Chapter
2.4 Epidemiology of endodontic diseases
2.4.1 Basic principles of epidemiologic approaches to dental disease
2.4.2 Infections with pulpal involvement
2.4.3 Infections with periapical involvement
2.4.4 Radiographic surveys of asymptomatic apical periodontitis: methodology
2.4.5 Results of epidemiologic surveys of asymptomatic apical periodontitis
2.5 Quality of root canal treatment and the development and persistence of apical periodontitis
2.6 Treatment strategies: prevention, treatment, and extraction
2.7 General oral health, oral health strategies, and tooth preservation as risk factors for oral infections
3 Microbiology of Dental Caries and Dentinal Tubule Infection
3.2 Oral biofilms associated with dental caries
3.3 Microbiota of dental caries
3.3.1 Microbiota of initial caries including white spot lesions
3.3.2 Microbiota of early childhood caries
3.3.3 Microbiota of root caries
3.3.4 Microbiota of dentinal caries and dentinal tubules
3.4 Microbial invasion of dentinal tubules
3.4.1 Colonization of dentinal tubules
3.5 Clinical aspects of dental caries microbiota and dentinal tubule infection
3.5.1 Invasion of coronal dentin: influence on the progression and management of pulp disease
3.5.2 Invasion of radicular dentin: influence on the progression and management of periapical disease
3.5.3 Invasion of radicular dentin: influence on the progression and management of periodontal disease
4 Culture-Based Analysis of Endodontic Infections
4.2 Historical perspectives
4.3 Culture-based analysis in clinical practice
4.3.3 Laboratory considerations
4.3.4 Sensitivity and specificity
4.4 Clinical interpretations
4.4.1 How to interpret the primary infection
4.4.2 Interpretation of growth during treatment
4.4.3 Use of specific antiseptics and antibiotics
4.5 Route of infection in vital and necrotic pulp
4.5.1 Root canals with vital pulps
4.5.2 Root canals with necrotic pulps
4.6.1 Acute symptomatic infection
4.6.2 Bacteria and symptoms
4.6.3 Abscess and fistula formation
4.6.5 The microflora of the root canal versus the deep periodontal pocket
4.7.1 Why is it so difficult to eliminate root canal microorganisms?
4.8 Persisting infections at root-filled teeth
4.9 Culture versus molecular biology methods
5 Molecular Analysis of Endodontic Infections
5.2 Limitations of culture methods
5.2.1 Difficulties in culturing: the as-yet-uncultivated majority
5.2.2 Difficulties in identification: species with uncommon phenotypes
5.3 Molecular biology techniques
5.3.1 Impact in medical microbiology
5.4 Gene targets for microbial identification
5.5 PCR and its derivatives
5.5.1 Species-specific PCR
5.5.4 Reverse transcriptase PCR
5.5.6 PCR-based microbial typing
5.5.7 Broad-range PCR and clone library analysis
5.6 Denaturing gradient gel electrophoresis
5.7 Terminal restriction fragment length polymorphism
5.8 DNA–DNA hybridization assays
5.8.1 Checkerboard DNA–DNA hybridization
5.9 Fluorescence in situ hybridization
5.10 Next-generation DNA sequencing technologies
5.12 Advantages and limitations of molecular methods
5.12.1 The too-high sensitivity issue
5.12.2 The dead-cell issue
5.13 Unraveling the endodontic microbiome with molecular biology methods
5.13.1 The five generations of endodontic microbiology studies
5.13.2 Impact of molecular methods in endodontic microbiology
5.14 Microbial diversity in endodontic infections
5.14.1 Primary intraradicular infections
5.14.2 Uncultivated bacteria
5.14.3 Newly cultivated and characterized species
5.14.4 Geographic influence
5.15 Persistent and secondary intraradicular infections
5.15.1 Bacteria at the root canal-filling stage
5.15.2 Microbiome in root canal-treated teeth
5.16 Extraradicular infections
5.17 Other microorganisms in endodontic infections
5.18 Next-generation DNA sequencing analyses of the endodontic microbiome
6 Extraradicular Endodontic Infections
6.2 Brief review of the endodontic microorganisms in infected root canals
6.3 Pathways of microbial access to the dental pulp
6.4 Infection of the root canal space
6.5 Sequelae of pulp infection
6.6 Bacterial invasion of the periapical tissues
6.7 Microbial factors in periapical lesions
6.8 Bacterial evasion of host defense
6.9 Extraradicular endodontic infections
6.9.1 Acute apical abscesses
6.9.2 Biofilms on the external root surface (extraradicular biofilms)
6.9.3 Periapical biofilms
6.10 Treatment of endodontic infections
7 Virulence of Endodontic Bacterial Pathogens
7.1.1 Virulence and pathogenicity
7.2 Genetic aspects of bacterial virulence
7.2.1 Horizontal gene transfer
7.2.2 Accessory genetic elements
7.3.6 Extracellular vesicles
7.3.8 Extracellular proteins
7.3.9 Metabolic by-products
7.4 Virulence associated with endodontic microorganisms
7.4.1 Porphyromonas and Prevotella
7.4.9 Combinations of microorganisms
7.5 Conclusions and future directions
8 Viruses in Endodontic Pathosis
8.2 General description of herpesviruses
8.3 Human cytomegalovirus
8.5 Herpes simplex virus types 1 and 2
8.6 Varicella-zoster virus
8.8 Human herpesvirus-7 and -8
8.9 Association between herpesviruses and apical disease
8.10 Pathogenesis of herpesvirus-associated apical disease
