M14: Oral Infections Flashcards
1. Give examples of the main bacterial, fungal and viral agents frequently detected in the mouth 2. Understand the classification of oral infections in terms of endogenous and exogenous infections of hard and soft tissues with examples 3. Describe how predisposing factors that disturb the oral flora can result in oral infections 4. Give examples of antimicrobial agents used to treat oral infectious agents
Classifications of oral infections
- Bacterial, fungal and viral - bacterial infections aren’t due to a single causative agent
- Endogenous = caused by micro-organisms usually in mouth e.g. plaque-related caries and periodontal disease
- Exogenous = not in normal flora e.g. herpes simplex, primary syphilis and secondary manifestations of systemic infections e.g. TB, viral infections
- Hard and soft tissue infections
Name the causative or associated organisms with caries (hard tissue bacterial infection)
Streptococcus mutants
Lactobaccilli
Name the causative or associated organisms with dental abscesses (hard tissue bacterial infections)
Oral streptococci
Oral anaerobes
Untreated caries lesion causes abscess formation to skin surface
Name the causative or associated organisms with dry socket (hard tissue bacterial infections)
Actinomyces spp.
Name the causative or associated organisms with osteomyelitis (hard tissue bacterial infections)
Staphylococcus aureus
Name the causative or associated organisms with periodontal disease (gingivitis and periodontitis) - (soft tissue infection)
Porphyromonas
Prevotella
Capnocytophaga spp.
Aggregatibacter actinomycetemcomitans
HIV necrotising periodontitis occurs when the patient is immunocompromised so cannot fight off the transient microorganisms
Name the causative or associated organisms with acute ulceration gingivitis (soft tissue infection)
Fusobacterium spp.
Treponema spp.
Prevotella intermedia
Acute necrotising gingivitis = AUG - metronidazole will kill the anaerobes; presents as swollen gums with necrosis and loss of interdental papillae
Name the causative or associated organisms with pericoronitis (soft tissue infection)
Oral anaerobes
P. gingivalis
P. intermedia
Caused by trauma from opposing tooth and damages soft tissues
Name the causative or associated organisms with sialadenitis (soft tissue infection)
S. aureus (skin and nose)
Oral streptococci
Name the causative or associated organisms with actinomycosis (soft tissue infection)
Actinomyces israelii
Presents as multiple draining sinuses with sulphur granules present
Name the causative or associated organisms with gonorrhoea (exogenous soft tissue)
Nisseria gonorrhoeae
Name the causative or associated organisms with syphilis (soft tissue infection)
Treponema pallidum
Secondary syphilis presents as a snail-track ulcer on soft tissue
Name the causative or associated organisms with tuberculosis (soft tissue infection)
Mycobacterium tuberculosis
Presents as granulomatous oral ulceration
Name the causative or associated organisms with candidiasis (fungal soft tissue infection)
Candida albicans
Candida spp.
Variations:
- acute pseudomembranous candidiasis = thrush
- candidate leukoplakia
- denture stomatitis
- angular chelitis
Name the causative or associated organisms with herpetic stomatitis and cold sores (primary viral soft tissue infections)
Herpes simplex
Gingivostomatitis presents as self-limiting blistering ulcers
Name the causative or associated organisms with herpes zoster (shingles) - (primary viral soft tissue infection)
Varicella-Zoster
Name the causative or associated organisms with herpangina (primary viral soft tissue infection)
Coxsackie A
Name the causative or associated organisms with oral warts (primary viral soft tissue infection)
Papilloma
Presents as oral papillomatosis (wart)
HPV in HIV
Cytomegalovirus infection in HIV + patient
Kaposi’s sarcoma (herpes virus)
Name the causative or associated organisms with hand, foot and mouth disease (secondary viral soft tissue infection)
Coxsackie A
Name the causative or associated organisms with glandular fever (secondary viral soft tissue infection)
Epstein-Barr virus
Presents as :
Infectious mononucleosis
Oral hairy leukoplakia
What do disturbances in the oral microflora result in
- Selective growth of endogenous species e.g. candidiasis in AIDS patients
- Displacement of endogenous species e.g. actinomycosis following trauma to oral mucosa/jaw
- Introduction of exogenous micro-organisms e.g. oral TB lesions following trauma, E.coli bone infections following radiotherapy
What oral infection does old age and infancy predispose and why
Candidiases
Root caries
Because there is decrease in antibodies and salivary flow rate
What oral infection does pregnancy predispose and why
Gingivitis
Unknown cause
What oral infection does localised trauma predispose and why
Opportunistic infections
Due to loss of tissue integrity
What oral infection does generalised trauma predispose and why
Candidiasis
Due to general debilitation and dehydration
What oral infection does malnutrition predispose and why
Candidiasis
Due to iron and folate deficiency
What oral infections do endocrine disorders predispose and why
Fungal infections
Unknown cause
What oral infection does AIDS predispose and why
Candidiasis
Opportunistic oral infections
Due to reduction of host immune defences
What oral infection does antibiotic therapy predispose and why
Candidiasis
Opportunistic oral infections
Due to loss of colonisation resistance
Selection of resistant flora
What oral infection does chemotherapy predispose and why
Candidiasis
Caries
Due to xerostomia and local mucosal effects
What oral infection does oral malignancies predispose and why
Caries
Candidiases
Xerostomia and loss of muscular function
What is metronidazole
It is an antimicrobial with increased activity against anaerobic bacteria
Metronidazole prescription
400mg BD or 200my TDS for 5-7days
Side effects of metronidazole
Metallic taste, effects on alcohol
What is amoxicillin
Broad spectrum antimicrobial with good oral absorption - works by interfering with cell Wal synthesis
Amoxycillin prescription
250mg - 500mg TDS for 7 days
Side effects of amoxicillin
Predisposes candidiasis
What is tetracycline
Antimicrobial for periodontal infections and herpes gingivostomatitis = broad spectrum antibiotic
Tetracycline prescription
250mg QDS for 5 days
Side effects of tetracycline
Risk of exacerbating renal failure
Don’t give to patients with renal disease, children <12 and those pregnant or breast feeding
What is nystatin and prescribe this
Polyene anti fungal (not absorbed by gut)
Patients with xerostomia find it difficult
100,000 units QDS for 7 days
What is ketoconazole and prescribe this
Systemic imidazole anti fungal
Shouldn’t use in patients with liver diease/alcoholics
200mg OD 14 days
What is miconazole and prescribe this
Gel and denture lacquer which is applied to clean dentures
25mg/ml used QDS for 14 days
What is amphotericin and prescribe this
Polyene anti fungal (not absorbed by gut)
Lozenges 10mg QDS for 10-15 days
What is fluconazole and prescribe this
Systemic triazole anti fungal well absorbed in mouth with a better toxicity profile which is expensive
50mg OD 7-14 days
When is topical acyclovir used
Treatment for recurrent herpes labialis applied in prodromal phase - antiviral applied 5% cream QDS 6 times daily for 5 days
When is systemic acyclovir used
For healthcare workers treating immunocompromised patients and those who present herpes infection within 48hrs
Primary HSV = 200mg 5 times daily for 5 days
Herpes zoster = 800mg 5 times daily for 7 days
