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Micro Flashcards

(49 cards)

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1
Q

4 types microbes in canal? most common?

A

bacteria (most), fungi, viral, prion

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2
Q

What 2 findings ended focal infection era

A
  1. blayney - endo infection can be treated with good tx

2. grossman - pulpless treated tooth can have healthy PDL

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3
Q

Culturing established most infected pulps had what bacteria?

A

73-90% anaerobes

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4
Q

Pyrosequencing est how many species bacteria in infected pulps? how many possibl?

A

40, 400+

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5
Q

Top 3 root canal bacteria

A

F nucleatum
Strep sp
Bacteroides

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6
Q

bacteria vs symptomatic teeth?

A

more symptomatic = more bacterial diversity

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7
Q

Interactive and associative characteristics of canal infections

A

interactive - selection for anaerobic

Associative - certain bacteria associate with certain others

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8
Q

Pathogenesis depends on 3 factors for infection

A
  1. density of bacteria
  2. virulence factors
  3. host resistance
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9
Q

4 main ecological factors of canal

A

Low Oxygen Tension
Low Reduction-Oxidation Potential
Nutrient-Rich
Byproducts

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10
Q

Fabricius found what about # anaerobes over time in canal?

A

increased over time;

by 1080 days, 98% are obligate anaerobes

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11
Q

8 virulence factors

A 
Fimbriae
Capsules
Extracellular vesicles
Enzymes
Metabolic byproducts
LTA
LPS (endotoxin)
Synergism
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12
Q 
Effects of:
Collagenase: 
Chondroitin Sulfatase: 
Hyaluronidase: 
Kinases:
Gelatinase: 
Proteases:  
Coagulase:  
Hemolysins:  
Leukocidin:  
DNA-ase:
A 
Collagenase: Destroys collagen
Chondroitin Sulfatase: Digests ground substances
Hyaluronidase: Digests ground substances
Kinases: Fibrinolysin
Gelatinase: Proteolytic
Proteases:  Proteolytic
Coagulase:  Activates fibrin clots
Hemolysins:  Destroys RBCs
Leukocidin:  Destroys WBCs
DNA-ase:  Destroys nucleic acids
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13
Q

ex of metabolic byproducts

A

sulfur granules produced by israeli

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14
Q

LTA is what, stimulates what

A

Lipoteichoic acid, part of gram+ wall, stimualtes specific immune response

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15
Q

LPS is what

A

endotoxin/lipopolysaccharides

from gram negative

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16
Q

LPS can cause what

A

fever, bone resorption, vasomotor shock, and T-cell stimulation

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17
Q

Speed of LPS spread vs bacteria?

A

can progress through canal/tubules faster than bacteria

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18
Q

3 patterns of synergism

A

planktonic, aggregates, Biofilms

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19
Q

Planktonic synergism most common in what kind of infections

A

acute purulent

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20
Q

81% infected RC samples have what kind of synergism

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A

co-aggregation

21
Q

what is a biofilm

Study These Flashcards
A

Polybacterial communities embedded in a polysaccharide matrix and attached to a surface

22
Q

communication methods (2) within biofilms

Study These Flashcards
A

quorum sensing, share genes

23
Q

5 ways biofilms resist

Study These Flashcards
A

Diffusion gradient – slow antimicrobial penetration requires 100-1000x [abx|
Many bacteria are in the stationary phase
Neutralizing reactions deplete antimicrobials
Persister cells – spore like/dormant
break down Ca++ from dentin and use as walls

