciento de las muestras). En cuanto al estudio de la asociación de los microorganismos con los signos y síntomas, Porphyromonas endodontalis presentó una asociación significativa con respecto al exudado (p< 0,05) y movilidad (p< 0,05). En cambio, Enterococcus spp. y Treponema denticola (p< 0,01) presentaron ambos una asociación significativa con respecto al dolor. En cuanto a la incidencia del red complex fue de 6 casos en total. Conclusiones: Fusobacterium nucleatum y Streptococcus spp. son los microorganismos identificados con mayor porcentaje en comparación a los restantes estudiados. Porphyromonas endodontalis es el microorganismo con mayor asociación estadística con respecto a los signos y síntomas de la periodontitis apical(AU)

Objectives: identify by polymerase chain reaction technique ten bacterial species obtained from necrotic root canals, and analyze their association with signs and symptoms of apical periodontitis (pain, exudate and mobility) in a specific geographic area: Santiago de Compostela (northwestern Spain). Methods: a descriptive study was conducted based on a one-year sample collection period. Forty-three samples were taken from necrotic root canals, at a rate of one sample per patient, who had been previously examined for radiographic apical periodontitis, of which the signs and symptoms were described. Sterile absorbent paper points were used to extract the DNA samples, applying the phenol-chloroform technique. The product was amplified by polymerase chain reaction, using specific primers for ten microorganisms. The result was visualized by electrophoresis using a UV transilluminator. Outcomes were analyzed statistically to determine which microorganisms were present individually and which formed associations such as the so-called red complex, according to the signs and symptoms present in the apical periodontitis. Results: Fusobacterium nucleatum was the most common individual microorganism (83.72 percent of the samples). As to the association of microorganisms with signs and symptoms, Porphyromonas endodontalis was found to be significantly associated with exudate (p< 0.05) and mobility (p< 0.05), while both Enterococcus spp. and Treponema denticola (p< 0.01) had a significant association with pain. Incidence of the red complex was 6 cases in all. Conclusions: Fusobacterium nucleatum and Streptococcus spp. were the microorganisms identified as displaying the highest percentages. Porphyromonas endodontalis showed the greatest statistical association with signs and symptoms of apical periodontitis(AU)

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.

Estudio histológico descriptivo de la colonización de bacterias en los túbulos dentinarios de dientes extraídos con necrosis pulpar / A descriptive histological study of bacterial colonization in the dentinal tubules of extracted teeth with pulp necrosis

Antecedentes: uno de los objetivos del tratamiento endodónticoconsiste en lograr la eliminación de los microorganismos residentes enlos conductos radiculares. Sin embargo, los microorganismos presentesen la necrosis pulpar se adaptan a las condiciones de los conductosnecróticos penetrando en los túbulos dentinarios, lo que complica elpronóstico del tratamiento. Objetivo: El propósito de esta investigaciónfue describir histológicamente las zonas de formación y distribución dela biopelícula tanto en los conductos como en los túbulos dentinarios dedientes extraídos con patología pulpo-periapical. Material y métodos:Se estudiaron 34 muestras de dientes extraídos con lesiones periapicales.Ninguno de los especímenes tenía tratamiento de conductos previo, nilesión endoperiodontal, ni fractura longitudinal o fractura de la raíz.Los dientes fueron descalcifi cados en ácido fórmico al 5% en formolamortiguado durante siete semanas. Se realizó el procedimiento histoló-gico de rutina para inclusión de las muestras en parafi na. Se obtuvieroncortes seriados longitudinales del conducto pulpar para someterlos atinción con hematoxilina y eosina, tinción de ácido peryódico de Schiff ,metenamina de plata y de Gram & Taylor Brown-Brenn para identifi carlos túbulos dentinarios, la presencia de hongos y bacterias. Resultados:De los 544 cortes estudiados, 75% (405) tuvieron colonizaciónmicrobiana. No se encontraron evidencias de la presencia de hongos.Con respecto a la profundidad de penetración de los microorganismosen los túbulos se identifi caron 194 cortes (35.6%) con presencia debacterias en 150 μm y 211 muestras (38.7%) en los que la penetraciónfue más allá de 500 μm...

Background: one of the main goals of endodontic treatment is toachieve the elimination of resident microorganisms in the root canal.However, the microorganisms involved in the pulp necrosis adapt to theconditions of necrotic canals, penetrating the dentinal tubules, whichcomplicates treatment. Objective: The purpose of this research was tohistologically describe the areas of formation and distribution of biofi lmin both the canals and the dentinal tubules of teeth extracted with pulpand periapical pathology. Material and methods: 34 samples of teethwith periapical lesions were studied. None of the specimens had priorcanal treatment, endoperiodontal injury, fracture nor longitudinal rootfracture. Teeth were decalcifi ed with 5% formic acid and buff ered withformalin for 7 weeks. Histological routine procedure for includingsamples in paraffi n was conducted. Longitudinal serial sections wereobtained of the pulp canal space for submission to staining withhematoxylin and eosin, peryodic acid Schiff , methenamine silver, andGram & Taylor Brown-Brenn, to identify dentinal tubules and thepresence of fungi and bacteria. Results: Of the 544 histological sectionsunder study 75% (405) showed microbial colonization. No evidence offungi was found. 194 histological sections (35.6%) had microorganismspenetrating the dentinal tubules to a depth of 150 microns, and 211histological sections (38.7%) had microorganisms penetrating thedentinal tubules for more than 500 μm...

