Extreme resistance of Enterococcus faecalis and its role in endodontic treatment failure

A successful root canal treatment aims at complete elimination of microorganisms from the root canal space, thus preventing chances of reinfection. In spite of the relatively high success rate of endodontic procedures, failures occur. The high incidence of failure is attributed to microbial reinfection by facultative anaerobic microorganisms. The predominant microorganisms considered in secondary infections are Enterococcus faecalis. The objective of this review article is to provide a sound understanding of etiology and pathogenesis of the fundamental microbial pathogen. This article also provides an update on the virulence factors of E. faecalis, clinical significance, and treatment modalities to combat persistent endodontic infections. In the changing face of community oral care, continued research on E. faecalis and its elimination is of crucial importance. It is also likely that health-care professionals will benefit from this review and attain a deeper insight to deal with the highly complex nature of this organism.