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Gastrointestinal > Oral And Dental Infections > Flashcards

Oral And Dental Infections Flashcards

1
Q

Are oral bacterial infections usually monomicrobial or polymicrobial?

A

Polymicrobial

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2
Q

What are dental caries?

A

Localized destruction of the tenth due to acids produced during bacterial fermentation of carbohydrates

Acidic production in the mouth causes:

  • lower pH
  • ecological shift from S. Oralis/Sanguis species (normal) -> MS. Lactobacilli (abnormal)
  • demineralization of teeth
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3
Q

Dental caries epidemiology

A

Most prevalent chronic disease of childhood

High dental caries rates are associated with:

  • increased carbohydrate consumption
  • low socio -economic status
  • meth use
  • developing nations
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4
Q

“Meth Mouth”

A

Meth use causes all of the following:

1) xerostomia (dry mouth)
- this is bad since saliva has natural antibacterial properties and buffers acid production

2) clenching/grinding of teeth
- bad since it wear enamel down

3) low overall oral hygiene
4) cravings for high carbohydrate/sugar foods and beverages

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5
Q

“Baby bottle tooth decay”

A

Front teeth caries seen in childhood due to repeated ingestion of sweetened liquids

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6
Q

What are the 4 main factors in development in caries?

A

Plaque microorganisms

Host factors present:

  • teeth
  • saliva (antimicrobial properties and possess large amounts of Ca and P ions = remineralization)
  • oral hygiene

Time

Diet (amount of carbohydrates)

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7
Q

Streptococcus mutans

A

Is part of normal oral flora

Gram (+) cocci bacteria that induces lactic acid fermentation in the presence of high carb diets
- decreases pH and initiates dental caries

  • does this via glucosyltransferase*
  • turns sucrose into glucan molecules which stick to teeth
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8
Q

Lactobacillus

A

super small part of normal flora, higher numbers is either pathogenic or in response to an already low pH environment

Gram (+) bacilli bacteria that induces lactic acid fermentation in the presence of high carb diets

  • decreases pH and initiates dental caries
  • also further progresses caries formation after initiating of streptococcus mutans
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9
Q

Actinomycosis Viscosus

A

Is not a part of the normal mouth flora

Gram (+) bacilli that has an unknown role, but is known to function in root surface caries
- needs caries to be formed already to colonize

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10
Q

Veillonella species

A

Normal oral flora that combats caries production

Gram (-) cocci that is anaerobic and in the presence of lactate, produces weaker acids to raise the pH in the mouth
- elevated pH kills other bacterial species that forms caries

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11
Q

What is the most cariogenic sugar?

A

Sucrose
- is the prime substrate in lactic acid fermentation

in dental carries used by S. Mutans to form glucan’s which are used for adherence

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12
Q

Diagnosis of caries

A

White spot on tooth enamel = early

Fissure lesions often appear brown

Root lesions appear leathery

Cavitation viewed by eye (if severe) or by light-induced fluorescence

Use of probe = soft on texture with (+/-) tenderness

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13
Q

What two cariogenic bacteria are most closely tied to caries activity based on amount?

A

strep mutans and lactobacillus species

High = >10^6 mutans and >10^5 lactobacillus

Low = <10^5 mutans and <10^4 lactobacillus

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14
Q

Treatments of dental caries

A

1) removal of lesions and followed up by replacement with restoration material
- fillings/sealants/etc

2) use of remineralization agents

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15
Q

What is fluoride’s action in prevention of dental caries?

A

Makes minerals of the teeth less soluble in acid

  • flurosis = excessive exposure to fluoride while permanent teeth are developing
  • looks like a white stripe along edges of teeth
  • is usually benign and is a cosmetic issue*
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16
Q

How does normal flora in mouth shift from healthy -> periodontitis?

A

Healthy:

  • (+) cocci and rods dominant
  • facultative organisms dominant

Gingivitis:

  • (+) cocci and rods are equal to negative rods
  • facultative organisms dominant

Periodontitis:

  • (-) rods are dominant
  • anaerobic organisms dominant

increases in actinomycetes, capnocytophaga and anaerobic organisms increase in gingivitis

increases in Porphyromonas gingivalis and prevotella intermedia and anaerobic organisms in periodontitis

17
Q

Chronic gingivitis

A

Inflammatory response limited to marginal gingiva without bone loss of deep periodontal pockets
- is reversible with good oral hygiene and removal of plaque/calculus

Common signs/symptoms:

  • red swollen gingiva
  • bleeding gums
  • halitosis
18
Q

Periodontitis

A
  • predominant cause of tooth loss in adults*
  • gets worse with age

Progression of gingivitis which includes:

  • loss of collagen attached to tooth and bone
  • loss of bone
  • deep periodontal pockets

spreading of plaque causes periodontal pocket formation -> increases anaerobic environment and increased replication of anaerobic organisms

Signs/symptoms:

  • inflamed gingiva
  • gingival recession
  • bleeding pockets
  • tooth mobility/migration
  • bone loss around teeth
  • halitosis
19
Q

What is the primary organisms responsible for chronic periodontitis?

