spirochetes, candida, penicillin, Flagyl, all related to dental infections

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Interesting studies on endontic infections from OSU school of dentistry. Here's just a few, covering everything from succesfully using metronidazole (flagyl) and penicillin, to the presence of spirochetes and candida, and actinomyces.More studies can be found at:http://www.ohsu.edu/sod/endo/endo_publications.html"Antibiotic Susceptibility of Bacteria Associated with Endodontic Abscesses"J. Craig Baumgartner, DDS, PhD, Tian Xia, DDS. J Endodon 29:44-47.January 2003.Antibiotics to treat endodontic infections are routinely prescribedbased on previously published susceptibility tests. There isincreased concern that bacteria have increased resistance to thecurrently recommended antibiotics. The purpose of this investigationwas to perform antibiotic susceptibility tests on a panel

ofbacteria recently isolated from endodontic infections. The bacteriain this study were aseptically aspirated with a needle fromendodontic abscesses, cultivated, and identified at the specieslevel. Each of the 98 species of bacteria was tested for antibioticsusceptibility to a panel of six antibiotics using the Etest. Theantibiotics were penicillin V, amoxicillin, amoxicillin + clavulanicacid, clindamycin, metronidazole, and clarithromycin. Thepercentages of susceptibility for the 98 species were penicillin V ­83/98 (85%), amoxicillin ­ (89/98) 91%, amoxicillin + clavulanic acid(98/98) 100%, clindamycin ­ 94/98 (96%), metronidazole ­ 44/98 (45%).Metronidazole had the greatest amount of bacterial resistance,however, if it is used in combination with penicillin V oramoxicillin, susceptibility of the combination with penicillin V oramoxicillin increased to 93% and 99% respectively. Clarithromycinappears to have

efficacy but it is still considered an antibioticunder investigation because the minimum inhibitory concentration hasnot been established.Identification of bacteria in acute endodontic infections and their antimicrobial susceptibility.Saengusa Khemaleelakul, J. C. Baumgartner, Sumalee Pruksakorn.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:746-755.December 2002.Purpose: To identify the bacterial composition of the microbiotafrom acute endodontic abscesses/cellulitis and their antimicrobialsusceptibilities.Study design: Purulence from 17 patients with acute endodonticabscesses/cellulitis was obtained by needle aspiration and processedunder anaerobic conditions. Bacteria were isolated and identified bybiochemical or molecular methods. The antimicrobial susceptibilityof isolated bacteria was determined by using the Etest.Results: All 17 aspirates contained a mix of microorganisms.

Themean number of strains per sample was 7.6 (range 3-13). The averagenumber of viable bacteria was 6.37 x 107 (range 104-108) CFU/ml.Strict anaerobes and microaerophillics were the dominant bacteria in82.35% (14/17). The genera of bacteria most frequently encounteredwere Prevotella and Streptococcus. The combination of Prevotella andStreptococcus was found in 52.94% (9/17). The previouslyreported "uncultured Prevotella clone PUS 9.180" was frequentlyidentified. The percentage of bacteria susceptible/intermediate foreach antibiotic in this study was penicillin V: 79.84% (99/124),metronidazole: 41.94% (52/124), amoxicillin: 84.68% (105/124),amoxicillin+clavulanic acid: 100% (124/124), and clindamycin: 88.71%(110/124).Conclusion: The present results confirm the existence of mixedinfection with the predominance of anaerobic bacteria in acuteendodontic abscesses/cellulitis. The frequency of "unculturedPrevotella clone PUS

