The Bacteriological and Clinical Study of Bacteremia due to Periapical Lesion

几位作者报道了因根管治疗引起的菌血症。本研究的目的是评估有根尖周病变的牙齿是否有可能在没有操作的情况下诱发菌血症，以及菌血症是否会引起猫同一口腔内受损牙髓的血行性感染。这项研究使用了10只猫的97颗牙齿。在37颗牙齿中，将以下一种或两种细菌的菌悬液接种到扩大的根管中。使用的菌种有血链球菌、金黄色葡萄球菌、肠球菌和牙龈卟啉单胞菌。同时及术后3周，在严格无菌条件下对49颗牙髓进行热刺激或机械刺激，每颗牙用橡胶坝隔离。11颗牙齿不进行治疗作为对照。术前、术后3周、5周分别取大隐静脉血样4ml。采用裂解-过滤法对样品进行了研究。5周后，从受损牙髓中采集细菌样本，在肉汤中进行好氧和厌氧培养。然后切开下颌骨，拍x光片。x线片显示，金黄色葡萄球菌和单肠球菌感染以及混合感染的动物根尖周围有放光区。然而，细菌学检查显示外周血及受损牙髓的培养均为阴性。认为本研究未发生由根尖周围病变引起的菌血症，或者由于菌血症的程度和发生率过低而未被发现。

Bacteremia due to endodontic treatment has been reported by several authors. The purpose of this study was to estimate whether teeth with periapical lesions could have the possibility of inducing bacteremia without manipulation, and whether bacteremia could cause hematogenous infection into damaged dental pulps in the same oral cavity in cats.Ninety-seven teeth of ten cats were used in this study. In 37 teeth, a bacterial suspension of one or two of the following bacterial species was inoculated into the enlarged root canals. The species used were Str. Sanguis, S. aureus, Enterococcus and P. gingivalis. At the same time and 3 weeks after the operation, the dental pulps of 49 teeth were irritated by heat or mechanical stimulation under a strict sterile condition with each tooth isolated by a rubber dam. Eleven teeth were left untreated for controls. Blood samples, 4ml each, were collected from the saphenous vein before, 3 and 5 weeks after the operation. The samples were studied by means of lysis-filtration. After 5 weeks, bacterial samples were collected from damaged dental pulps and incubated in broth aerobically and anaerobically. Then the mandibles were dissected out and radiographs were taken.The radiographs revealed that periapical radiolucent areas were observed in the animals with S. aureus- and Enterococcus-monomfection, and with mixed infection. However, bacteriological examination revealed that all cultures of peripheral blood as well as those of damaged dental pulps were negative.It was considered that bacteremia due to periapical lesions formed in this study did not occur, or that it was not detected because the degree and the incidence of bacteremia were too low.