Increase Toll-like receptors 2 and 4 in apical periodontitis of rats with chronic liver disease.

The aim of this study was to evaluate the influence of liver fibrosis (LF) on the expression of Toll-like receptors (TLR) 2 and 4 in apical periodontitis (AP) in Wistar rats. Forty Wistar rats were allocated in the following groups (n = 10): C-control; AP-apical periodontitis; LF-liver fibrosis; AP + LF-rats with AP and LF. LF and AP were induced by established methodologies. Histological, bacteriological, and immunohistochemical analyses were performed according to pre-established scores. For comparisons between AP and AP + LF groups, the Mann-Whitney test was used (P < .05). The livers of the LF and AP + LF groups showed generalized portal inflammatory infiltrate and collagen fibers confirming the presence of LF. Histopathological analysis in the maxilla of the AP + LF group showed areas of necrosis comprising the entire dental pulp and periapical tissue surrounded by a more intense inflammatory infiltrate than observed in the AP group (P = 0.032). A significant number of specimens in the AP + LF group showed microorganisms beyond the apical foramen adhered to the extraradicular biofilm, demonstrating greater invasion compared to the AP group (P = .008). Immunohistochemical analysis showed a large number of cells immunoreactive for TLR2 and TLR4 in the AP + LF group, compared to the AP group (P < 0.05). Liver fibrosis favors the inflammation and contamination of microorganisms in apical periodontitis and triggers the expression of TLR2 and TLR4, modulating innate immunity response in periapical lesions.

Evolution of endodontic medicine: a critical narrative review of the interrelationship between endodontics and systemic pathological conditions.

Endodontics has gained emphasis in the scientific community in recent years due to the increase in clinical and in animal models studies focused on endodontic medicine, which aims to evaluate the interrelationship between systemic and periapical tissues pathological conditions. These studies have shown that systemic changes can boost the pathogenesis of endodontic infection, favoring its development and progression. A contrary relationship is reported in numerous studies that affirm the potential of endodontic infection to trigger systemic damage and may lead to the worsening of pre-existing pathologies. Recently, the potential of filling materials to develop systemic changes such as neurological alterations had been evaluated, also showing that systemic diseases can negatively influence tissue responses to filling materials after endodontic treatment. Despite advances in endodontic medicine studies, there are still gaps in knowledge on the mechanisms of interactions between apical periodontitis (AP) and systemic diseases and much research to be done. In this sense, this critical narrative literature review aimed to show the evolution of studies in endodontic medicine to help the endodontist to know the role of systemic diseases in the pathogenesis of AP and the possible interference in the repair of periapical tissues after endodontic treatment, as well as to evidence the systemic complications that can be triggered or aggravated in the presence of endodontic infection.

Worldwide pattern of antibiotic prescription in endodontic infections.

BACKGROUND: Odontogenic infections, and especially endodontic infections, are polymicrobial, involving a combination of Gram-positive and Gram-negative facultative anaerobes and strictly anaerobic bacteria. Therefore, antibiotics can be used as an adjunct to endodontic treatment. However, most chronic and even acute endodontic infections can be successfully managed by disinfection of the root-canal system, which eliminates the source of infection, followed by abscess drainage or tooth extraction, without the need for antibiotics. The literature provides evidence of inadequate prescribing practices by dentists. The aim of this concise review was to analyse the worldwide pattern of antibiotic prescription in endodontic infections. METHODS: Comprehensive searches were conducted in MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. The databases were searched up to 13 March 2016 for studies in which dentists used systemic antibiotics to treat endodontic lesions and which reported data on the type of antibiotic prescribed and on the diagnosis of the endodontic disease treated. RESULTS: The electronic and hand searches identified 69 titles, of which 25 were included in the final analysis. Amoxicillin was reported as the drug of choice for endodontic infections in most countries, and clindamycin and erythromycin were the choice for patients allergic to penicillin. Dentists worldwide prescribe antibiotics for non-indicated conditions, such as pulpitis. CONCLUSION: Antibiotics are overprescribed for the management of endodontic infections. It is necessary to improve antibiotic-prescribing habits in the treatment of endodontic infections, as well as to introduce educational initiatives to encourage the coherent and proper use of antibiotics in such conditions.

Viruses in pulp and periapical inflammation: a review.

The presence of viruses in endodontic disease has been studied in the last decade. Their presence is associated with periapical radiolucency and with clinical findings, such as pain. The aim of this review is to analyze the scientific evidence currently published about viruses in pulp and periapical inflammation, and its possible clinical implications. A literature review was carried out using the Medline/Pubmed database. The search was performed, in English and Spanish, using the following keyword combinations: virus AND endodontic; virus AND periapical; virus AND pulpitis; herpesvirus AND periapical; papillomavirus AND periapical. We subsequently selected the most relevant studies, which complied with the search criterion. A total of 21 articles were included, of which 18 detected the present of viruses in the samples. In 3 of the studies, viral presence was not found in the samples studied. The Epstein-Barr virus was found in about 41 % of cases compared to controls, in which it was present in about 2 %. The main association between viruses and endodontic pathosis is between Cytomegalovirus and Epstein-Barr virus; these are found in 114 of the 406 samples of different endodontic pathosis. Some evidence supports that the Epstein-Barr virus is present in a significant number of endodontic diseases, without exact knowledge of their action in these diseases.

Virus en Endodoncia / Viruses in Endodontics

La infección endodóntica es la infección que afecta al sistema de conductos radiculares y, sin duda, es el principal agente etiológico de las periodontitis apicales. Además, de las bacterias patógenas endodónticas, se ha buscado en los últimos años asociar la presencia de virus en distintos tipos de patología endodóntica. Los virus que más se han buscado y asociado son los pertenecientes a la familia herpesvirus, los cuales se han encontrado presentes en patologías periapicales principalmente. Se ha buscado además, relacionar su presencia a patologías que cursan con mayor sintomatología, o que presentan a la imagen radiográfica destrucciones óseas periapicales mayores. El rol de los virus en las lesiones apicales de origen endodóntico está aún poco claro, se habla de efectos acumulativos a los de las bacterias, además de posibles inmunosupresiones locales que favorecerían el crecimiento y el efecto de estas últimas.

Endodontic infection is an infection of the root canal system and undoubtedly is the main etiological agent of apical periodontitis. In recent years, research has aimed to associate the presence of virus and endodontic bacterial pathogens in the different types of endodontic disease. The most common viruses that have been researched and associated are members of the herpesvirus family, which are mainly present in periapical pathologies. Furthermore, research has been carried out relating their presence to pathologies with important symptoms, or those where radiographic imaging shows extensive apical bone reabsorption. The role of viruses in apical lesions of endodontic origin are still unclear, it hypothesizes the cumulative effect with bacteria, in addition to possible local immunosuppression that favors the growth and the effect of bacteria.