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Endo > Microbiology of the RC System > Flashcards

Microbiology of the RC System Flashcards

1
Q

What type of environement is the root canal system?

A
  • warm
  • moist
  • nutritious (has lots of substrate)
  • variable but largely anaerobic climate
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2
Q

What is privileged sanctuary?

A

This area is now largely protected from the host defenses due to lack of circulation in a diseased pulp

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3
Q

__________ is the basic science most closely associated with the practice of Endodontics

A

Microbiology

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4
Q

What are the routes of root canal infection?

A
  • Dental Caries
  • CEJ defect
  • Open Dental Tubules
  • Lateral Canal
  • Periodontal or Periapical invasion
  • Cracks or fractures
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5
Q

Endodontic infections may be classified according to…

A

-Location
-Symptoms (Acute or Chronic)
-Degree of Virulence
-Organization (localized or diffuse & spreading)

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6
Q

What are the different symptom classifications of endodontic infections?

A

*Acute
*Chronic

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7
Q

What are the different locations classifications of endodontic infections?

A

*Intraradicular (Pulpal Necrosis)
*Extraradicular (Periapical Tissues)

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8
Q

What are the different degree of virulence classifications of endodontic infections?

A

*Localized
*Diffuse

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9
Q

What is a primary intra-radiuclar infection?

A

caused by microorganisms that initially invade and colonize necrotic pulp tissue within the RCS

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10
Q

What is a secondary intra-radiuclar infection?

A

by microorganisms not present in the primary infection but introduced into the RCS sometime following professional intervention

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11
Q

What is a persistent intra-radiuclar infection?

A

caused by bacteria that were involved with a primary or secondary infection and in some way, resisted intracanal antimicrobial procedures and were able to endure periods of nutrient deprivation within the RCS

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12
Q

What type of infection occurs if the root canal fails to heal?

A

persistent infection

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13
Q

What is an extra-radicular infection?

A

Characterized by microbial invasion of and proliferation in the inflamed peri radicular tissue

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14
Q

What is an example of a secondary infection?

A

when symptoms arise in a previously ASYMPTOMATIC infected tooth if operator allowed R. Dam leakage or placed leaky temporary

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15
Q

What is the progression of root canal system infections?

A
  1. Carious Lesion or Trauma opens tubules to bacterial invasion
  2. Bacteria inflame pulp locally
  3. Inflammation may overcome pulpal defenses and localized abscesses may form in coronal pulp
  4. Infection increases in pulp and necrosis begins
  5. Necrosis involves entire RC System
  6. Infection uses “portals of exit” (apical foramen and lateral canals) to invade peri-radicular tissues (apical periodontitis)
  7. Periradicular infection occurs beyond apex (apical abscess)
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16
Q

What are the main type of endodontic microbiota: gram - or gram +?

A

gram - bacteria

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17
Q

Current evidence reveals that Gram __________ bacteria appears to be the most common microorganisms in endodontic infections

A

negative

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18
Q

The polymicrobial nature of endodontic infections with a dominance of _____________ ________ bacteria

A

obligate anaerobic

  • in primary infections
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19
Q

Chronic infections within the RC System tend to favor _________ bacterial flora

A

anaerobic

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20
Q

What is a facultative anaerobe?

A

May become more numerous & virulent with addition of oxygen

  • Aerobes which can also survive in an anaerobic environment
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21
Q

What is an obligate anaerobe?

A
  • must have anaerobic environment to survive
    -cannot survive in an AEROBIC environment
  • NaOCl liberates O2
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22
Q

What are the main sources of nutrients for bacteria?

A

-Pulp Necrosis
-Saliva
-Toxins
-Proteins and Glycoproteins

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23
Q

The primary cause of endodontic treatment failure has been attributed to intra-radicular infections usually in the form of _______

A

BIOFILMS

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24
Q

Microorganisms present in the ________ portion of the root have
the potential to sustain a long standing infection.

A

apical

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25
Q

What is a biofilm?

A

a multicellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self produced matrix of extra cellular polymeric substance usually polysaccharide

26
Q

The primary cause of endodontic treatment failure has been attributed to what type of infection?

A

intra-radicular infections

27
Q

The canal walls/spaces are
conducive to formation of…

A

Biofilm

28
Q

What endo infections are responsible by only one organism?

A

NONE
- all endo infections are mixed (polymicrobial)

29
Q

What are most bacteria in an endo infection?

A

Mostly facultative and obligate anaerobes

30
Q

What six things must a biofilm accomplish to cause disease within the root canal system?

