Microbiology Oral and Pathology Flashcards
How is periodontal health characterized?
Periodontal health is characterized by the predominant inhabitants of the oral cavity, mostly gram positive facultative species such as streptococcus sanguis, Streptococcus mitis, streptococcus salivarius, actinomyces viscosus, actinomyces naeslundii, and a few beneficial gram negative species such as veillonella parvula and Capnocytophaga ochracea
What microorganism is most commonly found on the surface of the tongue?
Streptococcus salivarius
Describe the composition, adhesion location and organization of Plaque
- An organized biofilm consisting of 80% water and 20% solids: 95% microorganisms; and 5% organic components (calcium, phosphorus), desquamated cells (epitheial cells, leukocytes) and food debris
- It adheres to teeth, dental prostheses, and oral mucosal surfaces and is also found in the gingival sulcus and periodontal pockets
- Dental plaque is classified as supragingival and subgingival based on its position along the tooth surface
- Supragingival = G+ cocci
- Subgingival = G - Bacilli and spirochetes
- As plaque matures, there is a transition from the early aerobic environment characterized by gram-positive facultative species to an exceedingly oxygen deprived milieu in which gram negative anaerobes predominate.
- It is the key etiologic agent in the initiation of both caries and periodontal diseases
Explain the series of steps for plaque formation
- Pellicle formation: Salivary and GCF glycoproteins bind to oral mucosal, tooth, and dental prosthesis surfaces almost immediately via electrostatic and van der Waals forces. It prevents tissue desiccation and provides surface lubrication, but also promotes bacterial adherence.
- Bacterial colonization: Occurs within a few hours of pellicle formation. Gram-positive facultative species (streptococcus sp. Actinomyces sp., Lactobacillus sp.) are the first to colonize through the binding of their adhesins and fimbriae to the pellicle.
- Maturation: Multiplication and coaggregation of bacterial species that do not inititally colonize tooth and gingival epithelial surfaces
- Mineralization: Calculus formation. Plaque becomes 50% mineralized in about 2 days, and 90% mineralized in about 12 days
Explain the composition, adhesion and location of calculus formation
- Calcified bacterial plaque that forms on teeth and dental prostheses
- 70-90% of calculus is composed of inorganic components (calcium, phosphorus), the majority of which are crystalline (hydroxyapatite)
- The remaining 10-30% of calculus is organic, consisting of protein- carbohydrate complexes, desquamated cells (epithelial cells, leukocytes), and microorganisms
- Saliva is the main mineral source for supragingival calculus, but GCF (gingival cervicular fluid) provides most of the mineral for subgingival calculus
- The most common locations for supragingival calculus are the lingual of mandibular anterior teeth and the buccal of maxillary molars (due to their proximity to salivary ducts)
What is the calculus formation epitatic concept?
Epitactic Concept:
- The predominant theory of calculus formation, which suggests that seeding agents (protein-carbohydrate complexes or bacteria) induce small foci of mineralization, which ultimately enlarge and coalesce to form a calcified mass
Calculus does NOT directly cause gingival inflammation, but provides a rough surface for the continued accumulation of perio-pathogenic bacterial plaque
What is materia alba
Material Alba
Loosely adherent matter largely composed of desquamated cells, food debris, and other components of dental plaque that is easily washed away
Explain the characteristics of cariogenic bacteria and how it synthesises material that leads to caries
- Cariogenic bacteria synthesize glucan (dextrans) and fructans (levans) from their metabolism of dietary sucrose (via glucosyltransferase), which contribute to their adherence to tooth structure
- As a consequence, lactic acid is formed, reducing salivary pH and creating sites of enamel demineralization and cavitation
What are the three main items that caries need for their formation?
- Cariogenic bacteria
- A susceptible surface
- A fermentable carbohydrate source
Explain Stephan Curve for oral pathology
State common microbes for early colonizers and where they likely colonize
What are recurrent caries?
