Term
| For treatment to be evidence based, what two factors are ideally known? |
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Definition
1. Identity of the infecting organism 2. its antimicrobial susceptibility |
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Term
| What information is available for empirical treatment? |
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Definition
Statistical data and epidemiological data infecting organism and antibiotic susceptibility are not known |
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Term
What type of microbial isolates cause dental sepsis? What would be a recommended treatment? |
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Definition
Fusobacterium sp. Prevotella/Porphyromonas streptococci Penicillin + metronidazole |
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Term
| What are the basic components of penicillins and whats their MOA? |
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Definition
They have a Beta-lactam ring MOA: blocking synthesis of bacterial cell wall (peptidoglycan) |
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Term
| What are the five classes of penicillin, give at least one example of each. |
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Definition
1. Natural penicillin (Pen G, Pen V, Pen VK) 2. Penicillinase Resistant Penicillin (Methicillin, Cloxacillin) 3. Aminopenicillins (Ampicillin, Amoxicillin) 4. Carboxy-, indanyl, penicillins (Carbenicillin) 5. Extended spectrum penicillin (Azlocillin) |
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Term
| Who are UTIs common among and what is the prevalence? |
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Definition
Adolescent and young women (Rare in males) incidence of 0.5-0.7 episodes/person/year Recurrent UTIs become a problem in 25-30% of women |
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Term
| What is the most common bacterial infection in women? |
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Definition
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Term
| What is the UTI prevalence in young men? |
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Definition
5-8 infections per 10,000 men Elderly men have equal prevalence as women |
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Term
| What are some risk factors for UTIs |
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Definition
Coitus (Esp. with diaphragm) Prior UTIs Family history of UTIs Pathologies Obstruction Tumors/calculi Neurogenic Bladder Diabetes Mellitus |
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Term
| What are UTI risk factors in postmenopausal women? |
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Definition
Incontinence Residual urine (after peeing) Cystocoele Loss of lactobacillus and increase of E. coli |
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Term
| What bacterium is the primary cause of UTIs |
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Definition
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Term
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Definition
Pyuria (urine with pus) Bacteriuria (urine normally sterile) Acute dysuria (painful urination) presence of leukocytes in urine -5-10 leukocytes in microscope view |
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Term
| What is the preferred treatment for cystitis in women? |
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Definition
If no risk for renal invasion: 3 day regimen of TMP-SMX* or Fluoroquinolones -NO beta-lactam agents! (penicillin) If risk for renal invasion: Min. 7-10 day treatment TMP-SMX* or Fluoroquinolones *TMP-SMX means sulfonamide antibacterial combination of trimethoprim and sulfamethoxazole, in the ratio of 1 to 5, used in the treatment of a variety of bacterial infections. |
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Term
| What is the most common nosocomial (hospital related) infection and what is the most common cause? |
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Definition
UTIs are most common nosocomial infection Most often catheter-related |
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Term
| Why are pathologic changes in the pulp, even small ones, cause so much pain? |
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Definition
The pulp is almost completely surrounded by hard tissue so instead of swelling it becomes compressed. This causes extreme pain and death of pulp |
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Term
| In the first half of the 20th century, what was the only treatment used for pulp infections? |
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Definition
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Term
| What factors evolved which made endodontics possible in the second half of the 20th century? |
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Definition
antibiotics better root canal debriders cements for obturation better understanding of bacteria |
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Term
| What organisms are generally associated with pulp infections? |
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Definition
endogenous oral bacteria (normally present in oral cavity) which gain access to the pulp by: -direct extension of caries -mechanical exposure -trauma -association with periodontal disease |
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Term
| What are four possible causes of pulp infections? |
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Definition
1. Direct extension of caries -cariogenic bacteria (strep or lactobacilli) 2. Mechanical exposure -Preparation of tooth -Pressure pushes bacteria down -Bruxism 3. Trauma occlusal trauma of any sort -anachoretic effect 4. Periodontal disease -accessory canals become infected and it spreads |
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Term
| What is a particularly hardy bacteria that causes pulp infections, has antibiotic resistance, and is commonly isolated from failed root canals. |
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Definition
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Term
| What are the four factors affecting the growth of microorganisms in the oral cavity? |
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Definition
1. redox potential facultative anaerobes (grows in oxy or no oxy) obligate anaerobes (oxygen toxic) 2. pH Saliva = 6.75-7.25 Acidogenicity/aciduricity 3. nutrients endogenous (from saliva) exogenous (from diet) 4. adherence |
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Term
| How are streptococci grouped? |
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Definition
According to hemolysis Alpha- greenish, weak hemolysis Beta- Strong, complete hemolysis Gamma- no hemolysis Also group by wall antigen |
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Term
| What are the stages of infection? |
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Definition
AAPDIS Access the host Adhere to tissues penetrate host defenses damaging tissues invasion of tissues spreading of infection |
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Term
| What is the general rule for bacterial adhesion? |
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Definition
Bacterial adhesion is SPECIFIC Any tissue can be an adhesion substrate, but not all bacteria can bind to all tissues |
