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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
| CE article antibiotics 10 roots 4 2016 Endodontic disease is infectious. Microorganisms cause virtually all pathoses of the pulp and periapical tissues. There is ample evidence to support that op- portunisticnormaloralmicrobiatacolonizeinasym- biotic relationship with the host, resulting in end- odontic infections.12 The majority of endodontic infections do not require systemic antibiotic therapy when the cause of the infection has been properly managed (complete debridement of the pulp space and proper obturation and sealing of the pulp space from the oral environment). Apical periodontitis lesions of pulpal origin are generatedbytheimmunesystemandaretheresultof intra radicular infections (Fig.1). In most situations, thisinflammatoryprocesssuccessfullyeliminatesthe bacteria emerging from the apical foramen and pre- vents their spread to the periapical tissues. This pro- cessisprimarilyfacilitatedbythepolymorphonuclear leukocytes that eventually phagocytize and kill the bacteria.13 Asymptomatic apical periodontitis of pul- pal origin does not routinely require systemic antibi- otic therapy for satisfactory resolution and healing. Endodontic therapy alone is usually sufficient. When the intraradicular infection is able to over- whelm the host’s immune response, viable bacteria are able to gain access to the periapical tissues and colonize,forminganactiveinfection.Thisresultsinthe formation of an apical abscess. A chronic apical ab- scess usually presents with gradual onset, no to mild symptoms and the presence of a sinus tract or parulis (Fig. 2). The majority of chronic apical abscesses of endodontic origin do not require systemic antibiotic therapy for satisfactory resolution and healing. Anacuteapicalabscessusuallypresentswithrapid onset, spontaneous pain and swelling, both localized and intraoral, sometimes with exudate present, or with diffuse facial cellulitis. When the abscess is in- traoral and localized (Fig. 3), debridement of the pulp spaceandplacementofcalciumhydroxideandsurgi- calincisionfordrainageisusuallysufficienttoresolve the problem. Systemic antibiotic therapy is not rou- tinely indicated, depending on the patient’s general medical status. However, when the patient presents with diffuse facial swelling (cellulitis) resulting from an acute apical abscess or an infection with systemic involvement(feverormalaise)(Fig.4),debridementof the pulps pace with placement of calcium hydroxide, surgical incision for drainage, when possible, and an appropriate regimen of systemic antibiotics (oral or IV) are the treatments of choice. Understanding the enemy is an important factor in winning any battle. The rational choice and use of antimicrobial agents begins with the knowledge of the microorganisms most likely responsible for com- mon dental infections of pulpal origin. The bacterial flora found in endodontic infections is indigenous, mixed (Gram-positive and Gram-negative) and pre- dominately anaerobic. Several species have been im- plicated with acute apical abscesses. These species includedark-pigmentedbacteria(PrevotellaandPor- phyromonas), eubacteria, fusobacteria and Actino- myces.12 BaumgartnerandXiapublishedareportofthesus- ceptibilityofbacteriarecoveredfromacuteapicalab- scessestofivecommonlyusedantibioticsindentistry. Antibiotic susceptibility data from 98 species of bac- teria recovered from 12 acute apical abscesses led to the following conclusions: 1. Pen-V-K is the antibiotic of choice for endodontic infections due to its effectiveness inpolymicrobial infections, its relative narrow spectrum of activity against bacteria most commonly found in end- odontic infections, its low toxicity and low cost. Fig.3: Acute apical abscess with intraoral localized swelling. Fig.4: Acute apical abscess with extraoral diffuse facial cellulitis. Fig.4 Fig.3 42016