The prevalence of enterococcus faecalis and candida albicans in teeth with periapical lesions and the antimicrobial susceptibility of these isolates

The aim of this study was to investigate the presence of E.faecalis and C.albicans in endodontic infections and in saliva by culture and PCR methods.Microbial samples were obtained from 117 teeth in 100 patients with infected root canals (primary infection) and 114 teeth with 70 patients with root-filled teeth with persisting periapical lesions (secondary infection). Saliva samples were obtained under tongue.E.faecalis was cultured from 16 (%14) of 117 necrotic canals and 10 (%9) of 114 re-treated root canals. PCR detection identified the target specie in 19 (%16) and 11 (%10) of primary and secondary infections respectively.C.albicans was cultured from 20 (%17) of 117 necrotic canals and 10 (%9) of 114 re-treated canals. PCR detection identified the target specie in 23 (%20) and 13 (%11) of primary and secondary infections respectively.From the saliva samples, E.faecalis was cultured from 7 (%7) of 100 patients with primary infections and 6 (%9) of 70 patients with secondary infections. PCR detection identified the target specie respectively 6 (%6) and 7 (%10). C.albicans was cultured from 15 (%15) of 100 patients with primary infections and 11 (%16) of 70 patients with secondary infections. PCR detection identified the target specie respectively 17 (%17) and 15 (%21).The susceptibility of 18 E.faecalis and 18 C.albicans isolates to antimicrobial and antifungal agents (penicillin, vancomycin, spiramisin, colistin for E.faecalis and amphotericin B, nistatin, fluconazole, ketoconazole for C.albicans) was determined by agar dilution method. In vitro antimicrobial activity of %5 NaOCl, %2,5 NaOCl, %17 EDTA and %2 CHX against E.faecalis and C.albicans isolates were tested by strip diffusion method. In vitro susceptibility of E.faecalis and C.albicans isolates to three intracanal medicaments: Ca(OH)2+Steril saline solution, Ca(OH)2+Glycerin and Ca(OH)2+Chlorhexidine were evaluated by agar diffusion method. Saline was used as the positive control for all study groups.All tested E.faecalis isolates showed resistance to penicillin, vancomycin, spiramisin, colistin. Through irrigation solutions, %2 Chlorhexidine is more effective in killing E.faecalis but %5 NaOCl produced larger inhibition zone than %2,5 NaOCl, %17 EDTA and %2 Chlorhexidine. For intracanal medication, CHX+Ca(OH)2 worked efficiently in killing E.faecalis isolates than Ca(OH)2+Steril saline solution, Ca(OH)2 +Glycerin.For C.albicans, all tested isolates were susceptible to amphotericin B, nistatin, fluconazole. And 18 of the root canal isolates showed resistance to ketoconazole. %5 NaOCl is more effective in killing and produced larger inhibition zone than %2,5 NaOCl, %17 EDTA and %2 Chlorhexidine. Ca(OH)2+Glycerin intracanal medication was better in killing C.albicans isolates and produced larger inhibition zone than other Ca(OH)2 medicaments.The flare up rates was also investigated. Four (%4) of the 100 patients with necrotic canals and 6 (%9) of the 70 patients with root-filled teeth with persisting periapical lesions had severe pain in 2 days.Key Words: Primary root canal infection, Secondary root canal infection, E.faecalis, C.albicans, Antimicrobial medicaments, Irrigation solutions.