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Micro > MOUTH NF path > Flashcards

MOUTH NF path Flashcards

1
Q

saliva contains

A
  • lysozyme: attacks bac cell walls
  • lactoperoxidase: prod. hypohalides (antimicrob.)
  • lactoferrin: chelates iron–>restricts microbe access to iron
  • IgA: appear in saliva thru transudation not active sec.
  • sec. blood group Ag (glycolipids): blocks microbial attachment
  • buffering capacity
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2
Q

persons with this have higher #s of bac, more probs with oral cavity infections, dental caries, gum recession, etc.

A

saliva production deficiency (Sjogren’s syndrome, radiation-ind., drug-induced xerostomia)

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3
Q

the gingival sulcus contains

A

IgG and other transudated imm.globs, complement, PMNs, exp. during inflamm. states

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4
Q

factors which alter oral NF

A 
sig. change in diet
presence/absence of teeth
absence of saliva
Ab tx
hospitalization: G+-->G-rods
change in immune status (suppress.)
overall health
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5
Q

clin sig oral NF: aerotolerant anaerobes: G+ a-hemolytic streptococci:

A

s. mutans, s. sanguis, s. salivarius, s. mitis

* also etiologic agents of endocarditis (disp. NF), dental caries (OG @ origin)!

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6
Q

clin sig oral NF: facultative anaerobes

A

Eikenella corrodens (G-rod): causes skin/soft tissue ing/abscesses (mouth/hd), bite wounds
(@ origin or disp. NF)
Actinomycetes israelii: (G+, thin, branching filaments w/ clubbed ends): soft tiss. absc. in mouth/head(@ origin) and bronchial-pulm inf. by direct tiss extension and aspiration of saliva/oral fluids w/ org. (disp. NF)

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7
Q

anaerobes present on teeth, saliva, gingival crevices (can spread to lungs, blood)

A

Treponema denticola, T. vincentii (spirochetes)
Fusobacterium spp. (G-rod)
Porphyromonas gingivalis (G-rod)
Prevotella intermedia (G- rod)
Bacteroides forsythus (G-rod)
Aggregaitbacter (form. Actinobacillus)- actinomycetemcomitans (G- coccobacillus)
*all can cause periodontal disease (OG @ origin)

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8
Q

faculative anaerobes

A

yeast : Candida spp, C. albicans

oral thrush, dental stomatitis, pharyngitis (OG @ origin)

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9
Q

dental caries

A

demineralization at tooth
endogenous origin, mixed NF–>cariogenic orgs
e.g. S. mutans (G+ cocci)–>acid prod. via fermentation

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10
Q

dental caries risk

A

high sucrose diets, high simp. sugars, carbs
non fluoridated water
accum. of plaque from not cleaning

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11
Q

DC transmission

A

Streptococcus mutans: trans. in family units/close contacts

humans: resevoir

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12
Q

DC not freq. observed in

A

the v. young (it’s a chronic process)

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13
Q

DC pathogenesis

A 
chronic, slow, not self-limiting
biofilm formation (mult. genera)-->calcifies (tartar)-->chronic, slowly prog.
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14
Q

DC mechanism

A

bac ferment sugar–>org. acid (lactic)–>solubilize hydroxyapatite–>demineralize enamel/dentin–>caries

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15
Q

DC mech depends on pres. of bac that

A

produce organic acids (ferm. of sugars) and water INSOLUBLE glucans (via glycosyltransferase)

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16
Q

fermentation results in..which lead to..

A

cracks, fissures, erosions, pits w/ calculus/tartar

dentoalveolar inf.

