The Influence of Enterococcus faecalis as a Dental Root Canal Pathogen on Endodontic Treatment: A Systematic Review.

Faisal Alghamdi,Marwa Shakir

doi:10.7759/cureus.7257

Abstract

Endodontic treatment failure may occur due to different causes such as persistence of bacteria, root canals that are poorly cleaned and obturated, improper coronal seal (leakage), and untreated canals (missed canals). The main reason for endodontic failure is the presence of some species of bacteria inside the root canal system such as Enterococcus (E.) faecalis. Those bacteria are more resistant to disinfection agents, causing a persistent intra-radicular or extra-radicular infection.The current review aims to compile all the current studies concerning Enterococcus faecalis as a dental root canal pathogen that causes endodontic failure. In this systemic review, two databases, PubMed and Google Scholar, were searched using specific inclusion and exclusion criteria. Among 2943 studies, only 11 met the inclusion criteria and were included in the review for further analysis.The 11 studies give prominence to the high distribution of Enterococcus faecalis within the root canal system. These studies investigated different aspects of Enterococcus faecalis, including its prevalence, resistance mechanisms, characteristics, express survival genes, and treatment.The compiled data observed that most of the studies highlight Enterococcus faecalis as the primary pathogen associated with endodontic treatment. It has characteristic proprieties that make it capable of escaping disinfection means. Furthermore, clinical trials are required to examine E. faecalis and may provide valuable information about novel microbial detection methods to decrease the number of E. faecalis within the root canal system.

Highlights

BackgroundIt is essential to remove all pulpal tissues, dentinal debris, and viable microorganisms from the root canal system during endodontic treatment
It presented the ability of E. faecalis to affect the size of the periapical lesion and the microbial load within the root canal systems during the endodontic treatment
Lee D, et al Korea (In-vitro study). These results suggest that phage HEf13 has the characteristics of a lytic phage and is a potential therapeutic agent for the treatment or prevention of E. faecalis-associated infectious diseases

Summary

Introduction

It is essential to remove all pulpal tissues, dentinal debris, and viable microorganisms from the root canal system during endodontic treatment. Since bacteria and their byproducts are the causative factors of pulpal and peri-radicular inflammation, their elimination is vital for successful endodontic treatment. Proper canal instrumentation and adequate irrigation with sodium hypochlorite can decrease the number of bacteria, it cannot remove Enterococcus (E.) faecalis from the root canal entirely [1,2]. Several studies showed that E. faecalis was found more in cases of failed endodontic treatment than in cases with primary infections. Among all cases with primary endodontic infection, E. faecalis was more likely to be associated with asymptomatic cases than with symptomatic ones [3,4,5]

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