The purpose of the study was to analyze the available data about the role of the microbial factor in the development and course of chronic periodontitis at the present stage on the basis of available domestic and foreign specialized literature, to identify unsolved problems and outline directions for further research. Materials and methods. The special literature is analyzed: periodicals for the last 10 years, basic manuals and monographs. We used descriptive method. Results and discussion. A large number of works are devoted to the analysis of the composition and properties of bacterial biofilm of the oral cavity using microscopic, bacteriological and molecular research methods used to assess microbial risk factors for periodontal diseases. At the same time, satisfactory results of conservative treatment of this pathology vary from 61.1% to 93.9%. The situation is aggravated by the fact that apical periodontitis, cystogranulomas and radicular cysts in 65.0% are the cause of severe complications that threaten death. Even outside of exacerbation, the presence of foci of focal infection is accompanied by sensitization of the patient's body and contribute to its generalization. The accumulated experience of research on the etiology and pathogenesis of periodontal diseases over the past decades indicates that the leading role in the formation and development of the inflammatory process of this localization belongs to obligate-anaerobic and microaerophilic facultative-anaerobic microflora. Despite a significant number of studies devoted to this issue, the problem of the effectiveness of endodontic treatment nowadays is far from its final solution, which convinces of the relevance of the research undertaken and its expediency. Conclusion. The results of the analysis of special literature allow us to conclude that the development of new rational complex methods of treatment based on an in-depth analysis of morphological, microbiological, immunological, biochemical, clinical and somatic components is based not only on the need to create effective methods of treatment of chronic periodontitis and the justification of their differentiated use, but also on the need for preventive measures aimed at preventing the development of severe complications of acute odontogenic infection and its generalization. The development of new effective and rational methods for the treatment of chronic periodontitis based on their differentiated use will reduce the number of cases of acute odontogenic infection and its severe complications, which will positively affect the quality of life of patients, increase the rates of specialized medical care and will have a certain socio-economic significance

Keywords: microflora, oral cavity, chronic periodontitis, root canal, periapical tissues

Full text: PDF (Rus) 279K

1. Tsarev VN, Nikolaeva EN, Ippolitov EV. Parodontopatogennye bakterii – osnovnoj faktor vozniknovenija i razvitija parodontita [Periodontopatogenic bacteria of the main factors of emer-gence and development of periodontitis]. J Microbiol Epidemiol Immunobiol. 2017;5:101-12. [Russian]. https://doi.org/10.36233/0372-9311-017-5-101-112
2. Korona-Glowniak I, Piatek D, Fornal E, Lukowiak A, Gerasymchuk Yu, Kedziora A, et al. Patterns of oral microbiota in patients with apical periodontitis. J Clin Med. 2021;10(12):2707. PMID: 34205290. PMCID: PMC8234888. https://doi.org/10.3390/jcm10122707
3. Kukushkin VL, Dutova AA, Kukushkina EA, Kordyuk MYu, Smirnitskaya MV. Anajerobnaja mikroflora jendodonta v dinamike lechenija hronicheskogo apikal'nogo periodontita [Anaerobic endodontic microflora in dynamics of chronic apical periodontitis treatment]. Endodontids Today. 2018;16(4):26-7. [Russian]. https://doi.org/10.25636/PMP.2.2018.4.6
4. Bahl R, Sandhu S, Singh K, Sahai N, Gupta M. Odontogenic infections : microbiology and management. Contemp. Clin. Dent. 2014;5(3):307-11. PMID: 25191064. PMCID: PMC4147804. https://doi.org/10.4103/0976-237X.137921
5. Lima AR, Herrera DR, Francisco PA, Pereira AC, Lemos J, Abranches J, et al. Detection of Streptococcus mutans in symptomatic and asymptomatic infected root canals. Clin Oral Investig. 2021;25(6):3535-42. PMID: 33170373. PMCID: PMC8152374. https://doi.org/10.1007/s00784-020-03676-9
6. Solov'eva ZhV. Analiz mikroflory kornevogo kanala pri jendodonticheskoj patologii po rezul'tatam pervichnogo obsledovanija pacientov [Analysis of the microflora of the root canal in endodontic pathology based on the results of the initial examination of patients]. Int J Appl Fundam Res. 2014;2:168-72. [Russian]
