Endo-Systematic Flashcards
Endodontic Infections
- ____ of____ with oral bacteria
- ¡Commonly linked to ___/____bacteria
- ____,_____
- ___
- _____ ____
- ____ ___ ___
- __ __ __ ___ (____)
- ____ infections
- ¡among the ____ infections seen by dentists
- ¡Pulp is very___ to___
Endodontic Infections
¡Infection of pulp with oral bacteria
¡
¡Commonly linked to caries/periodontal bacteria
endogenous,polymicrobial
§pulp
§periapical area
§orofacial soft tissues
§bone of the jaw (osteomyelitis)
§
¡acute infections
¡
¡among the commonest infections seen by dentists
¡
¡Pulp is very sensitive to inflammation
Pulpal Infection Routes
¡caries
¡fractured tooth
¡microleakage from restorations
¡
¡dentinal tubules
¡lateral and accessory canals (periodontal disease)
¡anachoresis
Pulpitis through an Open Cavity
¡Due to ___ ___ exposure to the ___ and ___
Pulp can be exposed by
___
___
____
¡High numbers of bacteria introduced directly into ___ ___
¡Inflammatory response can __ __ ___ to the pulp
__ ___ plus ___ of ____ lead to rapid ___ and ____ of tissue
¡
What kind of bacteria?¡_____________
¡
____
____
¡
¡Due to direct pulpal exposure to the mouth and saliva
§decay
§trauma
§Instrumentation
§
¡High numbers of bacteria introduced directly into sterile tissue
¡
¡Inflammatory response can cut off circulation to the pulp
¡
¡Bacterial challenge plus loss of circulation lead to rapid disintegration and liquefaction of tissue
¡
¡Mixed, mainly anaerobic infection
¡
¡Polymicrobial, endogenous!
¡
Pulpitis via Caries -Dentinal tubules
_____ and certain ____ dominate in advancing carious lesion
¡Bacterial penetration of tubules is ___, but ___ and other___ ___ diffuse quickly
¡Damage to ___ and ___ ___ ___
§may be ___ if the bacteria have not ___ __ ___
¡Bacterial invasion by ___ and ___, then ___ oral species
¡large numbers of ____
____ develop and ____
¡result is gradual ___ and ____ of pulp tissue
¡Lactobacilli and certain streptococci dominate in advancing carious lesion
¡Bacterial penetration of tubules is slow, but acids and other toxic products diffuse quickly
¡Damage to odontoblasts and local pulp tissue
§may be transient if the bacteria have not infected the pulp
¡Bacterial invasion by lactobacilli and streptococci, then other oral species
¡large numbers of PMN’s
¡microabscesses develop and enlarge
¡result is gradual death and liquefaction of pulp tissue
Pulpitis through the Apical Foramen, Periodontium
¡from a ___ ___ in communication with a ___ ___ ___(____-___ lesion)
¡from an adjacent ____ ____
_____ spread (_____)
¡Pulpitis from other ____ a risk factor*
¡from a lateral canal in communication with a deep periodontal pocket (perio-endo lesion)
¡from an adjacent periapical lesion
¡hematological spread (anachoresis)
¡Pulpitis from other stimuli a risk factor*
Microflora Associated with Endodontic Pulp Infection
¡Primary infections –____ infection; mostly gram-____ ____ ( O2) bacteria belonging to the genera, ____ ____ ___(____, ____, anaerobes, __________ complex)
¡
¡Secondary infections- ___ ___ ___; usually ___ or ___ ___ than primary infections, and are often gram-___ organisms and ___ – ____ ____
Microflora Associated with Endodontic Pulp Infection
¡Primary infections –pulp infection; mostly gram-negative anaerobic bacteria belonging to the genera, Porphyromonas, Prevotella, Fusobacterium, Treponema, Peptostreptococcus, Eubacterium, and Campylobacter (Endogenous, polymicrobial, anaerobes, orange and red complex)
¡
¡Secondary infections- failing root canal; usually singular or less diverse than primary infections, and are often gram-positive organisms and fungi – Enterococcus faecalis
Enterococcus faecalis
____organism
¡Common ___ ____ in ___ infections
¡___ to common treatments for root canals
- ___
- ___ resistant
- ___ resistant
- ▪___ ___
¡Strong association with __ __ __
¡Enteric organism
¡Common opportunistic pathogen in pulp infections
¡Resistant to common treatments for root canals
§Biofilms
§Antibiotic resistant
§Acid/Base resistant
▪Calcium hydroxide
¡Strong association with failing root canals
Pulpitis: Possible Complications
___ and _____ infection
___ of ___ to ___ ___ __
¡Abscess and peri-apical infection
