M14: Oral Infections Flashcards

1. Give examples of the main bacterial, fungal and viral agents frequently detected in the mouth 2. Understand the classification of oral infections in terms of endogenous and exogenous infections of hard and soft tissues with examples 3. Describe how predisposing factors that disturb the oral flora can result in oral infections 4. Give examples of antimicrobial agents used to treat oral infectious agents (47 cards)

1
Q

Classifications of oral infections

A
  1. Bacterial, fungal and viral - bacterial infections aren’t due to a single causative agent
  2. Endogenous = caused by micro-organisms usually in mouth e.g. plaque-related caries and periodontal disease
  3. Exogenous = not in normal flora e.g. herpes simplex, primary syphilis and secondary manifestations of systemic infections e.g. TB, viral infections
  4. Hard and soft tissue infections
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2
Q

Name the causative or associated organisms with caries (hard tissue bacterial infection)

A

Streptococcus mutants

Lactobaccilli

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3
Q

Name the causative or associated organisms with dental abscesses (hard tissue bacterial infections)

A

Oral streptococci
Oral anaerobes

Untreated caries lesion causes abscess formation to skin surface

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4
Q

Name the causative or associated organisms with dry socket (hard tissue bacterial infections)

A

Actinomyces spp.

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5
Q

Name the causative or associated organisms with osteomyelitis (hard tissue bacterial infections)

A

Staphylococcus aureus

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6
Q

Name the causative or associated organisms with periodontal disease (gingivitis and periodontitis) - (soft tissue infection)

A

Porphyromonas
Prevotella
Capnocytophaga spp.
Aggregatibacter actinomycetemcomitans

HIV necrotising periodontitis occurs when the patient is immunocompromised so cannot fight off the transient microorganisms

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7
Q

Name the causative or associated organisms with acute ulceration gingivitis (soft tissue infection)

A

Fusobacterium spp.
Treponema spp.
Prevotella intermedia

Acute necrotising gingivitis = AUG - metronidazole will kill the anaerobes; presents as swollen gums with necrosis and loss of interdental papillae

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8
Q

Name the causative or associated organisms with pericoronitis (soft tissue infection)

A

Oral anaerobes
P. gingivalis
P. intermedia

Caused by trauma from opposing tooth and damages soft tissues

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9
Q

Name the causative or associated organisms with sialadenitis (soft tissue infection)

A

S. aureus (skin and nose)

Oral streptococci

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10
Q

Name the causative or associated organisms with actinomycosis (soft tissue infection)

A

Actinomyces israelii

Presents as multiple draining sinuses with sulphur granules present

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11
Q

Name the causative or associated organisms with gonorrhoea (exogenous soft tissue)

A

Nisseria gonorrhoeae

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12
Q

Name the causative or associated organisms with syphilis (soft tissue infection)

A

Treponema pallidum

Secondary syphilis presents as a snail-track ulcer on soft tissue

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13
Q

Name the causative or associated organisms with tuberculosis (soft tissue infection)

A

Mycobacterium tuberculosis

Presents as granulomatous oral ulceration

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14
Q

Name the causative or associated organisms with candidiasis (fungal soft tissue infection)

A

Candida albicans
Candida spp.

Variations:

  • acute pseudomembranous candidiasis = thrush
  • candidate leukoplakia
  • denture stomatitis
  • angular chelitis
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15
Q

Name the causative or associated organisms with herpetic stomatitis and cold sores (primary viral soft tissue infections)

A

Herpes simplex

Gingivostomatitis presents as self-limiting blistering ulcers

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16
Q

Name the causative or associated organisms with herpes zoster (shingles) - (primary viral soft tissue infection)

A

Varicella-Zoster

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17
Q

Name the causative or associated organisms with herpangina (primary viral soft tissue infection)

A

Coxsackie A

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18
Q

Name the causative or associated organisms with oral warts (primary viral soft tissue infection)

