Periapical actinomycosis: In reply

Abstract

We thank Drs Aldred and Talako for their comments regarding our article. The purpose of the study was to evaluate the incidence of accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination.We agree with Drs. Aldred and Talako that the clinical course of periapical actinomycosis differs considerably from that of actinomycosis in other sites. However, the term periapical actinomycosis has been applied by most authors to a periapical lesion associated with actinomycotic infection and has been suggested as a contributing factor in the perpetuation of periapical infection. Therefore, in any case in which a nonhealing and endodontically nonresolving periapical lesion is associated with histologic identification of actinomycotic colonies in the periapical specimen, the diagnosis of periapical actinomycosis should be applied. The results of the present study showed that the prevalence of actinomycotic infection is low and has a favorable outcome. Periapical actinomycosis has been regarded in the literature as a mild form of cervicofacial actinomycosis, and as such, has required prolonged antibiotic treatment. The results of the present study, along with the review of the literature, do not support this approach. Most cases of periapical actinomycosis do not differ clinically from other periapical lesions, and the outcome following surgical treatment is good. Nevertheless, it should be remembered that it is possible for the microorganisms to invade the surrounding structures and propagate to cervicofacial actinomycosis. In these cases, a more vigorous treatment should be taken. We thank Drs Aldred and Talako for their comments regarding our article. The purpose of the study was to evaluate the incidence of accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination. We agree with Drs. Aldred and Talako that the clinical course of periapical actinomycosis differs considerably from that of actinomycosis in other sites. However, the term periapical actinomycosis has been applied by most authors to a periapical lesion associated with actinomycotic infection and has been suggested as a contributing factor in the perpetuation of periapical infection. Therefore, in any case in which a nonhealing and endodontically nonresolving periapical lesion is associated with histologic identification of actinomycotic colonies in the periapical specimen, the diagnosis of periapical actinomycosis should be applied. The results of the present study showed that the prevalence of actinomycotic infection is low and has a favorable outcome. Periapical actinomycosis has been regarded in the literature as a mild form of cervicofacial actinomycosis, and as such, has required prolonged antibiotic treatment. The results of the present study, along with the review of the literature, do not support this approach. Most cases of periapical actinomycosis do not differ clinically from other periapical lesions, and the outcome following surgical treatment is good. Nevertheless, it should be remembered that it is possible for the microorganisms to invade the surrounding structures and propagate to cervicofacial actinomycosis. In these cases, a more vigorous treatment should be taken.