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Sabeti M, Simon JH et al. J Endodon 2003; 29: 321–323

This interesting study reports findings from periapical lesions in 5 patients without a history of trauma who had experienced acute dental pain, and been referred to an endodontic practice, where examination revealed no restorations, caries, cracks, craze lines, sinus tracts, fractures, periodontal attachment loss > 2mm or apical radiolucencies, and virtually complete obliteration of pulp chamber and canals.

During treatment, the endodontist was unable to identify canals with a surgical microscope, and apicectomy was performed with retrograde root filling. During the latter procedure, extraradicular tissue was biopsied and subsequently examined by PCR for viral transcripts indicative of active infection.

Human CMV and EBV were identified in all lesions, but no active herpes simplex virus was found. The authors consider that activation of these latent herpes viruses (CMV and EBV) may account for the onset of symptoms, and suggest mechanisms.