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Term
| Discuss the steps in the process of plaque formation. |
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Definition
1. Clean surface 2. Pellicle Formation 3. Initial colonization 4. Plaque* 5. Calculus *Plaque- the complex microbial community found on tooth suface, embedded in a matrix of polymers of bacterial and salivary origin. |
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Term
| Under what conditions does a pellicle form? |
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Definition
Surface is bathed in saliva Salivary glycoproteins absorb to surface -lose their solubility -become altered by action of bacterial enzymes Pellicle is easily removed by brushing but immediately reforms -bacteria colonize right after formation |
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Term
| What are the different types of plaque and how long does it take for them to form? |
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Definition
Types: Immature -Lighter in color Mature plaque -More pathogenic Takes about 24hrs for immature plaque to form - |
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Term
| Explore the process of calculus formation. |
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Definition
Calculus is formed by the deposition of calcium and phosphate salts (in saliva) in bacterial plaque. Takes 24-72 hours for plaque mineralization to occur. Maturation takes about 12 days. Calculus augments disease and caries by providing foci (a structure/protection). Does not inately cause disease/caries. |
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Term
| What are some factors that increase calculus formation? |
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Definition
Elevated pH Elevated salivary calcium, protein, urea, and lipid concentration Elevated protein and lipid concentration |
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Term
Define periodontal disease |
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Definition
| Inflammatory response of gingiva and surrounding connective tissue by plaque accumulation at the gum line. |
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Term
| What are the two groups of periodontal disease and what is the difference. |
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Definition
Gingivitis Inflammation/bleeding of gingiva No bone loss or periodontal pockets Reversible Periodontitis Loss of bone structure loss of collagen attachment=deep pockets NOT Reversible |
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Term
| What is the genetic risk factor for periodontal disease? |
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Definition
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Term
| What are some common problems with identifying perodontopathogens? |
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Definition
1. Nature and complexity of the disease. -Different types of Perio, severity, and pocket dpth 2. Technical Considerations Microbial identification (Microscopic,culture, DNA assay, Immuno assay) Selection of sampling sites Problems Sampling (Site access, sampling methods) 3. Nature and complexity of dental plaque. -Can't cultivate species, varying virulence |
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Term
| Approximately what is the composition of subgingival plaque? |
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Definition
75-85% Gram Positive, Fac. Anaerobe (cocci/rods) -streptococci, actinomyces 13% Gram-negative strictly anaerobic rods -fusobacterium, capnocytophaga |
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Term
| Once formed, microbial flora of subgingival plaque remains relatively stable over time, this dynamic balance is known as _______. |
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Definition
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Term
Describe the shift in oral microbiota associated with the shift from chronic gingivitis to bleeding gingivitis. |
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Definition
In general, an increase in % of Actinomyces Chronic gingivitis has an increase of Actinomyces at the expense of streptococci. The next step to bleeding gingivitis shows a shift to higher % of Actinomyces naeslundii -With high number of Prevotella intermedia and bacteroides intermedius |
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Term
| What are the three types of bacteria associated with chronic periodontitis? |
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Definition
1. Porphyromonas gingivalis 2. Treponema denticola 3. Tanerella forsythensis |
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Term
| The transition from healthy gums to periodontitis is associated with an increase in ________. |
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Definition
Gram-negative strictly anaerobic rod-shaped bacteria More motile organisms |
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Term
| (T/F) Periodontitis is caused by a single organism. |
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Definition
False! periodontal pathogens act as part of a synergistic consortium aka polymicrobial. |
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Term
| Where do periodontopathogens come from? |
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Definition
Endogenous -Usually present in high numbers in host but normally in a supressed non-disease state. -More than 70% of the population.
Exogenous Not part of normal flora Vertical transmission of Aa (30-60%) Pg (rare) Horizontal Trans. of Aa (14-60%) Pg (30-75%) |
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Term
| What are the three types of Plaque Hypothesis? |
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Definition
1. Non-Specific -caused by wide range of bacteria 2. Specific Plaque -activity of single or select group of bacteria 3. Ecological Plaque -endogenous or exogenous oportunistic infection |
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Term
What are two common types of bacteria associated with periodontal disease. What host tissues do they attach to and what types of virulence factors do they have? |
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Definition
1. P. gingivalis -Attaches to hydroxyapatite, epithelial cells -V. Factors are LPS, hemagglutinins, protease, fimbiae 2. A. actinomycetemcomitans -Attaches hydroxyapatite, epithelial cells, collagen -V-factors fimbriae, pili, MAV, EAM, surface proteins |
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Term
| What causes a change in oral microbiota that leads to periodontal disease? |
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Definition
An alteration in the local environment (Ecological Plaque Hypothesis) |
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Term
| What type of bacteria are associate with most periodontal disease? |
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Definition
| Gram-negative obligate anaerobes |
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Term
| Describe pathogenic synergism in periodontal disease |
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Definition
Periodontal disease is caused by a combination of virulence factors, which are expressed by a variety of bacterial pathogens in the periodontal pocket. NOT BY A SINGLE PATHOGEN! |
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