Oral inflammatory process and general health. Part 2: How does the periapical inflammatory process compromise general health?

At present, the focal infection theory still has very controversial aspects. In spite of the great number of studies, there is no evidence that focal infections or even antigenic mimicry are responsible for anything other than sporadic abscesses/infections and possibly rare autoimmune disorders. linflammation of endodontic origin (i.e., apical periodontitis--AP) has not received the same attention as inflammation originating from the periodontium. Endodontics is a microbiological problem, since the bacterial infection is the "prime mover" of pulp (before) and periapical (later) disease. The aims of endodontic treatment have to be considered from a microbiological viewpoint. Considering these problems in this second part of their study, the Authors, after close examination of the virulence of microorganisms and of the host defense, analyze the endodontic infection and microbiological species. They emphasize the possibility of a relationship between periapical inflammatory lesions and bacterial endocarditis in preventing metafocal disease. Bacterial endocarditis deserves special mention because despite involving specialists of two scientific fields, its prophylaxis is almost always assigned to medical practice, and especially, to dentistry. Given the dangers of the disease, antibiotic prophylaxis is both absolutely necessary and can be very effective, and it should be used especially in clinical situations with high risk individuals. However, the ability of antibiotic therapy to prevent or reduce the frequency, magnitude or duration of bacteremia associated with a dental procedure is controversial. Studies should also be undertaken to determine to compare the efficacy of endodontic treatment with alternative therapy such as implants, prosthetic replacements or no treatment other than extraction. To date, these studies have not been carried out, and there is no evidence to support the theory that modern endodontic therapy is not safe and effective.