Lecture 2 - Oral Bacteria & Systemic Connections

Question 1

The oral microbiome consists of about ___ species of bacteria.

Answer 1

700

Question 2

Resistance against pathogens, metabolic functions, and immune activation are three mechanisms by which microbes are…

Answer 2

beneficial

Question 3

Chronic diseases are caused by microbial community _________ and loss of _______ species.

Answer 3

disruptions

healthy

Question 4

Antibiotics and antiseptics are therapies that focus on broad (nonspecific) _________ of germs.

Answer 4

eradication

Question 5

Probiotics, prebiotics, and targeted antimicrobials are therapies that encourage _______ communities.

Answer 5

healthy

Question 6

T/F

Oral bacteria can translocate to cause disease elsewhere in the body.

Answer 6

True

Question 7

T/F

Oral infections can release toxins that cause systemic problems.

Answer 7

True

Question 8

In the early 1900’s, teeth and tonsils were thought to be the source of many diseases and were ________. This focal infection theory was discredited by year ____.

Answer 8

removed

1930

Question 9

25 years ago, oral infections were linked with ___________ disease.

Answer 9

cardiovascular

Question 10

What are the two direct mechanisms for oral connections?

Answer 10

• translocation of bacteria

- translocation of toxin

Question 11

A distant site becomes infected via seeding by oral bacteria. Give an example of this mechanism.

Answer 11

• translocation of bacteria

- oral bacteria gain entry into circulatory system (bacteremia)

Question 12

A distant site effect from toxin produced by oral bacteria. Give an example of this mechanism.

Answer 12

• translocation of toxin

- endotoxin from gram negative bacteria in periodontal pocket enters circulatory system (promotes inflammation)

Question 13

Interleukin-1 (IL-1) gene polymorphisms associated with increase in periodontitis and systemic diseases is an example of what common pathway to disease?

Answer 13

Host hyper-inflammatory phenotype

Question 14

What constitutes good evidence for oral systemic effects?

Answer 14

• epidemiological studies (show association)

- evidence of causality (human trials, demonstration of effects)

Question 15

Platelets and fibrin adhere to exposed connective tissues producing ___________ __________ _________ (NBTE)

Answer 15

nonbacterial thrombotic endocarditis

Question 16

In infective endocarditis, bacteria from oral cavity enter blood stream (________) and adhere to NBTE.

Answer 16

bacteremia

Question 17

In infective endocarditis, adhered bacteria from oral cavity multiply and cause _______/_______ injury.

Answer 17

cardiac/valvular

Question 18

In infective endocarditis, multiplied bacteria are discharged into circulation producing what two conditions?

Answer 18

• emboli

- stroke

Question 19

The oral bacteria primarily responsible for infective endocarditis is…

Answer 19

streptococci (60+%)

Question 20

Two other oral bacteria associated with infective endocarditis are…

Answer 20

A. actinomycetemcomitans

Gemella

Question 21

Skin bacteria associated with infective endocarditis is…

Answer 21

staphylococci

Question 22

In theory, _________ ________ prevents hematogenous spread of bacteria (bacteremia).

Answer 22

antibiotic prophylaxis (AP)

Question 23

In practice, antibiotic prophylaxis (does or does not) prevent bacteremia?

Answer 23

does NOT

Question 24

T/F

There is no solid evidence that dental procedures are associated with infective endocarditis.

Answer 24

True

Question 25

What may reduce bacteremia?

Answer 25

good oral health and hygiene practices

Question 26

T/F Random bacteremia from dental procedures is more likely to cause infective endocarditis than routine activities (such as brushing or chewing).

Answer 26

False | Other way around - routine activities more likely to cause IE than dental procedures

Question 27

It's more important to optimize regular _____ ________ measures to keep bacterial load low than to give _________ _________.

Answer 27

oral hygiene | antibiotic prophylaxis

Question 28

What are the two causes of aspiration pneumonia?

Answer 28

- aspiration of oral secretions | - oral bacteria

Question 29

Give two examples of when airway protective reflexes may be compromised.

Answer 29

- physically handicapped | - elderly

Question 30

This is the leading cause of death from infection in those > 65 years old.

