diagnostics sessions Flashcards
appropriate clinical specimen for cariogenic MO in 4-5 year olds
young children involved - general swab of saliva or tooth surface
minimal invasiveness
cariogenic MO
s.mutans
lactobacillus
veillonella
anaerobic cariogenic bacteria
would you isolat cariogenic bacteria from 4-5 year old mouth swabs from county
probably would not - large sample size and difficulty to differentiate diverse colonies
possible methods isolating cariogenic bacteria from 4-5 year old mouth swabs from county
antibiotic resistance zone of clearance
molecular biology - DNA probes, PCR
enzymatic activity biochemical identification tests (next generation sequencing NGS etc)
Do you think acquiring the knowledge on levels of carriage will impact the overall levels of caries in the Greater Glasgow & Clyde area for 4-5 year olds?
yes - establish baseline prevalence data
compare to other sites nationally/internationally
can be used to monitor changes over time
if significant can lead to wide range public health measures e.g. fluoridation
preventative measures that can be implemented to minimise cariogenic bacteria carriage
OHI and diet advice
public health measures - higher F toothpaste, F varnish at schools and nurseries
localised gingivitis with inflammation
what specimen and where from
subgingival plaque biofilm
paper point from gingiva crevice on site of inflammation (could take one from opposite of mouth and compare with health)
organisms important in localised gingivitis with inflammation
porphyromonas gingivalis
prevotella intermedia
actinobacillus actinomycetemecomitans
methods that can be used to identify culprit organisms
selective agars (need to know what you are looking for - assuming)
PCR
NGS
ideally grown on plates and undertake sensitivity testing
how to determine cause and effect
removal of culprit organisms leads t resolution of disease - hard
what tx options are available for localised gingivitis
OH - mechanical disruption - brushing and scaling
antisepsis - chlorohexidine potentially antibiotics if non-responsive
does microbial knowledge of localised gingivitis in pt influence clinical management
probably not - still tx the same way as no clear way of stating one bacteria is responsible
severe inflammation of upper palate of denture pt
caused by
denture associated biofilm
- candida interactions with bacteria and penetration as denture not cleaned effectively regularly
MO associated with denture stomatitis
candida (albicans, glabrata, oral bacteria - use candida as scaffold)
specimens to isolate denture stomatitis organisms
oral rinse or swab if more localised
why important to identify MO in denture stomatitis
Differing resistance to antifungal medications so need to differentiate candida albicans from glabrata (c.g is completely resistant to azoles – fluconazole (make worse – need nystatin))
systemic implications of indwelling prosthesis for pt
Yes – can progress into systemic candidiasis if enters the blood stream – morbidity risk – chronic inflammation link
possible aspiration pneumonia if sleep with it in
pt pain tender and swollen, pain lower right mandible, elevated temperature
IO - abscess
microbiological concerns
systemically unwell - pt has elevated temperature and evidence of abscess
endo infection connecting to systemic circulation possible
clinical specimen for abscess
sample of pus - needle aspirate (remove pus and relieve pressure)
MO suspect in abscess
oral anarobes
Fusobacterium nucleatum, porphyromonas endodontalis, s.aureus (gram positive cocci)
why necessary to ID MO in abscess
need oral microbiology lab to ID as MO associated with sepsis when pt showing systemic signs of infection
need to know its antibiotic sensitivity
does the type of MO associated with abscesses have bearing on how you will take a sample
Obligate anaerobes are oxygen sensitive – so if you want t grow these you must be wary – need suitable transport media
is timing of specimen collection and transport important
Yes as unless organism may not survive outwith the abscess lesion due to oxygen exposure (anaerobic) – need anaerobic transport media
techniques to identify MO from abscess lesion
standard plate culture and possibility of microscopy
systemic implications if abscess lesion not dealt with correctly
spreading odontogenic infection - possibility sepsis
labour breathing
high temperature
Med emergency -> A&E
management of abscess
needle in to drain - collect pus sample and relieve pressure
need to put in transport media need for transport rapidly to test as anaerobic– what is it and what is sensitively
abscess and clinical signs of sepsis (laboured breathing, fever)
taxi to hosp
risk of death
when in clinical practice do you really need to carry out microbiology test
abscess
best way to manage biofilm (future)
outgrow pathogenic microrganisms with good things (prebiotics, probiotics - manipulate biofilm towards health than disease)
endo canal contains
spill over of bacteria from saliva
common MO in secondary endo infection
Enterococcus faecalis
how to tx secondary endo infection of Enterococcus faecalis
high sodium hypochlorite (toxic) and edta (EDPA inhibit microbial)
Tx with standard irrigants – hard to get complete sterility – hard to get down into dentinal tubules
issue with standard irrigants used in endo
Tx with standard irrigants – hard to get complete sterility – hard to get down into dentinal tubules
When RC filled want to suppress microbial level so don’t have chance to grow
microbiological role of RC filling
When RC filled want to suppress microbial level so don’t have chance to grow
caries caused by
any bacteria that can metabolise sugar, starches (crisps, cereals)
what is key factor caries development not recognised
retention in oral cavity
pH for caries
needs to acidic
is microbiological dx needed for caries
no
OH advice
most problematic candida
candida albicans - hyphe penetration
but sensitive to antifungals
candida glabrata
not sensitive to fluconazole
if present in mixed candida infection - tx with fluconazole - albicans killed but not glabrata (grow rapidly now)
1st line tx for candida
chlorohexidine
if pt not responding to chlorohexidine candida tx
refer to oral med
mixed infection – antifungal – fluconazole, then nystatin
tea tree oil
broad spectrum antifungal
nystatin act
kill candida albicans and glabrata
but pt poor compliance due to taste but effective
why is candidiasis a disease of the diseased?
immunocompromised, genetic predisposition, low neutrophil, polypharmacy – indicator
- Die from other thing but immunocompromised have it too e.g. pneumonia
Takes over edge
azoles are
fungistatic
pseudomembranous candidosis tx
scrape off before agent
agents
- capspofungin – not used in dentistry – used in systemic fungal infections
- azole – useless – cannot diffuse through it
azole action pseudomembranous candidiosis
useless – cannot diffuse through it
like how penicillin only works on actively growing cells
if on clinic what is the best way to clean denture
place in plastic bag with some water into Ultrasonic bath
key for denture stomatitis management
get pt to be compliant with removing denture at night and denture hygiene
Need to maintain what you have in healthy state – only when disrupt this then invasive species can penetrate – e.g. change diet, OH regime
persisting population of MO
Persist irrespective of tx – hard to completely sterilise a surface
Persisted population re populate after cleaning if put media back
Need something to be slow releasing to prevent them coming back
Need to maintain what you have in healthy state – only when disrupt this then invasive species can penetrate – e.g. change diet, OH regime
