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Enterococcus faecalis is one of the main microorganisms that infects root canals, ranking among the most prevalent microorganisms associated with endodontic treatment failure. Given its pervasive presence in persistent endodontic infections, the successful elimination of Enterococcus faecalis is crucial for effective endodontic treatment and retreatment. Furthermore, Enterococcus faecalis can form biofilms - defense structures that microbes use to fight environmental threats. These biofilms confer resistance against host immune system attacks and antibiotic interventions. Consequently, the presence of biofilms poses a significant challenge in the complete eradication of Enterococcus faecalis and its associated disease. In response, numerous scholars have discovered promising outcomes in addressing Enterococcus faecalis biofilms within root canals and undertaken endeavors to explore more efficacious approaches in combating these biofilms. This study provides a comprehensive review of strategies and mechanisms for the removal of Enterococcus faecalis biofilms. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the bacterial reduction effect of disinfection protocols used in mandibular molars infected by Enterococcus faecalis. Methods: Eighty extracted mandibular molars were prepared and inoculated with E. faecalis for 2 months. The teeth were then divided into 2 control groups (n=4) and 4 experimental groups (n=18) according to the disinfection protocol utilized: G1. WaveOne Gold (WOG), passive ultrasonic irrigation (PUI) and Ultracal; G2. WOG, PUI and calcium hydroxide (CH); G3. WOG, XP-Endo Finisher (XPF) and Ultracal; G4. WOG, XPF and CH. Bacteriological samples were collected previously (S1), after preparation (S2), final agitation (S3) and intracanal dressing (S4). Microbial growth was assessed according to culture turbidity and UV spectrophotometry. Statistical analyses used the Friedman test for paired samples and Kruskal-Wallis test for non-paired data (p<0.05). Results: No protocol eliminated E. faecalis effectively. The S2, S3 and S4 samples were statistically different from the S1 samples in G1, G2, G3 and G4 (p<0.05). Statistical differences were observed in bacterial reduction between G1 and G2 and G1 and G3 after the intracanal medicament (S4) (p<0.05). Conclusion: The combination of WOG with PUI and CH disinfection protocol showed higher percentages of bacterial reduction. [ABSTRACT FROM AUTHOR]

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI‐rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots. Methodology: Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque‐derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP‐endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony‐forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony‐forming units per mL (CFU/mL) were analysed using One‐way anova. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray‐Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at.05. Results: PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (p <.05). The pre‐treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (p <.05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera Fusobacterium, Actinomyces, Porphyromonas, and Capnocytophaga. Conclusions: The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures. [ABSTRACT FROM AUTHOR]

Endodontic infections arise from the interactive activities of microbial communities colonizing in the intricate root canal system. The present study aims to update the latest knowledge of nanomaterials, their antimicrobial mechanisms, and their applications in endodontics. A detailed literature review of the current knowledge of nanomaterials used in endodontic applications was performed using the PubMed database. Antimicrobial nanomaterials with a small size, large specific surface area, and high chemical activity are introduced to act as irrigants, photosensitizer delivery systems, and medicaments, or to modify sealers. The application of nanomaterials in the endodontic field could enhance antimicrobial efficiency, increase dentin tubule penetration, and improve treatment outcomes. This study supports the potential of nanomaterials as a promising strategy in treating endodontic infections. [ABSTRACT FROM AUTHOR]

BackgroundTo explore the antibiofilm efficacy of plant extracts against in vitro formed single and multispecies endodontic biofilms, in comparison to conventional root canal irrigants.MethodsPubMed, Scopus, Web of Science, and EMBASE were searched up to April 2024. Studies investigating the antibiofilm efficacy, of at least one plant extract and one conventional root canal irrigant, against endodontic biofilms were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Data were extracted, and studies were critically assessed using the Joanna Briggs Institute checklist.ResultsAmong 78 articles, eight articles met the criteria and were eventually included in this review. One study showed a high risk of bias, six showed a moderate risk of bias, and one showed a low risk. A total of twelve plant extracts were tested for their antibiofilm efficacy against eight different single-species biofilms and one multispecies biofilm. A combination of microscopy methods and culturing techniques was used for the assessment of their efficacies. Plant extracts exhibited either a biofilm disruption and/or inhibition of biofilm formation. Psidium cattleianum extract and Psidium guajava exhibited enhanced efficacy compared to Chlorhexidine and NaOCl, respectively. Allium sativum demonstrated comparable efficacy to NaOCl. Furthermore, the combination of Cymbopogon martinii essential oil and NaOCl was found to be more effective than either alone when tested on a multispecies biofilm. However, the other plant extracts, such as Mikania Sprengel, Salvadora persica, Camellia sinensis, and Vitis vinifera showed efficacy but were still inferior compared to the control group.ConclusionsOverall, the tested plant extracts demonstrated promising potential for combating in vitro endodontic biofilms. In that context, integrating conventional therapy protocols with plant-inspired treatments may allow effective endodontic biofilm eradication. Hence, future research should focus on optimizing the synergistic combinations of these extracts with NaOCl to maximize the therapeutic outcomes. Heterogeneity amongst the studies prevented a meta-analysis.

Methanobrevibacter oralis (M. oralis) has predominated human oral microbiota methanogenic archaea as far back as the Palaeolithic era in Neanderthal populations and gained dominance from the 18th century onwards. M. oralis was initially isolated from dental plaque samples collected from two apparently healthy individuals allowing its first characterization. The culture of M. oralis is fastidious and has been the subject of several studies to improve its laboratory growth. Various PCR methods are used to identify M. oralis, targeting either the 16S rRNA gene or the mcrA gene. However, only one RTQ-PCR system, based on a chaperonin gene, offers specificity, and allows for microbial load quantification. Next-generation sequencing contributed five draft genomes, each approximately 2.08 Mb (±0.052 Mb) with a 27.82 (±0.104) average GC%, and two ancient metagenomic assembled genomes. M. oralis was then detected in various oral cavity sites in healthy individuals and those diagnosed with oral pathologies, notably periodontal diseases, and endodontic infections. Transmission pathways, possibly involving maternal milk and breastfeeding, remain to be clarified. M. oralis was further detected in brain abscesses and respiratory tract samples, bringing its clinical significance into question. This review summarizes the current knowledge about M. oralis, emphasizing its prevalence, associations with dysbiosis and pathologies in oral and extra-oral situations, and symbiotic relationships, with the aim of paving the way for further investigations.

