Acute pulpal-alveolar cellulitis syndrome. IV. Clinical parameters, demographics, and affirmation of a traditional etiologic theory. Part 2.

The Part 1 report revealed the microbiologic etiology and introduced the oxidation-reduction potential (Eh) as a major factor in acute cellulitis exacerbations during endodontic therapy. Facultative streptococci were the predominant group of microbes specifically isolated. This Part 2 study revealed a 9.5% incidence of cellulitis exacerbations in patients during endodontic treatment of 168 primarily intact nonvital teeth. These teeth were usually asymptomatic, manifesting radiographic periapical lesions without fistulous tracts and necrotic canals. This category of pulpal periapical inflammation is virtually the only type of tooth that is predisposed to cellulitis exacerbations. A frequency distribution of the 34 permanent teeth studied revealed a spectrum of mandibular and maxillary molars, premolars, and anterior teeth involved with the exacerbations. Sex and age did not appear to be factors. Further clinical evidence is cited, which support the concept of altering the tissue oxidation-reduction potential as the prime etiologic factor in favoring the growth of aerobic microbial pathogens.