24
Q

Viruses indirectly increase virulence how

Study These Flashcards
A

bacteriophages inject virulence factor DNA into bacteria

25
types of viruses directly implicated in RC infection
CMV/EBV
26
Why are CMV/EBV implicated in symptomatic infections?
increase proinflammatory cytokines
27
Bleach irrigant composition? SPectrum? Unique bc? bad bc?
5.25% NaOCl Broad spectrum Only irrigant that dissolves organic material Toxic if extruded from canal, must continuously replenish
28
Chlorhexidine concentration? Kills what? effect on tissue? Caution when used with what?
2% Kills bacteria No tissue dissolution Not toxic unless mixed with bleach, forms parachloroanaline
29
EDTA concentration? What kind of agent/action? Action vs microbes? Used in conjuction with what?
17% chelating - opens tubules and enhances penetration No antimicrobial activity Conjunction with bleach
30
MTAD is what?
Mixture of Tetracycline, citric Acid, and Detergent (Tween 80)
31
Does MTAD contain bleach? Affect on tissue? Adjunct with what? Better than other adjunct?
No No tissue dissolution Bleach, but not better than EDTA
32
Majority of endo infections require abx?
NO
33
Indications of abx in endo (8)
Fever Immunocompromised Lymphadenopathy Malaise Cellulitis Osteomyelitis Swelling Trismus FILM COST
34
Abx of choice? | Abx for PCN allergic?
PenVK | Clinda
35
Considerations for use of Augmentin/Amox? | For Metronidazole?
Aug/Amox - broad spectrum and $$$, use only for immunocompromised Metro - Only affective against obligate anaerobes, cant use alone.
36
Rank abx in decreasing susceptibility?
``` Augmentin Clinda Amox PenVK Metro ```
37
Can abx cure endo infections? What is their function?
No, only cured by removing infected tissue; they assist in restoring proper balance
38
Two mechanisms of resistance transfer?
vertical (daughter) horizontal (to other strains not even exposed)
39
Contraindications of abx in endo? (3) What could these be?
Pain without signs of infection (Symptomatic irreversible pulpitis, Acute periradicular perio) Asymptomatic teeth with necrotic pulps (asymptomatic apical perio) Teeth with sinus tract (chronic apical abcess)
40
``` PenVK Major advantage? Spectrum? Drug of choice for? Major disadvantage? Dose? ```
Major advantage? Low cost, low toxicity Spectrum? High effectiveness against anaerobic in root Drug of choice for? periradicular abcesses Major disadvantage? can cause allergy in 10% Dose? 1g loading, 500mg q6h for 5-7d
41
``` Amox Major advantage? Spectrum? Drug of choice for? Major disadvantage? Dose? Relationsihp to Augmentin? Dose? ```
Major advantage? More rapid absorption, longer halflife, higher serum levels Spectrum? extended (vs PenVK) Drug of choice for? medically compromised, serious odontogenic infections Major disadvantage? Resistance Dose? 1g loading, 500mg q8h for 5-7days Augmentin is Amox + Clavulanate for beta-lactamase bacteria Dose: 875/125mg q12h for 7d
42
``` Clinda Major advantage? Spectrum? Drug of choice for? Major disadvantage? Dose? ```
Major advantage? high conc in bone Spectrum? gram positive, anaerobes Drug of choice for? pen allergic pt Major disadvantage? can cause pseudomembranous colitis Dose? 600mg loading, 300mg q8h for 5-7days
43
``` Metronidazole Major advantage? Spectrum? Drug of choice for? Major disadvantage? Dose? ```
Major advantage? used in combination with penicillin if symptoms worsen/resistance Spectrum? narrow; anaerobes only Drug of choice for? resistant to pcn Major disadvantage? many bacteria resistant Dose? 1g loading, 500mg q6h for 5-7d
44
Erythromycin spectrum?
none vs anaerobes
45
``` Clarithromycin aka? Clarith and Azith Spectrum? Major disadvantage? Dose? ```
Spectrum aerobic coverage but not ideal food/metal slow absorption 500mg loading, 250mg q12h for 5-7d Azith same but qd
46
Cephalosporins first vs second gen? How many % cross react with pen?
1st - no efficacy 2nd - better vs aerobes 15% cross react
47
Tetracycline/Doxycycline good b/c but bad bc?
very broad spectrum but may produce resistance
48
Quinolones aka? Spectrum? Good for?
Ciprofloxacin Bad against anaerobes in RC infections Persistent infections with sensitivity testing
49
Abx treat ____ not ____
treat infection not pain

Endo (9 decks)

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