Endodontic infection is a common problem that can result in tooth loss if not effectively treated. This study focused on investigating the use of rutin-gallium (Ga)(III) complex–mediated antimicrobial photodynamic therapy (aPDT) for the photoinactivation of Enterococcus faecalis biofilm. The minimum biofilm eradication concentration of the rutin-Ga(III) complex and the minimum biofilm eradication dose of light-emitting diode against E. faecalis were evaluated. The antimicrobial effect of rutin-Ga(III) complex–mediated aPDT against E. faecalis was assessed. Additionally, the expression of genes associated with E. faecalis virulence, such as ace , gelE , and esp , as well as the production of reactive oxygen species within the cells were evaluated. The minimum biofilm eradication concentration of the rutin-Ga(III) complex was determined to be 25 μmol/L, whereas the minimum biofilm eradication dose of light-emitting diode irradiation was defined as 5 minutes with an energy density of 300–420 J/cm2. Rutin-Ga(III) complex–mediated aPDT demonstrated a significant dose-dependent reduction in the growth of E. faecalis biofilms. Moreover, aPDT led to increased intracellular reactive oxygen species generation in treated E. faecalis cells. Furthermore, the messenger RNA levels of ace , gelE , and esp genes were significantly down-regulated in E. faecalis treated with rutin-Ga(III) complex–mediated aPDT (P <.05). Rutin-Ga(III) complex–mediated aPDT effectively reduces E. faecalis biofilm growth by disrupting biofilm structure and down-regulating virulence genes. These findings highlight the potential of aPDT with the rutin-Ga(III) complex as an adjuvant therapeutic approach against E. faecalis biofilms. [ABSTRACT FROM AUTHOR]

Complex microbial communities have been reported to be involved in endodontic infections. The microorganisms invade the dental pulp leading to pulpitis and initiating pulp inflammation. Fusobacterium nucleatum is a dominant bacterium implicated in both primary and secondary endodontic infections. Drugs targeting the molecular machinery of F. nucleatum will minimize pulp infection. LpxA and LpxD are early acyltransferases involved in the formation of lipid A, a major component of bacterial membranes. The identification of leads which exhibit preference towards successive enzymes in a single pathway can also prevent the development of bacterial resistance. A stringent screening strategy utilizing physicochemical and pharmacokinetic parameters along with a virtual screening approach identified two compounds, Lomefloxacin and Enoxacin, with good binding affinity towards the early acyltransferases LpxA and LpxD. Lomefloxacin and Enoxacin, members of the fluoroquinolone antibiotic class, exhibit wide-ranging activity against diverse bacterial strains. Nevertheless, their effectiveness in the context of endodontic treatment requires further investigation. This study explored the potential of Lomefloxacin and Enoxacin to manage endodontic infections via computational analysis. Moreover, the compounds identified herein serve as a foundation for devising novel combinatorial libraries with enhanced efficacy for endodontic therapeutic strategies. [ABSTRACT FROM AUTHOR]

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. Objectives: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. Methods: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle–Ottawa Scale. The certainty of evidence was assessed using GRADE. Results: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Conclusions: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to describe the effects of two single-file systems on the diversity of the endodontic microbiome of teeth with primary asymptomatic apical periodontitis. Materials and methods: The root canals from single-rooted teeth with apical periodontitis were prepared using either the Reciproc Blue (RB) or the XP-endo Shaper (XPS) instrument system. The latter was followed by a supplementary step with the XP-endo Finisher (XPF) instrument. For irrigation, 5.25% sodium hypochlorite was used. Root canal samples were taken at the baseline (S1), after preparation (S2), and after the supplementary step (S3). DNA was extracted and subjected to high-throughput sequencing using the MiSeq Illumina platform. Results: Samples from 10 teeth from the RB and 7 from the XPS group were subjected to DNA sequencing. Initial samples differed significantly from post-preparation samples in bacterial diversity, with no significant difference when comparing the two instrument systems. The most dominant phyla in S2 were Bacteroidetes, Proteobacteria, Firmicutes, Fusobacteria, and Actinobacteria. The same phyla were found to dominate baseline samples and samples taken after using XPF, but with differences in the ranking of the most dominant ones. At the genus level, the most dominant genera identified after RB instrumentation were Bacteroidaceae [G-1], Fusobacterium, and Staphylococcus, while the most dominant genera after XPS instrumentation were Fusobacterium and Porphyromonas. These genera were also dominant in the initial samples. Conclusions: Both treatment protocols had measurable effects on the root canal microbial diversity, with no significant differences between them. Most of the dominant taxa involved in the primary infection and probably in the aetiology of apical periodontitis were eliminated or substantially reduced. Clinical relevance: The most dominant taxa that persisted after instrumentation were Fusobacterium, Porphyromonas, Staphylococcus, and Bacteroidaceae [G-1]. [ABSTRACT FROM AUTHOR]

Endodontic infections arise from the interactive activities of microbial communities colonizing in the intricate root canal system. The present study aims to update the latest knowledge of nanomaterials, their antimicrobial mechanisms, and their applications in endodontics. A detailed literature review of the current knowledge of nanomaterials used in endodontic applications was performed using the PubMed database. Antimicrobial nanomaterials with a small size, large specific surface area, and high chemical activity are introduced to act as irrigants, photosensitizer delivery systems, and medicaments, or to modify sealers. The application of nanomaterials in the endodontic field could enhance antimicrobial efficiency, increase dentin tubule penetration, and improve treatment outcomes. This study supports the potential of nanomaterials as a promising strategy in treating endodontic infections.

ABSTRACTAcyl-homoserine lactones (AHLs) are typical quorum-sensing molecules of gram-negative bacteria. Recent evidence suggests that AHLs may also affect gram-positives, although knowledge of these interactions remains scarce. Here, we assessed the effect of AHLs on biofilm formation and transcriptional regulations in the gram-positive Enterococcus faecalis. Five E. faecalis strains were investigated herein. Crystal violet was employed to quantify the biomass formed, and confocal microscopy in combination with SYTO9/PI allowed the visualisation of biofilms’ structure. The differential expression of 10 genes involved in quorum-sensing, biofilm formation and stress responses was evaluated using reverse-transcription-qPCR. The AHL exposure significantly increased biofilm production in strain ATCC 29212 and two isolates from infected dental roots, UmID4 and UmID5. In strains ATCC 29212 and UmID7, AHLs up-regulated the quorum-sensing genes (fsrC, cylA), the adhesins ace, efaA and asa1, together with the glycosyltransferase epaQ. In strain UmID7, AHL exposure additionally up-regulated two membrane-stress response genes (σV, groEL) associated with increased stress-tolerance and virulence. Altogether, our results demonstrate that AHLs promote biofilm formation and up-regulate a transcriptional network involved in virulence and stress tolerance in several E. faecalis strains. These data provide yet-unreported insights into E. faecalis biofilm responses to AHLs, a family of molecules long-considered the monopole of gram-negative signalling.