¡
¡Spread of infection to local soft tissue
Microbiology of Dentoalveolar Abscesses
_____ infections
______
(O2) important
___ ____bacteria
___ ___bacteria
¡Endogenous infections
¡Polymicrobial
¡anaerobes important
§black pigmented bacteria
§non-pigmented bacteria
Black Pigmented Bacteria
_____
- ____
- _____
§
____
§P. ____
§P. ____
§P. ____—most prevalent
¡Porphyromonas
§P. gingivalis
§P. endodontalis
§
¡Prevotella
§P. melaninogenicus
§P. intermedia
§P. nigrescens—most prevalent
Strep. milleri group
Very common for them to be in these abscesses as well
Sites of Spread from a Dental Abscess
___ ____ is probably the better outcome because at least it is draining to the surface
If it doesn’t drain you may end up with ____
- Infection moves to ___ __ of the ___ and ___
You will have ___ ___ ____ around site of infection
Teeth, circulatory system and soft tissue of the face are highways that the bacteria can move thru
Depending on which tooth is infected and where infection trying to drain things can go down or they can go up
If they get into soft tissue of face or neck that is an _____
Neck: that can cut off your___
Draining fistula is probably the better outcome because at least it is draining to the surface
If it doesn’t drain you may end up with cellulitis
Infection moves to soft tissue of face and neck
You will have heat tender swelling around site of infection
Teeth, circulatory system and soft tissue of the face are highways that the bacteria can move thru
Depending on which tooth is infected and where infection trying to drain things can go down or they can go up
If they get into soft tissue of face or neck that is an EMERGENCY
Neck: that can cut off your airway
Ludwigs Angina
¡Spreading infection of ___ and ___ ___, ___ infection
¡Cellulitis of ___ ___, little ___
___ swelling-____ may become compromised
¡90% of cases associated with ____ ____-____ flora
___/____, eliminate primary source of infection
¡Spreading infection of sublingual and submandibular space, acute infection
¡
¡Cellulitis of facial tissue, little pus
¡
¡Brawny swelling-airway may become compromised
¡
¡90% of cases associated with dental source-endogenous flora
¡
¡Amoxicillin/Metronidazole, eliminate primary source of infection
¡
Actinomycosis
¡“___ ____”
¡_____ region is most common site
¡usually ___ with history of ___ ___, ___ developing, ___ painful
___ ____ seen in lesion biopsy
____ _____—most frequent isolate
___ ____ required due to formation of ___ ____ around the lesions
___ ___antibiotic treatment—___ or ____
¡“Lumpy jaw”
¡
¡cervicofacial region is most common site
¡usually chronic with history of tooth extraction, slow developing, not painful
¡
¡sulfur granules seen in lesion biopsy
¡
¡Actinomyces israelii—most frequent isolate
¡
¡surgical drainage required due to formation of fibrous walls around the lesions
¡
¡long-term antibiotic treatment—penicillin or erythromycin
Oral Bacteria and Endogenous Infections
Brain abscess
Sinuses could get infected
Oral infections are most common in head and neck because that is closest to where the bacteria are
But they can also spread elsewhere in the body from the blood stream
Oral Bacteria and Endogenous Infections
Brain abscess
Sinuses could get infected
Oral infections are most common in head and neck because that is closest to where the bacteria are
But they can also spread elsewhere in the body from the blood stream
Transient bacteremias
__ ___ presence of bacteria in the___ , ___ ___
Often follows ___ or ____ procedures.
Daily activities like ___ and___ cause some bacteremia
Even people with good dental plaque
____ risk for the healthy
Their body handles it not problem
Can result in___ ____for the compromised
This is normal
We actually have organ in our body to deal with that
____: there to filter out bacteria that is transiently in the blood stream
___ ____ causes the most bacteria to go into the blood stream
Higher risk if you are dealing with the mucosa
Not everything is going to be the same amount of bacteria
Brain abscess
Piercing in mouth more susceptible to these infections
Transient bacteremias
Short term presence of bacteria in the blood, circulatory system.
