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MOUTH NF path Flashcards

1
Q

saliva contains

A
  • lysozyme: attacks bac cell walls
  • lactoperoxidase: prod. hypohalides (antimicrob.)
  • lactoferrin: chelates iron–>restricts microbe access to iron
  • IgA: appear in saliva thru transudation not active sec.
  • sec. blood group Ag (glycolipids): blocks microbial attachment
  • buffering capacity
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2
Q

persons with this have higher #s of bac, more probs with oral cavity infections, dental caries, gum recession, etc.

A

saliva production deficiency (Sjogren’s syndrome, radiation-ind., drug-induced xerostomia)

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3
Q

the gingival sulcus contains

A

IgG and other transudated imm.globs, complement, PMNs, exp. during inflamm. states

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4
Q

factors which alter oral NF

A 
sig. change in diet
presence/absence of teeth
absence of saliva
Ab tx
hospitalization: G+-->G-rods
change in immune status (suppress.)
overall health
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5
Q

clin sig oral NF: aerotolerant anaerobes: G+ a-hemolytic streptococci:

A

s. mutans, s. sanguis, s. salivarius, s. mitis

* also etiologic agents of endocarditis (disp. NF), dental caries (OG @ origin)!

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6
Q

clin sig oral NF: facultative anaerobes

A

Eikenella corrodens (G-rod): causes skin/soft tissue ing/abscesses (mouth/hd), bite wounds
(@ origin or disp. NF)
Actinomycetes israelii: (G+, thin, branching filaments w/ clubbed ends): soft tiss. absc. in mouth/head(@ origin) and bronchial-pulm inf. by direct tiss extension and aspiration of saliva/oral fluids w/ org. (disp. NF)

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7
Q

anaerobes present on teeth, saliva, gingival crevices (can spread to lungs, blood)

A

Treponema denticola, T. vincentii (spirochetes)
Fusobacterium spp. (G-rod)
Porphyromonas gingivalis (G-rod)
Prevotella intermedia (G- rod)
Bacteroides forsythus (G-rod)
Aggregaitbacter (form. Actinobacillus)- actinomycetemcomitans (G- coccobacillus)
*all can cause periodontal disease (OG @ origin)

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8
Q

faculative anaerobes

A

yeast : Candida spp, C. albicans

oral thrush, dental stomatitis, pharyngitis (OG @ origin)

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9
Q

dental caries

A

demineralization at tooth
endogenous origin, mixed NF–>cariogenic orgs
e.g. S. mutans (G+ cocci)–>acid prod. via fermentation

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10
Q

dental caries risk

A

high sucrose diets, high simp. sugars, carbs
non fluoridated water
accum. of plaque from not cleaning

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11
Q

DC transmission

A

Streptococcus mutans: trans. in family units/close contacts

humans: resevoir

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12
Q

DC not freq. observed in

A

the v. young (it’s a chronic process)

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13
Q

DC pathogenesis

A 
chronic, slow, not self-limiting
biofilm formation (mult. genera)-->calcifies (tartar)-->chronic, slowly prog.
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14
Q

DC mechanism

A

bac ferment sugar–>org. acid (lactic)–>solubilize hydroxyapatite–>demineralize enamel/dentin–>caries

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15
Q

DC mech depends on pres. of bac that

A

produce organic acids (ferm. of sugars) and water INSOLUBLE glucans (via glycosyltransferase)

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16
Q

fermentation results in..which lead to..

A

cracks, fissures, erosions, pits w/ calculus/tartar

dentoalveolar inf.