Complex microbial communities have been reported to be involved in endodontic infections. The microorganisms invade the dental pulp leading to pulpitis and initiating pulp inflammation. Fusobacterium nucleatum is a dominant bacterium implicated in both primary and secondary endodontic infections. Drugs targeting the molecular machinery of F. nucleatum will minimize pulp infection. LpxA and LpxD are early acyltransferases involved in the formation of lipid A, a major component of bacterial membranes. The identification of leads which exhibit preference towards successive enzymes in a single pathway can also prevent the development of bacterial resistance. A stringent screening strategy utilizing physicochemical and pharmacokinetic parameters along with a virtual screening approach identified two compounds, Lomefloxacin and Enoxacin, with good binding affinity towards the early acyltransferases LpxA and LpxD. Lomefloxacin and Enoxacin, members of the fluoroquinolone antibiotic class, exhibit wide-ranging activity against diverse bacterial strains. Nevertheless, their effectiveness in the context of endodontic treatment requires further investigation. This study explored the potential of Lomefloxacin and Enoxacin to manage endodontic infections via computational analysis. Moreover, the compounds identified herein serve as a foundation for devising novel combinatorial libraries with enhanced efficacy for endodontic therapeutic strategies.

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. Objectives: The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. Methods: PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle–Ottawa Scale. The certainty of evidence was assessed using GRADE. Results: The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Conclusions: Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

Objectives: To compare the root canal microbiome profiles of primary and persistent/secondary infections using high-throughput sequencing with the help of a reliable bioinformatics algorithm. Materials and methods: Root canal samples of 10 teeth in the primary endodontic infection (PEI) group and 10 teeth in the persistent/secondary endodontic infection (SEI) group were included resulting in a total of 20 samples. After DNA extraction from the samples, sequencing was performed on the Illumina MiSeq platform. Pair-end Illumina reads were imported to QIIME 2; amplicon sequence variants (ASVs) generated by DADA2 were mapped to GreenGenes database. Weighted UniFrac distances were calculated and principal coordinates analysis (PCoA) was used to compare beta diversity patterns. The multiple response permutation procedure (MRPP), the analysis of similarities (ANOSIM), and permutational multivariate analysis of variance (adonis) were conducted for testing group differences. Linear discriminant analysis effect size (LEfSe) analysis was utilized to identify differentially abundant taxa between the groups. The linear discriminant analysis (LDA) score threshold was set to 4.0. Results: Within the Gram-negative facultative anaerobic Gammaproteobacteria class outgroup, two orders (Pasteurellales, Vibrionales) and two families (Pasteurellaceae, Vibrionaceae) were significantly more abundant in the PEI group, whereas Gram-positive bacteria, Actinomycetales order, and Gram-positive anaerobic taxa, one genus (Olsenella) and one species (Olsenella uli), were identified as significantly more abundant in the SEI group. Conclusions: A few taxa were differentially abundant within either the PEI or SEI group. Clinical relevance: Reliable bioinformatic tools are needed to define microbial profiles of endodontic infections. Based on a limited number of samples, no distinct variation was determined between the bacterial diversity of initial and recurrent endodontic infections. [ABSTRACT FROM AUTHOR]

Abstract Enterococcus faecalis (E. faecalis) biofilm-associated persistent endodontic infections (PEIs) are one of the most common tooth lesions, causing chronic periapical periodontitis, root resorption, and even tooth loss. Clinical root canal disinfectants have the risk of damaging soft tissues (e.g., mucosa and tongue) and teeth in the oral cavity, unsatisfactory to the therapy of PEIs. Nanomaterials with remarkable antibacterial properties and good biocompatibility have been developed as a promising strategy for removing pathogenic bacteria and related biofilm. Herein, carbon dots (CDs) derived from fucoidan (FD) are prepared through a one-pot hydrothermal method for the treatment of PEIs. The prepared FDCDs (7.15 nm) with sulfate groups and fluorescence property are well dispersed and stable in water. Further, it is found that in vitro FDCDs display excellent inhibiting effects on E. faecalis and its biofilm by inducing the formation of intracellular and extracellular reactive oxygen species and altering bacterial permeability. Importantly, the FDCDs penetrated the root canals and dentinal tubules, removing located E. faecalis biofilm. Moreover, the cellular assays show that the developed FDCDs have satisfactory cytocompatibility and promote macrophage recruitment. Thus, the developed FDCDs hold great potential for the management of PEIs. Graphical Abstract

Objectives: Bacterial biofilms can increase the survival of bacteria through providing resistance to conventional disinfectants as well as antibiotics, thus biofilm considered a serious risk to human health with hug loss. Consequently, novel approaches to deal with bacterial biofilms are required. Viruses that may eradicate bacteria are known as bacteriophages, they are also known as "bacteria eaters." Due to their activity on bacteria, bacteriophages are distinct from other organisms and do not pose a threat to human. Consequently, they are regarded as secure substitutes for antibiotics in the management of bacterial infections. Aim of the Study: In this study, we report the full genome sequencing of bacteriophage, namely BAG1 that targeting an endodontic clinical strain of Enterococcus faecalis (K3). Furthermore, we evaluate it killing efficiency to eliminate E. faecalis in both planktonic media and dentine slabs. Materials and Methods: We used the previously isolated endodontic E. faecalis clinical strain, namely K3 and enterococcus bacteriophage BAG1 in this study by spotting on the double layer agar technique. DNA extracted proceeded with NORGEN phage DNA isolation kit. Phage full genome sequencing was performed using Illumina nova Seq 600, 150 bp PE. In addition, the killing capacity of BAG1 phage against E. faecalis K3 was measured by infecting 5 × 106 E. faecalis with BAG1 phage at multiplicity of infection of 0.1. Furthermore, the biofilm fraction and the number of E. faecalis colony-forming unit in planktonic media were measured after infecting 24 dentine slabs with K3 bacteria and BAG1 phage. SYTO® 9 green LIVE/DEAD® BacLight Bacterial Viability Kits were used to visualize K3 biofilm on dentine slabs using fluorescent microscope. Results: Full Genome Organization of BAG1 phage was circular composed of 68 open reading frame with GC percentage of 34.56%. An efficient killer reflecting by completely eliminating K3 strain within 180 min in killing test. In addition, the result revealed that BAG1 highly significant to eliminate K3 bacteria in both planktonic broth and biofilm fraction obtained from dentine slabs infection with the endodontic K3 clinical strain. Conclusion: Our results support that anti E. faecalis bacteriophage BAG1 significantly eliminate biofilm of E. faecalis K3 on dentine slabs with a lytic properties due to the absence of lysogenic genes which make it a suitable substitute to adjunctive anti E. faecalis therapy. [ABSTRACT FROM AUTHOR]

