Acute pulpal-alveolar cellulitis syndrome. IV. Exacerbations during endodontic treatment: a clinical study of specific microbial isolates and their etiologic role. Part 1.

A statement has been made by Sundqvist that it has not been possible to isolate the specific bacteria that is responsible for acute exacerbations during endodontic treatment of existing periapical inflammation. This clinical study presents specific microbial isolates from 34 intact nonvital teeth involved with acute cellulitis exacerbations during endodontic therapy. No obligate anaerobes were isolated. Forty-seven aerobic and facultative microbes were isolated. Streptococci, primarily facultative, were the major group of microbes isolated (80%); alpha hemolytic streptococci and the group D enterococcus were predominant as mixed and pure culture specimens. Gram-negative microbes as strict aerobic and facultative microbes were also reported as specific isolates. The biological role of anaerobes were discussed in primary pulpal-periapical infections. The alteration of the tissue oxidation-reduction potential, (Eh) is proposed as an etiologic factor in cellulitis exacerbations during endodontic treatment. This is further substantiated in the Part 2 report. Attention is drawn to the pathogenic potential of streptococci and other microbes isolated in this study.