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

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 extraradicular 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.

Enterococcus faecalis shifts macrophage polarization toward M1-like phenotype with an altered cytokine profile

“…In addition, E. faecalis is frequently identified in failed root canal treatment with persistent apical periodontitis (i.e. chronic inflammation and destruction of the hard and soft tissues surrounding the root/s of a tooth caused by etiological agents of endodontic infection) [24]. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated infection within the root canal space.…”

Antimicrobial Effect of Natural Berry Juices on Common Oral Pathogenic Bacteria

“…In the present study, it was found that blackcurrant juice suppressed the gram-positive bacterial species E. faecalis completely ( Figure 2 ). E. faecalis , in particular, often withstands treatment with customary disinfectants and is therefore frequently responsible for root canal treatment failures [ 30 ]. Compared to the action of blackcurrant juice, CHX revealed a rather low antibacterial effect on E. faecalis in the present study.…”

Antimicrobial Efficacy of Fruit Peels Eco-Enzyme against Enterococcus faecalis: An In Vitro Study

“…However, the complete elimination of debris and bacteria in the root canal system is impossible because of the complexity of the root canal anatomy [ 1 ]. The remnant bacteria, especially Enterococcus faecalis, are believed to be the most resistant microorganism that contribute to the persistent periradicular lesion after root canal treatment [ 2 ]. Different virulence factors, such as aggregation substance, lipoteichoic acid, and pheromones, have facilitated Enterococcus faecalis to survive in dentinal tubules up to 400 μm depth in a nutrient deficiency ecology environment and cause secondary infection [ 3 ].…”