Acyl-homoserine lactones (AHLs) are typical quorum-sensing molecules of gram-negative bacteria. Recent evidence suggests that AHLs may also affect gram-positives, although knowledge of these interactions remains scarce. Here, we assessed the effect of AHLs on biofilm formation and transcriptional regulations in the gram-positive Enterococcus faecalis. Five E. faecalis strains were investigated herein. Crystal violet was employed to quantify the biomass formed, and confocal microscopy in combination with SYTO9/PI allowed the visualisation of biofilms’ structure. The differential expression of 10 genes involved in quorumsensing, biofilm formation and stress responses was evaluated using reverse-transcriptionqPCR. The AHL exposure significantly increased biofilm production in strain ATCC 29212 and two isolates from infected dental roots, UmID4 and UmID5. In strains ATCC 29212 and UmID7, AHLs up-regulated the quorum-sensing genes (fsrC, cylA), the adhesins ace, efaA and asa1, together with the glycosyltransferase epaQ. In strain UmID7, AHL exposure additionally upregulated two membrane-stress response genes (σV, groEL) associated with increased stresstolerance and virulence. Altogether, our results demonstrate that AHLs promote biofilm formation and up-regulate a transcriptional network involved in virulence and stress tolerance in several E. faecalis strains. These data provide yet-unreported insights into E. faecalis biofilm responses to AHLs, a family of molecules long-considered the monopole of gramnegative signalling [ABSTRACT FROM AUTHOR]

Innate immunity is the first line of defence and fights against microorganisms. Nucleic acids are important pathogen‐associated molecular patterns to be recognized in innate immunity. There are three types of nucleic acid sensors, including endosomal sensors (NA‐sensing TLRs), cytosolic DNA sensors (cGAS and AIM2) and cytosolic RNA sensors (RLG‐I, MDA5 and LGP2). Recent studies have shown that nucleic acid sensors are expressed differently in a variety of dental pulp cells and mediate inflammation through complex pathways. Nucleic acid sensing may play a vital role in the development of endodontic infection. This review aims to summarize and analyse the possible roles of various nucleic acid sensors in endodontic infection. It may help better understand the pathogenesis of these diseases and find new strategies for prevention and treatment. [ABSTRACT FROM AUTHOR]

Endodontic retreatment is often necessitated by several factors, including the persistence of microorganisms in the root canal system (RCS). Their complex organization in biofilms increases their pathogenic potential, necessitating new disinfection strategies. This study aimed to standardize a new in vitro protocol for collecting biofilm from the RCS. Thirty-four bovine incisors were used in the study, divided into two experimental groups with two collection steps each: (a) biofilm collection protocol and (b) absorbent paper points protocol. Twelve specimens from each group were selected for counting colony-forming units (CFUs), while eight specimens were prepared for scanning electron microscopy (SEM). Two additional specimens served as sterilization controls to ensure that experiments were free of contamination. The coronal region was removed and standardized at 15 mm. After preparation with ProTaper up to F5, the apical foramen was sealed with composite resin, and the roots were stabilized with acrylic resin in 1.5-mL Eppendorf tubes. The specimens were sterilized and inoculated with Enterococcus faecalis NTCT 775 every 24 h for 21 days. After this period, each group underwent biofilm collection protocols, and CFU and scanning electron microscopy (SEM) data were analyzed. The Shapiro–Wilk test was performed to assess the normality of log-transformed data, and the results indicated a normal distribution for all groups, allowing parametric testing. The Levene test was used to evaluate the equality of variances. The proposed biofilm collection method yielded significantly higher CFU counts compared with the absorbent paper points method, particularly when analyzed on a log₁₀ scale. An independent samples t -test confirmed a statistically significant difference between the two methods (p < 0.0001). The proposed protocol achieved an efficiency rate of 95.85 % ± 1.15 %, whereas the absorbent paper points protocol yielded a lower efficiency of 5.46 % ± 1.37 %. Therefore, the biofilm collection protocol proposed in this study proved to be more effective for biofilm removal from the RCS. • Biofilms crucial in endodontics for understanding pathogenic potential. • New protocol devised for in vitro biofilm collection from RCS. • 44 bovine incisors used, divided into three experimental groups. • Proposed protocol yielded significantly more CFUs than others. • Study highlights efficacy of proposed protocol in mimicking endodontic infections. [ABSTRACT FROM AUTHOR]

Aim: The role of various host response mediators in pulpitis has been extensively documented as these components may operate as biomarkers that reflect the condition of pulp tissues. The expression of these biomarkers is further affected in the presence of different systemic diseases. This review aims to assess if a correlation exists in the expression of cytokines and endodontic infection in patients having various systemic diseases undergoing nonsurgical endodontic therapy. Materials and Methods: The review includes a complete manual search as well as electronic databases such as PubMed, Scopus, and EBSCOhost. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to frame the review process. The critical appraisal checklist for quasi experimental studies developed by Joanna Briggs Institute was used to examine the risk of bias. For prospective clinical studies, eight criteria were used to assess the risk of bias. The studies included were clinical trials that estimated mRNA expression of cytokines from periapical interstitial fluid before and following disinfection of the root canals in patients suffering from various systemic diseases. Results: This review included a total of four papers from the initial 122 publications. When compared to normal controls, endodontic infection was associated with altered expression of these cytokines in patients presenting various systemic diseases. Conclusions: This information can subsequently be utilized to correctly distinguish between diseased and healthy pulp tissues. The interaction of cytokines in systemic diseases and their possible use in endodontics as a more precise and biologically based diagnostic tool can be planned.

Background: Calcium hydroxide is the gold standard medicament for root canal treatment. Enterococcus faecalis, the primary cause of intraradicular persistent endodontic infection, is often identified even after endodontic treatment. Thymoquinone, an active ingredient of Nigella sativa, has an antimicrobial effect on both gram-negative and positive bacteria, including E. faecalis. Purpose: This study aimed to evaluate the inhibitory effect of calcium hydroxide combined with Nigella sativa extract and determine the best ratio for the combined material. Methods: This is an experimental study comprised of six groups (n = 4 per group) based on the material and its ratio, namely; (1) calcium hydroxide; (2) Nigella sativa extract; and groups of the combination of calcium hydroxide and Nigella sativa extract with a ratio (3) 70:30, (4) 50:50, (5) 30:70, (6) 10:90. The inhibitory effect against E. faecalis was evaluated by the agar well diffusion method in Muller–Hinton agar. Observation of the inhibitory zone was performed on the first, third, and seventh days. The collected data were analysed by a one-way ANOVA and LSD post hoc test. Results: Calcium hydroxide has the highest inhibitory effect, and the combination of Nigella sativa extract with calcium hydroxide ratio 50:50 was second. The inhibitory zone of these two groups was significantly higher than in any other group (p

