Apical periodontitis: prevalence and etiopathogenetic aspects

Abstract

Apikaalne periodontiit (AP) on hamba juurekanalisüsteemis paikneva bakterpõletiku tagajärjel tekkinud kahjustus hambajuuretipu ümbruses. AP tekib enamasti kaugelearenenud hambakaariese tagajärjel ning sellega kaasnev hambajuuretipu ümbruse kudede häving on radioloogiliselt nähtav. AP on maailmas laialt levinud haigus, mille esinemist seostatakse vanuse, soo, teiste hambahaiguste, hambaravikvaliteedi ja indiviidi sotsiaalmajandusliku seisundiga. Käesoleva doktoritöö eesmärgiks oli välja selgitada AP levimus Eestis ning seda põhjustavad ja soodustavad faktorid. Selleks viidi läbi 3 suuremat uuringut. AP levimuse hindamiseks vaadeldi 6552 patsiendi radioloogilisi uuringuid, kus hinnati kõikide hammaste seisukorda. AP diagnoositi üle pooltel uuritavatest ja haigusel leiti tugev seos eelnevalt teostatud hambahaiguste ja -ravi kvaliteediga. Haigestumise risk oli oluliselt madalam kvaliteetse hambaravi korral. Mikrobioloogiliseks uuringuks koguti proove 12 hamba juurekanalist, eraldati DNA ja tuvastati bakteri liigid. Mikroobikooslused olid indiviiditi erinevad ja mitmekesised, kuid domineerisid anaeroobsed bakterid. Avastati mitmeid raskesti kultiveeritavaid ja seni juurekanalitest avastamata mikroobiliike. Eelnevast võib järeldada, et kuna AP’d põhjustavad väga paljud mikroobid, siis spetsiifiliste mikrobioloogiliste analüüside teostamine juurekanalisüsteemist ei ole mõistlik ja raviprotsess tuleb suunata kõikide mikroobide ja nende koosluste vastu. Oksüdatiivse stressi (OxS) markerite määramiseks kasutati 86 patsiendi sülge ja juurekanali sisaldust. OxS esines nii kõikide uuritud juureravi vajavate hammaste juurekanalis kui ka kogu organismis. Tervetel inimestel seevastu olid OxS tasemed madalad. Märkimisväärseks osutus OxS seos hambavalu ja hamba juuretipu ümbruse luu hävinguga. Seega on OxS tähtis mehhanism juurekanali põletike korral.Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root that is caused by infection in root canal system. AP can be considered a sequela of advanced dental caries, and it is radiologically visible as hard tissue destruction around the apex of the tooth root. AP is a widespread condition all around the world and its prevalence is associated with age, gender, level of previous dental diseases and treatment and socioeconomic status of the region. The general aim of the present thesis was to clarify the prevalence, determining factors and etiopathogentic aspects of AP among Estonian population. To clarify the prevalence of AP we analyzed radiographs of 6552 patient, we described and evaluated all teeth and their status. AP was diagnosed over half of the patients and we found a strong correlation between AP and previous dental diseases as well as the quality of previous dental treatment. The prevalence of AP was considerably lower in patients with high quality dental treatment. Microbial samples were collected from 12 root canals, DNA was isolated and the bacteria were characterized. The communities were individually different but anaerobic bacteria predominated as the rule. We discovered several hard to cultivate and even some not yet discovered spices from root canals. Therefore, the microbiological analysis of the root canal content in case of endodontic pathologies is meaningless, and the treatment measures must be directed against wide spectrum of aerobic and anaerobic bacteria.

To measure oxidative stress (OxS), the saliva and root canal samples of 86 patients were analyzed. OxS levels were elevated in patients with endodontic pathologies compared to healthy subjects. OxS appeared to be an important pathogenetic mechanism in several endodontic pathologies being significantly associated with essential clinical markers like dental pain and bone destruction area around the apex of the tooth.