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Flashcards in MOUTH NF path Deck (68):
1

saliva contains

-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

2

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

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

3

the gingival sulcus contains

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

4

factors which alter oral NF

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

5

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

s. mutans, s. sanguis, s. salivarius, s. mitis
*also etiologic agents of endocarditis (disp. NF), dental caries (OG @ origin)!

6

clin sig oral NF: facultative anaerobes

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)

7

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

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)

8

faculative anaerobes

yeast : Candida spp, C. albicans
oral thrush, dental stomatitis, pharyngitis (OG @ origin)

9

dental caries

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

10

dental caries risk

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

11

DC transmission

Streptococcus mutans: trans. in family units/close contacts
humans: resevoir

12

DC not freq. observed in

the v. young (it's a chronic process)

13

DC pathogenesis

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

14

DC mechanism

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

15

DC mech depends on pres. of bac that

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

16

fermentation results in..which lead to..

cracks, fissures, erosions, pits w/ calculus/tartar
dentoalveolar inf.

17

immunitity to DC

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

18

DC s/s

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

19

DC tx

removed dis. tissue, replace w/ inert restoration

20

prev/control of DC

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

21

dentoalveolar infections

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

22

dentalv inf. pathogenesis

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-->

23

end result of dentalv. inf

periapical or acute alveolar abscess and osteomyelitis

24

dentalv. inf immunity

Ab mediated

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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