Revista de Odontologia da UNESP
ISSN 1807-2577 (Eletrônico)
Artigo Original

Enterococcus faecalis: considerações clínicas e microbiológicas

Enterococcus faecalis: clinical and microbiological considerations

Paradella, T.C.; Koga Ito, C.Y.; Jorge, A.O.C.


O gênero Enterococcus abrange diversas espécies, incluindo E. faecalis, que participam de diversas doenças na cavidade bucal, tais como cárie, infecções endodônticas recorrentes e periodontites apicais. O objetivo deste artigo foi descrever as principais características microbiológicas do gênero Enterococcus, relacionando-as com patologias clínicas endodônticas e periapicais. Após descrição das espécies mais patogênicas do gênero Enterococcus, concluiu-se que os fatores de virulência determinam sua elevada patogenicidade, o que se traduz em condições clínicas pouco favoráveis e persistência das infecções endodônticas, mesmo quando o retratamento é instituído.


Enterococcus faecalis, endodontia, periodontia


Enterococcus genus gathers species, including E. faecalis, which has participation in oral pathologies, such as caries, recurrent endodontic infections and apical periodontites. The purpose of this article was to describe the main microbiologic characteristics of the Enterococcus genus, relating them to clinical endodontic and periapical pathologies. After description of the most pathogenic species of the Enterococcus gender, it was concluded that its virulence factors determine the great pathogenesis of this gender, which relates to the poor prognosis clinical conditions and persistency of endodontic infections, even when re-treatment is established.


Enterococcus faecalis, endodontics, periodontics


1. Kayaoglu G, Orstavik D. Virulence factors of Enterococcus faecalis: relationship to endodontic disease. Crit Rev Oral Biol Med. 2004;15:308-20.

2. Jett BD, Huycke MM, Gilmore MS. Virulence of enterococci. Clin Microbiol Rev. 1994;7:462-78.

3. Sundqvist G. Associations between microbial species in dental root canal infections. Oral Microbiol Immunol. 1992;7:257-62.

4. Figdor D, Davies JK, Sundqvist G. Starvation survival, growth, and recovery of Enterococcus faecalis in human serum. Oral Microbiol Immunol. 2003;18:234-9.

5. Zoletti GO, Siqueira JF Jr, Santos KR. Identification of Enterococcus faecalis in root-filled teeth with or without periradicular lesions by culture-dependent and-independent approaches. J Endod. 2006;32:722-6.

6. Rocas IN, Siqueira JF Jr, Santos KR. Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod. 2004;30:315-20.

7. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn Jr WC. Color atlas and textbook of diagnostic microbiology. 5th ed. Chicago: Lippincott Williams & Wilkins; 1997.

8. Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J. 2002;35:221-8.

9. Sedgley CM, Nagel AC, Shelburne CE, Clewell DB, Appelbe O, Molander Al. Quantative real-time PCR detection of oral Enterococcus faecalis in humans. Arch Oral Biol. 2005;50:575-83.

10. Portenier I, Haapasalo H, Orstavik D, Yamauchi M, Haapasalo M. Inactivation of the antibacterial activity of iodine potassium iodide and chlorhexidine digluconate against Enterococcus faecalis by dentin, dentin matrix, type-I collagen, and heat-killed microbial whole cells. J Endod. 2002;28:634-7.

11. Reynaud AF, Geijersstam A, Sorsa T, Stackelberg S, Tervahatiala T, Haaspalo M. Effect of E. faecalis on the release of serine proteases elastase and cathepsin G, and collagenase-2 (MMP-8) by human polymorphonuclear leukocytes (PMNs). Int Endod J. 2005;38:667-77.

12. Baldassarri L, Creti R, Montanaro L, Orefici G, Arciola CR. Pathogenesis of implant infections by enterococci. Int J Artif Organs. 2005;28:1101-9.

13. Kreft B, Marre S, Schramm U, Wirth R. Aggregation substance of Enterococcus faecalis mediates adhesion to cultured renal tubular cells. Infect Immun. 1992;60:25‑30.

14. Vanek NN, Simon SI, Jacques-Palaz K, Mariscalco MM, Dunny GM, Rakita RM. Enterococcus faecalis aggregation substance promotes opsonin independent binding to human neutrophils via complement receptor type 3-mediated mechanism. Immunol Med Microbiol. 1999;26(1):49-60.

15. Jappe U. Superantigens and their association with dermatological inflammatory diseases: facts and hypothesis. Acta Dermatol. 2000;80:321-8.

16. Schilievert PM, Gahr PJ, Assimacopoulos AP, Dinges MM, Stoehr JA, Harmala JW, et al. Aggregation and binding substance enhance pathogenicity in rabbit models of Enterococcus faecalis endocarditis. Infect Immun. 1998;66:218-33.

17. Shankar V, Baghdayan AS, Huycke MM, Lindahl G, Gilmore MS. Infection-derived Enterococcus faecalis strains are enriched in esp, a gene encoding a novel surface protein. Infect Immun. 1999;67:193-200.

18. Distel JW, Hatton JF, Gillespie MJ. Biofilm formation in medication root canals. J Endod. 2002;28:689-93.

19. Beachey EH, Chiang TM, Ofek I, Kang AH. Interaction of lipoteichoic acid of grupo A Streptococci with human platelets. Infect Immun. 1977;16:649-54.

20. Beachey EH, Dale JB, Grebe S, Ahmed A, Simpson WA, Ofek I. Lymphocyte binding and T-cell mitogenic properties of group A streptococcal lipoteichoic acid. J Immunol. 1979;122:189-95.

