La biopelícula dental

Med Oral Patol Oral Cir Bucal 2007;12:E154-9.

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Management of odontogenic infection

Management of odontogenic infection of pulpal and periodontal origin
Roberto López-Píriz 1, Lorenzo Aguilar 2, Maria José Giménez 3

(1) Degree in Medicine and Surgery. Degree in Odontology. Doctoral student (2) Doctor in Medicine and Surgery (3) Doctor in Pharmacy. Microbiology Department, Faculty ofMedicine, UCM

Correspondence: Dr. Roberto López-Píriz. C/ General Álvarez de Castro, nº 5, 1º B. 28010. Madrid. E-mail: lopezpiriz@telefonica.net López-Píriz R, Aguilar L, Giménez MJ. Management of odontogenic infection of pulpal and periodontal origin. Med Oral Patol Oral Cir Bucal 2007;12:E154-9.
© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946

Received: 12-11-2006 Accepted:25-01-2007
Indexed in: -Index Medicus / MEDLINE / PubMed -EMBASE, Excerpta Medica -SCOPUS -Indice Médico Español -IBECS

ABSTRACT
The dental biofilm is a complex bacterial ecosystem that undergoes evolution, maturing and development, and thus leads to odontogenic infection. The infection is normally located in the tissues of the dental organ itself, and follows a chronic course of evolution.However, bacterial pathogens express virulence factors in the biofilm, and this together with changes in host immunity, may cause clinical exacerbations and spread of infection to other areas of the body. Odontogenic infection management should take into consideration the fact that therapeutic success lies in the control of the infectious aetiologic agent, using mechanical-surgical debridement and/orantimicrobial therapy. Debridement techniques have a fundamentally quantitative effect (by reducing the size of the inoculum) and therefore if these techniques are used alone to control infection, despite an initial clinical improvement that is sometimes prematurely considered as therapeutic success, odontopathogens may persist and the process may recur or become chronic. Microbiological examinationmay be helpful in defining therapeutic success in a more reliable way, it could define the prognosis of recurrence more precisely, and could enable the most appropriate antibiotic to be selected, thus increasing therapeutic efficacy. Antimicrobial therapy brings about a quantitative and qualitative change in the bacterial composition of the biofilm, in addition to being able to act on sites thatare inaccessible through mechanical debridement. However, incorrect antimicrobial use can lead to a selection of resistant bacterial species in the biofilm, in addition to side effects and ecological alterations in the host. In order to minimise this risk, and obtain maximum antimicrobial effect, we need to know in which clinical situations their use is indicated, and the efficacy of differentantibiotics with regard to bacteria isolated in odontogenic infection. Key words: Odontogenic infection, treatment, odontogenic infection, microbiological diagnosis, dental biofilm, dental abscess.

RESUMEN
La biopelícula dental es un ecosistema bacteriano complejo cuya evolución, maduración y desarrollo ocasiona la infección odontogénica. Habitualmente la infección se encuentra localizada en lostejidos del propio órgano dentario y sigue un curso evolutivo crónico, aunque la expresión de factores de virulencia bacterianos en la biopelícula o cambios en la situación inmune del huésped pueden ocasionar exacerbaciones clínicas y la extensión de la infección a otras zonas del organismo. En el abordaje de la infección odontogénica debemos tener presente que el éxito terapéutico radica en elcontrol del agente etiológico infeccioso, mediante desbridamiento con técnicas mecánico-quirúrgicas y/o administración de antimicrobianos. El efecto de las técnicas de desbridamiento sobre la biopelícula es fundamentalmente de tipo cuantitativo (disminuye el tamaño del inóculo) de modo que su empleo como único medio de control de la infección puede suponer la persistencia de odontopatógenos y la...