Stephan Curve
- Rapid drop in salivary pH within a few minutes after fermentable carbohydrate (eg. sucrose) intake
- Enamel demineralization occurs once the pH falls below 5.5
- Recovery to a normal salivary pH can take 15-40 minutes
- The frequency of carbohydrate intake is more detrimental than the quantity because it maintains a prolonged decrease in pH
Common microbs for early colonizers:
- Strepococcus (S. mutans, S. sanguis, S. salivarius) generally cause pit and fissure, smooth-surface and root caries
- Lactobacillus sp (L. casei, L. acidophilus) generally cause pit and fissure caries
-
Actinomyces sp (A. viscosus, A. naeslundii) generally cause root caries
- They are acidogenic (make acid) and aciduric (tolerate living in acid)
Recurrent caries: occurs around an existing restoration. It may occur on the crown or the root
Explain plaque-induced gingivitis characterizations and predominant microbial flora
Plaque-Induced Gingivitis
Characteristics
- Presence of plaque
- Absense of attachment loss
- Gingival inflammation, starting at the gingival margin
- Can be modified by systemic factors, medications, or malnutrition
- Reversible with removal of plaque (and modifying factors)
Predominant Microbial Flora
- Variable microbial pattern containing predominantly gram-positive and gram-negative facultative and anaerobic cocci, bacilli, and spirochetes such as Streptococcus sanguis, streptococcus mitis, Actinomyces viscosus, Actinomyces naeslundii, Peptostreptococcus micros, Fusobacterium nucleatum, Prevotella intermedia, and Campylobacter rectus
- Gingivitis associated with sex steroid fluctuations (pregnancy, puberty, menstrual cycle, oral contraceptive use) is associated with elevated proportions of Prevotella intermedia, which uses these steroids as growth factors
Explain Chronic Periodontitis characterizations and predominant microbial flora
Chronic periodontitis
Formerly known as adult periodontitis
Characteristics
- Presence of plaque
- Presence of attachment loss
- Amount of periodontal destruction is consistent with prescence of microbial deposits (subgingival plaque and calculus)
- Most prevalent in adults but can occur in children and adolescents
- Generally progresses at a slow to moderate rate but may have periods of rapid progression
- Can be modified by other local factors, systemic factors, medications, smoking, or emotional stress
Predominant Microbial Flora
- Variable microbial pattern containing predominantly gram-negative, anaerobic bacilli and spirochetes such as Prophyromonas gingivalis, Tanerella forsythensus (formally Bacteroides forsythus), Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Eikenella corrodens, and Campylobacter rectus
What is the difference between Recurrent periodontits and Refractory periodontitis?
Recurrent periodontitis:
- Describes a recurrence of periodontitis after successful treatment
Refractory periodontitis:
- describes periodontitis that does not respond to treatment
Explain Aggressive Periodontitis characterizations and predominant microbial flora
Describe the difference between localized and generalized
Aggressive Periodontitis
Formaly known as juvenile periodontitis or early-onset periodontitis
Characterisitcs
- Presence of plaque
- Presence of attachment loss
- Amount of periodontal destruction is generally inconsistent with presence of microbial deposits
- Familial aggregation
- Usually affects individuals younger than 30 yrs but can occur in older patients
- Generally progresses rapidly but may be self-arresting
- Phagocyte abnormalities are common
- Hyper-responsive monocyte/macrophage phenotype is common
- Can be modified by other local factors, systemic factors, medications, smoking or emotional stress
Classification
- Localized: Localized to first molars and/or incisors. Typically a circumpubertal onset. Often self-limiting (“burns out”) in 20s
- Generalized: Affects at least three permanent teeth other than first molars and incisors. Usually affects people < 30years old, but patients may be older. Often associated with systemic diseases (neutropenias, leukemias, etc)
Predominant Microbial Flora
- Similar to chronic periodontitis with often elevated proportions of Aggregatibactor actinmomycetemcomitans (formerly Actinobacillus actinmomycetemcomitans) and/or Porphyromonas gingivalis
Explain Necrotizing Periodontal disease Characteristics, Classifications, and Predominant Microbial flora
Necrotizing Periodontal disease
Formerly known as trench mouth or Vincent’s disease
Characteristics
- Presence of plaque
- Interproximal gingival necrosis (“punched out” papillae)
- Marginal gingival pseudomembrane formation
- Attachment loss may or maynot be present
- Gingiva bleeds easily
- Pain when brushing or eating
- Bad breath (fetor oris)
- Commonly associated with emotional stress, malnutrition, smoking or immunosuppression (HIV)
Classification:
- Necrotizing ulcerative gingivitis (NUG): No attachment loss