A

Porphyromonas gingivalis

  • normal flora opportunistic bacterium that only thrives in acidic environments (stays in check until caries form)
  • is asaccharolytic: can use sugars as fuel but can also use amino acids and lipids*

Is a BLACK PIGMENTED anaerobic gram (-) coccobacilli
- virulence factors = fimbriae, hemagglutinins, hemolysis, proteases, K antigens (capsule)

20
Q

Other chronic periodontitis species

A

Prevotella intermedia
Tannerella forsythia
these two can only use saccharides as fuel sources (saccharolytic)

Capnocytophaga

  • Gram (-) bacilli that is fusiform/spindle shape and has gliding motility
  • is a facultative anaerobe and capnophilic
  • *is associated only with aggressive periodontitis**
21
Q

Treatment of chronic periodontitis

A

Mechanical therapies

  • removal of plaque and inflamed tissues
  • replacement of lost teeth

Oral hygiene improvements

Antimicrobial agents

  • mouthwashes
  • antibiotics (tetracycline/doxycycline (#1)/metronidazole)
22
Q

Aggressive periodontitis epidemiology

A

Rare with possible genetic links (unknown for sure thou)

  • occurs in younger adults
  • more common in Asians and west Africans
  • more common in females
  • associated with immune deficiencies

currently tetracycline is the most effective

23
Q

Acute necrotizing ulcerations gingivitis (ANUG)

A

Is very aggressive periodontitis

Epidemiology:

  • poor oral hygiene
  • malnutrition
  • heavy smoking
  • emotional stress
  • recent infections

Sings/symptoms:

  • gingiva are red, inflamed, shiny, and bleeding with ulcers
  • lesions are painful with pseudomembrane
  • metallic taste in mouth with halitosis
  • NO fever/malaise or lymphadenopathy

Treatment:

  • removal of plaque and local debridement
  • improve oral hygiene
  • tetracycline antibiotics
24
Q

What organisms are predominant in ANUG?

A

Fusobacterium nucleatum

  • gram (-) bacilli
  • normal flora obligated anaerobic that is in check until acidic conditions

Treponema vincentii; denticola

  • gram (-) spirochete
  • obligate anaerobe
25
Q

What is requirements for confirmatory diagnosis of ANUG

A

2 components

1) fusospirochetal complex must be present
2) leukocytes must be present in surrounding tissues

in addition to clinical signs/symptoms

26
Q

NOMA

A

Severe ANUG

Epidemiology

  • young children <10 yrs
  • developing countries
  • severe malnourishment
  • recent infections of viral pathogens or TB

In a compromised immune system, the lesion can spread and cause permanent tissue destruction and disfigurement

Treatment:

  • debridement of tissue and reconstructive surgery is required in all cases
  • tetracycline antibiotics to stop spread
27
Q

Dentoalveolar infections

A

Are pyogenic infections of the teeth and supporting structures
- usually caused by normal flora bacteria due to caries and surgical procedures

28
Q

Dentoalveolar abscesses

A

Pathogenesis = varies but most common are prevotella, Porphyromonas and fusobacterium species

Signs/symptoms:
- vary with pathogen virulence and host response

Treatment:

  • drain pus and remove source of infection
  • tetracycline antibiotics to prevent hematogenous spread
29
Q

Ludwigs angina

A

Pathogenesis: * polymicrobial*

  • prevotella, Porphyromonas, fusobacterium, anaerobic streptococcus species
  • usually spreads from dental or post extraction infections and spreads to sublingual or submandibular spaces

Signs/symptoms:

  • swelling of glottis/tongue can lead to airway obstruction
  • fever
  • swelling of the front of the neck (usually bilaterally but can be unilateral)

Treatment:

  • ensure airway remains open
  • tetracycline antibiotics
  • surgical drainage
30
Q

Periodontal abscesses

A

Pathogenesis: monomicrobial
- prevotella, Porphyromonas, fusobacterium, spirochete, capnocytophaga, actinomycosis, anaerobic streptococcus species

Signs/symptoms:

  • red, swollen and tender gingiva overlying abscess
  • continuous pain and pain with mastication
  • loss of teeth and periodontal tissues (chronic)

Treatment:

  • extraction of teeth (may or may not be required)
  • drainage of pus and irrigation of pocket with mouthwash
  • tetracycline antibiotics
31
Q

Cervicofacial actinomycosis

A

Pathogenesis:
- actinomycosis infections caused by trauma of invasive oral procedures

Signs/symptoms:

  • submandibular region is most commonly affect = “lumpy jaw”
  • swelling and fibrosis of the area
  • gritty/sand-like yellow pus

Treatment:

  • drainage
  • penicillin antibiotics
32
Q

Actinomycosis Israeli

A

Most common pathogenic cause of cervicofacial actinomycosis

Is a gram (+) branched bacilli

  • anaerobic
  • “molar tooth” colonies morphology
33
Q

Oral candidiasis

A

Caused by opportunistic infections in immunocompromised populations

Pathogenesis:

  • candida species adhere to fibronectin and extracellular matrix to form pseudohyphae
  • pseudohyphae penetrates underlying tissues

Signs/symptoms

  • “cottage cheese” thrush on tongue/buccal mucosa and palate
  • dysphagia and extreme halitosis
34
Q

Oral viral infections

A

Caused by HSV, VZV and coxsackie A viruses

1) HSV 1/2: both can cause oral and genital lesions
- usually HSV-1= oral and HSV-2 = genital
Signs/symptoms:
- usually asymptomatic with cold/sores and fever blisters and gingivostomatitis

2) VZV (HSV-3/shingles)
- asymptomatic lesions that follow along nerve ganglia dermatomes

3) coxsackie A
- herpangina
- hand foot mouth disease
- aseptic menginits

35
Q

Herpetic whitlow

A

Finger lesions seen in patients with HSV infections

Gastrointestinal (71 decks)

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