Citric acid has the ability to change the surfaces of the treated root by removing the smear layer, expose the dentinal tubules and making the tubules appear wider and with funnel-shaped orifices. In periodontal disease, exposed cementum show accumulation of plaque and calculus on root surface with loss of collagen cross banding. Citric acid partially exposes the collagen from radicular dentin that improves fibrin linkage and inhibits epithelial down growth to stimulate fibrous attachment and migration, it also acts as a potent antibacterial agent. Periodontal diseases are a bacterial infection that destroys the gum and the bone that hold the teeth in the mouth. Periodontal disease can affect one tooth or many teeth. The mean cause of periodontal disease is a bacterial plaque. Periodontal disease is multifactorial; tobacco, hormonal change, genetic, stress, some medications, destructive habit, poor nutrition, systemic diseases, and chronic periodontitis is the condition that results in inflammation within the soft tissue surrounding the teeth causing progressive attachment and bone loss. Demineralization of dental root surface exposed to periodontal disease is widely employed in periodontology to recreate a biologically active substrate for cell reattachment and cementogenesis. When citric acid demineralization was combined with growth factors on disease human root surface, increased proliferation of the fibroblast for human periodontal ligament was produced in culture. The first step in the physiological mechanism of bone remodeling is demineralization by local production of acid by the osteoclasts. Studies had shown citric acid can cause collagen fiber exposure which augments the connective tissue attachment to the root surface. The aim of the study is to estimate the effect of citric acid on different bacterial growth caused by periodontitis.

Periodontal disease is the most frequent reason for teeth extraction in patients over 40 years of age. Identification of the microorganisms responsible for periodontal pathology and their relation to periodontal inflammation in addition to their accurate management are some of the goals of recent dental, as well as general medical research. Streptococcus mutans is an aciduric Gram positive bacterium which may be naturally found in saliva and dental plaque. In the present study, Streptococcus mutans strain was isolated from swabs taken from the periodontal area of chronic periodontitis patients before teeth extraction. A higher presence of S. mutans in patients with chronic moderate or severe periodontitis before extraction of teeth might derive from a lower oxygen tension within the periodontal pockets. This is in accordance to studies by Cortelli et al.  and Dani et al. who found a high proportion of this microorganism in subgingival plaque samples of chronic periodontitis patients.

Elevated Streptococcus mutans levels appear directly coassociated with untreated periodontal disease. Concentrations of citric acid of (0.4, 0.5, 0.75, 1) g/ml were proved to be effective in removing smear layer of the periodontal area for teeth with periodontitis, so it could be suggested to be used as a root conditioning agent. Attention should be given to periodontitis patients who may harbor pathogenic microorganisms in the oral cavity so as to decrease the risk of systemic infections.

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