Skip to main content
SpringerLink
Log in

Microbiology and Immunology of Endodontic Infections

  • Chapter
  • First Online:
Endodontic Prognosis

Abstract

Endodontic infections are complex diseases associated with apical tissue inflammation that is determined by microbial, immunological, and environmental factors. During the past years, the integration of research tools, including molecular techniques for identification, sophisticated in vitro modeling, and human microbiome analysis, has provided additional insight in the understanding of endodontic infections. Recent studies suggest that the basis for infections associated to root canals of teeth is polymicrobial in nature and includes the emergence of microbial colonization in form of biofilms. Biofilms deep seated in areas that are difficult to reach by mechanical treatment will enhance microbial virulence, antibiotic resistance, colonization potential, and resistance. Furthermore, with the advent of the human oral microbiome project, insights on the differences among oral microfloras in different individuals appear to have an important role in progressing endodontic infections. This chapter discusses the current data regarding the role that microbial biofilms play in endodontic infections, as well as its place in the current knowledge of endodontic microbiology. The complex relations between the root canal microflora and the inflammatory response in apical periodontitis are also highlighted in this chapter, as well as their implications in regard to the diagnosis and clinical management of endodontic infections.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bowden GH, Hamilton IR. Survival of oral bacteria. Crit Rev Oral Biol Med. 1998;9(1):54–85.

    Article  PubMed  Google Scholar 

  2. Marsh PD, Hunter JR, Bowden GH, Hamilton IR, McKee AS, Hardie JM, Ellwood DC. The influence of growth rate and nutrient limitation on the microbial composition and biochemical properties of a mixed culture of oral bacteria grown in a chemostat. J Gen Microbiol. 1983;129(3):755–70.

    PubMed  Google Scholar 

  3. Marsh PD. Dental plaque as a biofilm: the significance of pH in health and caries. Compend Contin Educ Dent. 2009;30(2):76–8, 80, 83–77; quiz 88, 90.

    PubMed  Google Scholar 

  4. Marsh PD. Microbiology of dental plaque biofilms and their role in oral health and caries. Dent Clin N Am. 2010;54(3):441–54.

    Article  PubMed  Google Scholar 

  5. Marsh PD. Are dental diseases examples of ecological catastrophes? Microbiology. 2003;149(Pt 2):279–94.

    Article  PubMed  Google Scholar 

  6. Do T, Devine D, Marsh PD. Oral biofilms: molecular analysis, challenges, and future prospects in dental diagnostics. Clin Cosmet Investig Dent. 2013;5:11–9.

    PubMed  PubMed Central  Google Scholar 

  7. Marsh PD, Devine DA. How is the development of dental biofilms influenced by the host? J Clin Periodontol. 2011;38 Suppl 11:28–35.

    Article  PubMed  Google Scholar 

  8. Cook GS, Costerton JW, Lamont RJ. Biofilm formation by Porphyromonas gingivalis and Streptococcus gordonii. J Periodontal Res. 1998;33(6):323–7.

    Article  PubMed  Google Scholar 

  9. Nair PN. Apical periodontitis: a dynamic encounter between root canal infection and host response. Periodontol 2000. 1997;13:121–48.

    Article  PubMed  Google Scholar 

  10. Sundqvist G. Ecology of the root canal flora. J Endod. 1992;18(9):427–30.

    Article  PubMed  Google Scholar 

  11. Sundqvist G. Taxonomy, ecology, and pathogenicity of the root canal flora. Oral Surg Oral Med Oral Pathol. 1994;78(4):522–30.

    Article  PubMed  Google Scholar 

  12. Chávez de Paz LE. Redefining the persistent infection in root canals: possible role of biofilm communities. J Endod. 2007;33(6):652–62.

    Article  PubMed  Google Scholar 

  13. Nair PN, Sjögren U, Krey G, Kahnberg KE, Sundqvist G. Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: a long-term light and electron microscopic follow-up study. J Endod. 1990;16(12):580–8.

