#2 Oral Microbiome and Systemic Disease Flashcards
2 aims of the Human micro biome project
-characterize microbial communities form multiple human body sites-find correlations between micro biome changes and human health
we used to think of microbes as “germs” that are pathogenic invaders but now we are switching our thinking to believe that some are _____
essential
3 ways microbes are beneficial
-resistance against pathogens-metabolic functions-immune activation (if kids are too clean they will have immune problems later in life)
old goal of bacteria vs new goal of bacteria
old: sterile environmentnew: manage and preserve NATIVE microbes
old way of thinking in which it was believed that a disease is caused by a single cause
Koch’s postulate*now we now it is a community disruption and loss of healthy species
what are two example of OLD therapies that focused on broad eradication
-antibiotics-antiseptics
what are three examples of NEW therapies to encourage healthy communities
-probiotics (yogurt)-prebiotics (encourages growth of good bacteria)-targeted antimicrobials
idea that oral “focus of infection” causes systemic disease
theory of focal infection*Hippocrates cured arthritis by pulling a tooth
this was an old way thought to treat mental illness
therapeutic eduntulation (pulling teeth)*ended by 1930
when did evidence for connections between oral infections and systemic diseases start?
25 years ago with cardiovascular disease
oral-systemic connections
-infective endocarditis (infection of heart valves)-pneumonia-cardiovascular disease-type 1 diabetes-cancer-preterm birth-immunosuppression-biofilm infections on implanted devices
what are the two direct mechanisms for oral connections to systemic diseases?
-translocation of bacteria (seeded by oral bacteria)-translocation of toxin (produced by oral bacteria)
what two things constitute good evidence for oral systemic effects?
-epidemiologic studies (no correlation)-evidence of causality —human trials show tx prevents disease—presence of oral bacteria at disease site—effect in animal model
spread of bacteria throughout the blood
bacteremia
60% of the oral bacteria
streptococci (sanguis, mitis, mutans)
in practice does antibiotic prophylaxis prevent bacteremia?
no
what are the two risks to antibiotics?
-allergy-cost
T/F dental procedures associated with infective endocarditis
False
how do you reduce the risk of getting Infective Endocarditis?
-good health and hygiene-optimize regular hygiene measures to keep bacterial load low than give antibiotic prophylaxis
aspiration pneumonia is caused by what two things?
-aspirations of oral secretions-oral bacteria
when is Pneumonia seen?
common when airway protective refexes compromised—physically handicapped or elderly
what prevents lung infection?
oral hygiene measuresreduce nosocomial pneumonia by 40%could prevent 10% of deaths in nursing homes
how is preterm birth carried out?
bacteria in the amniotic fluid, some of them common oral species, associate with it
does periodontal tx reduce the risk of pre-term birth or low birth weight?
no*no strong evidence for cause and effect relationship
tx of periodontitis improves what?
glycemic controlshows causality btw periodontitis and diabeteshyperactive innate immune response of both*synergistic effect on inflammation
what is the effect of treating oral bacteria to help with cardiovascular disease
effect is modest
inc risk of what type of cancer with periodontitis
pancreas
cardiovascular implantable electronic device infections are caused by what?
bacteria from skin of pts or hands of hospital workers or environment*recommend NO antibiotic prophylaxis for dental treatment
____ rates are high when the infection is around a vascular graft/stent *90% caused by bacteria native to skin or bowel
mortality *recommend NO antibiotic prophylaxis for dental treatment
what percentage of joints become infected
1-2%morbidity is highmost infections occur in preoperative period from wound contamination
evidence for PRIMARY antibiotic prophylaxis relating to joints is when?
at the time of device placement
is there any dental risks associated with joints?
no
concerning joints, late infections occur from where?
hematogenous seeding
is there an indication for antibiotics to prevent oral bacterial source for pts with pins, plates, and screws?
no
is prophylaxis recommended with cerebrospinal fluid shunts?
nono vascular structures so low bacteremiahigh rate of infection
do dental procedures cause infections with CSF shunts?
no
what conditions involve DIRECT TRANSFER OF ORAL BACTERIA?
-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
what conditions involve TRANSFER OF ORAL BACTERIA OR TOXIN, OR COMMON INFLAMMATORY PATHWAY
-type II diabetes-cardiovascular disease-pancreatic cancerprimary preventative strategy is to treat periodontal disease to improve microbial profileimprove overall health by improving risk factors
what conditions involve NON ORAL CONDITIONS
-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
