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Flashcards in Endo-Systematic Deck (23)
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1

Endodontic Infections

  • ____ of____ with oral bacteria
  • ¡Commonly linked to ___/____bacteria
  • ____,_____
    • ___
    • _____ ____
    • ____ ___ ___
    • __ __ __ ___ (____)
  • ____ infections
  • ¡among the ____ infections seen by dentists
  • ¡Pulp is very___ to___

Endodontic Infections

¡Infection of pulp with oral bacteria

¡

¡Commonly linked to caries/periodontal bacteria

  endogenous,polymicrobial

§pulp

§periapical area

§orofacial soft tissues

§bone of the jaw (osteomyelitis)

§

¡acute infections

¡

¡among the commonest infections seen by dentists

¡

¡Pulp is very sensitive to inflammation

2

Pulpal Infection Routes

 

¡caries

¡fractured tooth

¡microleakage from restorations

¡

¡dentinal tubules

¡lateral and accessory canals (periodontal disease)

¡anachoresis

3

Pulpitis through an Open Cavity

¡Due to ___ ___ exposure to the ___ and ___

Pulp can be exposed by 

___
___
____

 

¡High numbers of bacteria introduced directly into ___ ___

¡Inflammatory response can __ __ ___ to the pulp

__ ___ plus ___ of ____ lead to rapid ___ and ____ of tissue

¡

What kind of bacteria?¡_____________

¡

____

____

¡

¡Due to direct pulpal exposure to the mouth and saliva

§decay

§trauma

§Instrumentation

§

¡High numbers of bacteria introduced directly into sterile tissue

¡

¡Inflammatory response can cut off circulation to the pulp

¡

¡Bacterial challenge plus loss of circulation lead to rapid disintegration and liquefaction of tissue

¡

¡Mixed, mainly anaerobic infection

¡

¡Polymicrobial, endogenous!

¡

4

Pulpitis via Caries -Dentinal tubules

_____ and certain ____ dominate in advancing carious lesion

¡Bacterial penetration of tubules is ___, but ___ and other___ ___ diffuse quickly

¡Damage to ___ and ___ ___ ___

§may be ___ if the bacteria have not ___ __ ___

¡Bacterial invasion by ___ and ___, then ___ oral species

¡large numbers of ____

____ develop and ____

¡result is gradual ___ and ____ of pulp tissue

¡Lactobacilli and certain streptococci dominate in advancing carious lesion

¡Bacterial penetration of tubules is slow, but acids and other toxic products diffuse quickly

¡Damage to odontoblasts and local pulp tissue

§may be transient if the bacteria have not infected the pulp

¡Bacterial invasion by lactobacilli and streptococci, then other oral species

¡large numbers of PMN’s

¡microabscesses develop and enlarge

¡result is gradual death and liquefaction of pulp tissue

5

Pulpitis through the Apical Foramen, Periodontium

¡from a ___ ___ in communication with a ___ ___ ___(____-___ lesion)

¡from an adjacent ____ ____

_____ spread (_____)

¡Pulpitis from other ____ a risk factor* 

¡from a lateral canal in communication with a deep periodontal pocket (perio-endo lesion)

¡from an adjacent periapical lesion

¡hematological spread (anachoresis)

¡Pulpitis from other stimuli a risk factor* 

6

Microflora Associated with Endodontic Pulp Infection

¡Primary infections –____ infection; mostly gram-____  ____ ( O2) bacteria belonging to the genera, ____ ____ ___(____, ____, anaerobes, __________ complex)

¡

¡Secondary infections- ___ ___ ___; usually ___ or ___ ___ than primary infections, and are often gram-___ organisms and ___ – ____ ____

Microflora Associated with Endodontic Pulp Infection

¡Primary infections –pulp infection; mostly gram-negative anaerobic bacteria belonging to the genera, Porphyromonas, Prevotella, Fusobacterium, Treponema, Peptostreptococcus, Eubacterium, and Campylobacter (Endogenous, polymicrobial, anaerobes, orange and red complex)

¡

¡Secondary infections- failing root canal; usually singular or less diverse than primary infections, and are often gram-positive organisms and fungi – Enterococcus faecalis