Susceptibilidad antimicrobiana de microorganismos anaerobios aislados de infecciones endodónticas primarias a amoxicilina y metronidazol y su asociación con los parámetros clínicos: serie de casos / Antimicrobial susceptibility of anaerobic microorganisms isolated from primary endodontic infections to amoxicillin and metronidazole and its association with clinical parameters: case series

El objetivo de este estudio es describir la composición de la microbiota anaerobia estricta/aerotolerante en infecciones endodónticas primarias, su susceptibilidad antimicrobiana, y la asociación con los parámetros clínicos. Se tomaron muestras de siete pacientes con necrosis pulpar sintomática o asintomática. Se utilizaron técnicas para la conservación, cultivo, incubación e identificación de anaerobios estrictos/aerotolerantes. Para determinar la susceptibilidad antimicrobiana a amoxicilina y metronidazol, se utilizó el método de dilución en agar. Se aislaron un total de 32 cepas, 20 (62,5 %) fueron anaerobios estrictos/aerotolerantes, y 8 (25 %) anaerobios facultativos. El microorganismo anaerobio estricto/aerotolerante más frecuente fue Fusobacterium nucleatum, se aisló en tres casos, todos relacionados con algún tipo de dolor, y en dos casos estuvo relacionado con Prevotella spp. Se encontró una colonia de F. nucleatum resistente a amoxicilina y con producción de ß-lactamasa, y otra de F. nucleatum resistente a metronidazol. Una colonia de P. propionicum/avidus presentó resistencia intermedia a amoxicilina y con producción de ß-lactamasa. Se encontró la presencia de bacterias anaerobias estrictas/aerotolerantes en los pacientes con infecciones endodónticas primarias. Existen algunos microrganismos relacionados con algún tipo de dolor, como F. nucleatum y P. micra. Los hallazgos muestran presencia de F. nucleatum resistentes a los antimicrobianos evaluados.

The objective of this study is to describe the composition of the strict / aerotolerant anaerobic microbiota in primary endodontic infections, antimicrobial susceptibility, and the association with clinical variables. Samples were taken from seven patients with symptomatic or asymptomatic pulp necrosis. conservation techniques, cultivation, incubation and identification of strict / aerotolerant anaerobes. We used the agar dilution method to determine the antimicrobial susceptibility to amoxicillin and metronidazole. A total of 32 strains, 20 (62.5 %) were isolated were strict / aerotolerant anaerobes, and 8 (25 %) facultative anaerobe organisms. The strict anaerobe / more Fusobacterium nucleatum was frequently aerotolerant, it was isolated in three cases, all related to some type of pain, and in two cases it was related to Prevotella spp. a colony of F. nucleatum resistant to amoxicillin and ß-lactamase production was found, and another F. nucleatum resistant to metronidazole. A colony of P. propionicum / avidus presented intermediate amoxicillin and ß-lactamase producing resistance. Conclusions: the presence of strict anaerobic bacteria / aerotolerant in patients with primary endodontic infections was found. There is some related pain, as F. nucleatum and P. micra microorganisms. The findings show the presence of F. nucleatum resistant to the antimicrobial organisms evaluated.

Bacteriological analysis of necrotic pulp and fistulae in primary teeth

Objectives: Primary teeth work as guides for the eruption of permanent dentition, contribute for the development of the jaws, chewing process, preparing food for digestion, and nutrient assimilation. Treatment of pulp necrosis in primary teeth is complex due to anatomical and physiological characteristics and high number of bacterial species present in endodontic infections. The bacterial presence alone or in association in necrotic pulp and fistula samples from primary teeth of boys and girls was evaluated. Material and Methods: Necrotic pulp (103) and fistula (7) samples from deciduous teeth with deep caries of 110 children were evaluated. Bacterial morphotypes and species from all clinical samples were determined. Results: A predominance of gram-positive cocci (81.8%) and gram-negative coccobacilli (49.1%) was observed. In 88 out of 103 pulp samples, a high prevalence of Enterococcus spp. (50%), Porphyromonas gingivalis (49%), Fusobacterium nucleatum (25%) and Prevotella nigrescens (11.4%) was observed. Porphyromonas gingivalis was detected in three out of seven fistula samples, Enterococcus spp. in two out of seven samples, and F. nucleatum, P. nigrescens and D. pneumosintes in one out of seven samples. Conclusions: Our results show that Enterococcus spp. and P. gingivalis were prevalent in necrotic pulp from deciduous teeth in boys from 2 to 5 years old, and that care of the oral cavity of children up to five years of age is important. .