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17
Q

immunitity to DC

A

adaptive imm. is Ab mediated : prev. binding of cariogenic orgs. to tooth surface
-vaccine not need due to water fluoridation

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18
Q

DC s/s

A

cracks, fissures, erosions, pits w/ calculus/tartar–> tooth ache

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19
Q

DC tx

A

removed dis. tissue, replace w/ inert restoration

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20
Q

prev/control of DC

A

change diet: avoid ref. sugar
inc. oral hygiene
fluoride (hyroxyapatitie–>fluorohydroxyapatite)
sealants
future prevention: sp. targeted antimicrob. pep: STAMP: C16G2

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21
Q

dentoalveolar infections

A

pyogenic infections of tooth and surrounding tissues

agents: oral and carious flora that have gained access to inner tooth tissue
risk: those w. dental caries or traumatic injury

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22
Q

dentalv inf. pathogenesis

A

via caries or trauma, orgs. get to inner tooth tissue–>microb. invasion of pulp w/ pulpits–>if drainage blocked–>pulpal necrosis, invasion of alveolar bone–>

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23
Q

end result of dentalv. inf

A

periapical or acute alveolar abscess and osteomyelitis

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24
Q

dentalv. inf immunity

A

Ab mediated

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25
Q

dentalv. s/s

A

tooth sensitive to pressure, percussion, heat, cold, etc. +/- drainage

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26
Q

dentalv dx

A

clinical s/s + caries or enamel compromise

radiographs to detect silent lesions, esp. in interproximal caries (btw teeth)

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27
Q

dentalv tx

A

dep. on severity

- elim of inf. pulp, deep periodontal scaling, drainage if abscesses, tooth extraction if req, analgesics

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28
Q

ppx, prevention of dentalv. inf

A

avoid sugar, inc. hygiene, fluoride, sealants, C16G2 STAMP (same as caries)

29
Q

Gingivitis–>Periodontal disease

A

NF induce inflamm. via imm system to attack tooth and supporting structures (gingival, period. lig, alv. bone, cementum) s/s: painless gum bleeding–>sig. pain, pungent breath and reabsorption of bone and tooth loss

30
Q

gingivitis

A

plaque builds on teeth and gingival margins/crevices and calcifies–>inflamm. and friability of gingiva

31
Q

orgs of chronic gingivitis

A

Prevotella intermedia, Bacteroides sp., Fusobacterium spp. (G- rod)

32
Q

orgs of acute ulcerative gingivitis (Vincent’s disease, trench mouth)

A

Treponema denticola, T. vincentii (Spirochetes)

Prevotella intermedia, Fusobacterium spp (G-rod)

33
Q

Periodontitis

A

inflamm. and invol of deeper tissue, involvement of periodontal lig. and alv. bone (chronic)–>tooth loss

34
Q

destruction of supp. structs is

A

irreversible
bac invade and cause inflammation thru niche in plaque–>neutros stim to rel. lysosomal contents (mettalprot/elastases)–>tiss destr.–>bac. hide from imm sys. in tooth and in supra/sub gingival plaque (biofilm) and inhib. neutrophil phagocytosis

35
Q

this org. subverts norm cell surface rec-IC sig to cause imm. dysfunc

A

Porphyromonas gingivalis

36
Q

P. gingivalis can colonize gum via…

and can be sustained via..

A

C5a rec
C3
(comp cascade can be damaging!)

37
Q

forms of periodontitis: classic periodontitis

A

retract. of gums, plaque pres., calculi abundant, bone resorption**

38
Q

chronic periodontitis

A

periodontitis + loosening and sep. of teeth–>tooth loss
abscess can form and involve period. lig and alv. bone
*major cause of tooth loss in adults

39
Q

localized juvenile periodontitis

A

severe, rapid progression, destructive *not plaque associated (no bone resorption?)

org: Aggregaitbacter actinomycetemcomitans
others: P. gingivalis, P. intermedia

40
Q

periodontitis orgs

A

Porphyromonas gingivalis* keystone
Prevotella intermedia
Bacteroides sp.
Fusobacterium spp. (G-rod)

41
Q

periondontitis tx

A

remove plaque/tartar, antimicrob. tx (lose teeth by 30, 40 if untx)

42
Q

necrotizing ulcerative gingivitis and periodontitis

A

(Vincent’s dis, trench mouth)

like periodontitis, but more acute

43
Q

NUGP orgs

A

Treponema spp. (spirochetes)
Fusiform bac
P. intermedia

44
Q

NUGP affects

A

males 18-30

risks: poor hygiene, malnutr., fatigue/stress, smtms mouth trauma

45
Q

NUGP path/clin manif

A

like gingivitis +
pt. more compromised
s/s: 4 P’s: papillae (irreg. necrotic ulcers), pseudomem. in aff. area (gray), pain, pungent breath
+ reg. lymphadenopathy, fever, malaise (syst.)

