A rare case of polymicrobial chronic maxillary sinusitis due to concurrent isolation of Parvimonas micra and Fusobacterium nucleatum.

Parvimonas micra and Fusobacterium nucleatum are commensal pathogens very rarely isolated simultaneously in clinical specimens. We report a case of chronic maxillary sinusitis caused by these two pathogens, presumably resulting from a co-existing dental infection.

Correlation between clinical/radiographic features and inflammatory cytokine networks produced by macrophages stimulated with endodontic content.

INTRODUCTION: Macrophages are highly activated by endodontic contents. This study investigated the correlation between different clinical signs/symptoms and radiographic features according to the levels of interleukin (IL)-1ß, tumor necrosis factor α (TNF-α), IL-6, IL-10, prostaglandin E(2) (PGE(2)), and their networks produced by endodontic content-stimulated macrophages collected from primary endodontic infection with apical periodontitis (PEIAP). METHODS: Samples were taken from 21 root canals with PEIAP by using paper points. The presence of exudate (EX), pain on palpation (POP), tenderness to percussion (TTP), and the size of the radiographic lesion (SRL) were recorded. Polymerase chain reaction (16S rDNA) was used for bacterial detection and limulus amebocyte lysate (LAL) assay for endotoxin measurement. Raw 264.7 macrophages were stimulated with bacterial contents during 24 hs. The amounts of IL-1ß, TNF-α, IL-6, IL-10 and PGE(2) were measured by enzyme-linked immunosorbent assay. Log-based data were correlated by multiple logistic regression (P < .05). RESULTS: Bacteria and endotoxin were detected in 100% of the samples. IL-6 and TNF-α were positively correlated with SRL and EX, respectively (P < .05). Clinical signs/symptoms and radiographic findings were set as dependent variables for EX-positive correlations between PGE(2), IL-1ß, and TNF-α (P < .05), whereas IL-6 and PGE(2) were positively correlated to each other in POP but negatively correlated in SRL (P < .05). When POP and TTP-POP were set as dependent variables, different cytokine networks were found. CONCLUSIONS: Our findings suggest different roles for each cytokine in the development of apical periodontitis, whose effects of overlapping networks depend on the signs/symptoms and radiographic features found in endodontic infection.

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% 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%) for detection of microorganisms in the root canal of traumatized teeth; 3 teeth (15%) 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%) 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% of teeth presented microorganisms in the root canal, despite the presence of an intact crown. Concerning the microscopic findings, 100% of traumatized teeth presented pulp necrosis; the pulp vitality tests based on pulp response to heat, cold and vertical percussion were the most reliable to diagnose pulp necrosis in traumatized teeth.

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 ...

A microbiological profile of symptomatic teeth with primary endodontic infections.

The aim of this study was to evaluate the composition of the microbiota of primary endodontic infections associated with symptomatic teeth. Samples were collected by means of a #15 H-type file and 2 sterile paper points from 60 symptomatic (n = 30) or asymptomatic (n = 30) single-rooted teeth with necrotic pulp. The presence of 40 bacterial species was determined by the checkerboard DNA-DNA hybridization method. The species found in higher counts (x10(5)) in symptomatic cases were Fusobacterium nucleatum ssp. vincentii, Veillonella parvula, Treponema socranskii, Enterococcus faecalis, and Campylobacter gracilis and in asymptomatic cases were F. nucleatum ssp. vincentii, Fusobacterium nucleatum ssp. nucleatum, E. faecalis, Eubacterium saburreum, and Neisseria mucosa. Total bacterial counts and counts of Tannerella forsythia were significant higher in symptomatic cases (p < 0.05), whereas levels of Propionibacterium acnes were reduced in this group of teeth. The data of the present investigation suggested an association between higher total bacterial counts and levels of T. forsythia and the presence of pain.

Polymerase chain reaction of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in primary endodontic infections.