7

Enterococcus faecalis

____organism

¡Common ___ ____ in ___ infections

¡___ to common treatments for root canals

  • ___
  • ___ resistant
  • ___ resistant
    • ▪___ ___

¡Strong association with __ __ __

¡Enteric organism

¡Common opportunistic pathogen in pulp infections

¡Resistant to common treatments for root canals

§Biofilms

§Antibiotic resistant

§Acid/Base resistant

▪Calcium hydroxide

¡Strong association with failing root canals

8

Pulpitis: Possible Complications

___ and _____ infection

 

___ of ___ to ___ ___ __

¡Abscess and peri-apical infection

¡

¡Spread of infection to local soft tissue

9

Microbiology of Dentoalveolar Abscesses

_____ infections

______

(O2) important

___ ____bacteria

___ ___bacteria

¡Endogenous infections

¡Polymicrobial

¡anaerobes important

§black pigmented bacteria

§non-pigmented bacteria

10

Black Pigmented Bacteria

_____

  • ____
  • _____

§

____

§P. ____

§P. ____

§P. ____—most prevalent

¡Porphyromonas

§P. gingivalis

§P. endodontalis

§

¡Prevotella

§P. melaninogenicus

§P. intermedia

§P. nigrescens—most prevalent

11

Strep. milleri group

Very common for them to be in these abscesses as well

12

Sites of Spread from a Dental Abscess

___ ____ is probably the better outcome because at least it is draining to the surface

If it doesn’t drain you may end up with ____

  • Infection moves to ___ __ of the ___ and ___

You will have ___ ___ ____ around site of infection

Teeth, circulatory system and soft tissue of the face are highways that the bacteria can move thru

Depending on which tooth is infected and where infection trying to drain things can go down or they can go up

If they get into soft tissue of face or neck that is an _____

Neck: that can cut off your___

Draining fistula is probably the better outcome because at least it is draining to the surface

If it doesn’t drain you may end up with cellulitis

Infection moves to soft tissue of face and neck

You will have heat tender swelling around site of infection

Teeth, circulatory system and soft tissue of the face are highways that the bacteria can move thru

Depending on which tooth is infected and where infection trying to drain things can go down or they can go up

If they get into soft tissue of face or neck that is an EMERGENCY

Neck: that can cut off your airway

13

Ludwigs Angina

¡Spreading infection of ___ and ___ ___, ___ infection

¡Cellulitis of ___ ___, little ___

___ swelling-____ may become compromised

¡90% of cases associated with ____ ____-____ flora

___/____, eliminate primary source of infection

 

¡Spreading infection of sublingual and submandibular space, acute infection

¡

¡Cellulitis of facial tissue, little pus

¡

¡Brawny swelling-airway may become compromised

¡

¡90% of cases associated with dental source-endogenous flora

¡

¡Amoxicillin/Metronidazole, eliminate primary source of infection

¡

14

Actinomycosis

¡“___ ____”

¡_____ region is most common site

¡usually ___ with history of ___ ___, ___ developing, ___ painful

___ ____ seen in lesion biopsy

____ _____—most frequent isolate

___ ____ required due to formation of ___ ____ around the lesions

___ ___antibiotic treatment—___ or ____

¡“Lumpy jaw”

¡

¡cervicofacial region is most common site

 

¡usually chronic with history of tooth extraction, slow developing, not painful

¡

¡sulfur granules seen in lesion biopsy

¡

¡Actinomyces israelii—most frequent isolate

¡

¡surgical drainage required due to formation of fibrous walls around the lesions

¡

¡long-term antibiotic treatment—penicillin or erythromycin

15

Oral Bacteria and Endogenous Infections

Brain abscess

Sinuses could get infected

Oral infections are most common in head and neck because that is closest to where the bacteria are

But they can also spread elsewhere in the body from the blood stream

 

Oral Bacteria and Endogenous Infections

Brain abscess

Sinuses could get infected

Oral infections are most common in head and neck because that is closest to where the bacteria are

But they can also spread elsewhere in the body from the blood stream

 

16

Transient bacteremias

__ ___ presence of bacteria in the___ , ___ ___

Often follows ___ or ____ procedures.

Daily activities like ___ and___  cause some bacteremia

Even people with good dental plaque

____ risk for the healthy

Their body handles it not problem

Can result in___ ____for the compromised

This is normal

We actually have organ in our body to deal with that

____: there to filter out bacteria that is transiently in the blood stream

___ ____ causes the most bacteria to go into the blood stream

Higher risk if you are dealing with the mucosa

Not everything is going to be the same amount of bacteria

Brain abscess

Piercing in mouth more susceptible to these infections

Transient bacteremias

Short term presence of bacteria in the blood, circulatory system.