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17
Q

immunitity to DC

A

adaptive imm. is Ab mediated : prev. binding of cariogenic orgs. to tooth surface
-vaccine not need due to water fluoridation

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18
Q

DC s/s

A

cracks, fissures, erosions, pits w/ calculus/tartar–> tooth ache

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19
Q

DC tx

A

removed dis. tissue, replace w/ inert restoration

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20
Q

prev/control of DC

A

change diet: avoid ref. sugar
inc. oral hygiene
fluoride (hyroxyapatitie–>fluorohydroxyapatite)
sealants
future prevention: sp. targeted antimicrob. pep: STAMP: C16G2

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21
Q

dentoalveolar infections

A

pyogenic infections of tooth and surrounding tissues

agents: oral and carious flora that have gained access to inner tooth tissue
risk: those w. dental caries or traumatic injury

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22
Q

dentalv inf. pathogenesis

A

via caries or trauma, orgs. get to inner tooth tissue–>microb. invasion of pulp w/ pulpits–>if drainage blocked–>pulpal necrosis, invasion of alveolar bone–>

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23
Q

end result of dentalv. inf

A

periapical or acute alveolar abscess and osteomyelitis

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24
Q

dentalv. inf immunity

A

Ab mediated

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25
dentalv. s/s
tooth sensitive to pressure, percussion, heat, cold, etc. +/- drainage
26
dentalv dx
clinical s/s + caries or enamel compromise | radiographs to detect silent lesions, esp. in interproximal caries (btw teeth)
27
dentalv tx
dep. on severity | - elim of inf. pulp, deep periodontal scaling, drainage if abscesses, tooth extraction if req, analgesics
28
ppx, prevention of dentalv. inf
avoid sugar, inc. hygiene, fluoride, sealants, C16G2 STAMP (same as caries)
29
Gingivitis-->Periodontal disease
NF induce inflamm. via imm system to attack tooth and supporting structures (gingival, period. lig, alv. bone, cementum) s/s: painless gum bleeding-->sig. pain, pungent breath and reabsorption of bone and tooth loss
30
gingivitis
plaque builds on teeth and gingival margins/crevices and calcifies-->inflamm. and friability of gingiva
31
orgs of chronic gingivitis
Prevotella intermedia, Bacteroides sp., Fusobacterium spp. (G- rod)
32
orgs of acute ulcerative gingivitis (Vincent's disease, trench mouth)
Treponema denticola, T. vincentii (Spirochetes) | Prevotella intermedia, Fusobacterium spp (G-rod)
33
Periodontitis
inflamm. and invol of deeper tissue, involvement of periodontal lig. and alv. bone (chronic)-->tooth loss
34
destruction of supp. structs is
irreversible bac invade and cause inflammation thru niche in plaque-->neutros stim to rel. lysosomal contents (mettalprot/elastases)-->tiss destr.-->bac. hide from imm sys. in tooth and in supra/sub gingival plaque (biofilm) and inhib. neutrophil phagocytosis
35
this org. subverts norm cell surface rec-IC sig to cause imm. dysfunc
Porphyromonas gingivalis
36
P. gingivalis can colonize gum via... | and can be sustained via..
C5a rec C3 (comp cascade can be damaging!)
37
forms of periodontitis: classic periodontitis
retract. of gums, plaque pres., calculi abundant, bone resorption**
38
chronic periodontitis
periodontitis + loosening and sep. of teeth-->tooth loss abscess can form and involve period. lig and alv. bone *major cause of tooth loss in adults
39
localized juvenile periodontitis
severe, rapid progression, destructive *not plaque associated (no bone resorption?) org: Aggregaitbacter actinomycetemcomitans others: P. gingivalis, P. intermedia
40
periodontitis orgs
Porphyromonas gingivalis* keystone Prevotella intermedia Bacteroides sp. Fusobacterium spp. (G-rod)
