#2 Oral Microbiome and Systemic Disease

Question 1

2 aims of the Human micro biome project

Answer 1

-characterize microbial communities form multiple human body sites-find correlations between micro biome changes and human health

Question 2

we used to think of microbes as “germs” that are pathogenic invaders but now we are switching our thinking to believe that some are _____

Answer 2

essential

Question 3

3 ways microbes are beneficial

Answer 3

-resistance against pathogens-metabolic functions-immune activation (if kids are too clean they will have immune problems later in life)

Question 4

old goal of bacteria vs new goal of bacteria

Answer 4

old: sterile environmentnew: manage and preserve NATIVE microbes

Question 5

old way of thinking in which it was believed that a disease is caused by a single cause

Answer 5

Koch’s postulate*now we now it is a community disruption and loss of healthy species

Question 6

what are two example of OLD therapies that focused on broad eradication

Answer 6

-antibiotics-antiseptics

Question 7

what are three examples of NEW therapies to encourage healthy communities

Answer 7

-probiotics (yogurt)-prebiotics (encourages growth of good bacteria)-targeted antimicrobials

Question 8

idea that oral “focus of infection” causes systemic disease

Answer 8

theory of focal infection*Hippocrates cured arthritis by pulling a tooth

Question 9

this was an old way thought to treat mental illness

Answer 9

therapeutic eduntulation (pulling teeth)*ended by 1930

Question 10

when did evidence for connections between oral infections and systemic diseases start?

Answer 10

25 years ago with cardiovascular disease

Question 11

oral-systemic connections

Answer 11

-infective endocarditis (infection of heart valves)-pneumonia-cardiovascular disease-type 1 diabetes-cancer-preterm birth-immunosuppression-biofilm infections on implanted devices

Question 12

what are the two direct mechanisms for oral connections to systemic diseases?

Answer 12

-translocation of bacteria (seeded by oral bacteria)-translocation of toxin (produced by oral bacteria)

Question 13

what two things constitute good evidence for oral systemic effects?

Answer 13

-epidemiologic studies (no correlation)-evidence of causality —human trials show tx prevents disease—presence of oral bacteria at disease site—effect in animal model

Question 14

spread of bacteria throughout the blood

Answer 14

bacteremia

Question 15

60% of the oral bacteria

Answer 15

streptococci (sanguis, mitis, mutans)

Question 16

in practice does antibiotic prophylaxis prevent bacteremia?

Answer 16

no

Question 17

what are the two risks to antibiotics?

Answer 17

-allergy-cost

Question 18

T/F dental procedures associated with infective endocarditis

Answer 18

False

Question 19

how do you reduce the risk of getting Infective Endocarditis?

Answer 19

-good health and hygiene-optimize regular hygiene measures to keep bacterial load low than give antibiotic prophylaxis

Question 20

aspiration pneumonia is caused by what two things?

Answer 20

-aspirations of oral secretions-oral bacteria

Question 21

when is Pneumonia seen?

Answer 21

common when airway protective refexes compromised—physically handicapped or elderly

Question 22

what prevents lung infection?

Answer 22

oral hygiene measuresreduce nosocomial pneumonia by 40%could prevent 10% of deaths in nursing homes

Question 23

how is preterm birth carried out?

Answer 23

bacteria in the amniotic fluid, some of them common oral species, associate with it

Question 24

does periodontal tx reduce the risk of pre-term birth or low birth weight?

Answer 24

no*no strong evidence for cause and effect relationship

Question 25

tx of periodontitis improves what?

Answer 25

glycemic controlshows causality btw periodontitis and diabeteshyperactive innate immune response of both*synergistic effect on inflammation

Question 26

what is the effect of treating oral bacteria to help with cardiovascular disease

Answer 26

effect is modest

Question 27

inc risk of what type of cancer with periodontitis

Answer 27

pancreas

Question 28

cardiovascular implantable electronic device infections are caused by what?

Answer 28

bacteria from skin of pts or hands of hospital workers or environment*recommend NO antibiotic prophylaxis for dental treatment

Question 29

____ rates are high when the infection is around a vascular graft/stent *90% caused by bacteria native to skin or bowel

Answer 29

mortality *recommend NO antibiotic prophylaxis for dental treatment

Question 30

what percentage of joints become infected

Answer 30

1-2%morbidity is highmost infections occur in preoperative period from wound contamination

Question 31

evidence for PRIMARY antibiotic prophylaxis relating to joints is when?

Answer 31

at the time of device placement

Question 32

is there any dental risks associated with joints?

Answer 32

no

Question 33

concerning joints, late infections occur from where?

Answer 33

hematogenous seeding

Question 34

is there an indication for antibiotics to prevent oral bacterial source for pts with pins, plates, and screws?

Answer 34

no

Question 35

is prophylaxis recommended with cerebrospinal fluid shunts?

Answer 35

nono vascular structures so low bacteremiahigh rate of infection

Question 36

do dental procedures cause infections with CSF shunts?

Answer 36

no

Question 37

what conditions involve DIRECT TRANSFER OF ORAL BACTERIA?

Answer 37

-infective endocarditis-pneumonia in compromised airway-immunosuppression-preterm birthprimary preventative strategy is to improve oral health and reduce bacterial loadantibiotic prophylaxis is indicated in specific HIGH RISK situations

Question 38

what conditions involve TRANSFER OF ORAL BACTERIA OR TOXIN, OR COMMON INFLAMMATORY PATHWAY

Answer 38

-type II diabetes-cardiovascular disease-pancreatic cancerprimary preventative strategy is to treat periodontal disease to improve microbial profileimprove overall health by improving risk factors

Question 39

what conditions involve NON ORAL CONDITIONS

Answer 39

-cardiovascular implantable electronic devices-vascular grafts/stents-intravascular access devices-prothetic joints-bone pins, plates, screws-renal dialysis shunts-CSF shunts*no specific oral precautions