Often follows dental or surgical procedures.
Daily activities like toothbrushing and eating cause some bacteremia
Even people with good dental plaque
Low/no risk for the healthy
Their body handles it not problem
Can result in local infections for the compromised
This is normalWe actually have organ in our body to deal with that
Spleen: there to filter out bacteria that is transiently in the blood stream
Dental extraction causes the most bacteria to go into the blood stream
Higher risk if you are dealing with the mucosa
Not everything is going to be the same amount of bacteria
Brain abscess
Piercing in mouth more susceptible to these infections
Infective Endocarditis
Infectious endocarditis is an infection of the l___ of the ___ ____ and ___ ___that is caused by__ ,____, or other ___ substances.
Results from ____ infection. Bacteria can enter the bloodstream during certain ___procedures, including ___ procedures, and ___ to the ___, where it can settle on ___ ___ ___.
The bacteria can ___ and may form__ ___that __ __and travel to the__ __ ___ ___
Most people who develop infectious endocarditis have underlying ___ __ or ___ ___
Often associated with dental procedures
Infective Endocarditis
Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances.
Results from bloodstream infection. Bacteria can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves.
The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen.
Most people who develop infectious endocarditis have underlying heart disease or valve problems.
Often associated with dental procedures
Organisms involved:
Organisms involved:Alpha hemolytic strep
50% come from oral step
Skin
Ventilator/Aspiration
Higher dental plaque levels predict the risk of___ ___ ___
Ventilator/Aspiration
Higher dental plaque levels predict the risk of ventilator-acquired pneumonia
Pregnancy Complications
Women with ___ to ___ ___ ___ or “___ ____ gingivitis” are more likely to give birth to ___ and ___ ___ ___ babies
Treatment of gingivitis during pregnancy with___ and ___ ____ has been shown to be ___(transient bacteremia don’t seem to cause problem to the baby), and ___ ____the risk for premature birth/low birth weight.
Not as much as you would think
Pregnancy Complications
Women with moderate to severe periodontal disease or “pregnancy associated gingivitis” are more likely to give birth to premature and low birth weight babies
Treatment of gingivitis during pregnancy with scaling and root planing has been shown to be safe (transient bacteremia don’t seem to cause problem to the baby), and slightly decreases the risk for premature birth/low birth weight.
Not as much as you would think
Association with Pregnancy
In animal models, infection with_____ causes
-
An increase in levels of _____ ___ and ___ ___ (may trigger___ ___)
- From inflammation of oral infection
- ___ of ___ ___
Oral bacteria have also been found infecting the____ in animal models, and the ___ ____and ____ in human studies.
Association with PregnancyIn animal models, infection with P. gingivalis causesAn increase in levels of Prostaglandin E2, and Interleukine -1 (may trigger early labor)
From inflammation of oral infection
Reduction of birth weight
Oral bacteria have also been found infecting the placenta in animal models, and the amniotic fluid and placenta in human studies.
The Placenta Harbors a Unique Microbiome
Several groups looking at what bacteria you expect to be associated with the placenta
Several papers looking at microbiome of placenta
They found that in healthy women with normal birthBacteria in the placenta came from the oral cavity
This can be a problem if you have bad oral flora
Treat the Mouth Before Pregnancy?
If you have periodontal disease when you get pregnant, your placenta is probably already compromised
Should treat BEFORE pregnancy
The Placenta Harbors a Unique Microbiome
Several groups looking at what bacteria you expect to be associated with the placenta
Several papers looking at microbiome of placenta
They found that in healthy women with normal birthBacteria in the placenta came from the oral cavity
This can be a problem if you have bad oral flora
Treat the Mouth Before Pregnancy?
If you have periodontal disease when you get pregnant, your placenta is probably already compromised
Should treat BEFORE pregnancy
Systemic Impact of Chronic Inflammation
Bacteria in the mouth can cause an increase in ___ ___ in the entire body, which has negative effects on certain health conditions
Systemic Impact of Chronic Inflammation
Bacteria in the mouth can cause an increase in inflammatory mediators in the entire body, which has negative effects on certain health conditions
Oral Microbiology