The aim of this study was to investigate the correlation between endodontic clinical signs and symptoms and the presence of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia or their association by nested polymerase chain reaction assay. Microbial samples were taken from 50 cases with necrotic pulp tissues in primary infections. DNA was extracted from the samples, which were analyzed for the presence of three endodontic pathogens by using species-specific primers. P gingivalis, T denticola, and T forsythia were detected in 46%, 38%, and 22% of the symptomatic cases, respectively. The bacterial complex composed by T forsythia, P gingivalis, and T denticola was found in 14% of the cases with spontaneous pain, tenderness to percussion, swelling, and pain on palpation. The high prevalence of P gingivalis, T denticola, and T forsythia in the samples examined suggests that these bacteria are related to the etiology of symptomatic periradicular diseases.

Relationships between caries bacteria, host responses, and clinical signs and symptoms of pulpitis.

Knowledge of caries bacteria and the inflammatory responses they elicit in the dental pulp is prerequisite to our understanding of the pathogenesis of pulpitis. Recent advances in immunology and neurophysiology can now explain some of the clinical manifestations of pulpitis. The purpose of this review is twofold. The first purpose is to review the literature of the caries microflora, the host immune responses they elicit, and how they do so. The relationship between both proinflammatory and anti-inflammatory cytokines and pulpitis is discussed. The proinflammatory properties of lipoteichoic acid, which is a common virulence factor among Gram-positive bacteria such as those found among the caries bacteria, are reviewed. The second purpose is to review how bacteria and their metabolites, as well as pulpal immune and inflammatory reactions to them, modify the pain sensation in pulpitis.

Investigation of bacterial communities associated with asymptomatic and symptomatic endodontic infections by denaturing gradient gel electrophoresis fingerprinting approach.

The purpose of the present study was to investigate the bacterial communities associated with asymptomatic and symptomatic endodontic infections and to compare denaturing gradient gel electrophoresis (DGGE) fingerprinting patterns of these two clinical conditions. The root canal microbiota of teeth associated with asymptomatic or symptomatic periradicular lesions was profiled by the PCR-DGGE method and then compared, taking into consideration the banding patterns. Bacteria were present in all examined cases. Comparative analysis of the two clinical conditions revealed bands that were common to both symptomatic and asymptomatic cases, but most DGGE bands appeared to be unique for each clinical condition. No single band occurred in all profiles. The mean number of bands detected in the 16S rDNA community profiles were 12.1 +/- 9.4 (range 2-29) for symptomatic samples and 6.7 +/- 2.7 (range 2-11) for asymptomatic ones. Clustering methods and principal component analysis of DGGE banding pattern placed the samples according to the presence or absence of symptoms. Four intense bands that were excised from the gel and sequenced showed similarities to species of the Campylobacter genus (found in 5/12 asymptomatic and in 3/11 symptomatic cases), Fusobacterium genus (4/11 symptomatic cases), Acinetobacter genus (5/12 asymptomatic cases), and Enterobacteriaceae family (11/12 asymptomatic and 2/11 symptomatic cases). The profiles of the predominant bacterial community appeared to be unique for each individual. These findings confirm that endodontic infections are polymicrobial and showed that there are significant differences in the predominant bacterial composition between asymptomatic and symptomatic cases.

Fusobacterium nucleatum in endodontic flare-ups.

OBJECTIVE: The extent to which Fusobacterium nucleatum is recovered from root canals of teeth that present with an interappointment flare-up following endodontic instrumentation was investigated. STUDY DESIGN: Included in the study were 28 patients that sought emergency treatment after initiation of root canal therapy. Only non-painful teeth that had been treated because of a necrotic pulp and periapical inflammatory lesion were studied. Root canal samples for bacterial analysis were taken, transported to a bacteriological laboratory, and processed for a semiquantitative assessment of bacterial isolates. Bacterial findings were correlated with self-assessed pain intensity as recorded by means of a Visual Analogue Scale. Clinical presentation of swelling and presence of exudate in the treated root canals were also linked. RESULTS: Bacteria were recovered from all teeth examined. Gram-negative anaerobic coccoid rods (Prevotella species and Porphyromonas species) were frequent isolates. All teeth in patients who were reported to be in severe pain (Visual Analogue Scale > or = 6) displayed F nucleatum. Nine out of 10 of these teeth also had swelling and exudate in the root canals. Samples from the remaining patients that had teeth with less pain score showed a variable bacterial recovery. None of these teeth displayed F nucleatum. CONCLUSION: F nucleatum appears to be associated with the development of the most severe forms of interappointment endodontic flare-ups.

