Department of Endodontics and Molecular Microbiology Laboratory, Estácio de Sá University, Rio de Janeiro, Brazil.
Clin Microbiol Rev. 2013 Apr;26(2):255-73. doi: 10.1128/CMR.00082-12.
Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema. Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease.
急性根尖脓肿是最常见的牙脓肿形式，由牙齿根管感染引起。它通常局限于口腔内，但在某些情况下，根尖脓肿可能会扩散，导致严重的并发症，甚至死亡。为什么牙齿根管感染会出现症状，并发展为严重的扩散性，有时甚至危及生命的脓肿，其原因仍不清楚。使用培养和先进的分子微生物学方法对根尖脓肿中的微生物进行鉴定的研究表明，多物种群落明显以厌氧菌为主。在这些感染中常见的物种/类群属于梭杆菌属、卟啉单胞菌属、普雷沃氏菌属、卟啉单胞菌属、戴氏菌属、链球菌属和密螺旋体属。DNA 测序技术和计算生物学的进步极大地增强了与急性根尖脓肿相关的微生物群的知识，并为该疾病的病因发病机制提供了一些线索。物种丰富度和丰度以及群落成员之间相互作用的网络可能会影响集体致病性，并有助于急性感染的发展。疾病修饰因子，包括暂时或永久的宿主相关因素，也可能影响急性脓肿的发展和严重程度。这篇综述重点介绍了关于急性根尖脓肿的病因和治疗的最新证据，以及宿主相关因素如何影响这一过程，并提出了未来在研究、诊断和治疗方法方面应对这一疾病的方向。