An investigation of the presence of specific anaerobic species in necrotic primary teeth

Different microbial identification methods have shown that the microbial community profiles in endodontic infections are diverse and assorted. The aim of this study was to evaluate the frequency of selected endodontic pathogens in the pulp chambers (PCs) and root canals (RCs) of infected primary teeth using PCR methods. Paired PC and RC samples were collected from 15 subjects and analyzed by PCR for the presence of Filifactor alocis, Fusobacterium nucleatum, Parvimonas micra, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Prevotella tannerae, Tanerella forsythia, Treponema denticola, and Treponema socranskii. The frequency of each species was determined in the PC and RC of each case. The species most frequently detected in PCs were P. nigrescens (86.7%), P. gingivalis (73.3%), and F. alocis (73.3%). Of the PC samples, 13.3% contained P. micra and T. denticola, and 6.7% contained T. forsythia. The species most frequently detected in RCs were P. gingivalis (100%) and P. nigrescens (93.3%). P. tannerae, P. micra, and T. denticola were found in 40% of the RC samples; T. forsythia was found in 26.7% of the RC samples. The “red complex”, which comprises P. gingivalis, T. denticola, and T. forsythia, was not found in the PC of any tooth but was found in 30% of the RC samples. The detection of P. nigrescens in the PC was statistically associated with the presence of P. nigrescens in the RC (p = 0.04). The results suggest high heterogeneity among the samples, even among those from the same subject.

Avaliação da comunidade microbiana, com ênfase para a espécie Enterococus faecalis, em dentes decíduos com necrose pulpar através de técnicas fenotípicas e moleculares / Evaluation of microbiota with emphasis on species of Enterococcus faecalis, in primary teeth root canals with pulp necrosis, using conventional and molecular microbiological techniques

Infecção endodôntica em dentes decíduos tem sido pouca avaliada, apesar da influência destes sobre a dentição permanente. No presente estudo foi avaliada a microbiota, com ênfase na espécie de Enterococcus faecalis, de canais radiculares de dentes decíduos com diagnóstico de necrose pulpar, utilizando-se técnicas microbiológicas convencionais e moleculares. Para tanto, um estudo do tipo seccional, clínico e laboratorial foi desenvolvido, sendo a coleta do material endodôntico realizada na clínica de Odontopediatria da Faculdade de Odontologia da UFRJ. Para o estudo, 244 crianças saudáveis foram examinadas no período de um ano, e destas, 43 se enquadravam nos critérios de inclusão. O material foi coletado do canal radicular utilizando-se cones estéreis de papel, dos quais dois foram inoculados em caldo seletivo-indicador Enterococcosel e os outros dois em TSB-DMSO sob congelamento a -20º C. A identificação de E. faecalis foi realizada a partir do cultivo inicial no caldo e subcultivo em agar sangue para observação de colônias bacterianas características. Testes bioquímicos e enzimáticos e a Reação em Cadeia da Polimerase (PCR) para o gene do rRNA 16S também foram utilizados para identificação da espécie. A técnica de Eletroforese em Gel com Gradiente Desnaturante (DGGE) foi utilizada para avaliação do perfil da comunidade microbiana presentes nos espécimes clínicos. Os resultados mostraram que dos 43 espécimes clínicos obtidos, 18 foram excluídos devido à contaminação no controle. Entre os 25 casos estudados, 10 foram positivos no caldo de enterococcosel, sendo cinco (20%) positivos para a espécie E. faecalis nos testes fenotípicos e na PCR. Outros cinco espécimes foram positivos no caldo, mas as amostras bacterianas não apresentaram bioquímica compatível com a espécie E. faecalis, e foram então submetidas ao seqüenciamento de um fragmento do gene do rRNA 16S. Foram identificados Lactobacillus plantarum (4 amostras) e Lactobacillus rhamnosus (1 amostra). Não houve relação dos dados clínicos com a presença de E. faecalis (p > 0,05). A técnica de DGGE mostrou uma comunidade polimicrobiana nos 25 espécimes analisados e, considerando-se o número de bandas no gel, um número ≥ 20 foi relacionado com pacientes com idade ≤ 4 anos e  20 bandas com pacientes com mais de 4 anos de idade (p  0,05). Relação significativa também foi observada entre idade  4 anos e cárie em dente posterior, assim como entre idade  4 anos e cárie em dente anterior. Trauma como causa de infecção endodôntica foi significativa entre crianças com 4 anos de idade. Os resultados demostram a presença de E. faecalis em infecções endodônticas com necrose pulpar em dentição decídua, confirmando sua presença na cavidade oral destes pacientes. Adicionalmente, a técnica de DGGE mostrou uma comunidade polimicrobiana, indicando associação entre idade do paciente e doença cárie.

