Molecular Diagnosis of Porphyromonas Gingivalis And Enterococcus Faecalis Associated Endodontic–Periodontic Lesions With Special Reference to Comorbid Conditions

Abstract

Background: The Endodontic periodontic lesions (EPLs) are clinically diverse inflammatory lesions in which infection and inflammation affect the pulpal or root canal and the periodontal compartments either simultaneously or successively. Their diagnosis is further complicated by the lack of specific diagnostic parameters due to overlapping clinical features, anatomical the communication, polymicrobial biofilms and systemic disease-modulated host responses. Porphyromonas gingivalis and Enterococcus faecalis were selected for their contrasting ecological and pathogenic features. The P. gingivalis is more commonly associated with periodontal dysbiosis whereas E. faecalis is more commonly targeted in persistent or secondary endodontic infections.

Objective: The present review summarizes the current evidence on the microbiological importance of P. gingivalis and E. faecalis in EPLs and reviews the molecular methods used for their detection and quantification, especially as regards type 2 diabetes mellitus and other system modifier factors.

Material and Methods: A systematic review framework was constructed from peer-reviewed biomedical literature on EPLs, P. gingivalis, E. faecalis, polymerase chain reaction (PCR), quantitative PCR (qPCR), multiplex PCR, checkerboard DNA-DNA hybridization, 16S rRNA, next-generation sequencing (NGS), diabetes mellitus and apical or perioidal disease. A modern classification system and diagnostic-reporting scheme was also explored.

Result: Endodontic periodontic lesions (EPLs) are a mixed microbial condition and not a disease entity. Molecular studies have identified P. gingivalis and E. faecalis in periodontal and endodontic tissue, though prevalence reports vary widely depending on disease phenotype, previous therapy, sample site, and methodology used. A prevalence study of type 2 diabetes patients with EPLs identified E. faecalis in 73.3% of root canals, P. gingivalis in 70% of root canals, and E. faecalis in 73.3% of pocket samples (skin, root end, pocket sample). The organism specific detection and quantification techniques such as targeted PCR and qPCR are extremely sensitive; broad screening by sequencing can provide a more comprehensive bacteria assessment. Presence of DNA does not necessarily imply viability or causality.

Conclusion: The molecular diagnostics will be adjuncts rather than substitutes for clinical periodontal and endodontic examination. Dedicated site-specific sampling, validated molecular tests, quantitative microbiology, host/systemic data and longitudinal clinical outcomes should be combined in future research. Standardization of pre-analytical and analytical protocols will be necessary before routine use of molecular tests in precision endodontic-periodontal practice can be achieved.