Enterococcus faecalis in dental infections: Virulence factors, molecular characteristics, antibacterial and anti-infective techniques

Enterococcus faecalis is a commensal bacterium inhabiting the gastro-intestinal tract of humans. Interestingly, although it is not clear whether E. faecalis is part of the oral cavity microbiome, it is frequently recovered from root canal infections. Specifically, it is the major pathogen found in persistent infections associated with root canal treatment failure. Moreover, E. faecalis is one of the leading multidrug resistant nosocomial pathogens, causing infective endocarditis, and participating in urinary tract, wound, and device-device-related infections. The present chapter discusses E. faecalis virulence factors contributing to its high prevalence in nosocomial infections and root canal post treatment disease, including its ability to compete with other microorganisms, its cell to cell communication, its ability to invade various tissues, resist nutritional deprivation, facilitate the adherence of host cells and extracellular matrix, produce an immunomodulatory effect and cause toxin-mediated damage. Antiseptic techniques, conventional as well as novel, to overcome the survival ability of E. faecalis as well as virulence factors, are discussed in detail.