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Oral Microbiology > Lecture # 19-20 Prevention > Flashcards

Lecture # 19-20 Prevention Flashcards

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1
Q

Dentistry spends too much time _________ instead of ________

A
  • Fixing the problem

- Not preventing

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2
Q

What are some treatments for Dentistry?

A

1) Caries restoration
2) Periodontal therapies
3) Orthodontics
4) Implants

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3
Q

What are some prevention for dental diseases?

A

1) Diet
2) Oral hygiene
3) Professional care
4) Fluoride dental products
5) water fluoridation
6) Disease control + management
- sealants
- fluoride products
- anti bacterials
- chlorhexidiuc (CHX)
- tridosan (colgate total; broad spectrum antimicrobial)
- STAMP?

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4
Q

The problem of Caries and Perio disease has gotten __________ since the last 2 decades.

A

Worse

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5
Q

How does xylitol work?

A
  • Saliva reducing and non fermentable somewhat specific for s. mutans (looks like fructose) they add a phosphate to xylitol and then it accumulates with xylitol-phosphate so then it uses ATP to pump it out by ( adding P+ tp pump it out).
  • This is a useless cycle that makes S. mutans “weaken” less energy
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6
Q

What can vaccines do to target dental diseases?

A

Targets most cariogenic bacteria, S. mutans

-Nasal spray?

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7
Q

What is STAMP?

A
  • In vitro biofilms treated w/ S. mutans (specifically targeted anti-microbial peptides) resisted recolonization w/ S. mutans.
  • Once established an ecosystem resists change
  • 90% reduction
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8
Q

What are the benefits of Probiotics?

A

Live microorganisms, which when consumed in adequate amounts, confer a health benefit on the host

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9
Q

What is replacement therapy?

A
  • Gentically modified, “designer” probiotics. GMOs are a hard sell in many communities. GMO germs would probably be even harder!
  • Adding ethanol or lactate dehydrogenase to eliminate lactate + DH. End Result to kill otehr species of S. mutans
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10
Q

How affective are sealants for children?

A

IF properly placed 71% prevented caries

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11
Q

Fluoridated water is how affective in treating caries?

A

25%

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12
Q

Xylitol vs sorbitol gum benefits is what % ?

A 
Sorbitol = 21% 
Xylitol = 50%
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13
Q

Why would STAMP be used?

A

Use to pick only 1 sp. Good guys can fill in specific weed killer

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14
Q

What is Chlorohexadine?

A
  • Kills EVERYTHING (both pathogenic and normal flora bacteria)
  • so bacteria will eventually recolonize (maybe worse) if more competition
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15
Q

What are the regions within STAMP?

A

1) Targeting region (De novo binding peptides)
2) Linker region (Flexible groups)
3) Antimicrobial region(Short antimicrobial peptides)

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16
Q

New trial that effectively removed S. Mutans in mice will have what positive and negative effect ?

A

Positive effect: Significantly reduced caries (90%) by targeting only S.mutans.
-Has proceeded to phase 3

Downside: Potential for bugs to dodge

  • Resistance for the antibiotic
  • Not need targeting region
  • Use for high risk population
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17
Q

What is the target for vaccine?

A

Lactate Dehydrogenase
-attack host enzyme inside so antibody cant

GT:
Specific to S. mutans
-Want to induce IgA in saliva via mist (nose spray)- not injection
-prevent gum drop dome

Fimbrae:
Unique attachment structure for S, mutans
-prevent colonization
(Works in mice, no human trials as of yet)

Goal : to have young children vaccinated to make antibodies to prevent the binding and prevent colonization of S. mutans before tooth erupts

18
Q

What was Metchnikoff theory in the early 1900’s?

A

Theory: Optimize microbial flora= longer life

Due to the observation that people living in rural parts of Russia seemed to live longer because they ate a lot of dairy products

***He revolutionized the thinking that in fact some Microbes are “good”

19
Q

What is the rational for probiotics?

A

To enhance microbial assests and to offset liabilities. In fact most of the microbes that colonize us (normla flora) are “on our side”

20
Q

In the Late 1990s, what happen to the market?

A
  • Reawakening interest of research into Probiotics.

- Marketing “ahead of the curve”

21
Q

What are some large scale examples of life forms used to enhance human life?

A

1) cat vs rat poison
2) Ladybug vs. Bug spray
3) Yougurt vs. Antibiotic

22
Q

What are the 4 major Probiotic mechanisms?