A

Papilloma

Presents as oral papillomatosis (wart)
HPV in HIV
Cytomegalovirus infection in HIV + patient
Kaposi’s sarcoma (herpes virus)

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19
Q

Name the causative or associated organisms with hand, foot and mouth disease (secondary viral soft tissue infection)

20
Q

Name the causative or associated organisms with glandular fever (secondary viral soft tissue infection)

A

Epstein-Barr virus

Presents as :
Infectious mononucleosis
Oral hairy leukoplakia

21
Q

What do disturbances in the oral microflora result in

A
  1. Selective growth of endogenous species e.g. candidiasis in AIDS patients
  2. Displacement of endogenous species e.g. actinomycosis following trauma to oral mucosa/jaw
  3. Introduction of exogenous micro-organisms e.g. oral TB lesions following trauma, E.coli bone infections following radiotherapy
22
Q

What oral infection does old age and infancy predispose and why

A

Candidiases
Root caries

Because there is decrease in antibodies and salivary flow rate

23
Q

What oral infection does pregnancy predispose and why

A

Gingivitis

Unknown cause

24
Q

What oral infection does localised trauma predispose and why

A

Opportunistic infections

Due to loss of tissue integrity

25
What oral infection does generalised trauma predispose and why
Candidiasis Due to general debilitation and dehydration
26
What oral infection does malnutrition predispose and why
Candidiasis Due to iron and folate deficiency
27
What oral infections do endocrine disorders predispose and why
Fungal infections Unknown cause
28
What oral infection does AIDS predispose and why
Candidiasis Opportunistic oral infections Due to reduction of host immune defences
29
What oral infection does antibiotic therapy predispose and why
Candidiasis Opportunistic oral infections Due to loss of colonisation resistance Selection of resistant flora
30
What oral infection does chemotherapy predispose and why
Candidiasis Caries Due to xerostomia and local mucosal effects
31
What oral infection does oral malignancies predispose and why
Caries Candidiases Xerostomia and loss of muscular function
32
What is metronidazole
It is an antimicrobial with increased activity against anaerobic bacteria
33
Metronidazole prescription
400mg BD or 200my TDS for 5-7days
34
Side effects of metronidazole
Metallic taste, effects on alcohol
35
What is amoxicillin
Broad spectrum antimicrobial with good oral absorption - works by interfering with cell Wal synthesis
36
Amoxycillin prescription
250mg - 500mg TDS for 7 days
37
Side effects of amoxicillin
Predisposes candidiasis
38
What is tetracycline
Antimicrobial for periodontal infections and herpes gingivostomatitis = broad spectrum antibiotic
39
Tetracycline prescription
250mg QDS for 5 days
40
Side effects of tetracycline
Risk of exacerbating renal failure | Don't give to patients with renal disease, children <12 and those pregnant or breast feeding
41
What is nystatin and prescribe this
Polyene anti fungal (not absorbed by gut) Patients with xerostomia find it difficult 100,000 units QDS for 7 days
42
What is ketoconazole and prescribe this
Systemic imidazole anti fungal Shouldn't use in patients with liver diease/alcoholics 200mg OD 14 days
43
What is miconazole and prescribe this
Gel and denture lacquer which is applied to clean dentures 25mg/ml used QDS for 14 days
44
What is amphotericin and prescribe this
Polyene anti fungal (not absorbed by gut) Lozenges 10mg QDS for 10-15 days
45
What is fluconazole and prescribe this
Systemic triazole anti fungal well absorbed in mouth with a better toxicity profile which is expensive 50mg OD 7-14 days
46
When is topical acyclovir used
Treatment for recurrent herpes labialis applied in prodromal phase - antiviral applied 5% cream QDS 6 times daily for 5 days
47
When is systemic acyclovir used
For healthcare workers treating immunocompromised patients and those who present herpes infection within 48hrs Primary HSV = 200mg 5 times daily for 5 days Herpes zoster = 800mg 5 times daily for 7 days