A
  1. MO must adhere to host surfaces
  2. Obtain nutrients from the host
  3. Multiply
  4. Invade tissue
  5. Overcome host defenses
  6. Induce tissue damage
31
Q

BIOFILM becomes more varied, complex, and difficult to control when the tooth is further challenged by…

A

salivary contact or operative contamination

32
Q

What should you do to prevent biofilm formation in the root canal system?

A
  • Avoid leakage of rubber dam or temporary
  • Avoid iatrogenic contamination during treatment (leaky dental dam, etc.)
33
Q

How do we destroy bacteria in root canal system?

A

kill directly or starve them out

34
Q

What tools do we use to destroy bacteria in root canal system?

A

cleaning and shaping with 8.3% NaOCl and intra-canal medicaments

35
Q

Correct use of _______is extremely important in eliminating microorganisms in the pulpal system

A

NaOCl

36
Q

Do files remove all the complex pulpal system?

A

no
- diverse shapes are resistant to
mechanical shaping (pulp chambers)

37
Q

What does NaOCl do to the pulpal system?

A
  • Disinfects over time
  • Dilutes & Inactivates toxins
  • Dissolves substrate over time
  • Dissolves necrotic tissue over time
  • Flushes & Floats out Debris
  • Lubricates Canal
38
Q

What does it mean if the patient is feeling swelling, fever, and mild to severe pain?

A

acute apical abscess, cellulitis

39
Q

If bacteria from the infected pulp tissue gain entry into the periradicular tissue and the immune system is unable to suppress the invasion, what is that called?

A

acute periradicular abscess, cellulitis, or both

40
Q

What can happen with swelling of the face due to infection root canals?

A

localized to the vestibule or may extend into a fascial space (cellulitis)

41
Q

What are the systemic manifestations of cellulitis?

A

-fever
-chills
-lymphadenopathy
-headache
-nausea

42
Q

What is important in relation to where the lesion points?

A

muscle attachments

43
Q

If lesion exits coronal to muscle attachment, it is generally on..

A

attached gingiva or alveolar mucosa

44
Q

If lesion exits coronal to muscle attachments what type of abscess is it?

A

localized abscess (no systemic involvement)

45
Q

How does the tooth respond to percussion tests in a cellulitis patient?

A

in most cases, the tooth elicits a positive response to percussion, and the periradicular area is tender to palpation

46
Q

What are are potential anatomic areas that exist between the fascia and underlying organs and other tissues?

A

Fascial spaces

47
Q

What teeth should you be especially vigilant with in terms of infection and cellulitis?

A

mandibular molars (especially 2nd and 3rd)

48
Q

Why should you be extra vigilant of infections of mandibular 2nd and 3rd molars?

A
  • Access from S-M space to Sublingual and Submental spaces
  • All 3 are called Ludwig’s angina
  • can have swallowing difficulties and cut off airway
49
Q

If the source of the infection is a mandibular molar and the apices of the molar lie closer to the lingual cortical plate and above the attachment of the mylohyoid muscle, the purulent exudate breaks through the lingual cortical plate into the…

A

sublingual space

50
Q

If the apices lie below (or apical) to the attachment of the mylohyoid muscle, the infection spreads into the…

A

submandibular space

51
Q

What is important in controlling the infection?

A

incision and drainage

52
Q

When do we use antibiotics in endodontics?

A
  • persistent or spreading infection
  • systemic involvement with temp over 100
  • medically compromised patient
  • pre-med when indicated
53
Q

Use of antibiotics to relieve pain is…

A

useless

54
Q

Systemic antibiotics are useful only in…

A
  • acute periapical infections (swelling and fever)
  • patient is immunologically supressed
55
Q

Healthy patients without systemic signs and symptoms of infection but with symptomatic pulpitis, symptomatic apical periodontitis, a draining sinus tract, or localized swelling do or do not require antibiotics?

A

DO NOT

56
Q

What happens when you give antibiotics to patients who do not need antibiotics?

A

create resistance

57
Q

The ability to form BIO has been regarded as a…

A

virulence factor

58
Q

Gram – anaerobes) can cause direct tissue damage & osseous breakdown by releasing:

A
  • enzymes (collagenase, chondroitinase and hyaluronidase)
  • endotoxins and exotoxins
  • lipo polysaccharide (LPS)
  • peptides/amino acids
59
Q

What bacteria can cause serious suppurative infections?

A

Staphylococcus Aureus
(aka) S. Pyogenes (Gram +)

60
Q

What does S. pyogenes produce?

A

penicillinase, a B lactamase that has the potential to render Penicillin ineffective

61
Q

What do you treat S. pyogenes with?

A

Augmentin = Amoxicillin + Clavulanic acid (inhibits penicillinase)

Endo (18 decks)

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