Endodontic infections in primary teeth have been poorly evaluated despite their influence on permanent dentition. In the present study we assessed the microbiota, with emphasis on species of Enterococcus faecalis, in primary teeth root canals with pulp necrosis, using conventional and molecular microbiological techniques. Thus, a cross-sectional study of clinical and laboratory data was developed. The material was collected at the endodontic clinic of Pediatric Dentistry, Faculty of Dentistry, UFRJ. For the study, 244 healthy children were examined during one year, and of these, 43 met the inclusion criteria. Material was collected from root canals using sterile paper cones. Four paper cones were used for each canal: two were inoculated in the selective broth indicator Enterococcosel and anothers two placed in TSB-DMSO and frozen at -20 ° C until required. Identification of E. faecalis was initially made using culture in broth and subculture on blood agar for observational characteristics of bacterial colonies. Biochemical and enzymatic analysis as well as Polymerase Chain Reaction (PCR) for the 16S rRNA gene were also used for species identification. The Gradient Gel Electrophoresis Agents denaturants (DGGE) technique was used to assess the profile of the microbial communities present in the clinical specimens. Eighteen (18) of the 43 clinical specimens obtained were excluded due to contamination. Among the 25 cases studied, 10 were positive for the species E. faecalis in Enterococcosel broth, five (20%) were positive in the phenotypic tests and PCR. Another five specimens were positive in the broth medium, but the bacterial samples showed no biochemical species compatible with E. faecalis, and so were subjected to sequencing of a fragment of the 16S rRNA gene. Lactobacillus plantarum were identified (4 samples) and Lactobacillus rhamnosus (1 sample). There was no statistically significant correlation of clinical data with the presence of E. faecalis (p> 0.05). The DGGE analysis showed a community polymicrobial. About 20 bands or more were associated with patients ≤ 4 years old and that lesser 20 bands were associated with patients over 4 years old (p  0,05). A significant relationship was also found between patients > 4 years old and caries in posterior teeth, as well as between patients  4 years and anterior tooth caries. Trauma as the cause of endodontic infection was significant among children  4 years old. The results show the presence of E. faecalis in endodontic infections with pulp necrosis in the primary dentition, confirming its presence in the oral cavity of patients. Additionally, DGGE showed a polymicrobial community in 25 samples obtained, suggesting an association between patient age and tooth decay.

Prevalence of Candida species in necrotic pulp with chronic periapical processes

El propósito de este estudio fue identificar especies del géneroCandida en mucosa de cavidad bucal y dientes unirradiculares con necrosis pulpar con procesos periapicales crónicos de origen endodóntico con imágenes radiográficas entre 2±4 mm sin sintomatología clínica en pacientes inmunocompetentes. El estudio incluyó 82 pacientes inmunocompetentes de ambos sexos con edades entre 18-70 años con diagnóstico clínico dentario de necrosis pulpar séptica. Las muestras fueron obtenidas del conducto radicular con conos de papel estéril # 25 y de lamucosa bucal mediante hisopo estéril. Se identificaron 7 especies diferentes de Candida (C. albicans, C. dubliniensis,C. guilliermondii, C. krusei, C. arapsilopsis, C. tropicalis y C. glabrata). Todas estuvieron presentes en mucosa bucal, mientras que dos de ellas (C. parapsilopsis y C. glabrata) nose identificaron en zona periapical de conductos con necrosis Del total de las muestras aisladas de mucosa bucal hubo una frecuencia significativamente mayor de C. albicans que la proporción de estas levaduras en la zona periapical en conductos con necrosis.

Preferencias dos cirurgioes-dentistas do municipio do Rio de Janeiro com relacao ao tratamento de dentes deciduos com necrose pulpar / Preferences of dentists from the city of Rio de Janeiro regarding the treatment of primary teeth with pulp necrosis

Objetivo: Conhecer as condutas adotadas por cirurgioes-dentistas que atuam em unidades de atendimento basico de saude do municipio do Rio de Janeiro, com relacao ao tratamento de dentes deciduos com necrose pulpar e identificar os fatores capazes de influenciar a escolha dessas condutas. Metodo: Foram entrevistados 51 cirurgioes-dentistas de 10 unidades de saude localizadas em 4 areas programaticas, atraves de um questionario previamente testado. Os entrevistados forneceram informacoes sobre sua idade, sexo, faculdade frequentada, pos-graduacao, tempo de formado e de atuacao no servico publico. Alem disso, os cirurgioes-dentistas foram questionados sobre as suas condutas em diferentes situacoes clinicas que sugeriam a necrose pulpar em um dente deciduo de uma crianca de 4 anos de idade. Resultados: A maioria dos cirurgioes-dentistas optou por manter os dentes deciduos com necrose pulpar, especialmente nos casos de trauma e de criancas com bom comportamento. Geralmente, esses profissionais realizavam terapias pulpares minimamente invasivas com tratamentos restritos a camara pulpar ou com uma instrumentacao limitada a entrada dos canais radiculares. Nenhum dos cirurgioes-dentistas entrevistados optou pelo tratamento endodontico convencional. Nao foi observada associacao significante entre qualquer conduta clinica e fatores relacionados aos profissionais (p>0,01). Conclusao: Verificou-se uma grande diversidade na escolha do tratamento para dentes deciduos com necrose pulpar, demonstrando a necessidade de se adotar na rede publica de saude um protocolo para esses casos com base em evidencia cientifica e na disponibilidade dos recursos.

