Endodontic Microbiology PDF
14.51 MB PDF
Endodontic infections are very prevalent, because they mostly represent complications of dental caries and its treatment, as well as traumatic injuries to teeth, which are all very prevalent occurrences. Collectively, they represent the majority of dental infections that present with significantly acute local and systemic signs and symptoms. This is the first textbook devoted to the study of endodontic infections, which hitherto has been limited to isolated single chapters in endodontic textbooks. This textbook is intended to provide a collection of work showing the state of the knowledge in this field. It is also intended to provide some research questions and hypotheses that, hopefully, will stimulate more efforts to understand the disease process and identify effective treatment methods.
The study of endodontic microbiology has been complicated by difficulty in epidemiological data in obtaining adequate endodontic diagnosis on large numbers of nonpatient populations. In addition, sampling is a major challenge in endodontics. Contamination from the tooth surface, caries, or saliva must first be avoided. Access to the potentially very complex root canal anatomy and disruption of biofilm on the majority of canal walls in these areas are necessary. It is almost impossible to differentiate specimens obtained from the apical and coronal portions of the root canals; thus, the effect of location of microflora within the canal is poorly understood, and can only be studied in teeth that are extracted. Finally, sampling after completion of treatment to assess effectiveness of treatment and determine the long-term outcome risk is complicated by the fact that only the areas that reached could be sampled.
The differences in sensitivity between traditional culturing and modern molecular methods are especially important in endodontic microbiology, because the endodontic specimen has so little material, and sensitivity, therefore, plays a major role in microbial identification. The description of traditional bacterial pathogens and their virulence factors represents most of the available literature today. The contributions of the not-yet-cultivated bacteria and the bacteria rendered temporarily uncultivable by traditional treatment methods have not been adequately studied. Likewise, we are just beginning to understand some of the contributions of fungi and viruses to the pathogenesis of endodontic infections.
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