Controlling Root Canal Infection in Oncological Patients with Apical Periodontitis

This study evaluated the effectiveness of chemomechanical preparation associated with intracanal medication in reducing the total bacterial load of infected root canals in cancer patients undergoing antineoplastic treatment. The prevalence, levels, and response to treatment of Streptococcus and Actinobacteria species were also assessed.

The root canals of teeth with apical periodontitis from oncological and control patients were treated using rotary instrumentation, 2.5% NaOCl irrigation, and 2-week calcium hydroxide medication (n = 23/group). Bacteriological root canal samples were taken before (S1) and after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracted from the samples was subjected to 16S rRNA gene-based quantitative real-time polymerase chain reaction assays for evaluation of the treatment effects on total bacteria, Streptococcus species, and members of the Actinobacteria phylum.

All S1 samples were positive for bacteria. S1-S2 and S1-S3 bacterial reduction values were highly significant (P < .01). Although bacterial counts were reduced from S2 to S3, the decrease was not statistically significant (P > .05). Intergroup comparisons showed no significant differences in S1, S2 and S3 counts (P > .05). In the oncological group, 77% of the cases were positive for bacteria in S2, and 68% in S3. In the control group, corresponding figures were 65% for both S2 and S3. There were no significant differences between groups as for streptococci and actinobacteria prevalence, levels, and response to treatment (P > .05).

Root canal treatment using rotary instruments, NaOCl irrigation, and calcium hydroxide medication was highly effective in reducing the bacterial populations in infected teeth with apical periodontitis from cancer patients, with no significant differences to controls.