Objective: To know the approaches adopted by dentists that work at public health centers (PHC) in the city of Rio de Janeiro, RJ, Brazil, with respect to the treatment of primary teeth with pulp necrosis, and to identify factors capable of influencing the choices of these approaches. Method: Fifty dentists from 51 from 10 PHC located in 4 programmatic areas were interviewed using a previously calibrated questionnaire. The interviewees provided information about their age, gender, dental school they graduated from, post-graduate degree, time since graduation and, public service activity. In addition, the dentists were argued about their conduct in different clinical situations that suggested the presence of pulp necrosis in a primary tooth in a year-old child. Results: Most dentists opted for maintaining the primary teeth with necrotic pulp, especially in cases of trauma and children with good behavior. These professionals usually performed minimally invasive pulpal therapies with treatments restricted to the pulp chamber or with instrumentation limited to the root canal entrance. None of the interviewed dentists opted for conventional endodontic treatment. There was no significant association (p>0.01) between any clinical approach and factors related to the professionals. Conclusion: There was great diversity in treatments proposed for primary teeth with pulp necrosis, demonstrating the need for the public health service adopting a protocol for these cases based on scientific evidence and availability of resources.

Microbiological and microscopic analysis of the pulp of non-vital traumatized teeth with intact crowns

OBJECTIVE: This study evaluated the presence of microorganisms and analyzed microscopically the pulp of 20 traumatized human teeth with intact crowns and clinical diagnosis of pulp necrosis, based on the association of at least three of the clinical criteria: crown discoloration, negative response to thermal and electric pulp vitality tests, positive response to vertical and horizontal percussion, pain on palpation or mobility. MATERIAL AND METHODS: Microbiological collection was performed from the root canals to evaluate the presence of microorganisms. The pulp samples were stained with hematoxylin and eosin (H.E.) for histological evaluation of possible morphological alterations. RESULTS: Analysis of results was performed by statistical tests (linear regression test and diagnostic analysis) and subjective analysis of the sections stained with H.E. and revealed that only 15 percent of the sample did not exhibit microbial development. The time elapsed between dental trauma and onset of endodontic intervention ranged from 15 days to 31 months; the percussion test presented high sensitivity (80 percent) for detection of microorganisms in the root canal of traumatized teeth; 3 teeth (15 percent) did not present pulp tissue, being characterized as complete autolysis; analysis of pulp samples was performed on the other 17 cases, among which 3 (15 percent) exhibited partial necrosis without possibility of repair and 14 presented complete necrosis; none of the clinical criteria employed for the diagnosis of pulp necrosis in traumatized teeth was pathognomonic. CONCLUSIONS: The present results allowed the following conclusions: with regard to microbiological findings, 85 percent of teeth presented microorganisms in the root canal, despite the presence of an intact crown. Concerning the microscopic findings, 100 percent of traumatized teeth presented pulp necrosis; the pulp vitality tests based on pulp response to heat, cold and vertical percussion ...

Contaminación de las puntas de papel usando cuatro protocolos diferentes de manejo / Paper point contamination using four different management protocols

El tratamiento endodóntico debe garantizar la reducción o eliminación de los microorganismos que ocasionan patología pulpar. Las puntas de papel son útiles para secar el conducto antes de la obturación. Objetivo: identificar microorganismos presentes en las puntas de papel y determinar si se contaminan durante su manipulación con bacterias del ambiente o por contaminación cruzada, según cuatro protocolos diferentes de manejo. Materiales y métodos: se entregaron 6 cajas nuevas y selladas de puntas de papel Hygenic(R) a cuatro IPS para realiar el protocolo de manejo habitual. Se analizaron 26 puntas incubadas en caldo tripticasa soya, y siembra en agar tripticasa soya en presencia de turbidez, a 37º C de 24-28 horas. Las puntas se distribuyeron de la siguiente manera: control positivo: una punta de papel introducida en conducto con diagnóstico de necrosis pulpar. Control negativo: una punta de papel de caja sin destapar, manipulada en el laboratorio bajo condiciones estériles. Protocolos 1, 2, 3 y 4: seis para cada protocolo (24) se analizaron en el laboratorio. Resultados: según los diferentes protocolos propuestos para este trabajo, se encontró que en el protocolo 1 hubo contaminación en 2 cajas de puntas, se detectó presencia de S. aureus y Epidermidis. En protocolos 2, 3 y 4 no hubo presencia de microorganismos. Conclusiones: la contaminación que sufren las puntas de papel es mínima; no hubo diferencia significativa según los 4 protocolos de manejo usados en este trabajo.

