Enterococcus faecalis demonstrates pathogenicity through increased attachment in an ex vivo polymicrobial pulpal infection.

This study investigated the host response to a polymicrobial pulpal infection consisting of Streptococcus anginosus and Enterococcus faecalis, bacteria commonly implicated in dental abscesses and endodontic failure, using a validated ex vivo rat tooth model. Tooth slices were inoculated with planktonic cultures of S. anginosus or E. faecalis alone or in co-culture at ratios of 50:50 and 90:10 S. anginosus to E. faecalis Attachment was semi-quantified by measuring area covered by fluorescently labelled bacteria. Host response was established by viable histological cell counts and inflammatory response using RT-qPCR and immunohistochemistry. A significant reduction in cell viability was observed for single and polymicrobial infections, with no significant differences between infection types (≈2000cells/mm2 for infected pulps compared to ≈4000cells/mm2 for uninfected pulps). E. faecalis demonstrated significantly higher levels of attachment (6.5%) compared to S. anginosus alone (2.3%) and mixed species infections (3.4% for 50:50 and 2.3% for 90:10), with a remarkable affinity to the pulpal vasculature. Infections with E. faecalis demonstrated the greatest increase in TNF-α (47.1 fold for E. faecalis, 14.6 fold for S. anginosus, 60.1 fold for 50:50 and 25.0 fold for 90:10) and IL-1β expression (54.8 fold for E. faecalis, 8.8 fold for S. anginosus, 54.5 fold for 50:50 and 39.9 fold for 90:10) when compared to uninfected samples. Immunohistochemistry confirmed this with the majority of inflammation localised to the pulpal vasculature and odontoblast regions. Interestingly, E. faecalis supernatant and heat killed E. faecalis treatment was unable to induce the same inflammatory response, suggesting E. faecalis pathogenicity in pulpitis is linked to its greater ability to attach to the pulpal vasculature.