Aim: The aim of the study was to evaluate the effect of systemic curcumin administration on the severity of apical periodontitis (AP). Methodology: Forty male Wistar rats weighing 250–280 g each, age 2.5 months, were distributed into four groups (n = 10): control untreated rats (C), control rats treated with curcumin (CUR), rats with pulp exposure‐induced apical periodontitis (AP) and rats with pulp exposure‐induced apical periodontitis treated with curcumin (AP‐CUR). Curcumin treatment was administered orally once daily for 15 days before pulp exposure and continued for 30 days after pulp exposure. The rats were sacrificed at 30 days, and the jaws were collected and reconstructed in a programme specific for micro‐CT. The jaws were processed for analysis of the inflammatory process using haematoxylin and eosin staining and immunohistochemical assays for interleukin tumour necrosis factor alpha (TNF‐α), interleukin (Il)‐6 and Il‐1β. Tartrate‐resistant acid phosphatase (TRAP) and osteocalcin (OCN) staining were used to analyse the resorptive process on the bone surface of periapical area. Kruskal–Wallis with Dunn's test was performed for nonparametric data and anova with Tukey's test for parametric data, p <.05. Results: Micro‐CT revealed no statistically significant differences in bone resorption between the AP and AP‐CUR groups (p >.05). The levels of inflammatory cell infiltration and immunoreactivity for the proinflammatory cytokines TNF‐α, Il‐6 and Il‐1β were significantly higher in the periapical lesions of the AP group than in the AP‐CUR group (p <.05). The number of TRAP‐positive multinucleated cells was higher in the AP group than in the AP‐CUR group (p <.05). In OCN‐positive cells, no differences were observed between the AP and AP‐CUR groups (p >.05). Conclusions: Oral supplementation with curcumin had a significant effect on the AP severity in rats, suggesting an anti‐inflammatory effect of curcumin on AP development. [ABSTRACT FROM AUTHOR]

Introduction: Nowadays, antibiotics are not correctly used among some dental practitioners. Thus, the misuse of antibiotics could lead to antibiotic resistance in the long run. The aim of this study was to evaluate the prescribing attitudes of dental practitioners in Northern Morocco when treating pulpal and periapical pathologies. Materials and Methods: This cross-sectional study involved 220 dental practitioners registered on the board of the National Council Order of Dentists of Morocco. A self-administered questionnaire, regarding the types of antibiotics used for endodontic treatment in healthy adult patients with endodontic pathological situations, was used and filled out via the E-mail addresses of practitioners chosen randomly. The data were analyzed with Jamovi (version 1.8.1). Quantitative variables were expressed as mean and standard deviation and qualitative variables as number and percentage. The Chi-square and the ANOVA tests were performed. The significance level was P < 0.05. Results: Forty percentage of dental practitioners prescribed amoxicillin as a first-line therapy for a patient who does not have a penicillin allergy and for patients with a penicillin allergy; azithromycin was the drug of choice prescribed by 41.1% of practitioners. The duration of prescription was 6.5 days ± 0.7. No statistically significant difference was noted regarding the duration of the prescription, in relation to age, sex, specialization, and country of graduation (P > 0.05). The acute apical abscess represents the pathology for which most antibiotics are prescribed. Practitioners aged between 24 and 35 years prescribe more than the oldest practitioners (P = 0.04). Antibiotics were also prescribed for the management of pulpitis and chronic apical periodontitis. The lowest prescription rates were noted among practitioners specializing in or having benefited from endodontic training. Conclusion: It emerges from this study that very few practitioners use antibiotics appropriately in treating pulpal and periapical pathologies. A real lack of knowledge has been noted with regard to indications, dosages, and duration. [ABSTRACT FROM AUTHOR]

Background: A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies. Methods: The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed. Results: The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02-2.29, p = 0.039; I² = 75.0%; p < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67-2.29, p = 0.494; I² = 82.1%; p < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71-2.27, p = 0.413; I² = 69.1%; p = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity. Conclusions: Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up. Registration: PROSPERO database (CRD42020204379). [ABSTRACT FROM AUTHOR]

Methanobrevibacter oralis ( M. oralis ) has predominated human oral microbiota methanogenic archaea as far back as the Palaeolithic era in Neanderthal populations and gained dominance from the 18 th century onwards. M. oralis was initially isolated from dental plaque samples collected from two apparently healthy individuals allowing its first characterization. The culture of M. oralis is fastidious and has been the subject of several studies to improve its laboratory growth. Various PCR methods are used to identify M. oralis , targeting either the 16S rRNA gene or the mcrA gene. However, only one RTQ-PCR system, based on a chaperonin gene, offers specificity, and allows for microbial load quantification. Next-generation sequencing contributed five draft genomes, each approximately 2.08 Mb (±0.052 Mb) with a 27.82 (±0.104) average GC%, and two ancient metagenomic assembled genomes. M. oralis was then detected in various oral cavity sites in healthy individuals and those diagnosed with oral pathologies, notably periodontal diseases, and endodontic infections. Transmission pathways, possibly involving maternal milk and breastfeeding, remain to be clarified. M. oralis was further detected in brain abscesses and respiratory tract samples, bringing its clinical significance into question. This review summarizes the current knowledge about M. oralis , emphasizing its prevalence, associations with dysbiosis and pathologies in oral and extra-oral situations, and symbiotic relationships, with the aim of paving the way for further investigations., Competing Interests: Michel DRANCOURT is co-inventor of SAB medium (patent FR2990954A1)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Enterococcus faecalis (E. faecalis) biofilm-associated persistent endodontic infections (PEIs) are one of the most common tooth lesions, causing chronic periapical periodontitis, root resorption, and even tooth loss. Clinical root canal disinfectants have the risk of damaging soft tissues (e.g., mucosa and tongue) and teeth in the oral cavity, unsatisfactory to the therapy of PEIs. Nanomaterials with remarkable antibacterial properties and good biocompatibility have been developed as a promising strategy for removing pathogenic bacteria and related biofilm. Herein, carbon dots (CDs) derived from fucoidan (FD) are prepared through a one-pot hydrothermal method for the treatment of PEIs. The prepared FDCDs (7.15 nm) with sulfate groups and fluorescence property are well dispersed and stable in water. Further, it is found that in vitro FDCDs display excellent inhibiting effects on E. faecalis and its biofilm by inducing the formation of intracellular and extracellular reactive oxygen species and altering bacterial permeability. Importantly, the FDCDs penetrated the root canals and dentinal tubules, removing located E. faecalis biofilm. Moreover, the cellular assays show that the developed FDCDs have satisfactory cytocompatibility and promote macrophage recruitment. Thus, the developed FDCDs hold great potential for the management of PEIs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the physicochemical properties of five root canal sealers and assess their effect on an ex vivo dental plaque‐derived polymicrobial community. Methodology: Dental plaque‐derived microbial communities were exposed to the sealers (AH Plus [AHP], GuttaFlow Bioseal [GFB], Endoseal MTA [ESM], Bio‐C sealer [BCS] and BioRoot RCS [BRR]) for 3, 6 and 18 h. The sealers' effect on the biofilm biomass and metabolic activity was quantified using crystal violet (CV) staining and MTT assay, respectively. Biofilm community composition and morphology were assessed by denaturing gradient gel electrophoresis (DGGE), 16S rRNA sequencing and scanning electron microscopy. The ISO6876:2012 specifications were followed to determine the setting time, radiopacity, flowability and solubility. Obturated acrylic teeth were used to assess the sealers' effect on pH. Surface chemical characterization was performed using SEM with coupled energy‐dispersive spectroscopy. Data normality was assessed using the Shapiro–Wilk test. One‐way anova and Tukey's tests were used to analyze data from setting time, radiopacity, flowability and solubility. Two‐way anova and Dunnett's tests were used for the data analysis from CV, MTT and pH. 16S rRNA sequencing data were analyzed for alpha (Shannon index and Chao analysis) and beta diversity (Bray–Curtis dissimilarities). Differences in community composition were evaluated by analysis of similarity (p <.05). Results: The sealers significantly influenced microbial community composition and morphology. All sealers complied with ISO6876:2012 requirements for setting time, radiopacity and flowability. Although only AHP effectively reduced the biofilm biomass, all sealers, except BRR, reduced biofilm metabolic activity. Conclusion: Despite adequate physical properties, none of the sealers tested prevented biofilm growth. Significant changes in community composition were observed. If observed in vivo, these changes could affect intracanal microbial survival, pathogenicity and treatment outcomes. [ABSTRACT FROM AUTHOR]