In vitro antimicrobial activity of endodontic pastes with propolis extracts and calcium hydroxide: a preliminary study

The purpose of this study was to evaluate the antimicrobial activity of two experimental pastes containing propolis extract associated with calcium hydroxide against polymicrobial cultures collected from 16 necrotic and fistulae root canals in primary molars of 4-8-year-old children of both sexes. The agar-well diffusion technique was used to determine the antimicrobial activity of the following pastes: 11.0 percent ethanolic extract of propolis (EEP) + calcium hydroxide; and 11.0 percent extract of propolis without ethanol (EP) + calcium hydroxide. EEP, EP and the association of calcium hydroxide and propylene glycol (CHP) was used as the positive control groups, and propylene glycol was used as a negative control group. Friedman and Wilcoxon tests were used to compare the data from the microbial growth inhibition zones (p<0.05). Paste 1 and Paste 2 showed larger growth inhibition zones against microorganisms from root canal samples than CHP (p=0.021 and 0.003, respectively). Paste 2 tended to have larger growth inhibition zones than Paste 1 (p=0.053). The association between propolis and calcium hydroxide was effective in controlling dental infections in vitro.

O objetivo dessa pesquisa foi avaliar a atividade antimicrobiana de duas pastas experimentais, contendo própolis associada a hidróxido de cálcio, contra culturas polimicrobianas coletadas de 16 molares decíduos necrosados e com fístulas extraídos de crianças entre 4 e 6 anos de idade de ambos os sexos. A técnica de difusão em ágar foi utilizada para determinar a atividade antimicrobiana das seguintes pastas: (1) 11,0 por cento extrato etanólico de própolis + hidróxido de cálcio e (2) 11,0 por cento extrato de própolis sem álcool + hidróxido de cálcio. A associação de hidróxido de cálcio com propilenoglicol foi utilizada como o grupo de controle positivo (CHP). Testes estatísticos de Friedman and Wilcoxon foram empregados para comparar dados do crescimento das zonas de inibição (p<0,05). Pasta 1 e Pasta 2 apresentaram zonas de inibição maiores contra os microrganismos coletados dos canais radiculares do que CHP (p=0,021 e 0,003 respectivamente). A Pasta 2 mostrou zonas de inibição um pouco mais largas que a Pasta 1 (p=0,053). A associação entre própolis e hidróxido de cálcio foi efetiva no controle de infecções dentárias in vitro.

Primeiro relato de isolamento e identificação taxonômica de fungos filamentosos em infecções endodônticas / First report of isolation and taxonomic identification of filament fungus in endodontic infections

A proposta deste trabalho foi demonstrar in vivo, por meio de técnicas específicas de isolamento, a presença de fungos filamentosos nos canais radiculares de dentes portadores de necrose pulpar e lesão periapical, relacionar sua presença a pacientes com resposta imunológica comprometida e realizar o estudo taxonômico dos isolados. Foram realizadas culturas de 60 canais radiculares com polpa necrosada e lesão periapical. Os pacientes responderam a um questionário de saúde e assinaram permissão para realização da pesquisa. Após isolamento absoluto e assepsia do campo operatório, as amostras foram coletadas utilizando-se 3 pontas de papel absorvente estéreis inseridas no canal radicular uma a uma, durante 1 minuto. Em campo isolado por duas lamparinas, o material coletado foi inoculado em um tubo de ensaio contendo meio de Saboraud Agar acrescido de Cloranfenicol. Próximo ao campo isolado pelas duas lamparinas, foi colocada uma placa de Petri aberta contendo o mesmo meio de cultura contido no tubo de ensaio, com o intuito de verificar a acuidade do isolamento do campo (controle negativo). Ao mesmo tempo foi efetuado um controle positivo, através de uma placa de Petri que permaneceu aberta durante a coleta, fora do campo isolado. Os tubos e placas de Petri foram mantidos em temperatura ambiente por um período de sete a quatorze dias observando o crescimento micelial. Aqueles que apresentaram crescimento foram semeados em meios específicos para microcultivo CYA Agar, Extrato de Malte Agar, ou Agar Batata. Com o auxílio de microscopia óptica, as colônias foram identificadas em gênero e espécie. Das 60 amostras coletadas, 17 apresentaram cultura positiva para fungos filamentosos, perfazendo um total de 28,3 %...