    Article  PubMed  Google Scholar 

  14. Siqueira Jr JF, Roças IN, Paiva SS, Magalhaes KM, Guimaraes-Pinto T. Cultivable bacteria in infected root canals as identified by 16S rRNA gene sequencing. Oral Microbiol Immunol. 2007;22(4):266–71.

    Article  PubMed  Google Scholar 

  15. Hahn CL, Liewehr FR. Relationships between caries bacteria, host responses, and clinical signs and symptoms of pulpitis. J Endod. 2007;33(3):213–9.

    Article  PubMed  Google Scholar 

  16. Martin FE. Carious pulpitis: microbiological and histopathological considerations. Aust Endod J. 2003;29(3):134–7.

    Article  PubMed  Google Scholar 

  17. Siqueira Jr JF, Roças IN. Bacterial pathogenesis and mediators in apical periodontitis. Braz Dent J. 2007;18(4):267–80.

    Article  PubMed  Google Scholar 

  18. Figdor D, Sundqvist G. A big role for the very small – understanding the endodontic microbial flora. Aust Dent J. 2007;52(1 Suppl):S38–51.

    Article  PubMed  Google Scholar 

  19. Roças IN, Siqueira Jr JF. In vivo antimicrobial effects of endodontic treatment procedures as assessed by molecular microbiologic techniques. J Endod. 2011;37(3):304–10.

    Article  PubMed  Google Scholar 

  20. Möller AJ, Fabricius L, Dahlén G, Öhman AE, Heyden G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scand J Dent Res. 1981;89(6):475–84.

    PubMed  Google Scholar 

  21. Costerton JW, Cheng KJ, Geesey GG, Ladd TI, Nickel JC, Dasgupta M, Marrie TJ. Bacterial biofilms in nature and disease. Annu Rev Microbiol. 1987;41:435–64.

    Article  PubMed  Google Scholar 

  22. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):1318–22.

    Article  PubMed  Google Scholar 

  23. van Loosdrecht MC, Lyklema J, Norde W, Zehnder AJ. Influence of interfaces on microbial activity. Microbiol Rev. 1990;54(1):75–87.

    PubMed  PubMed Central  Google Scholar 

  24. van Loosdrecht MC, Norde W, Zehnder AJ. Physical chemical description of bacterial adhesion. J Biomater Appl. 1990;5(2):91–106.

    Article  PubMed  Google Scholar 

  25. Mayer C, Moritz R, Kirschner C, Borchard W, Maibaum R, Wingender J, Flemming HC. The role of intermolecular interactions: studies on model systems for bacterial biofilms. Int J Biol Macromol. 1999;26(1):3–16.

    Article  PubMed  Google Scholar 

  26. Nair P. Light and electron microscopic studies on root canal flora and periapical lesions. J Endod. 1987;13:29–39.

    Article  Google Scholar 

  27. Ricucci D, Siqueira Jr JF. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod. 2010;36(8):1277–88.

    Article  PubMed  Google Scholar 

  28. Romling U, Kjelleberg S, Normark S, Nyman L, Uhlin BE, Akerlund B. Microbial biofilm formation: a need to act. J Intern Med. 2014;276(2):98–110.

    Article  PubMed  Google Scholar 

  29. Gode-Potratz CJ, Kustusch RJ, Breheny PJ, Weiss DS, McCarter LL. Surface sensing in Vibrio parahaemolyticus triggers a programme of gene expression that promotes colonization and virulence. Mol Microbiol. 2011;79(1):240–63.

    Article  PubMed  Google Scholar 

  30. Stewart PS, Franklin MJ. Physiological heterogeneity in biofilms. Nat Rev Microbiol. 2008;6(3):199–210.

    Article  PubMed  Google Scholar 

  31. Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001;358(9276):135–8.

