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Review
Published: 01-23-2025

Major clinical outcomes of the endodontic infections and gut microbiota axis: a systematic review

UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil

Abstract

Introduction: Endodontic therapy aims to shape, clean, and disinfect the root canal, and is performed by removing all pulp tissue or necrotic remains and microorganisms present in the root canal system. The gut microbiota or specific microbial metabolites not only locally influence the host's inflammatory responses, nutritional intake, or intestinal barrier function, but are also related to the immune and metabolic systems. In addition to antimicrobial activity, calcium hydroxide has properties such as dissolution of organic remnants, anti-inflammatory action, inhibition of inflammatory resorptions, and physical barrier function. Objective: To present the main considerations and clinical outcomes of the relationship between gut microbiota and endodontic infections and highlight endodontic treatment with calcium hydroxide, showing the mechanisms of antibacterial action. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from September to October 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 102 articles were found, 25 were evaluated in full and 09 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=79.2%<50%. It was concluded that, in the setting of endodontic therapy, the presence of microorganisms, particularly gramnegative anaerobes, in the root canal system and cementum resorption gaps after root canal treatment is considered one of the main causes of persistent periapical lesions and, therefore, of endodontic treatment failure. The gut microbiota or specific microbial metabolites not only locally influence the patient's inflammatory responses, nutritional intake, or intestinal barrier function, but are also related to the immune and metabolic systems. The change in the microbiota of the oral-gut axis and its interactions with Helicobacter pylori may be potential targets for the diagnosis and infectious treatment of Helicobacter pylori. Calcium hydroxide in endodontics is the most widely used medication to combat pathology-causing bacteria, but when used alone it may not be able to eliminate these microorganisms. The combination of other medications incorporated into calcium hydroxide contributes to positive results with the elimination of more resistant bacteria.

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How to Cite

Neves, F. E. de F., Pagioro, Y. F., & Castro, F. P. L. de. (2025). Major clinical outcomes of the endodontic infections and gut microbiota axis: a systematic review. MedNEXT Journal of Medical and Health Sciences, 6(1). https://doi.org/10.54448/mdnt25104