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D2 Fall - Endodontics > 9/3: Microbiology of the RC System > Flashcards

9/3: Microbiology of the RC System Flashcards

1
Q

How can endodontic infections be classified?

A

Location
Symptoms
Degree of virulence
Organization

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2
Q

What are the types of locations?

A

Intraradicular
Extraradicular

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3
Q

Intraradicular is caused by bugs colonizing

A

Within the RCS

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4
Q

Extraradicular infection is usually a sequel to

A

Untreated intraradicular infection

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5
Q

Extraradicular infection is characterized by

A

Microbial invasion of the periradicular tissues

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6
Q

What are the 3 subclasses of intraradicular infections?

A

Primary infections
Secondary infections
Persistent infections

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7
Q

This is caused by bugs that initially invade and colonize necrotic pulp tissue within the RCS

A

Primary infections

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8
Q

These are caused by bugs no present in primary infection but introduced into the RCS

A

Secondary infections

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9
Q

Secondary infections are ______ by definition

A

Iatrogenic

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10
Q

This infection is due to failure of RCT to heal

A

Persistent infection

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11
Q

The ability to form ____ has been regarded as a virulence factor

A

BIO

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12
Q

What bacteria products contribute to virulence?

A

Enzymes
Endotoxins and exotoxins
LPS
Peptide/amino acids

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13
Q

This is a virulent facultative anaerobe

A

Staph aureus or S. pyogenes

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14
Q

S. Aureus is thought to produce

A

Penicillinase

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15
Q

What can penicillinase do?

A

Render penicillin ineffective

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16
Q

Rx augmentin =

A

Amoxicillin + Clavulanic acid (inhibits penicillinase)

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17
Q

biofilm is enmeshed in _____, this is usually known as _____

A

extracellular polymeric substance (EPS), polysaccharide

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18
Q

can antibiotics prevent swelling and fever?

A

Yes - useful in acute P-R infecions or who are immunologically supressed

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19
Q

can antibiotics treat necrotic pulp?

A

No - pts with symptomatic pulpitis, symptomatic apical perio, a DST, or localized swelling do NOT require antibiotics

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20
Q

can systemic antibiotics be used to treate infection such as cellulits?

A

Yes

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21
Q

Biofilm is adhered to the

A

Root canal walls

21
Q

The canal walls/spaces are conducive to formation of

A

Biofilm

22
Q

Is there a single microorganism responsible?

A

no

23
Q

What is the progression of RC system infections?

A
  1. Caries lesions opens tubules
  2. Bacteria inflame pulp locally
  3. Inflammation may overcome pulpal defenses and localized abscesses in pulp
  4. Infections in the pulp and necrosis
  5. Necrosis involves entire RC system
  6. Infections use portals of exit to invade periradicular tissues
  7. Periradicular infection occurs beyond apex
24
Q

What is the “portal of exit”?

A

Apical foramen
Lateral canals

25
Q

Biofilm must accomplish ____ things to cause disease within the RC system

A

6

26
Q

What 6 things does biofilm need to accomplish?

A
  1. Microorganism must adhere to host surfaces
  2. Obtain nutrients from the host
  3. Multiply
  4. Invade tissue
    5.Overcome host defenses
    Induce tissue damage
27
Q

This is defined as a multicellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self produced matric of extracellular polymeric substance

A

Biofilm

28
Q

What bacteria is MOST COMMON in primary endodontic infections

A

Anaerobic gram

29
Q

What are some anaerobic gram bacteria?

A

Porphyromonas
Prevotella
Peptostreptococcus
Streptococcus
Actinomyces
Olsenella
Propionibacterium

30
Q

Chronic infections with the RC system tend to favor

A

Anaerobic bacterial flora

31
Q

All endo infections are

A

Mixed (polymicrobial)

32
Q

Most endo infections have what bacteria?

A

Facultative and obligate anaerobes

33
Q

What can we use for obligate anaerobes?

A

NaOCl liberates O2

34
Q

What can be used to liberate O2?

A

NaOCl

35
Q

Biofilm becomes more varied and complex when the tooth is further challenged by

A

Salivary contact
Operative contamination

36
Q

In order to avoid biofilm becoming more complex, we should

A

Avoid leakage of rubber dam
Avoid iatrogenic contamination

37
Q

How do we destroy biofilm?

A

NaOCl (9.3% sodium hypochlorite)

38
Q

What are the 6 functions of NaOCl?

A

Disinfects over time
Dilutes and inactivates toxins
Dissolves substrates over time
Dissolves necrotic tissue over time
Flushes and floats out debris
Lubricates canal

39
Q

The use of antibiotics to relieve pain is

A

Useless

40
Q

Systemic antibiotics are useful only in

A

Acute P-R infections (swelling or fever)
Immunologically suppressed

41
Q

If a healthy patient with systemic signs and symptoms of infection but with symptomatic pulpitis, symptomatic apical periodontitis, a drinking sinus tract, or localized swelling ________

A

Do not require antibiotics

42
Q

When do we use antibiotics in endo?

A

Persistent or spreading infection
Systemic involvement w/ Temp of 100+
Medically compromised
Pre-med

43
Q

This is a serious infection in the fascial plane

A

Cellulitis

44
Q

If a lesion exits coronal to muscle attachment, it is generally on attached gingiva or alveolar mucosa and we have a

A

Localized abscess

45
Q

Is there systemic involvement in a localized abscess?

A

No

46
Q

These spaces are formed as a result of spread of purulent exudate

A

Fascial spaces

47
Q

The spread of infections of odontogenic origin into the fascial spaces of the head and neck is determined by

A

Location of the root end of the involved tooth

48
Q

We should be especially vigilant with infection of the mandibular molars (2nd and 3rd molars) when cellulitis occurs in the submandibular spaces, why?

A

Access from S-M spaces to sublingual and submental spaces, this is ludwig’s angina and life threatening

49
Q

With cellulitis of the submandibular spaces, the infection pointed apical to the attachment of what muscles?

A

Mylohyoid muscles
Superior to the platysma muscles

D2 Fall - Endodontics (7 decks)

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