Clinical significance of dental root canal microflora.

OBJECTIVES: Previous work by this group has shown that a significant association exists between pain and the presence of either Prevotella or Peptostreptococcus spp. in dental root canals. The aim of this study was to examine a more extensive series of canals microbiologically, to determine whether any other particular endodontic symptoms or clinical signs showed specific associations with individual bacterial species. METHODS: Seventy root canals were examined microbiologically and clinical data collected to investigate in detail such associations. RESULTS: Of the canals studied, 37 were associated with pain, 49 with tenderness to percussion, 23 with swelling, six with purulent exudate and 57 presented with wet root canals. Anaerobes were isolated from 70.3% of painful canals and from 29.7% of pain-free canals. Significant associations were found between (a) pain and either Prevotella spp. or peptostreptococci, both with P < 0.01; (b) tenderness to percussion and Prevotella spp. (P < 0.01) or anaerobes (P < 0.05); (c) swelling and Eubacterium spp. (P < 0.01), or with Prevotella spp. or Pstr. micros, both with P < 0.05; (d) purulent exudate and any one of F. necrophorum (P < 0.01), Prev. loescheii, Streptoccoccus constellatus or Bacteroides spp. (each P < 0.05); (e) wet canal and facultative anaerobes (P < 0.01), and any one of the genera of Eubacterium, Peptostreptococcus, Prevotella or Propionibacterium (each P < 0.05). CONCLUSION: It was concluded that several different endodontic clinical signs and symptoms are significantly associated with specific bacterial species.

Associations of specific bacteria with some endodontic signs and symptoms.

Although a wide range of bacterial species has been isolated from infected dental root canals it remains necessary to determine whether any particular group of such bacteria is associated with specific endodontic symptoms and clinical signs. In this study 30 root canals were examined microbiologically; of these, 14 were associated with pain, 20 with tenderness to percussion, 23 presented with wet root canals, seven with swelling, five with purulent exudate and four with a sinus. Clinical and microbiological correlation was observed particularly with regard to pain where anaerobes were isolated from 93% of painful canals and only from 53% of painfree canals. The former yielded means of 2.5 anaerobic species and 1.6 facultative species per canal, compared with 1.5 and 2.4 in painfree canals. Prevotella spp. were isolated from 64.2% of painful canals and 12.5% of painless canals (P < 0.01) similarly, peptostreptococci were isolated from 71.4% of painful and 31.3% of painless canals (P < 0.05). It was concluded that a significant association exists between pain and the presence of Prevotella and Peptostreptococcus spp. in dental root canals.

Relationship between clinical symptoms and enzyme-producing bacteria isolated from infected root canals.

The object of this study was to determine the correlation between clinical symptoms and the activity of enzymes such as collagenase, chondroitinase, and hyaluronidase produced by bacteria isolated from infected root canals. The materials examined consisted of 28 teeth with apical periodontitis from 25 patients. Bacteria producing collagenase or chondroitinase and hyaluronidase were found to be significantly related to subacute clinical symptoms involving percussion pain. The frequency of bacteria producing collagenase was higher in isolates from root canals with a radiolucent area over 5 mm in diameter than in those from canals having a radiolucent area less than 5 mm in diameter.

Correlation between thermal sensitivity and microorganisms isolated from deep carious dentin.

The correlation between thermal sensitivity and the microorganisms present in 29 deep carious lesions was studied. The numbers of lactobacilli and total Gram-positive rods in the carious lesions were found to be negatively related to the length of pain triggered by cold and heat stimulants. The presence of Gram-positive cocci and non-black-pigmented Bacteroides were positively associated with both cold and heat sensitivities. Black-pigmented Bacteroides, Streptococcus mutans, and total anaerobic colony counts were positively related to the heat sensitivity. Recovery of Fusobacterium nucleatum, Actinomyces viscosus, and enterics on the selective plates was associated with cold sensitivity. Total counts of Gram-positive cocci and Gram-negative rods on the anaerobic nonselective medium were positively related to the cold sensitivity. It appeared that teeth with low numbers of lactobacilli in the carious lesions usually responded to thermal tests with longer duration of pain. Conversely, teeth with high numbers of lactobacilli in the carious lesions usually responded with shorter duration of pain.