Lecture 2 - Oral Bacteria & Systemic Connections Flashcards
The oral microbiome consists of about ___ species of bacteria.
700
Resistance against pathogens, metabolic functions, and immune activation are three mechanisms by which microbes are…
beneficial
Chronic diseases are caused by microbial community _________ and loss of _______ species.
disruptions
healthy
Antibiotics and antiseptics are therapies that focus on broad (nonspecific) _________ of germs.
eradication
Probiotics, prebiotics, and targeted antimicrobials are therapies that encourage _______ communities.
healthy
T/F
Oral bacteria can translocate to cause disease elsewhere in the body.
True
T/F
Oral infections can release toxins that cause systemic problems.
True
In the early 1900’s, teeth and tonsils were thought to be the source of many diseases and were ________. This focal infection theory was discredited by year ____.
removed
1930
25 years ago, oral infections were linked with ___________ disease.
cardiovascular
What are the two direct mechanisms for oral connections?
- translocation of bacteria
- translocation of toxin
A distant site becomes infected via seeding by oral bacteria. Give an example of this mechanism.
- translocation of bacteria
- oral bacteria gain entry into circulatory system (bacteremia)
A distant site effect from toxin produced by oral bacteria. Give an example of this mechanism.
- translocation of toxin
- endotoxin from gram negative bacteria in periodontal pocket enters circulatory system (promotes inflammation)
Interleukin-1 (IL-1) gene polymorphisms associated with increase in periodontitis and systemic diseases is an example of what common pathway to disease?
Host hyper-inflammatory phenotype
What constitutes good evidence for oral systemic effects?
- epidemiological studies (show association)
- evidence of causality (human trials, demonstration of effects)
Platelets and fibrin adhere to exposed connective tissues producing ___________ __________ _________ (NBTE)
nonbacterial thrombotic endocarditis
In infective endocarditis, bacteria from oral cavity enter blood stream (________) and adhere to NBTE.
bacteremia
In infective endocarditis, adhered bacteria from oral cavity multiply and cause _______/_______ injury.
cardiac/valvular
In infective endocarditis, multiplied bacteria are discharged into circulation producing what two conditions?
- emboli
- stroke
The oral bacteria primarily responsible for infective endocarditis is…
streptococci (60+%)
Two other oral bacteria associated with infective endocarditis are…
A. actinomycetemcomitans
Gemella
Skin bacteria associated with infective endocarditis is…
staphylococci
In theory, _________ ________ prevents hematogenous spread of bacteria (bacteremia).
antibiotic prophylaxis (AP)
In practice, antibiotic prophylaxis (does or does not) prevent bacteremia?
does NOT
T/F
There is no solid evidence that dental procedures are associated with infective endocarditis.
True
What may reduce bacteremia?
good oral health and hygiene practices
T/F
Random bacteremia from dental procedures is more likely to cause infective endocarditis than routine activities (such as brushing or chewing).
False
Other way around - routine activities more likely to cause IE than dental procedures
It’s more important to optimize regular _____ ________ measures to keep bacterial load low than to give _________ _________.
oral hygiene
antibiotic prophylaxis
What are the two causes of aspiration pneumonia?
- aspiration of oral secretions
- oral bacteria
Give two examples of when airway protective reflexes may be compromised.
- physically handicapped
- elderly
This is the leading cause of death from infection in those > 65 years old.
aspiration pneumonia
Name one thing that can prevent lung infection.
Oral hygiene measures
Bacteria in amniotic fluid, some of them common oral species, are associated with _______ ______.
preterm birth
Periodontitis is associated with what three pregnancy-related conditions?
- preterm birth
- low birthweight
- pre-eclampsia
T/F
Current evidence shows periodontal treatment reduces risk of preterm birth and low birthweight.
False
RCTs do not show reduced risk with treatment and current evidence for causal relationship is not strong
Immunosuppressed patients (neutropenia, chemotherapy, transplant patients) have a high risk for disseminated _____ or _______ of oral origin.
strep
candida
In immunosuppressed patients, the focus is on achieving and maintaining good ____ ______.
oral health
T/F
There is a lack of evidence for relationship to dental treatment or efficacy of antibiotics in the immunosuppressed.
True
What are three things to consider in the immunosuppressed patient?.
- invasiveness of the procedure
- bacterial load
- degree of immunosuppression (ANC)
One of the best studied relationships between oral health and systemic disease is…
periodontitis and diabetes
There is an increased prevalence of __________ in diabetics.
periodontitis
In diabetics, treatment of periodontitis improves ________ control.
glycemic
One of the more complex, but one of the first relationships studied is the relationship between…
cardiovascular disease and oral bacteria
What species of bacteria is associated with the evidence for causality for cardiovascular disease and oral bacteria?
P. gingivalis (found in atherosclerotic lesions)
Studies show an increased risk of _________ cancer in patients with periodontitis.
pancreatic
T/F
Antibiotic prophylaxis for dental treatment is not recommended for a patient with a nonvalvular cardiovascular device.
True
T/F
Most infections of vascular grafts/stents and intravascular access devices are caused by bacteria native to skin and antibiotic prophylaxis for dental treatment is not recommended.
True
Distinguish primary and secondary antibiotic prophylaxis with regard to joint prostheses.
Primary - at time of device placement unrelated to dental treatment (evidence supports this)
Secondary - to reduce dental procedure-related bacteremia and distant site infection (lack of evidence to support this)
What is the most common bacteria found in joint prostheses?
staphylococci
T/F
There is no indication for antibiotics to prevent oral bacterial source for patients with pins, plates, and screws.
True
Of the two types of cerebrospinal fluid shunts, ventriculo-peritoneal and ventriculo-atrial, which one is associated with a high rate of infection?
ventriculo-peritoneal
To summarize, direct transfer of oral bacteria involves what 4 conditions?
- infective endocarditis
- pneumonia in compromised airway
- immunosuppression
- preterm birth ..?
Primary preventative strategies in direct transfer of oral bacteria include…
- improve oral health and reduce bacterial load
- AP indicated in specific high risk situations
To summarize, transfer of oral bacteria, toxin, or the common inflammatory pathway involve what 3 conditions/diseases?
- Type 2 diabetes
- cardiovascular disease
- pancreatic cancer
Primary preventative strategies in the transfer of oral bacteria, toxin, or common inflammatory pathway include…
- treat periodontal disease to improve microbial profile
- improve overall health by addressing risk factors
T/F
There are no special oral precautions in patients with implanted devices/grafts/shunts/prostheses/etc.
True
Name 4 things that encourage healthy oral bacterial communities.
- oral hygiene
- healthy diets
- fluoride
- repair dentitions