    Article  PubMed  Google Scholar 

  32. Kayaoglu G, Erten H, Bodrumlu E, Orstavik D. The resistance of collagen-associated, planktonic cells of Enterococcus faecalis to calcium hydroxide. J Endod. 2009;35(1):46–9.

    Article  PubMed  Google Scholar 

  33. Noiri Y, Katsumoto T, Azakami H, Ebisu S. Effects of Er:YAG laser irradiation on biofilm-forming bacteria associated with endodontic pathogens in vitro. J Endod. 2008;34(7):826–9.

    Article  PubMed  Google Scholar 

  34. Zaura-Arite E, van Marle J, ten Cate JM. Confocal microscopy study of undisturbed and chlorhexidine-treated dental biofilm. J Dent Res. 2001;80(5):1436–40.

    Article  PubMed  Google Scholar 

  35. Chávez de Paz LE, Bergenholtz G, Svensäter G. The effects of antimicrobials on endodontic biofilm bacteria. J Endod. 2010;36(1):70–7.

    Article  PubMed  Google Scholar 

  36. Roças IN, Alves FR, Santos AL, Rosado AS, Siqueira Jr JF. Apical root canal microbiota as determined by reverse-capture checkerboard analysis of cryogenically ground root samples from teeth with apical periodontitis. J Endod. 2010;36(10):1617–21.

    Article  PubMed  Google Scholar 

  37. Auschill TM, Arweiler NB, Netuschil L, Brecx M, Reich E, Sculean A. Spatial distribution of vital and dead microorganisms in dental biofilms. Arch Oral Biol. 2001;46(5):471–6.

    Article  PubMed  Google Scholar 

  38. Boulos L, Prevost M, Barbeau B, Coallier J, Desjardins R. LIVE/DEAD BacLight : application of a new rapid staining method for direct enumeration of viable and total bacteria in drinking water. J Microbiol Methods. 1999;37(1):77–86.

    Article  PubMed  Google Scholar 

  39. Branda SS, Vik S, Friedman L, Kolter R. Biofilms: the matrix revisited. Trends Microbiol. 2005;13(1):20–6.

    Article  PubMed  Google Scholar 

  40. Byström A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1(5):170–5.

    Article  PubMed  Google Scholar 

  41. Molander A, Reit C, Dahlén G, Kvist T. Microbiological status of root-filled teeth with apical periodontitis. Int Endod J. 1998;31(1):1–7.

    Article  PubMed  Google Scholar 

  42. Möller AJ, Fabricius L, Dahlén G, Sundqvist G, Happonen RP. Apical periodontitis development and bacterial response to endodontic treatment. Experimental root canal infections in monkeys with selected bacterial strains. Eur J Oral Sci. 2004;112(3):207–15.

    Article  PubMed  Google Scholar 

  43. Chávez de Paz LE, Bergenholtz G, Dahlén G, Svensäter G. Response to alkaline stress by root canal bacteria in biofilms. Int Endod J. 2007;40(5):344–55.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endodontics, Karolinska Institute, Stockholm, Sweden

    Luis E. Chávez de Paz DDS, MS, PhD

  2. Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, Göteborg, SE, 40530, Sweden

    Gunnar Dahlén DDS, PhD

Authors
  1. Luis E. Chávez de Paz DDS, MS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gunnar Dahlén DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis E. Chávez de Paz DDS, MS, PhD .

Editor information

Editors and Affiliations

  1. Section of Endodontics, UCLA School of Dentistry, Los Angeles, California, USA

    Nadia Chugal

  2. Dept of Endodontics, NYU College of Dentistry, New York, New York, USA

    Louis M Lin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Chávez de Paz, L.E., Dahlén, G. (2017). Microbiology and Immunology of Endodontic Infections. In: Chugal, N., Lin, L. (eds) Endodontic Prognosis. Springer, Cham. https://doi.org/10.1007/978-3-319-42412-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42412-5_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42410-1

  • Online ISBN: 978-3-319-42412-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation