An inciteful perspective on bacterial species involved in the persistence of apical periodontitis

Abstract

Recalcitrant bacteria play an important role of the persistence of periapical disease following root canal procedures, especially when they a part of a complex and stable biofilms that are found in the intricacies of the apical root canal anatomy. This is particularly true in cases that are deemed as a “failure in root canal treatment.” However, the literature is replete with confusion with regard to this concept of failure, as general terms, such as endodontic pathology or endodontic infection are used to denote factors implicated in the failure, without specifically identifying the issues of concern and their eradication, especially as they relate to the overall systemic health of the patient. Thus, attention for the cause of the failure immediately focuses on bacterial species without considering a vast array of potential causes. In doing so many studies tend to look at only one specific species as being the causative agent in the presence of the diagnosed failure (E. faecalis) and this bacterial species has been the focus of a wide range of investigative studies used for proof of concept. Is it possible that this focus has missed the bigger picture and potentially more virulent, invasive, and persistent species are involved? Have too many studies relied on short-term, single-bacterial biofilms, negating the very essence of the long-term interplay of multiple species within these colonies? This short communication will address this perspective, attempting to expand the investigative process for the presence and persistence of periapical disease and its impact on the host.