The Bacteriological and Clinical Study of Bacteremia due to Periapical Lesion

根管治疗引起的菌血症已有多位作者报道。本研究的目的是评估猫根尖周病变的牙齿是否有可能诱发菌血症而不进行操作，以及菌血症是否会引起猫同一口腔内受损牙髓的血源性感染。在37颗牙齿中，将以下细菌中的一种或两种的细菌悬液接种到扩大的根管中。所用菌种为Sanguis、S.金黄色葡萄球菌、肠球菌和牙龈卟啉单胞菌。同时和术后3周，在严格无菌条件下，用橡皮障隔离49颗牙的牙髓，并对牙髓进行热刺激或机械刺激。11颗牙齿未处理作为对照。分别于术前、术后3周、5周从大隐静脉采血4 ml。通过裂解-过滤对样品进行了研究。5周后，从受损的牙髓中收集细菌样品，并在需氧和厌氧的肉汤中孵育。X线片显示，S.金黄色葡萄球菌和肠球菌单感染及混合感染。然而，细菌学检查显示，所有外周血培养和受损牙髓培养均为阴性，认为本研究中未发生因根尖周病变而导致的菌血症，或因菌血症的程度和发生率太低而未检测到。

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.