41
periondontitis tx
remove plaque/tartar, antimicrob. tx (lose teeth by 30, 40 if untx)
42
necrotizing ulcerative gingivitis and periodontitis
(Vincent's dis, trench mouth) | like periodontitis, but more acute
43
NUGP orgs
Treponema spp. (spirochetes) Fusiform bac P. intermedia
44
NUGP affects
males 18-30 | risks: poor hygiene, malnutr., fatigue/stress, smtms mouth trauma
45
NUGP path/clin manif
like gingivitis + pt. more compromised s/s: 4 P's: papillae (irreg. necrotic ulcers), pseudomem. in aff. area (gray), pain, pungent breath + reg. lymphadenopathy, fever, malaise (syst.)
46
NUGP tx
syst. abx (PCN, metronidazole) top. antimicrobs and antiseptic rinse (3% H202) * thorough pro cleaning and good oral hygiene
47
loc. juv. periodontitis pop.
neutropenic kids, or have chemotaxis defects | Afr. Am, host factors
48
loc. juv. periodontitis path, s/s
not plaque assoc., immuncomp is the prob. "lazy leuk. syndrome", leuk adh. def s/s: gums look norm, X-rays show loss of alv. bone (1st molars and incisors)-->loss of perm teeth
49
loc. juv. period. tx
surg root debridement and resections of aff. tissue | tx w/ abx (metro, tetra)
50
cervicofacial actinomycosis org
Actinomyces isrealii
51
cervfac act risks
poor hyg (etOH), trauma, dent extra, orthodontics, hd/nk surg
52
cervfac act path
pyogenic abscesses w/ tiss fibrosis | compromise in muc. integ-->org gets to submuc. tiss-->spreads by extension along fascial planes
53
cervfac act s/s
slowly progress., chronic (wks, mod) low grade/no fever painful/unilat indurated lesion in peri/submandib. reg w. soft tiss. edema and erythema +/- cervical lymphad. mult. draining sinus tracts w/ "sulfur granules" (small yellow/white grains w/ macros + org. filaments @ periphery) (NOT pathognom.) *Histoplasma capsulatum and Nocardia can also have "sulfur granules"*
54
cervfac act dx
Gs of sulfur granule-->G+ thin branching filament (sulf. grans not always observed)
55
cervfac act tx
PCN, tetra | remove source of inf.: disrupt abscess, drain pus, debride dead tiss, remove tooth/root canal
56
Ludwig's Angina
cellulitis, involves subling, submax, submand soft spaces-->airway compromise, asphyxiation, death
57
Ludwig's org
Actinomyces israelii (& other Actins)
58
Ludwig's risks
adults w/ caries, dentalv inf., trauma to enam/dent
59
Ludwig's path
dentalv inf-->spreads via facial planes to subs spaces (2nd/3rd molars often originating source)
60
Ludwig's s/s
bilateral** sub spaces rapid (w/in 24 hrs) spreading indurated cellulitis +/- abscess or lymp. involvement (nk lymphadenitis) inf. on floor of mouth-->swell. elevation of floor, pushes tongue to roof, swollen hard nk, diff eating/swallowing/breathing, mouth held open edema of nk and glottis-->airway obstr/asphyx +/- fever/syst. signs
61
Ludwig's tx
``` systemic abx (PCN, amox, metro) maintain airway (intub, trach) surg debridement/drainage ```
62
Stomatitis
inflammation of oral mucosal membranes (pharyngitis (sore throat))
63
Oral candidiasis- "thrush" and dental Stomatitis caused by
Candida albicans (yeast, euk fungi) 3 forms: yeast, pseudohyphae, hyphae biofilms in CV caths, dentures NF of mouth: fungal spores germ as sing. round cells-->oval/elong., repr. by budding form moist or mucoid colonies (resemb. bac colonies)
64
Oral candidiasis pop
newborns, Ca pts., abx therapy, AIDs pts, dentures (65%!)
65
oral candidiasis pres/s/s
white-->yellow "cottage cheese" patches in mouth oral pain-->don't try to remove patches-->exc. bleeding inflamm: eryth, edema, sore throat, gums, tongue, etc friable & tender under lesions
66
if have oral candidiasis and immuncomp(T cell suppr)
can present w/ candidal esophagitis
67
oral cand. dx
s/s, wet mount microscopy of saline or KOH prep: yeast w/ pseudohyphae, Gs
68
oral cand. tx
anti fungal drugs/rinses: ketoconazole

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