Often follows dental or surgical procedures.

Daily activities like toothbrushing and eating cause some bacteremia

Even people with good dental plaque

Low/no risk for the healthy

Their body handles it not problem

Can result in local infections for the compromised

This is normalWe actually have organ in our body to deal with that

Spleen: there to filter out bacteria that is transiently in the blood stream

Dental extraction causes the most bacteria to go into the blood stream

Higher risk if you are dealing with the mucosa

Not everything is going to be the same amount of bacteria

Brain abscess

Piercing in mouth more susceptible to these infections

17

Infective Endocarditis

Infectious endocarditis is an infection of the l___ of the ___ ____ and ___ ___that is caused by__ ,____, or other ___ substances.

Results from ____ infection. Bacteria can enter the bloodstream during certain ___procedures, including ___ procedures, and ___ to the ___, where it can settle on ___ ___ ___.

The bacteria can ___ and may form__ ___that __ __and travel to the__ __ ___ ___

Most people who develop infectious endocarditis have underlying ___ __ or ___ ___

Often associated with dental procedures

Infective Endocarditis

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances.

Results from bloodstream infection. Bacteria can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves.

The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen.

Most people who develop infectious endocarditis have underlying heart disease or valve problems.

Often associated with dental procedures

18

Organisms involved:

Organisms involved:Alpha hemolytic strep

50% come from oral step

Skin 

19

Ventilator/Aspiration

Higher dental plaque levels predict the risk of___ ___ ___

 

 

Ventilator/Aspiration

Higher dental plaque levels predict the risk of ventilator-acquired pneumonia

 

 

20

Pregnancy Complications

Women with ___ to ___ ___ ___ or “___ ____ gingivitis” are more likely to give birth to ___ and ___ ___ ___ babies

Treatment of gingivitis during pregnancy with___ and ___ ____ has been shown to be ___(transient bacteremia don’t seem to cause problem to the baby), and ___ ____the risk for premature birth/low birth weight.

Not as much as you would think

Pregnancy Complications

Women with moderate to severe periodontal disease or “pregnancy associated gingivitis” are more likely to give birth to premature and low birth weight babies

Treatment of gingivitis during pregnancy with scaling and root planing has been shown to be safe (transient bacteremia don’t seem to cause problem to the baby), and slightly decreases the risk for premature birth/low birth weight.

Not as much as you would think

21

Association with Pregnancy

In animal models, infection with_____ causes

  • An increase in levels of _____ ___ and ___ ___ (may trigger___ ___)
    • From inflammation of oral infection
  • ___ of ___ ___

Oral bacteria have also been found infecting the____ in animal models, and the ___ ____and ____ in human studies.

Association with PregnancyIn animal models, infection with P. gingivalis causesAn increase in levels of Prostaglandin E2, and Interleukine -1 (may trigger early labor)

From inflammation of oral infection

Reduction of birth weight

Oral bacteria have also been found infecting the placenta in animal models, and the amniotic fluid and placenta in human studies.

22

The Placenta Harbors a Unique Microbiome

Several groups looking at what bacteria you expect to be associated with the placenta

Several papers looking at microbiome of placenta

They found that in healthy women with normal birthBacteria in the placenta came from the oral cavity

This can be a problem if you have bad oral flora

Treat the Mouth Before Pregnancy?

If you have periodontal disease when you get pregnant, your placenta is probably already compromised

Should treat BEFORE pregnancy

The Placenta Harbors a Unique Microbiome

Several groups looking at what bacteria you expect to be associated with the placenta

Several papers looking at microbiome of placenta

They found that in healthy women with normal birthBacteria in the placenta came from the oral cavity

This can be a problem if you have bad oral flora

Treat the Mouth Before Pregnancy?

If you have periodontal disease when you get pregnant, your placenta is probably already compromised

Should treat BEFORE pregnancy

23

Systemic Impact of Chronic Inflammation

Bacteria in the mouth can cause an increase in ___ ___ in the entire body, which has negative effects on certain health conditions

 

Systemic Impact of Chronic Inflammation

Bacteria in the mouth can cause an increase in inflammatory mediators in the entire body, which has negative effects on certain health conditions

Oral Microbiology