7. Prada I, Micó-Muñoz P, Giner-Lluesma T, Micó-Martínez P, Collado Castellano N, Manzano-Saiz A. Influence of microbiology on endodontic failure. Literature review. Med Oral Patol Oral Cir Bucal. 2019;24(3):364-72. PMID: 31041915. PMCID: PMC6530959. https://doi.org/10.4317/medoral.22907
8. Pereira RS, Rodrigues VAA, Furtado WT, Gueiros S, Pereira GS, Avila-Campos MJ. Microbial analysis of root canal and periradicular lesion associated to teeth with endodontic failure. Anaerobe. 2017;48:12-8. PMID: 28666877. https://doi.org/10.1016/j.anaerobe.2017.06.016
9. Iordanishvili AK, Salmanov IB, Serikov AA. Metodologicheskie osnovy ocenki kachestva i jeffektivnosti jendodonticheskogo lechenija zubov na sovremennom jetape [Methodological basis for assessing the quality and effectiveness of endodontic dental care at the present stage]. Endodontics Today. 2018;4:16-21. [Russian]. https://doi.org/10.25636/PMP.2.2018.4.4
10. Bassam S, El-Ahmar R, Salloum S, Ayoub S. Endodontic postoperative flare-up: An update. Saudi Dent. J. 2021;33(7):386-94. PMID: 34803278. PMCID: PMC8589595. https://doi.org/10.1016/j.sdentj.2021.05.005
11. Glukhova EA, Mezhevikina GS. Kliniko-laboratornoe obosnovanie jeffektivnosti jendodonticheskogo lechenija [Clinical and laboratory substantiation of efficiency endodontic treatment]. Sci Young (Erudito Juvenium). 2019;7(2):294-300. [Russian]. https://doi.org/10.23888/HMJ201972294-300
12. Gomes BP, Berber VB, Kokaras AS, Chen T, Paster BJ. Microbiomes of endodontic-periodontal lesions before and after chemomechanical preparation. J Endod. 2015;41(12):1975-84. PMID: 26521147. PMCID: PMC7061340. https://doi.org/10.1016/j.joen.2015.08.022
13. Petrikas AZh, Zakharova EL, Goreva LA, Tolstova OO. Kliniko-rentgenologicheskaja ocenka kachestva jendodonticheskogo lechenija [Clinical and radiological quality assessment of root canal treatment]. Stomatologiya. 2013;92(2):17-8. [Russian]
14. Razumova SN, Timohina MI, Bulgakova VS, Anurova AE. Faktory, obespechivajushhie kachestvennoe jendodonticheskoe lechenie [The factors that quality endodontic treatment]. Medical and Pharmaceutical J “Pulse”. 2015;17(2):35-6. [Russian]
15. Galonsky VG, Tarasova NV, Surdo ES, Kazantsev ME, Chernichenko AA. Novyj sposob ocenki kachestvennyh rezul'tatov jendodonticheskogo lechenija oslozhnennyh form kariesa zubov [A new methods for evaluation of qualitative results endodontic treatment of complicated dental caries]. Avicenna Bull. 2016;2:75-81. [Russian]
16. Bainazarova NT, Iskakova MK. Analiz kachestva jendodonticheskogo lechenija, profilaktika oslozhnenij (po dannym literatury) [Analysis of the quality of endodontic treatment, prevention of complications (according to the literature)]. Vestnik KazNMU. 2017;3:186-9. [Russian]
17. Shott EV, Pohodenko-Chudakova IO. Morfologicheskie osobennosti stroenija kornevyh kanalov premoljarov i moljarov verhnej cheljusti na osnovanii konusno-luchevoj komp'juternoj tomografii [Morphological features of the structure of the root canals of premolars and molars of the upper jaw on the basis of cone-beam computed tomography]. Ukr J Med Biol Sport. 2021;6(5):322-8. [Russian]. https://doi.org/10.26693/jmbs06.05.322
18. Kogina EN. Mikrobiologicheskoe issledovanie soderzhimogo kornevyh kanalov v dinamike lechenija destruktivnyh form periodontita [Microbiological study of root canal content in dynamics of treatment of destructive forms of periodontitis]. Kazan Med J. 2018;99(1):161-6. [Russian]. https://doi.org/10.17816/KMJ2018-161
19. Budzinski NE, Ignatiadi ON, Arutyunov AV, Digov EA. Issledovanie sostava mikroflory periapikal'nyh tkanej pri obostrenii hronicheskogo periodontita [The study of the composition of the microflora of the periapical tissues during exacerbation of chronic periodontitis]. Kuban Sci Med Bull. 2015;150(1):28-31. [Russian]. https://doi.org/10.25207/1608-6228-2015-1-28-31
20. Bouillaguet S, Manoil D, Girard M, Louis J, Gaïa N, Leo S, et al. Root microbiota in primary and secondary apical periodontitis. Front Microbiol. 2018;9:2374. PMID: 30356779. PMCID: PMC6189451. https://doi.org/10.3389/fmicb.2018.02374
21. Mozgovaia LA, Kosolapova EIu, Zadorina II. Optimizacija metodov lechenija hronicheskih form apikal'nogo periodontita [Treatment optimization in chronic apical periodontitis]. Stomatologiya. 2012;91(5):14-8. [Russian]
22. Iordanishvili A.K., Slugina A.G., Balin D.V., Serikov A.A. Vozrastnye osobennosti rasprostranennosti hronicheskih periapikal'nyh ochagov odontogennoj infekcii u vzroslyh ljudej [Age-related features of prevalence of chronic periapical foci of odontogenic infection in adults]. Sci Pract Peer-Reviewed J “Humans and their health”. 2015;2:23-8. [Russian]