8.11 Model for herpesvirus-mediated apical disease
9 Fungi in Endodontic Infections
9.1 General characteristics of fungi
9.2 Oral yeasts and carriage
9.4 Virulence factors and pathogenicity
9.4.1 Morphogenesis and morphologic transition
9.4.5 Phenotypic switching
9.5 Presence and pathogenicity of yeasts in different dental tissues
9.5.1 Yeasts and dental caries
9.5.2 Dentin colonization and infection by yeasts
9.5.3 Yeast infection of periodontal tissues
9.5.4 Yeasts in root canals
9.5.5 Extraradicular yeast infections
9.6 Antifungal activity of endodontic irrigating solutions and disinfectants
9.6.1 Sodium hypochlorite
9.6.2 Ethylene diamine tetraacetic acid
9.6.6 Other antifungal measures
10 Severe Head and Neck Infections
10.2 Etiology and epidemiology
10.4 Anatomy and pathogenesis of spread
10.4.1 Submandibular space
10.4.5 Lateral pharyngeal space
10.5.2 Systemic examination
10.5.3 Head and neck examination
10.5.4 Laboratory investigations
10.7 Medical and surgical management
11 Endodontic Infections and Pain
11.2 Biology of the pain system
11.3 Central sensitization
11.4 Persistent pain following endodontic therapy
11.5 Mechanisms of pain due to endodontic infections
11.6 Clinical strategies for treating pain due to endodontic infections
12 Systemic Antibiotics in Endodontic Infections
12.2 General principles of antibiotic prescribing
12.3 Efficacy of antibiotics
12.4 Classification and mode of action of antibiotics
12.4.1 Cell wall and cell membrane disruption
12.4.2 Interference with protein production
12.4.3 Interference with DNA structure and replication
12.6 Antibiotic effectiveness and bacterial resistance in endodontics
12.7 Antibiotic toxicities, allergies, and superinfections
12.8 Role of antibiotics in clinical management of endodontic infections
12.9 Indications for prophylactic antibiotic therapy
13 Topical Antimicrobials in Endodontics
13.1.1 Targeting biofilm in endodontic disinfection
13.1.2 Therapeutic strategies against root canal biofilm
13.2 Challenges for topical antimicrobials in root canal disinfection
13.2.1 Root canal anatomy
13.2.2 Structure and composition of dentin
13.2.3 Fluid (irrigation) dynamics in root canal
13.3 Requirements of endodontic topical antimicrobials
13.4 Classification of topical antimicrobials in root canal therapy
13.4.1 Chemical-based antimicrobials
13.4.2 Nonchemical-based antimicrobials
13.4.3 Antimicrobial photodynamic therapy
13.4.4 Laser-assisted root canal disinfection
14 Endodontic Infections in Incompletely Developed Teeth
14.2 Review of tooth development as it relates to endodontic pathosis
14.3 Etiology, prevalence, and pathogenesis of pulp disease in incompletely developed teeth
14.4 Microbiology of endodontic infections in teeth from pediatric patients
14.5 Management of immature teeth
14.5.2 Clinical management
14.6 Orthodontic considerations in pathologically involved incompletely formed teeth
14.7 Stem cells for pulp and periodontal tissue regeneration
14.8 Recent innovations on the regeneration of tooth form
14.9 Conclusions and prospects
15 Prognosis of Healing in Treated Teeth with Endodontic Infections
15.1 Introduction: The critical importance of prognosis
15.2 Outcome measures and criteria in assessment of endodontic prognosis
15.2.1 Clinical outcome measures
15.2.2 Radiographic outcome measures
15.3 Levels of evidence in assessment of endodontic prognosis
15.3.2 Methodologic rigor
15.3.3 “Current best evidence” for the prognosis of endodontic treatment
15.4 Prognosis of primary apical periodontitis after initial treatment
15.4.1 Potential for healing
15.4.2 Time-course of healing
15.4.3 Prognostic variables
15.5 Prognosis of posttreatment apical periodontitis after orthograde retreatment
15.5.1 Potential for healing
15.5.2 Time-course of healing
15.5.3 Prognostic variables
15.6 Prognosis of posttreatment apical periodontitis after apical surgery
15.6.1 Potential for healing
15.6.2 Time-course of healing
15.6.3 Prognostic variables
15.7 Prognosis of posttreatment apical periodontitis after intentional replantation
15.7.1 Dynamics of external root resorption
15.8 Etiology of persistent apical periodontitis after endodontic treatment
15.8.1 Persistent infection after nonsurgical treatment
15.8.2 Persistent infection after apical surgery
16 Endodontic Infections and Systemic Disease
16.2 Systemic pain syndromes that mimic endodontic pathosis
16.2.2 Maxillary sinus mucosal pain
16.2.3 Neurovascular pain
16.3 Jawbone radiolucencies that mimic endodontic pathosis
16.4 Systemic diseases or conditions that may influence the pathogenesis or course of endodontic pathosis
16.5 Systemic viral infections
16.5.3 Other viral infections
16.8 Other systemic disease or abnormalities
16.9 Hormonal variation and pregnancy
16.10 Patients on systemic medications
16.11 Genetic and epigenetic variations
16.12 Can endodontic infections contribute to the pathogenesis of systemic disease?
16.12.1 Severe spreading endodontic infections
16.12.2 Bacteremia as a result of endodontic pathosis and/or treatment
16.12.3 Endodontic pathosis and cardiovascular disease
Endodontic Microbiology
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