diagnostics sessions

Question 1

appropriate clinical specimen for cariogenic MO in 4-5 year olds

Answer 1

young children involved - general swab of saliva or tooth surface

minimal invasiveness

Question 2

cariogenic MO

Answer 2

s.mutans
lactobacillus
veillonella

anaerobic cariogenic bacteria

Question 3

would you isolat cariogenic bacteria from 4-5 year old mouth swabs from county

Answer 3

probably would not - large sample size and difficulty to differentiate diverse colonies

Question 4

possible methods isolating cariogenic bacteria from 4-5 year old mouth swabs from county

Answer 4

antibiotic resistance zone of clearance
molecular biology - DNA probes, PCR
enzymatic activity biochemical identification tests (next generation sequencing NGS etc)

Question 5

Do you think acquiring the knowledge on levels of carriage will impact the overall levels of caries in the Greater Glasgow & Clyde area for 4-5 year olds?

Answer 5

yes - establish baseline prevalence data
compare to other sites nationally/internationally
can be used to monitor changes over time
if significant can lead to wide range public health measures e.g. fluoridation

Question 6

preventative measures that can be implemented to minimise cariogenic bacteria carriage

Answer 6

OHI and diet advice

public health measures - higher F toothpaste, F varnish at schools and nurseries

Question 7

localised gingivitis with inflammation

what specimen and where from

Answer 7

subgingival plaque biofilm

paper point from gingiva crevice on site of inflammation (could take one from opposite of mouth and compare with health)

Question 8

organisms important in localised gingivitis with inflammation

Answer 8

porphyromonas gingivalis
prevotella intermedia
actinobacillus actinomycetemecomitans

Question 9

methods that can be used to identify culprit organisms

Answer 9

selective agars (need to know what you are looking for - assuming)
PCR
NGS
ideally grown on plates and undertake sensitivity testing

Question 10

how to determine cause and effect

Answer 10

removal of culprit organisms leads t resolution of disease - hard

Question 11

what tx options are available for localised gingivitis

Answer 11

OH - mechanical disruption - brushing and scaling

antisepsis - chlorohexidine potentially antibiotics if non-responsive

Question 12

does microbial knowledge of localised gingivitis in pt influence clinical management

Answer 12

probably not - still tx the same way as no clear way of stating one bacteria is responsible

Question 13

severe inflammation of upper palate of denture pt

caused by

Answer 13

denture associated biofilm

- candida interactions with bacteria and penetration as denture not cleaned effectively regularly

Question 14

MO associated with denture stomatitis

Answer 14

candida (albicans, glabrata, oral bacteria - use candida as scaffold)

Question 15

specimens to isolate denture stomatitis organisms

Answer 15

oral rinse or swab if more localised

Question 16

why important to identify MO in denture stomatitis

Answer 16

Differing resistance to antifungal medications so need to differentiate candida albicans from glabrata (c.g is completely resistant to azoles – fluconazole (make worse – need nystatin))

Question 17

systemic implications of indwelling prosthesis for pt

Answer 17

Yes – can progress into systemic candidiasis if enters the blood stream – morbidity risk – chronic inflammation link

possible aspiration pneumonia if sleep with it in

Question 18

pt pain tender and swollen, pain lower right mandible, elevated temperature
IO - abscess

microbiological concerns

Answer 18

systemically unwell - pt has elevated temperature and evidence of abscess

endo infection connecting to systemic circulation possible

Question 19

clinical specimen for abscess

Answer 19

sample of pus - needle aspirate (remove pus and relieve pressure)

Question 20

MO suspect in abscess

Answer 20

oral anarobes

Fusobacterium nucleatum, porphyromonas endodontalis, s.aureus (gram positive cocci)

Question 21

why necessary to ID MO in abscess

Answer 21

need oral microbiology lab to ID as MO associated with sepsis when pt showing systemic signs of infection

need to know its antibiotic sensitivity

Question 22

does the type of MO associated with abscesses have bearing on how you will take a sample

Answer 22

Obligate anaerobes are oxygen sensitive – so if you want t grow these you must be wary – need suitable transport media