23. Kuratov IA, Nagaeva OM, Korneeva MV, Surkov MA. Analiz prichin neudach jendodonticheskogo lechenija i udalenija zubov s diagnozom «hronicheskij apikal'nyj periodontit» [Analysis of the causes of failure of endodontic treatment and the cuses of tooth extraction with a diagnosis of chronic apical periodontitis]. Actual Probl Dent. 2019;15(1):28-32. [Russian]. https://doi.org/10.18481/2077-7566-2018-15-1-28-32
24. Khalifa L, Brosh Y, Gelman D, Coppenhagen-Glazer S, Beyth S, Poradosu-Cohen R, et al. Targeting Enterococcus faecalis biofilms with phage therapy. Appl Environ Microbiol. 2015;81(8):2696-705. PMID: 25662974. PMCID: PMC4375334. https://doi.org/10.1128/AEM.00096-15
25. Ferrer-Luque CM, Arias-Moliz MT, Ruíz-Linares M, Martínez García ME, Baca P. Residual activity of cetrimide and chlorhexidine on Enterococcus faecalis-infected root canals. Int J Oral Sci. 2014;6(1):46-9. PMID: 24357857. PMCID: PMC3967309. https://doi.org/10.1038/ijos.2013.95
26. Pavlovich OA, Risovanniy SI, Nizhegorodzeva IA, Shumlivaya MO, Kamushkina LV, Risovannaya ON. Jeffektivnost' vnutrikanal'nogo primenenija preparatov gialudenta № 4 s doksiciklinom, klotrimazola i triakorta v lechenii destruktivnyh form hronicheskogo apikal'nogo periodontita na osnovanii dannyh mikrobiologicheskogo issledovanija [The effectiveness of usage Triacortum, Clotrimazole and Doxycycline for chronic apical periodontitis treatment]. Kuban Sci Med Bull. 2012;132(3):104-8. [Russian]
27. Dmitrieva NA, Krechina EK, Iarygina LB, Efremova NV. [Comporative evalution of antimicrobial activity of root canal irrigation agents]. Stomatologiya. 2013;92(5):9-11. [Russian]
28. Butvilovsky AV, Manak TN, Volodkevich DL, Omar S. Konservativnoe jendodonticheskoe lechenie: sovremennye principy i metody [Conservative endodontic treatment: modern principles and methods]. Sovremennaya stomatologiya. 2018;2:30-3. [Russian]
29. Berdieva RR, Mamytova AB. Analiz oshibok pervichnogo jendodonticheskogo lechenija zubov s hronicheskim periodontitom (Obzor) [Error analysis of primary endodontic dentistry with chronic periodontitis (Review)]. Int Res J. 2020;91(1):79-82. [Russian]. https://doi.org/10.23670/IRJ.2020.91.1.016
30. Stepanov EA, Mitrofanova NN, Stepanov DA, Melʼnikova VV. Osobennosti gnojno-septicheskoj infekcii u pacientov s patologijami cheljustno-licevoj oblasti [PSI features in patients with maxillofacial pathology]. University Proceedings Volga Reg Med Sci. 2019;50(2):50-61. [Russian]. https://doi.org/10.21685/2072-3032-2019-2-5
31. Mark R, Song S, Mark P. Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection. BMJ Case Rep. 2018;2018225019. PMID: 29848536. PMCID: PMC5990080. https://doi.org/10.1136/bcr-2018-225019
32. Weise H, Naros A, Weise C, Reinert S, Hoefert S. Severe odontogenic infections with septic progress – a constant and increasing challenge: a retrospective analysis. BMC Oral Health. 2019;19:173. PMID: 31375095. PMCID: PMC6679486. https://doi.org/10.1186/s12903-019-0866-6
33. Jevon Ph, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. Br Dent J. 2020;229(6):363-70. PMID: 32978579. PMCID: PMC7517749. https://doi.org/10.1038/s41415-020-2114-5
34. Naumova VN, Turkina SV, Maslak EE. Vzaimosvjaz' stomatologicheskih i somaticheskih zabolevanij: obzor literatury [Association between oral and general diseases: review of the literature]. Volgograd J Med Res. 2016;2:25-8. [Russian]
35. Surin AV, Pohodenko-Chudakova IO. The informative value of integral intoxication indices in patients with chronic odontogenic sinusitis of maxillary sinus. Ukr J Med Biol Sport. 2018;3(6):234-9. https://doi.org/10.26693.jmbs03.06.234
36. Pohodenko-Chudakova IO, Chudakov OP, Zhavoronok SV, Barmutzkaya AZ, Kabanova SA, Kabanova AA, et al. Klinicheskoe rukovodstvo: diagnostika, prognozirovanie i lechenie tjazhelyh oslozhnenij infekcionno-vospalitel'nyh processov cheljustno-licevoj oblasti i shei [Clinical handbook: diagnosis, prognosis and treatment of severe complications of infectious and inflammatory processes of the maxillofacial area and neck]. Ed by IO Pohodenko-Chudakova. Minsk: Publishing center of BSU; 2016. [Russian]
37. Katola VM, Komogortseva VE. Rol' oral'nogo mikrobioma v razvitii vospalenija i somaticheskoj patologii [The role of oral microbiome in the development of inflammation and somatic pathology]. Bull Physiol Pathol Respirat. 2018;68:117-22. [Russian]. https://doi.org/10.12737/article_5bla069e8a9318.69578013