The purpose of the present study was to evaluate in vivo, with specific techniques that isolates the presence of filament fungus in the root canal of teeth with necrotic pulp and perirradicular disease, see the relationship between the presence of these fungus and patients with immunological deficiency and carry out a taxonomic study of the fungus isolated. It was fulfilled the culture of 60 root canals of teeth with necrotic pulp and perirradicular disease. The patients answered a health questionnaire and signed a term to allow the research. After the absolute isolation and cleaning the operating field the samples were collected using three sterile paper points inserted into the root canal during 1 minute. In an isolated field by two lamps, the collected materials were inoculated in a tube with Saboraud Agar with Cloranfenicol. Nearby the isolated field with lamps it was placed an opened Petri plaque with the same culture material from the tubes with the purpose to verify the perceptiveness of the isolated field (negative control). At the same time it was carried out the positive control group with an opened Petri plaque that was maintained far from the isolated fields. The tubes and the Petri plaque were maintained in atmosphere temperature during seven to fourteen days to observe micelial growth. Those that showed growth were spread on specific environment for microcultivation CYA Agar, Extract of Agar Malt or Agar potato. With the help of an optic microscope the colonies were identified in genre and species. Among the 60 samples collected, 17 showed positive culture for filament fungus, making up a total of 28,3%...

Bacterial pathogenesis and mediators in apical periodontitis: [review]

Apical periodontitis is a group of inflammatory diseases caused by microorganisms (mainly bacteria) infecting the necrotic root canal system. The pathogenesis of different types of apical periodontitis and even the same type in different individuals is unlikely to follow a stereotyped fashion with regard to the involved bacterial mediators. Disease pathogenesis is rather complex and involves a multitude of bacteria- and host-related factors. This review article discusses the bacterial pathogenesis of acute and chronic apical periodontitis, with the main focus on the bacterial mediators conceivably involved in the different stages of the infectious process, including secreted products (enzymes, exotoxins, N-formyl-methionyl-leucyl-phenylalanine peptides, heat-shock proteins and metabolic end-products) and structural components (lipopolysaccharide, peptidoglycan, lipoteichoic acid, lipoproteins, fimbriae, flagella, outer membrane proteins and vesicles, DNA, and exopolysaccharides). Knowledge of the bacterial factors involved in the pathogenesis of apical periodontitis is important to the understanding of the disease process and to help establishing proper therapeutic measures to inactivate this bacterial "artillery".

Lesões perirradiculares compreendem um grupo de doenças inflamatórias causadas por microrganismos (principalmente bactérias) infectando o sistema de canais radiculares com polpa necrosada. É improvável que a patogênese dos diferentes tipos de lesão perirradicular, e até mesmo daquelas do mesmo tipo, mas em diferentes indivíduos, obedeça um padrão estereotipado com relação aos mediadores bacterianos envolvidos. A patogênese destas doenças é complexa e envolve inúmeros fatores relacionados às bactérias e ao hospedeiro. Este artigo de revisão discute a patogênese bacteriana das lesões perirradiculares agudas e crônicas, enfatizando os fatores bacterianos que estão possivelmente envolvidos nos diferentes estágios do processo infeccioso, incluindo produtos secretados (enzimas, exotoxinas, peptídeos N-formilados, proteínas de choque térmico e produtos terminais do metabolismo) e componentes estruturais (lipopolissacarídeo, peptidoglicano, ácido lipoteicóico, lipoproteínas, fímbrias, flagelos, proteínas e vesículas de membrana externa, DNA e exopolissacarídeos). O conhecimento dos fatores bacterianos envolvidos na patogênese das lesões perirradiculares é importante para o entendimento do processo patológico bem como para ajudar no estabelecimento de medidas terapêuticas adequadas para desativação desta "artilharia" bacteriana.

Influence of sodium hypochlorite-based irrigants on the susceptibility of intracanal microbiota to biomechanical preparation

This study evaluated the microbiological conditions of root canals, using smears and culture from anterior teeth and premolars with necrotic pulps associated with chronic periapical pathologies, before and after biomechanical preparation (BMP). During double-flared instrumentation, 1, 2.5 and 5 percent sodium hypochlorite (NaOCl)-based irrigants were used in 3 groups: GI (n=39), GII (n=36) and GIII (n=36), respectively. Before BMP, all cultures were positive and the smears showed microbiologically diverse morphotypes, including fusiforms, pleomorphic, rods, cocci and filaments. Quantitetively, 20, 20 and 23 morphotypes were identified in GI, GII and GIII, respectively). After BMP, the percentages of negative cultures in GI, GII and GIII were 74.2 percent, 86.3 percent and 93.4 percent (p>0.05) and the number of morphotypes decreased to 14, 15 and 5, respectively. All teeth with 2 root canals and/or associated fistulas were microbiologically negative after BMP, regardless of irrigant concentration. Gram-negative morphotypes were more susceptible to the action of irrigants. After irrigation with 5 percent NaOCl, only structural arrangements consisting of Gram-positive cocci and bacilli persisted. Thus, BMP plus 5 percent NaOCl offered the best antiseptic potential because in the few positive cultures a significant reduction in the number of microbiological morphotypes was also shown (p<0.05).

