Insights into the bacterial and fungal ecology of endodontic infections

In apical periodontitis, microorganisms infect the dental root canal system and evoke an inflammation in the periapical tissues. Since the host is unable to eliminate this infection, the root canal system has to be disinfected by the dentist during endodontic therapy. After this the inflammation should resolve spontaneously. However, current endodontic treatment strategies cannot always sufficiently decontaminate the complex root canal system.
Using next-generation sequencing, root canal infections are shown to include an immense diversity of bacteria. Bacteria are not the only microorganisms present in root canal infections. In a systematic review and meta-analysis of the literature, fungi were found to have significant prevalence in root canal infections. The co-occurrence of bacteria and fungi was further studied in another next-generation sequencing study. This study indicated that the bacterial diversity is different when fungi are present or absent. In a laboratory study, the interaction between bacteria, fungi and the host was further explored.
Since root canal infections appear to be more diverse and complex than previously considered, effective treatment is essential. Therefore, a new strategy using an enzyme that locally produces antimicrobial substances, was studied and optimised.
Future research should study the mechanisms underlying the functioning of the microbial community of root canal infections, and if and how this community interacts with the host. If a detrimental effect on the host is evident, more effective strategies to eliminate the infection and preserve oral function and well-being should be developed, possibly using VCPO.