Siqueira JF Jr. Microbial causes of endodontic flare-ups. International Endodontic Journal, 36, 453^463, 2003. Literature review Inter-appointment £are-up is characterized by the development of pain, swelling or both, following endodontic...
moreSiqueira JF Jr. Microbial causes of endodontic flare-ups. International Endodontic Journal, 36, 453^463, 2003. Literature review Inter-appointment £are-up is characterized by the development of pain, swelling or both, following endodontic intervention. The causative factors of £are-ups encompass mechanical, chemical and/or microbial injury to the pulp or periradicular tissues. Of these factors, microorganisms are arguably the major causative agents of £are-ups. Even though the host is usually unable to eliminate the root canal infection, mobilization and further concentration of defence components at the periradicular tissues impede spreading of infection, and a balance between microbial aggression and host defences is commonly achieved. There are some situations during endodontic therapy in which such a balance may be disrupted in favour of microbial aggression, and an acute periradicular in£am-mation can ensue. Situations include apical extrusion of infected debris, changes in the root canal microbiota and/or in environmental conditions caused by incomplete chemo-mechanical preparation, secondary intrar-adicular infections and perhaps the increase in the oxidation^reduction potential within the root canal favouring the overgrowth of the facultative bacteria. Based on these situations, preventive measures against infective £are-ups are proposed, including selection of instrumentation techniques that extrude lesser amounts of debris apically; completion of the chemo-mechanical procedures in a single visit; use of an antimi-crobial intracanal medicament between appointments in the treatment of infected cases; not leaving teeth open for drainage and maintenance of the aseptic chain throughout endodontic treatment. Knowledge about the microbial causes of £are-ups and adoption of appropriate preventive measures can signi¢cantly reduce the incidence of this highly distressing and undesirable clinical phenomenon.