Este estudo avaliou as condições microbiológicas dos canais radiculares, por meio de esfregaços e culturas de dentes anteriores e pré-molares com necrose pulpar associada à radiolucidezes periapicais, antes e após o preparo biomecânico (PBM). Utilizou-se a técnica de instrumentação biescalonada coadjuvada por soluções de hipoclorito de sódio (NaOCl) a 1, 2,5 ou 5 por cento nos grupos I (n=39), II (n=36) e III (n=36), respectivamente. Antes do PBM havia 100 por cento de culturas positivas e os esfregaços proveram diversificados morfotipos microbiológicos, sendo 20, 20 e 23 nos grupos I, II e III, respectivamente. Após o PBM, o percentual de culturas negativas nos grupos I, II e III foi 74,2 por cento, 86,3 e 93,4 por cento (p>0,05) e a incidência de morfotipos declinou para 14, 15 e 5, respectivamente. Todos os dentes birradiculados e/ou portadores de fístulas apresentaram-se microbiologicamente negativos após o PBM, independentemente do irrigante utilizado. Os morfotipos Gram-negativos foram mais suscetíveis à ação do PBM. Após o PBM persistiram apenas cocos e bacilos Gram-positivos no grupo III. Portanto, o PBM coadjuvado por solução de NaOCl a 5 por cento, proporcionou o melhor desempenho anti-séptico, pois, nas poucas culturas positivas, houve também significativa redução do número de morfotipos microbiológicos (p<0.05).

Bacterial profile in primary teeth with necrotic pulp and periapical lesions

O objetivo desse estudo foi avaliar, por meio de cultura bacteriológica, a prevalência de microrganismos em canais radiculares de dentes decíduos de humanos com necrose pulpar e lesão periapical. Foram selecionados 20 dentes decíduos humanos com necrose pulpar e lesão periapical. Após a realização da abertura coronária foi efetuada a colheita para exame bacteriológico do conteúdo do canal radicular, introduzindo-se seqüencialmente 4 cones de papel absorvente esterilizados, providos de aleta metálica, de número compatível com o diâmetro do canal radicular. Após 30 s, os cones foram removidos e transferidos para um tubo de ensaio contendo fluido para transporte reduzido (RTF) e enviados para processamento microbiológico. Os microrganismos anaeróbios foram quantificados em 100% dos casos, os bacilos pigmentados de negro em 30%, os aeróbios em 60%, os estreptococos em 85%, os bacilos gram-negativos aeróbios em 15% dos casos e os estafilococos não foram quantificados. Os estreptococos do grupo mutans foram quantificados em 6 canais radiculares (30%), sendo que em 5 canais estavam presentes Streptococcus mutans e em 1 canal Streptococcus mutans e Streptococcus sobrinus. Concluiu-se que nos canais radiculares de dentes decíduos de humanos portadores de necrose pulpar e lesão periapical há uma infecção polimicrobiana com predomínio de microrganismos anaeróbios.

Evaluation of the antimicrobial activity of three irrigating solutions in teeth with pulpal necrosis / Análise da atividade antimicrobiana de três soluções irrigantes em dentes com necrose pulpar

The antimicrobial activity of 0.4 percent papaine gel (FCF-USP), an antibacterial product derived from 3.3 percent castor oil (IQSC-USP), and 0.5 percent sodium hypochlorite (FORP-USP) was evaluated in teeth with radiographically visible pulpal necrosis and periapical lesion in vivo. After cavity access, under aseptic conditions, a first harvesting was performed. The 3 irrigating solutions were used for biomechanical preparation. After 72 hours, a second harvesting was performed, also under aseptic conditions. The number of colony forming units (cfu) was counted with a stereomicroscope under reflected light. Castor oil and 0.5 percent sodium hypochlorite presented similar antimicrobial activities for the reduction of the anaerobe number, S. mutans and streptococci; however, the papaine gel showed lower activity. We conclude that both castor oil and sodium hypochlorite are effective as antimicrobial agents and can be used in the treatment of root canals with pulpal necrosis

Reporte de microorganismos aislados en 15 muestras de pulpas dentales necróticas / Report of microorganisms isolated from 15 samples of necrotic dental pulps

Es conocida la presencia de microorganismos en la cavidad bucal, estando descritos diferentes tipos de éstos en la literatura. La pulpa necrótica es un tejido muerto contenido en estructuras vivas. El conocimiento de los microorganismos presentes en las pulpas necróticas de la población en que se vive es de importancia profesional. El empleo de la antibioticoterapia es de importancia en la práctica diaria. En este estudio la penicilina y la clindamicina fueron los medicamentos de elección