A

1) competitive exclusion of pathogens
2) Inhibit growth of pathogens
3) Optimize immune response
4) Restore normal flora after treatment

23
Q

What is the competitive exclusion principal ?

A
  • Empty seat provides an opening for more pathogenic microbes to sit and colonize
  • Once seated more pathogenic microbes are not good neighbors
  • A pathogen “gang” becomes established. Often influencing less pathogenic microbes to join. Area becomes trouble
  • By filling all the seats less harmful microbes make it harder for pathogens to first colonize area ( competitive exclusion)
24
Q

How can inhibition of pathogen growth occur?

A

1) Competing for nutrients

2) Releasing toxic substances (like pathogen bug does not like H2O2, bacteriocins, etc)

25
Q

How can you optimize the immune response?

A
  • The immune response is often seen in terms of the military or police protecting us. But TOO much “collateral damage” (i.e., the immune response itself causes most of the damage)
  • Lower the immune response or the opposite?
26
Q

How can we restore the Probiotic mechanisms?

A
  • Treatments (antibiotics, dental treatments, etc) often leave a lot of empty seats, which may allow opening for pathogens.
  • Start & maintain optimal normal flora development in young children.
  • Research suggests in children, a strong relationship between the timing of colonization of mutans strep. and future caries
27
Q

Where has probiotics shown (+) benefits in research that was done?

A

1) Neonatal necrotizing enterocolitis (great results)
2) Antibiotic- associated diarrhea
3) Clostridium difficile- associated diarrhea
4) Irritable Bowl Syndrome (IBS) (ok results)

28
Q

What are the results of Neonatal necrotizing enterocolitis with probiotics use?

A

Impressive results: Probiotics lower 15-20% of mortality–>5%

**Standard of care for premature babies

29
Q

What are the results of Antibiotic- associated diarrhea with probiotic use?

A

Modest, but consistent good results: Lower chance of developing diarrhea, less serve of tit develops.

30
Q

What are the results of Clostridium difficile- associated diarrhea with probiotic use?

A
  • A very serious, growing subset of Antibiotic-Associated diarrhea. Mortality = 7-15 %.
  • Modest but consistently GOOD results: LOWER chance of developing C. diff. : LESS severe if it does develop

**Standard of care if susceptible give antibiotics w/ probiotics

31
Q

What are the results of Irritable Bowl Syndrome (IBS) with probiotic use?

A

-The most commonly diagnosed GI pathology. Supportive evidence for probiotics, which lessen symptoms.

**MOST diagnosed bowel disease in the US

32
Q

What is the research they did with Dentistry?

A

1) gingivitis
2) halitosis
3) dental caries
4) periodontal disease

33
Q

What were the results done with probiotics for Gingivitis?

A

MODEST, but good results. Easy in vivo experiments to carry out. Simple, easy to measure outcomes

34
Q

What were the results done with probiotics for Halitosis?

A

Modest, but good results. Easy in vivo experiments ti carry out with simple easy to measure outcomes

35
Q

What were the results done with probiotics for Dental Caries?

A
  • Supportive evidence.
  • Harder, longer exp’s, that often involve surrogate outsomes such as S. mutans levels in saliva and or plaque. -Mostly using milk or yogurt containing probiotics
36
Q

What is the future for Probiotics future?

A

1) Need governmental oversight (FDA regulations?)
2) Still stuck using mostly yogurt bacteria (what about finding bugs that work better in oral cavity?

3) For more than a million years our ancestors only sharped one side of their stone tools
(good idea can impede great ideas!)

37
Q

What were the results done with probiotics for Periodontal disease?

A

Intriguinig results.
Hardest experiments to carry out, especially prevention.
But most similar to GUT experience! In vivo animal exp very promising as adjuncts to therapy (SRP)

38
Q

what is the yogurt bacteria?

A

Lactobacillus
Bifidobacterium
Streptococcus

39
Q

Recent studies (e.g Kanasi, 2010) have looked at the whole mouth in vivo it has shown that certain species (S.mutans) are highly influential in caries outcome. However other species are highly influential in the opposite direction are?

A

Lactobacillus acidophilus a common probiotic that has shown some benefits.

40
Q

The research done on oral administration of Lactobacillus reuteri (in yogurt) during the First Year of Life has shown what?

A
  • That during the 1st year of life it reduces Caries Prevalence in the Primary Dentition at 9 years of age.
  • Decrease in gingivitis
  • Decrease in 50% caries
  • Decrease in the sites of caries

Oral Microbiology (11 decks)

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