Aim: The role of various host response mediators in pulpitis has been extensively documented as these components may operate as biomarkers that reflect the condition of pulp tissues. The expression of these biomarkers is further affected in the presence of different systemic diseases. This review aims to assess if a correlation exists in the expression of cytokines and endodontic infection in patients having various systemic diseases undergoing nonsurgical endodontic therapy. Materials and Methods: The review includes a complete manual search as well as electronic databases such as PubMed, Scopus, and EBSCOhost. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to frame the review process. The critical appraisal checklist for quasi experimental studies developed by Joanna Briggs Institute was used to examine the risk of bias. For prospective clinical studies, eight criteria were used to assess the risk of bias. The studies included were clinical trials that estimated mRNA expression of cytokines from periapical interstitial fluid before and following disinfection of the root canals in patients suffering from various systemic diseases. Results: This review included a total of four papers from the initial 122 publications. When compared to normal controls, endodontic infection was associated with altered expression of these cytokines in patients presenting various systemic diseases. Conclusions: This information can subsequently be utilized to correctly distinguish between diseased and healthy pulp tissues. The interaction of cytokines in systemic diseases and their possible use in endodontics as a more precise and biologically based diagnostic tool can be planned. [ABSTRACT FROM AUTHOR]

Bacteria and its by-products are found to be the main cause of pulpal and periapical infection of tooth. Infected root canals of tooth harbours a wide variation of microbial flora that includes both Gram-positive and Gram-negative microorganisms. Bacterial components such as Lipopolysaccharide (LPS) of gram negative bacteria and Lipoteichoic Acid (LTA) of gram positive bacteria have the potential to enter the peri-apical tissue of tooth and initiate the inflammatory process. After microbial death that occurs either due to body’s defence cells or by antibiotic action , bacterial cell wall components such as LTA are released which can persist inside macrophages for prolonged periods causing chronic inflammation. Once these cell-wall components are recognized by the body immune surveillance cells, numerous inflammatory mediators are released leading to inflammation and subsequent pathological consequences. The purpose of this review is intend to summarize the role of gram positive bacterial component LTA in causing endodontic infection and use of potential therapeutic agents against LTA.

Apical periodontitis has a microbial aetiology and is one of the most common inflammatory diseases that affect humans. Fungi, archaea and viruses have been found in association with apical periodontitis, but bacteria are by far the most prevalent and dominant microorganisms in endodontic infections. Bacterial infection of the root canal system only occurs when the pulp is necrotic or was removed for previous treatment. In some specific cases, including acute and chronic abscesses, the bacterial infection may reach the periradicular tissues. Intracanal bacteria are usually observed as sessile multispecies communities (biofilms) attached to the dentinal root canal walls. Infection in the main root canal lumen can spread to other areas of the root canal system. Although more than 500 bacterial species have been detected in endodontic infections, a selected group of 20 to 30 species are most frequently detected and may be considered as the core microbiome. There is a high interindividual variability in the endodontic microbiome in terms of species composition and relative abundance. Obligate anaerobic species are more abundant in the intraradicular bacterial communities of teeth with primary apical periodontitis, while both anaerobes and facultatives dominate the communities in post‐treatment apical periodontitis. Bacterial interactions play an essential role in determining the overall virulence of the community, which has been regarded as the unit of pathogenicity of apical periodontitis. This article reviews the microbiologic aspects of endodontic infections and provides perspectives for future research and directions in the field. [ABSTRACT FROM AUTHOR]

Advanced DNA sequencing technology allows more detailed analysis and description of the endodontic microbiome. This study used the MiSeq high-throughput sequencing platform (Illumina, San Diego, CA) to describe the endodontic microbiome of teeth with primary asymptomatic apical periodontitis with no sinus tract. Root canal samples from 25 patients were prepared for DNA sequencing analysis. Bacterial diversity of the microbiome was identified and compared between cases and according to the size of the related apical periodontitis lesions. Statistical analyses of the operational taxonomic unit distribution was performed using principal component analysis with the Bray-Curtis distance and a principal coordinate analysis, 2-way permutational multivariate analysis of variance. The chi-square or Fisher exact test was used to evaluate the prevalence of different operational taxonomic units related to small and large apical periodontitis lesions. Although there was a very high bacterial diversity in the microbiome of teeth with asymptomatic apical periodontitis, 4 phyla dominated the microbiome: Firmicutes (27%), Bacteroidetes (21%), Proteobacteria (21%), and Actinobacteria (12%). There was high variability in species composition between root canal samples with no common species pattern for the cases. Large lesions showed a higher number of species but did not significantly differ from small lesions in bacterial diversity indexes. Bacteroidaceae [G-1] bacterium HMT 272, a previously uncultivated but still unnamed and uncharacterized taxon, was the most prevalent and abundant phylotype. High-throughput sequencing technology confirmed the complexity of the endodontic microbiome and revealed that microbial heterogeneity is a feature between cases. This indicates that various microbial combinations of the endodontic microbiome are able to illicit periapical inflammatory diseases. [ABSTRACT FROM AUTHOR]