- Necrotizing ulcerative periodontitis (NUP): attachment loss present
Predominant Microbial Flora
- Variable microbial flora with elevated proportions of spirochetes (Treponema sp), Prevotella intermedia, Fusobacterium sp, and Selenomonas sp
Explain Candidiasis Characteristics, Classifications, and Predominant Microbial flora
Candidiasis
Characteristics
- An opportunistic fungal infection
- Commonly associated with immunosuppresion (HIV), ill-fitting dentures, chronic xerostomia (Sjogren’s syndrome), or prolonged use of antibiotics
Classification
- Pseudomembranous candidiasis (thrush): Whitish patches of desquamative epithelium, which can be easily wiped off,* leaving a slighly bleeding surface. *most common form
- Atrophic (erythematous) candidiasis: Painful brigh-red, smooth, “beefy” lesions on the tongue, palate, or other mucosal surfaces, usually associated with ill-fitting dentures
- Chronic hyperplastic candidiasis: Asymptomatic* whitish plaques commonly found on the buccal mucosa near the commissures that *cannot be removed, resembling oral leukoplakia
Predominant Microbial Flora
- Candida albicans
Expain the mechanical means for plaque control
- Toothbrushing and flossing are proven methods to remove plaque
- However, they cannot remove subgingival plaque in pockets > 3 mm deep (as in cases of periodontal disease)
- Dental professionals must scale teeth and root plane in order to remove the subgingival plaque and calculus
Expain the chemical means for plaque control
Chemical Plaque Control
- Chemical means of plaque control is often used as an adjunct to mechanical cleaning
- Two mouthrinses are ADA approved for the treatment of gingivitis:
- Rx- only chlorhexidine gluconate and an OTC phenolic/essential oil compound
- Chlorohexidine gluconate is the most effective antiplaque mouth rinse due to its substantivity
What are the modes of cell injury
Modes of Cell Injury
- Hypoxia and ischemia
- Physical trauma: Burns, frostbite, radiation, electric shock, etc
- Microorganisms: Bacteria, viruses, fungi, parasites, etc
- Immunologic reactions: Autoimmunity and anaphylaxis
- Chemical/pharmacologic insulat: Poisons, drugs, alcohol, etc.
- Nutritional imbalances: Vitamin deficiency, obesity, etc
- Genetic defects: Hemoglobinopathies, storage diseases, etc.
- Aging: Increases telomerase activity, inaccurate repaire of DNA, etc
What tissues are the most vulnerable to hypoxia and what does it result from
Heart, brain and lungs are very vulnerable to hypoxia.
Results from:
- Vascular ischemia
- decreased blood oxygen (eg. anemia, pulmonary disease)
- decreased tissue perfusion (eg. shock, cardiac failure)
- CO poisoning
What are chemical-induced cell injuries caused by?
Carbon monoxide (CO)
Carbon tetrachloride (CCl4)
Mercury
Cyanide
Methanol
Lead
What chemical-induced cell injury causes the following:
- Systemic hypoxia
Carbon monoxide (CO) poisoning
Systemic hypoxia
What chemical-induced cell injury causes the following:
- Hepatocellular damage (“fatty liver”)
Carbon tetrachloride (CCl4)
Hepatocellular damage (“fatty liver”)
What chemical-induced cell injury causes the following:
- Renal tubular necrosis
- Pneumonitis
- GI ulceration
Gingival lesions
Mercury
Causes
- Renal tubular necrosis
- Pneumonitis
- GI ulceration
Gingival lesions
What chemical-induced cell injury causes the following:
- Prevents cellular oxidation
- Odor of bitter almonds
Cyanide
Causes:
- Prevents cellular oxidation
- Odor of bitter almonds
What chemical-induced cell injury causes the following:
- Blindness
Methanol
Causes
Blindness
What chemical-induced cell injury causes:
- Basophilic stippling of RBC’s
Lead
causes:
- Basophilic stippling of RBC’s
Explain Free Radical Injury
- Induced by
- Initiated reactions
- Cellular damage
- Generated form
- Antioxidants
Free Radical Injury
- Induced by activated oxygen species
- Inititate autocatalytic reactions
- Cellular damage:
- membrane lipid peroxidation
- Nucleic acid denaturation
- Cross-linking of proteins
- Generated from:
- Redox reactions
- Radiation (UV light)
- Drugs and chemicals
- Reperfusion injury
- Antioxidants:
- Superoxide dismutase (make peroxide)
- Catalase (degrades peroxide)
- Vitamine E
- Ceruloplasmin: carries copper in blood
Name and describe the two types of cell injury
Types of Cell Injury
Reversible Cell Injury
- Cellular and organelle swelling (due to Ca2+ influx)
- Bleb formation
- Ribosomal detachment from ER
- Clumping of chromatin (due to decreased pH)
- Increased lipid deposition (due to decreased protein synthesis)
Irreversible cell injury
- Extensive plasma membrane damage
- Massive Ca2+ influx
- Diminished oxidative phosphorylation within mitochondria (due to accumulation of Ca2+ rich densities)
- Release of lysosomal enzymes into the cytoplasm (due to lysosomal rupture)
- Nuclear fragmentation (karyorrhexis)
- Cell death (necrosis)
The outcome of cell injury depends largely on the severity and duration of the insult, but also on the cell type and its adaptive mechanism