46
Q

NUGP tx

A

syst. abx (PCN, metronidazole) top. antimicrobs and antiseptic rinse (3% H202)
* thorough pro cleaning and good oral hygiene

47
Q

loc. juv. periodontitis pop.

A

neutropenic kids, or have chemotaxis defects

Afr. Am, host factors

48
Q

loc. juv. periodontitis path, s/s

A

not plaque assoc., immuncomp is the prob.
“lazy leuk. syndrome”, leuk adh. def
s/s: gums look norm, X-rays show loss of alv. bone (1st molars and incisors)–>loss of perm teeth

49
Q

loc. juv. period. tx

A

surg root debridement and resections of aff. tissue

tx w/ abx (metro, tetra)

50
Q

cervicofacial actinomycosis org

A

Actinomyces isrealii

51
Q

cervfac act risks

A

poor hyg (etOH), trauma, dent extra, orthodontics, hd/nk surg

52
Q

cervfac act path

A

pyogenic abscesses w/ tiss fibrosis

compromise in muc. integ–>org gets to submuc. tiss–>spreads by extension along fascial planes

53
Q

cervfac act s/s

A

slowly progress., chronic (wks, mod)
low grade/no fever
painful/unilat indurated lesion in peri/submandib. reg w. soft tiss. edema and erythema +/- cervical lymphad.
mult. draining sinus tracts w/ “sulfur granules”
(small yellow/white grains w/ macros + org. filaments @ periphery) (NOT pathognom.)
Histoplasma capsulatum and Nocardia can also have “sulfur granules”

54
Q

cervfac act dx

A

Gs of sulfur granule–>G+ thin branching filament (sulf. grans not always observed)

55
Q

cervfac act tx

A

PCN, tetra

remove source of inf.: disrupt abscess, drain pus, debride dead tiss, remove tooth/root canal

56
Q

Ludwig’s Angina

A

cellulitis, involves subling, submax, submand soft spaces–>airway compromise, asphyxiation, death

57
Q

Ludwig’s org

A

Actinomyces israelii (& other Actins)

58
Q

Ludwig’s risks

A

adults w/ caries, dentalv inf., trauma to enam/dent

59
Q

Ludwig’s path

A

dentalv inf–>spreads via facial planes to subs spaces (2nd/3rd molars often originating source)

60
Q

Ludwig’s s/s

A

bilateral**
sub spaces
rapid (w/in 24 hrs) spreading indurated cellulitis +/- abscess or lymp. involvement (nk lymphadenitis)
inf. on floor of mouth–>swell. elevation of floor, pushes tongue to roof, swollen hard nk, diff eating/swallowing/breathing, mouth held open
edema of nk and glottis–>airway obstr/asphyx
+/- fever/syst. signs

61
Q

Ludwig’s tx

A 
systemic abx (PCN, amox, metro)
maintain airway (intub, trach)
surg debridement/drainage
62
Q

Stomatitis

A

inflammation of oral mucosal membranes (pharyngitis (sore throat))

63
Q

Oral candidiasis- “thrush” and dental Stomatitis caused by

A

Candida albicans (yeast, euk fungi)
3 forms: yeast, pseudohyphae, hyphae
biofilms in CV caths, dentures
NF of mouth: fungal spores germ as sing. round cells–>oval/elong., repr. by budding
form moist or mucoid colonies (resemb. bac colonies)

64
Q

Oral candidiasis pop

A

newborns, Ca pts., abx therapy, AIDs pts, dentures (65%!)

65
Q

oral candidiasis pres/s/s

A

white–>yellow “cottage cheese” patches in mouth
oral pain–>don’t try to remove patches–>exc. bleeding
inflamm: eryth, edema, sore throat, gums, tongue, etc
friable & tender under lesions

66
Q

if have oral candidiasis and immuncomp(T cell suppr)

A

can present w/ candidal esophagitis

67
Q

oral cand. dx

A

s/s, wet mount microscopy of saline or KOH prep: yeast w/ pseudohyphae, Gs

68
Q

oral cand. tx

A

anti fungal drugs/rinses: ketoconazole

Micro (61 decks)

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