Endodontic microbiology deals with the study of the microbial aetiology and pathogenesis of pulpal and periradicular inflammatory diseases. Research in endodontic microbiology started almost 130 years ago and since then has mostly focussed on establishing and confirming the infectious aetiology of apical periodontitis, identifying the microbial species associated with the different types of endodontic infections and determining the efficacy of treatment procedures in eradicating or controlling infection. Diverse analytical methods have been used over the years, each one with their own advantages and limitations. In this review, the main features and applications of the most used technologies are discussed, and advice is provided to improve study designs in order to properly address the scientific questions and avoid setbacks that can compromise the results. Finally, areas of future research are described. [ABSTRACT FROM AUTHOR]

This retrospective study evaluated the outcome of the endodontic treatment/retreatment of teeth with intraoral sinus tracts. Seventy‐two teeth from 70 individuals were included. One operator treated all teeth over about 20 years. Time for the sinus tract to heal was recorded. Treatment outcome was evaluated after at least 1 year and classified as healed, healing or diseased. The overall healed rate of periradicular lesions was 73.6% (74.1% for treatment and 72.2% for retreatment). In 6 (8.3%) teeth, lesions were healing. Thirteen teeth (18.1%) exhibited persistent disease. In 68/72 (94.4%) cases, the sinus tract healed in less than 1 month. No preoperative/intraoperative variable affected the outcome (P > 0.05). Missing restorations had a negative impact (P < 0.05). Healing of both the sinus tract quickly after treatment and the periradicular lesion later were usually achieved. Closure of the sinus tract in the first month was a good predictor of lesion healing. [ABSTRACT FROM AUTHOR]

Background: Enterococcus faecalis (E. faecalis) is the most common bacteria species in persistent endodontic infection of teeth undergoing root canal treatment at a prevalence of 38%. The virulence factor of this bacterium is Lipoteichoic acid (LTA) which can be recognized by Toll-like receptors-4 (TLR-4) that produce a stimulus and provoke an immune response. Inflammation results in bone defects that feature multiple cytokines and interactions between different cell types. Bone loss within a periapical tooth is characterized by osteoclast formation (osteoclastogenesis) in the bone. Purpose: This study aimed to determine the expression of nuclear factor of activated T cell c1 (NFATc1) and receptor activator of nuclear factor kappa β (RANK) which played a role in osteoclastogenesis at different time intervals. Methods: 36 upper molar teeth of the research subjects were induced with 106 CFU Enterococcus faecalis and subsequently observed for 7 and 21 days with the NFATc1 and RANK being counted microscopically at 1000X magnification across 20 viewing fields. Thereafter, the data was examined and analyzed by means of an independent T test using SPSS. Results: NFATc1 and RANK expression were higher in the group including E. faecalis on days 7 and 21 than in the control group. There were significant differences between the treatment group and control group with regard to NFATc1 and RANK expression (p

Enterococcus faecalis is one of the main microorganisms that infects root canals, ranking among the most prevalent microorganisms associated with endodontic treatment failure. Given its pervasive presence in persistent endodontic infections, the successful elimination of Enterococcus faecalis is crucial for effective endodontic treatment and retreatment. Furthermore, Enterococcus faecalis can form biofilms - defense structures that microbes use to fight environmental threats. These biofilms confer resistance against host immune system attacks and antibiotic interventions. Consequently, the presence of biofilms poses a significant challenge in the complete eradication of Enterococcus faecalis and its associated disease. In response, numerous scholars have discovered promising outcomes in addressing Enterococcus faecalis biofilms within root canals and undertaken endeavors to explore more efficacious approaches in combating these biofilms. This study provides a comprehensive review of strategies and mechanisms for the removal of Enterococcus faecalis biofilms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yang, Meng, Zhen, Baima, Wang, Jiang and Xu.)

(1) The objective of the study is to conduct a comprehensive systematic review of in vitro studies in order to assess the depth to which E. faecalis bacteria penetrate human dentinal tubules after the use of various irrigation solutions. (2) Methods: A literature search of the MEDLINE, Scopus, Cochrane CENTRAL, and Embase databases was conducted, as well as a backward and forward citation search. Two independent reviewers then selected suitable studies based on inclusion and exclusion criteria. Data were extracted and the risk of bias and methodology of the studies were evaluated. (3) Results: Out of a total of 504 papers evaluated following the removal of duplicates, 7 studies met the inclusion criteria and were included in the systematic review. The heterogeneity of the studies made it impossible to perform a meta-analysis. The majority of the studies reported that sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) can affect the penetration depth of E. faecalis suspensions. The studies included in this review possess a moderate to high risk of bias and thus represent moderate evidence that the antimicrobial activity of NaOCl and CHX affects the intra-tubular penetration of bacteria. (4) Conclusions: The evidence indicates that irrigants may affect the bacteria inside human dentinal tubules. Standardized high-quality methods are needed to evaluate bacterial penetration in in vitro studies.

Bacteria and its by-products are found to be the main cause of pulpal and periapical infection of tooth. Infected root canals of tooth harbours a wide variation of microbial flora that includes both Gram-positive and Gram-negative microorganisms. Bacterial components such as Lipopolysaccharide (LPS) of gram negative bacteria and Lipoteichoic Acid (LTA) of gram positive bacteria have the potential to enter the peri-apical tissue of tooth and initiate the inflammatory process. After microbial death that occurs either due to body's defence cells or by antibiotic action, bacterial cell wall components such as LTA are released which can persist inside macrophages for prolonged periods causing chronic inflammation. Once these cell-wall components are recognized by the body immune surveillance cells, numerous inflammatory mediators are released leading to inflammation and subsequent pathological consequences. The purpose of this review is intend to summarize the role of gram positive bacterial component LTA in causing endodontic infection and use of potential therapeutic agents against LTA. [ABSTRACT FROM AUTHOR]

Increased systemic inflammation has been identified in presence of oral disease, specifically endodontic disease. It is important to investigate whether treatment of the oral disease ameliorates systemic inflammation. Furthermore, there is no information about the extent to which different microorganisms may trigger inflammatory response. Objectives: Primarily (i) to compare the plasma concentrations of inflammatory mediators of apical periodontitis (AP) subjects to controls, (ii) to evaluate whether elimination of the endodontic infection reduces systemic inflammation (iii) to investigate the microbiome of root canal infections. Secondarily i) to correlate the inflammatory mediator data with the microbiome data to investigate whether the type of infection influences the type and severity of the inflammatory condition ii) to examine patterns in the inflammatory mediator data before and after tooth extraction in order to establish a biomarker signature of AP/oral disease.This is a multi-centre prospective case-control intervention study. The cohort will consist of 30 healthy human volunteers with one or two teeth with a root-tip inflammation and 30 matched healthy controls. Peripheral blood will be drawn at 6 time points, 3 before and 3 after the extraction of the tooth with apical periodontitis. The teeth will be pulverized, DNA extraction and sequencing will be performed.This study aims to compare the concentration of inflammatory blood plasma proteins in between AP-subjects and controls at different time points before and after the tooth extraction in a systematic and complete way. Additionally the composition of the root canal microbiome in association with the inflammatory response of the host will be assessed.

