Why do we culture?
It’s a general fact by now that cause of endo disease is bacteria. Therefore, getting rid of bacteria is one of treatment objectives. If bacterial eradication can be achieved (negative culture), successful treatment should then ensued. Was that making sense? Historically, that’s a rationale for culture (Bender et al. 1964).
The confusion arises because we now know better. We have now known that the dominant endodontic bacteria is anaerobic (Sundqvist 1976; Sundqvist 1992), which merely impossible to be cultured with the simple technique we normally use. So if aerobic culture technique is being employed in dental school, so what are we doing? Negative culture cannot mean no bacteria and higher success rate then.
Why do we still culture in dental school?
The argument I usually heard is to teach dental student about sterile technique, maintaining field of operation sterile, which I think it’s a legitimate argument. Even though, we can’t be certain of what are actually inside the canals with the simple culture technique, we can be certain that we did not inoculate new bacteria into the canals by poor sterile technique. In dental school, the students do not only require to do endo but also require to LEARN how to do it right. I think culture technique can be part of that learning process.
Why is culture not being practiced in the real world?
As a matter of fact negative culture does mean higher healing rate (Sjogren et al. 1997) (94% healed in negative culture group, while 68% healed in positive culture group) their culture technique was state of the art, though.
Practicality issue: to make culture results informative, it has to be anaerobic culture technique, which is time consuming and costly obviously it’s not practical. Cost effective, and cost benefit analysis might have shown that it’s not worth it.
If the culture result was negative after proper treatment i.e. antibacterial irrigants were used, canals prepared to reasonable size, they’ve been dressed with calcium hydroxide for at least one week, what could be done to change culture results? The answer is nothing, that’s why we don’t culture in the real world.
References
Bender IB, Seltzer S, Turkenkopf S (1964) To Culture or Not to Culture? Oral Surgery Oral Medicine and Oral Pathology 18, 527-40.
Sjogren U, Figdor D, Persson S, Sundqvist G (1997) Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis International Endodontic Journal 30, 297-306.
Sundqvist G (1976) Bacteriological Studies of Necrotic Dental Pulps. Umea Sweden: Umea University Odontological Dissertations no. 7.
Sundqvist G (1992) Ecology of the root canal flora Journal of Endodontics 18, 427-30.
It’s a general fact by now that cause of endo disease is bacteria. Therefore, getting rid of bacteria is one of treatment objectives. If bacterial eradication can be achieved (negative culture), successful treatment should then ensued. Was that making sense? Historically, that’s a rationale for culture (Bender et al. 1964).
The confusion arises because we now know better. We have now known that the dominant endodontic bacteria is anaerobic (Sundqvist 1976; Sundqvist 1992), which merely impossible to be cultured with the simple technique we normally use. So if aerobic culture technique is being employed in dental school, so what are we doing? Negative culture cannot mean no bacteria and higher success rate then.
Why do we still culture in dental school?
The argument I usually heard is to teach dental student about sterile technique, maintaining field of operation sterile, which I think it’s a legitimate argument. Even though, we can’t be certain of what are actually inside the canals with the simple culture technique, we can be certain that we did not inoculate new bacteria into the canals by poor sterile technique. In dental school, the students do not only require to do endo but also require to LEARN how to do it right. I think culture technique can be part of that learning process.
Why is culture not being practiced in the real world?
As a matter of fact negative culture does mean higher healing rate (Sjogren et al. 1997) (94% healed in negative culture group, while 68% healed in positive culture group) their culture technique was state of the art, though.
Practicality issue: to make culture results informative, it has to be anaerobic culture technique, which is time consuming and costly obviously it’s not practical. Cost effective, and cost benefit analysis might have shown that it’s not worth it.
If the culture result was negative after proper treatment i.e. antibacterial irrigants were used, canals prepared to reasonable size, they’ve been dressed with calcium hydroxide for at least one week, what could be done to change culture results? The answer is nothing, that’s why we don’t culture in the real world.
References
Bender IB, Seltzer S, Turkenkopf S (1964) To Culture or Not to Culture? Oral Surgery Oral Medicine and Oral Pathology 18, 527-40.
Sjogren U, Figdor D, Persson S, Sundqvist G (1997) Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis International Endodontic Journal 30, 297-306.
Sundqvist G (1976) Bacteriological Studies of Necrotic Dental Pulps. Umea Sweden: Umea University Odontological Dissertations no. 7.
Sundqvist G (1992) Ecology of the root canal flora Journal of Endodontics 18, 427-30.
No comments:
Post a Comment