21. Bleiweis AS, Zimmerman LN. Properties of proteinase from Streptococcus faecalis var. liquefaciens. J Bacteriol. 1964;88:653-88.

22. Mäkelä M. Matrix metalloproteinases (MMP-2 and MMP-9) of the oral cavity: cellular origin and relationship to periodontal status. J Dent Res. 1994;73:1397‑406.

23. Soell M, Elkaim R, Tenembaum H. Cathepsin C, matrix metalloproteinases, and their tissue inhibitors in gingiva and gingivas crevicular fluid from periodontitis-affected patients. J Dent Res. 2002;81:174-8.

24. Hashioka K, Suzuki K, Yoshida T, Nakane A, Horiba N, Nakamura H. Relationship between clinical symptoms and enzyme-producing bacteria isolated from infected root canals. J Endod. 1994;20:75-7.

25. Kayaoglu G, Erten H, Orstavik D. Growth at high pH increases Enterococcus faecalis adhesion to collagen. Int Endod J. 2005;38:389-96.

26. Xiao J, Hook M, Weinstock GM, Murray BE. Conditional adherence of Enterococcus faecalis to extracellular matrix proteins. Immunol Med Microbiol. 1998; 21:287-95.

27. Stuart CH, Schwartz, SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod. 2006;32:93-8.

28. Foschi F, Cavrini F, Montebugnoli L, Stashenko P, Sanbri V, Prati C. Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients. Oral Microbiol Immunol. 2005; 20:289-95.

29. Fouad AF, Zerella J, Barry J, Spangberg LS. Molecular detection of Enterococcus species in root canals of therapy-resistant endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:112-8.

30. Gonçalves LS, Ferreira SM, Silva A Jr, Villoria GE, Costinha LH, Souto R, et al. Association of T CD4 lymphocyte levels and subgingival microbiota of chronic periodontitis HIV-infected Brazilians under HAART. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:196-203.

31. Laplace JM, Thuault M, Hartke A, Boutibonnes P, Auffray Y. Sodium hypochlorite stress in Enterococcus faecalis: influence of antecedent growth conditions and induced proteins. Curr Microbiol. 1997;34:284-9.

32. Capiaux H, Giard JC, Lemarinier S, Auffray Y. Characterization and analysis of a new gene involved in glucose starvation response in Enterococcus faecalis. Int J Food Microbiol. 2000;10(55):99-102.

33. Gomes BP, Ferraz CC, Garrido FD, Rosalen PL, Zaia AA, Teixeira FB, et al. Microbial susceptibility to calcium hydroxide pastes and their vehicles. J Endod. 2002;28:758‑61.

34. Gomes BP, Lilly JD, Drucker DB. Associations of endodontic symptoms and signs with particular combinations of specific bacteria. Int Endod J. 1996;29:69-75.

35. Baker NE, Liewehr FR, Buxton TB, Joyce AP. Antibacterial efficacy of calcium hydroxide, iodine potassium iodide, betadine, and betadine scrub with and without surfactant against E. faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:359-64.

36. Vivacqua-Gomes N, Gurgel-Filho ED, Gomes BP, Ferraz CC, Zaia AA, Sousa-Filho FJ. Recovery of Enterococcus faecalis after single or multiple visit root canal treatments carried out in infected teeth ex vivo. Int Endod J. 2005;38:697-704.

37. Colak M, Evcil S, Bayindir YZ, Yigit N. The effectiveness of three instrumentation techniques on the elimination of Enterococcus faecalis from a root canal: an in vitro study. J Contemp Dent Pract. 2005;6:94-106.

38. Ferrari PHP, Cai S, Bombana AC. Effect of endodontic procedures on enterococci, enteric bacteria and yeasts in primary endodontic infections. Int Endod J. 2005;38:372-80.

39. Dahlen G, Samuelsson W, Molander A, Reit C. Identification and antimicrobial susceptibility of enterococci isolated from the root canal. Oral Microbiol Immunol. 2000;15:309-12.

40. Lui JN, Sae-Lim V, Song KP, Chen NN. In vitro antimicrobial effect of chlorexidine-impregnated gutta percha points on Enterococcus faecalis. Int Dent J. 2004;37:105‑13.

41. Segdley CM, Lennal SL, Appelbe OK. Survival of Enterococcus faecalis in root canals ex vivo. Int Endod J. 2005;38:735-42.

42. Basrani B, Tjardehane L, Santos JM, Pascon E, Grad H, Lawrence HP, et al. Efficacy of chlorexidine and calcium hydroxide containing medicaments against Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:618-24.

43. Menezes MM, Valera MC, Jorge AO, Koga-Ito CY, Camargo CH, Mancini MN. In vitro evaluation of the effectiveness of irrigants and intra-canal medicaments on microrganisms within root canals. Int Endod J. 2004;37:311-9.

44. Dametto FR, Ferraz CC, de Almeida Gomes BP, Zaia AA, Teixeira FB, de Souza-Filho FJ. In vitro assessment of immediate and prolonged antimicrobial action of chlorexidine gel as an endodontic irrigant against Enterococcus faecalis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:768-2.

45. Hems RS, Gulabivala K, Ng YL, Ready D, Spratt DA. An in vitro evaluation of the ability of ozone to kill a strain of Enterococcus faecalis. Int Endod J. 2005;38:22-9.

46. Gomes BP, Pinheiro ET, Gade-Neto CR, Souza EL, Ferraz CC, Zaia AA, et al. Microbiological examination of infected dental root canals. Oral Microbiol Immunol. 2004;19:71-6.
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