Endodontic infections are polymicrobial involving a combination of gram-positive, gram-negative, facultative anaerobes and strictly anaerobic bacteria. Thus, antibiotics, account for the vast majority of medicines prescribed by dentists. The inappropriate and excessive use of antibiotics is a major factor in the emergence of antibiotic resistance. Dentistry's contributions to the problem of antibiotic resistance can be important because dentists prescribe 10% of all general antibiotics. Till date, sparse literature is available in central India regarding the usage of prescribing antibiotics for endodontic treatment. Aim The aim of this study is to determine knowledge about prescribing antibiotics during and after endodontic treatment amongst dental practitioners in Central India. Materials and Methods A Web-based survey of 110 participants was conducted using validated questions in a population of central India. Results Amoxicillin (72.3%) was the drug of choice by most of the practitioner's (no medical allergies). Antibiotic usage was reported highest for surgical endodontic treatment (64.1%), but clinical scenario like pulpitis (5.8%) and necrosis (9.6%) also reports antibiotic prescription. Over prescription of antibiotic was seen when antibiotics were prescribed for cases where no improvement was seen with the previously prescribed antibiotic. Awareness regarding drug resistance was reported 86.7%. Summary and Conclusions Though practitioner shows fair knowledge about the prescription of antibiotic there is need to re- evaluate drug resistance. [ABSTRACT FROM AUTHOR]

Purpose: Differences in the endodontic microbiome of permanent and primary teeth during the mixed dentition period are still unknown. The purpose of this study was to examine bacterial diversity in endodontically infected primary and permanent teeth using 16S rRNA gene sequencing and the QIIME 2 (Quantitative Insights Into Microbial Ecology 2) bioinformatics pipeline. Methods: Microbial samples from endodontically infected primary (n equals 15) and permanent (n equals 15) maxillary or mandibular molar teeth were subjected to next-generation sequencing analysis based on examination of the hypervariable V3 to V4 region of the 16S rRNA gene. Statistical analysis was performed using R software. Results: Of 1,664,926 reads and 2,237 operational taxonomic units, 14 phyla, 89 families, and 236 genera were identified. Firmicutes were the most commonly detected phyla in both endodontically infected primary and permanent root canals. Bacteroides and Proteobacteria were more common in primary teeth, whereas Actinobacteria and Verrucomicrobia were more common in permanent teeth. The overall canal microbiota composition was similar in endodontically infected primary and permanent teeth (P=0.338). Conclusions: This study provides a comprehensive assessment of microbiota composition in endodontically infected primary and permanent teeth and gives a deeper insight into the origin of the root canal infections. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the mRNA expression levels of cytokines interferon-γ, tumour necrosis factor-α, interleukin IL-1β, IL-10, and the chemokine CCL2/MCP-1, CCL4, and CXCR4 in the periapical interstitial fluid from root canal infections before and after bacterial load reduction in patients undergoing haematopoietic stem cell transplantation (HSCT). Materials and methods: The case group was composed of 10 patients undergoing HSCT, and our control group included 10 healthy patients. Clinical samples were taken from teeth with pulp necrosis. Three paper points were placed in the RCS and maintained for 2 min for microbial evaluation before cleaning and shaping procedures. After cleaning and drying the canal, three paper points were introduced into the root canal, passing passively through the root apex (2 mm) into the periapical tissues for 1 min. Samples were collected immediately after root canal cleaning and 7 days later (restrained root canal bacterial load) to characterize gene expression using real-time PCR. Results: The results showed significantly reduction in the microbial load on day 7. An increased expression level of TNF-α and IFN-γ on day 7 in control and case groups was observed (p < 0.05). The mRNA levels of IL-1β and IL-10 in the pre-HSCT group increased in the samples from day 7 (p < 0.05). The chemokine CCL-2/MCP-1 was not detected in pre-HSCT group. Chemokine receptor CXCR4 levels increased in samples obtained from the day 7 in the control group (p < 0.05). Conclusions: Individuals undergoing HSTC presented similar cytokine and chemokine mRNA expression compared with healthy individuals. However, it was observed the total absence of mRNA MCP-1/CCL2 expression in those individuals undergoing HSCT. Clinical relevance: Patients undergoing HSCT are at higher risk of infection. No study has analysed the periapical immune responses to root canal infections in HSCT individuals. [ABSTRACT FROM AUTHOR]

Background: A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies. Methods: The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed. Results: The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02–2.29, p = 0.039; I2 = 75.0%; p < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67–2.29, p = 0.494; I2 = 82.1%; p < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71–2.27, p = 0.413; I2 = 69.1%; p = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity. Conclusions: Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up. Registration: PROSPERO database (CRD42020204379).

This study investigated the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on serum inflammatory mediators of rats with pulp exposure–induced apical periodontitis. Forty male Wistar rats were divided into the following groups: control, untreated rats (C); control rats treated with ω-3 PUFAs (C-O); rats with pulp exposure–induced apical periodontitis (AP); and rats with pulp exposure–induced apical periodontitis treated with ω-3 PUFAs (AP-O). ω-3 PUFAs were administered orally once a day for 15 days before pulp exposure and continued for 30 days after pulp exposure. The rats were sacrificed, and then blood and jaw samples were collected. Blood analysis was conducted to determine the total number of leukocytes including neutrophils, monocytes, and lymphocytes. Proinflammatory cytokines tumor necrosis factor alpha, interleukin (IL) 6, and IL-17 were quantified by enzyme-linked immunosorbent assay. Histologic analysis was performed to confirm the development of apical periodontitis. The data were statistically evaluated using analysis of variance and the Tukey posttest. The significance level was set at 5%. The development of apical periodontitis was confirmed in all infected groups. Bone destruction was larger in the AP group compared with the AP-O group (P <.05). Blood analysis showed that the AP and AP-O groups showed higher numbers of lymphocytes, leukocytes, monocytes, eosinophils, and expressions of tumor necrosis factor alpha and IL-6 compared with the C and C-O groups (P <.05). In contrast, the presence of leukocytes, lymphocytes, and the expression of IL-6 decreased in the AP-O group compared with the AP group (P <.05). ω-3 PUFA supplementation influences the systemic effects caused by apical periodontitis, decreasing the number of leukocytes, lymphocytes, and IL-6 in rat blood. [ABSTRACT FROM AUTHOR]