Estudio de la presencia de enterobacterias y enterococos en pulpas dentales infectadas extraídas previo al procedimiento endodóntico y evaluación de su relación con el fracaso del tratamiento
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Fecha
2015
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Profesor/a Guía
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Idioma
es
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Universidad Andrés Bello
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Licencia CC
Licencia CC
Resumen
Resumen. La pulpitis es la principal complicación de la caries dental, y por lo tanto representa un cuadro muy frecuente. Pese a que el tratamiento endodóntico es en la mayoría de los casos exitoso, es muy común ver la recurrencia de los pacientes, luego del tratamiento por persistencia de la infección. El género bacteriano Enterococcus, es uno de los más frecuentemente aislados en canales radiculares endodonciados, y actualmente llama la atención debido a la adquisición exponencial de resistencia a antibióticos comúnmente usados. Por su parte, las enterobacterias, también se han reportado presentes en la cavidad oral y se postula que la selección de cepas resistentes a estos antibióticos es preocupante. Es por eso que el objetivo de esta investigación es encontrar alguna relación entre la presencia de estos microorganismos y los fracasos en los tratamientos de endodoncia. Materiales y Métodos: Se recolectaron pulpas dentales trepanadas previo a tratamientos endodónticos para hacerles cultivos microbiológicos, en busca de identificar las dos bacterias mencionadas. Para ello se realizó tinción de Gram y otros test específicos de identificación, además de antibiograma con el fin de determinar sus resistencias antibióticas. Finalmente se hizo un seguimiento a los pacientes que aportaron con muestras para establecer si hubo relación con los hallazgos microbiológicos y los tratamientos endodónticos fallidos. Resultados: Un 16% de las muestras presentó Enterococcus spp., siendo predominante la especie E.faecalis por sobre E.faecium. En el antibiograma presentaron sensibilidad a Amoxicilina y Amoxicilina/Ac.Clavulánico, pero resistencia a Vancomicina y a Clincamicina. No se encontró la presencia de enterobacterias en las mustras pulpares. De un universo de 60 participantes, se contactó a 52 de ellos para el seguimiento, de los cuales solo el 67% realizó el tratamiento de endodoncia que requerían. De ellos solo 3 relataron tratamiento fallido. Conclusiones: Es posible encontrar Enterococcus en pulpas dentales infectadas, sin embargo no se encontró la presencia de enterobacterias. No es posible determinar una relación entre la presencia de estas bacterias con los fracasos endodónticos, por lo tanto, tampoco es posible comprobar la hipótesis experimental de este trabajo en base a la baja recurrencia de los fracasos endodóntico en nuestro universo.
Palabras clave: Endodoncia, Enterococcus, enterobacteria, antibiograma.
Abstract. Pulpitis is the main complication after dental caries, being higly frequent. Despite root canal therapy tends to be succesful, there are some cases of recurrent episodes because of persistant infection inside the root canal. Enterococcus is one of the most frequent isolated bacterial species inside endodontically trated teeth, recieving increased attention for its potential pharmacological resistance with widely used antibiotics. In addition, enterobacter have also been reported to be present in the oral cavity and it has been postulated that there are some resistant strains to these antibiotics, which is worrying. That is why the goal of this research is to find any relationship between the presence of microorganisms and failures in endodontics. Materials and Methods. We collected dental pulps from trephinated teeth prior to endodontics to perform microbiological cultures, seeking to identify the two above mentioned bacteria. For this, microbiological samples underwent Gram staining and other specific test identification, in addition to antibiogram in order to determine their antibiotic resistances. Finally, we made a follow-up for the patients who provided samples to establish if there was relationship with the microbiological findings and failed treatments. Results. 16% of the samples presented Enterococcus spp., being the predominant species E. faecalis over E. faecium. Antibiogram showed sensitivity to amoxicillin and amoxicillin/clavulanic acid, but resistance to vancomycin and clindamycin. There was not presence of enterobacter in pulpal samples. In a pool of 60 participants, 52 of them were followed-up, and only 67% of them underwent endodontic treatment which was required. Only 3 of them reported treatment failure. Conclusions. It is possible to found Enterococcus in infected dental pulps, however the presence of enterobacteria can’t be found. It was unable to determinate a relationship between the presence of these bacterias in endodontic failures, therefore, it’s not possible to test the experimental hypothesis of this work based on the low recurrence of endodontic failures because our universe.
Abstract. Pulpitis is the main complication after dental caries, being higly frequent. Despite root canal therapy tends to be succesful, there are some cases of recurrent episodes because of persistant infection inside the root canal. Enterococcus is one of the most frequent isolated bacterial species inside endodontically trated teeth, recieving increased attention for its potential pharmacological resistance with widely used antibiotics. In addition, enterobacter have also been reported to be present in the oral cavity and it has been postulated that there are some resistant strains to these antibiotics, which is worrying. That is why the goal of this research is to find any relationship between the presence of microorganisms and failures in endodontics. Materials and Methods. We collected dental pulps from trephinated teeth prior to endodontics to perform microbiological cultures, seeking to identify the two above mentioned bacteria. For this, microbiological samples underwent Gram staining and other specific test identification, in addition to antibiogram in order to determine their antibiotic resistances. Finally, we made a follow-up for the patients who provided samples to establish if there was relationship with the microbiological findings and failed treatments. Results. 16% of the samples presented Enterococcus spp., being the predominant species E. faecalis over E. faecium. Antibiogram showed sensitivity to amoxicillin and amoxicillin/clavulanic acid, but resistance to vancomycin and clindamycin. There was not presence of enterobacter in pulpal samples. In a pool of 60 participants, 52 of them were followed-up, and only 67% of them underwent endodontic treatment which was required. Only 3 of them reported treatment failure. Conclusions. It is possible to found Enterococcus in infected dental pulps, however the presence of enterobacteria can’t be found. It was unable to determinate a relationship between the presence of these bacterias in endodontic failures, therefore, it’s not possible to test the experimental hypothesis of this work based on the low recurrence of endodontic failures because our universe.
Notas
Tesis para optar al título de Cirujano-Dentista
Palabras clave
Endodontic treatment, Enterococcus, enterobacter , antibiogram; Endodoncia, Enterococcus, enterobacteria, antibiograma.