Question 23

is timing of specimen collection and transport important

Answer 23

Yes as unless organism may not survive outwith the abscess lesion due to oxygen exposure (anaerobic) – need anaerobic transport media

Question 24

techniques to identify MO from abscess lesion

Answer 24

standard plate culture and possibility of microscopy

Question 25

systemic implications if abscess lesion not dealt with correctly

Answer 25

spreading odontogenic infection - possibility sepsis labour breathing high temperature Med emergency -> A&E

Question 26

management of abscess

Answer 26

needle in to drain - collect pus sample and relieve pressure need to put in transport media need for transport rapidly to test as anaerobic– what is it and what is sensitively

Question 27

abscess and clinical signs of sepsis (laboured breathing, fever)

Answer 27

taxi to hosp | risk of death

Question 28

when in clinical practice do you really need to carry out microbiology test

Answer 28

abscess

Question 29

best way to manage biofilm (future)

Answer 29

outgrow pathogenic microrganisms with good things (prebiotics, probiotics - manipulate biofilm towards health than disease)

Question 30

endo canal contains

Answer 30

spill over of bacteria from saliva

Question 31

common MO in secondary endo infection

Answer 31

Enterococcus faecalis

Question 32

how to tx secondary endo infection of Enterococcus faecalis

Answer 32

high sodium hypochlorite (toxic) and edta (EDPA inhibit microbial) Tx with standard irrigants – hard to get complete sterility – hard to get down into dentinal tubules

Question 33

issue with standard irrigants used in endo

Answer 33

Tx with standard irrigants – hard to get complete sterility – hard to get down into dentinal tubules When RC filled want to suppress microbial level so don’t have chance to grow

Question 34

microbiological role of RC filling

Answer 34

When RC filled want to suppress microbial level so don’t have chance to grow

Question 35

caries caused by

Answer 35

any bacteria that can metabolise sugar, starches (crisps, cereals)

Question 36

what is key factor caries development not recognised

Answer 36

retention in oral cavity

Question 37

pH for caries

Answer 37

needs to acidic

Question 38

is microbiological dx needed for caries

Answer 38

no OH advice

Question 39

most problematic candida

Answer 39

candida albicans - hyphe penetration but sensitive to antifungals

Question 40

candida glabrata

Answer 40

not sensitive to fluconazole if present in mixed candida infection - tx with fluconazole - albicans killed but not glabrata (grow rapidly now)

Question 41

1st line tx for candida

Answer 41

chlorohexidine

Question 42

if pt not responding to chlorohexidine candida tx

Answer 42

refer to oral med mixed infection – antifungal – fluconazole, then nystatin

Question 43

tea tree oil

Answer 43

broad spectrum antifungal

Question 44

nystatin act

Answer 44

kill candida albicans and glabrata but pt poor compliance due to taste but effective

Question 45

why is candidiasis a disease of the diseased?

Answer 45

immunocompromised, genetic predisposition, low neutrophil, polypharmacy – indicator - Die from other thing but immunocompromised have it too e.g. pneumonia Takes over edge

Question 46

azoles are

Answer 46

fungistatic

Question 47

pseudomembranous candidosis tx

Answer 47

scrape off before agent agents - capspofungin – not used in dentistry – used in systemic fungal infections - azole – useless – cannot diffuse through it

Question 48

azole action pseudomembranous candidiosis

Answer 48

useless – cannot diffuse through it | like how penicillin only works on actively growing cells

Question 49

if on clinic what is the best way to clean denture

Answer 49

place in plastic bag with some water into Ultrasonic bath

Question 50

key for denture stomatitis management

Answer 50

get pt to be compliant with removing denture at night and denture hygiene Need to maintain what you have in healthy state – only when disrupt this then invasive species can penetrate – e.g. change diet, OH regime

Question 51

persisting population of MO

Answer 51

Persist irrespective of tx – hard to completely sterilise a surface Persisted population re populate after cleaning if put media back Need something to be slow releasing to prevent them coming back Need to maintain what you have in healthy state – only when disrupt this then invasive species can penetrate – e.g. change diet, OH regime