9.180" suggests the possible key role of thisPrevotella species in acute endodontic infections. Penicillin Vstill possesses antimicrobial activity against the majority ofbacteria isolated from acute endodontic infections. However, ifpenicillin V therapy has failed to be effective, the combination ofpenicillin V with metronidazole or amoxicillin with clavulanic acidis recommended. Switching to clindamycin is another good alternative.Identification of Spirochetes (Treponemes) in Endodontic InfectionsJ. Craig Baumgartner, DDS, PhD, Saeng-usa Khemaleelakul, DDS, TianXia, DDS. J Endodon 29:794-797. December, 2003.The purpose of this study was to determine the prevalence ofspirochetes in asymptomatic infected root canals and in endodonticabscesses/cellulitis. Aseptic clinical samples were collected usingpaper points from 54 infected root canals and from aspirates of 84abscesses/cellulitis. Oligonucleotide

primers were produced for PCRidentification of Treponema vincentii, T. pectinovorum, T. medium,T. amylovorum, T. denticola, T. maltophilum, and T. socranskii. PCRdetected spirochetes in 51/84 (60.7%) of the samples fromabscesses/cellulitis and in 20/54 (37.0%) of the samples fromasymptomatic infected root canals. T. socranskii was the mostfrequently detected (44.9%), followed by T. maltophilum (29.7%), T.denticola (28.9%), T. pectinovorum (13.7%) and T. vincentii (5.1%).The number of treponema species detected ranged from 1 to 5 speciesper sample. The mean numbers of species detected were 2.3 inabscesses/cellulitis and 2.6 in infected root canals. Significanceassociation among species were found between T. maltophilum and T.socranskii, as well as between T. maltophilum and T. denticola bydetermining the odds ratio ( > 2.0).Occurrence of Candida albicans in infections of endontic originJ. C.

Baumgartner, C.M. Watts, T. XiaJ. Endodon 26:695-696. December, 2000.Microorganisms are recognized as the etiologic agent for themajority of pulpal and periradicular disease. Although bacteria havebeen the most studied, fungi have also been associated with infectedroot canals. The purpose of this study was to evaluate the contentsof infected root canals and aspirates of cellulitis/abscesses ofendodontic origin for the presence of Candida albicans usingpolymerase chain reaction (PCR). PCR primers specific for the 16Sribosomal RNA gene of Candida albicans were used to survey 24samples taken from infected root canals and 19 aspirates fromperiradicular infections of endodontic origins. The results of thesurvey detected the presence of Candida albicans in five of twenty-four (21%) samples taken from root canals, but none were detected inthe periradicular aspirates. The results indicate that PCR is anextremely sensitive

molecular method that may be used to identifyCandida albicans directly in samples from infections of endodonticorigin.Occurrence of Actinomyces israelii, Actinomyces naeslundii andActinomyces viscosus in Infections of endodontic origin.Tian Xia, J. C. Baumgartner. J Endodon September 2003.Periapical actinomycosis has been repeatedly identified in cases offailed endodontic therapy often resistant to clinical treatment.Actinomyces are found in 11% infected root canals, which are theprimary port of entry for Actinomyces organisms into the periapicaltissue. Specie-specific primers and a pair of universal primer forActinomycetales order were designed to evaluate the contents ofinfected root canals and aspirates of cellulites/abscesses ofendodontic origin for the presence of Actinomyces israelii,Actinomyces naeslundii, Actinomyces viscosus and microorganisms inActinomycetales order using polymerase

chain reaction (PCR). PCRreactions were run with the DNA extracted from 131 clinical samples.The results show that Actinomyces israelii was found in 23.7%(31/131) of clinical samples. Of those 25.6% (11/43) were fromabscesses, 16.7% (6/36) were associated with cellulites, and 26.9%(14/52) were from infected root canals. Actinomyces naeslundii wasfound in 8.5% (11/129) of clinical samples. Of those 4.2% (2/48)were from abscesses, 6.7% (2/30) were associated with cellulites,and 13.7% (7/51) were from infected root canals. Actinomycesviscosus was found in 32.1% (42/131) of clinical samples. Of those14% (6/43) were from abscesses, 13.9% (5/36) were associated withcellulites, and 59.6% (31/52) were from infected root canals.Microorganisms of Actinomycetales order was found in 55.8% (72/129)of clinical samples. Of those 45.8% (22/48) were from abscesses, 30%(9/30) were associated with cellulites, and 80.4% (41/51) were

frominfected root canals.