Answer 30

aspiration pneumonia

Question 31

Name one thing that can prevent lung infection.

Answer 31

Oral hygiene measures

Question 32

Bacteria in amniotic fluid, some of them common oral species, are associated with _______ ______.

Answer 32

preterm birth

Question 33

Periodontitis is associated with what three pregnancy-related conditions?

Answer 33

- preterm birth - low birthweight - pre-eclampsia

Question 34

T/F | Current evidence shows periodontal treatment reduces risk of preterm birth and low birthweight.

Answer 34

False | RCTs do not show reduced risk with treatment and current evidence for causal relationship is not strong

Question 35

Immunosuppressed patients (neutropenia, chemotherapy, transplant patients) have a high risk for disseminated _____ or _______ of oral origin.

Answer 35

strep | candida

Question 36

In immunosuppressed patients, the focus is on achieving and maintaining good ____ ______.

Answer 36

oral health

Question 37

T/F | There is a lack of evidence for relationship to dental treatment or efficacy of antibiotics in the immunosuppressed.

Answer 37

True

Question 38

What are three things to consider in the immunosuppressed patient?.

Answer 38

- invasiveness of the procedure - bacterial load - degree of immunosuppression (ANC)

Question 39

One of the best studied relationships between oral health and systemic disease is...

Answer 39

periodontitis and diabetes

Question 40

There is an increased prevalence of __________ in diabetics.

Answer 40

periodontitis

Question 41

In diabetics, treatment of periodontitis improves ________ control.

Answer 41

glycemic

Question 42

One of the more complex, but one of the first relationships studied is the relationship between...

Answer 42

cardiovascular disease and oral bacteria

Question 43

What species of bacteria is associated with the evidence for causality for cardiovascular disease and oral bacteria?

Answer 43

P. gingivalis (found in atherosclerotic lesions)

Question 44

Studies show an increased risk of _________ cancer in patients with periodontitis.

Answer 44

pancreatic

Question 45

T/F | Antibiotic prophylaxis for dental treatment is not recommended for a patient with a nonvalvular cardiovascular device.

Answer 45

True

Question 46

T/F Most infections of vascular grafts/stents and intravascular access devices are caused by bacteria native to skin and antibiotic prophylaxis for dental treatment is not recommended.

Answer 46

True

Question 47

Distinguish primary and secondary antibiotic prophylaxis with regard to joint prostheses.

Answer 47

Primary - at time of device placement unrelated to dental treatment (evidence supports this) Secondary - to reduce dental procedure-related bacteremia and distant site infection (lack of evidence to support this)

Question 48

What is the most common bacteria found in joint prostheses?

Answer 48

staphylococci

Question 49

T/F | There is no indication for antibiotics to prevent oral bacterial source for patients with pins, plates, and screws.

Answer 49

True

Question 50

Of the two types of cerebrospinal fluid shunts, ventriculo-peritoneal and ventriculo-atrial, which one is associated with a high rate of infection?

Answer 50

ventriculo-peritoneal

Question 51

To summarize, direct transfer of oral bacteria involves what 4 conditions?

Answer 51

- infective endocarditis - pneumonia in compromised airway - immunosuppression - preterm birth ..?

Question 52

Primary preventative strategies in direct transfer of oral bacteria include...

Answer 52

- improve oral health and reduce bacterial load | - AP indicated in specific high risk situations

Question 53

To summarize, transfer of oral bacteria, toxin, or the common inflammatory pathway involve what 3 conditions/diseases?

Answer 53

- Type 2 diabetes - cardiovascular disease - pancreatic cancer

Question 54

Primary preventative strategies in the transfer of oral bacteria, toxin, or common inflammatory pathway include...

Answer 54

- treat periodontal disease to improve microbial profile | - improve overall health by addressing risk factors

Question 55

T/F | There are no special oral precautions in patients with implanted devices/grafts/shunts/prostheses/etc.

Answer 55

True

Question 56

Name 4 things that encourage healthy oral bacterial communities.

Answer 56

- oral hygiene - healthy diets - fluoride - repair dentitions