Oral and dental infections

Question 1

What is the function of flouride in toothpaste?

Answer 1

It prevents the formation of dental caries by inhibiting the demineralization of tooth enamel, enhancing the remineralization of enamel, and inhibiting bacterial enzymes involved in the metabolism of carbohydrates by cariogenic bacteria.

Question 2

List the sources of flouride

Answer 2

Toothpaste
Flouridated drinking water
Professionally applied topical flourides
Oral flouride supplementation

Question 3

Why is oral health and hygiene important?

Answer 3

Oral health and hygiene practices is linked to:
1. Dental disease
Periodontal (gum) disease
Many chronic diseases, incl heart disease and diabetes

Question 4

What are dental caries?

Answer 4

Transmissible, complex bacterial biofilm disease that creates prolonged periods of low pH in the mouth, resulting in net mineral loss, and thus destruction of the hard layers of the teeth.

Question 5

Which microbes are common causes of dental caries

Answer 5

Strep mutans, Lactobacillus, streptococcus sobrinus

Question 6

Symptoms of dental caries

Answer 6

Tooth sensitivity
Mild to sharp pain when eating something sweet, hot or cold
Visible holes and pits in teeth
Brown, black, orange, or white staining on tooth surfaces
Pain on biting
Toothache

Question 7

Aetiology of dental caries

Answer 7

sugar consumption»> bacterial fermentation of the sugars&raquo_space;» creation of an acidic environment

Question 8

What is dental abscess? List its characteristics

Answer 8

Acute or chronic suppuration related to teeth, due to infection. It is
characterised by:
* Acute, severe, throbbing pain
* Swelling adjacent to the tooth, or on the face
* Pain worsened by tapping on affected teeth
* Restricted mouth opening or difficulty chewing
* Pus collection located around the tooth or at the apex of the root

Question 9

What is the treatment of dental abscess

Answer 9

• Amoxicillin + Metronidazole for 5 days
• Severe penicillin allergy
• Azithromycin for 3 days
• Pain: Paracetamol

Question 10

What is periodontal disease?

Answer 10

Infection and inflammation of the gums and bone that surround and support the teeth

Question 11

Early stage of periodontal disease is characterized by what?

Answer 11

gingivitis - swollen and red, and sometimes bleeding gums

Question 12

What happens when gingivitis is left untreated?

Answer 12

Untreated gingivitis can advance to periodontitis, the destruction of the
tissues and bone that support the teeth.

Question 13

Explain the periodontal disease progression

Answer 13

Bacterial plaque hardens the teeth, forming calculus.
* An inflammatory host response against the microorganisms of the
bacterial plaque and their toxins occurs. The intense inflammatory reaction results in gums separating from the teeth and the creation of pockets that become infected.

• As the pockets deepen, more gum tissue and bone is destroyed.
• Often only mild symptoms are present throughout progression of the disease, until the teeth become loose, and sometimes must be removed.

Question 14

Which bacteria are implicated in the aetiology of adult periontitis?

Answer 14

Porphyromonas gingivalis
Aggregatibacter actinomycetemcomitans

Question 15

What are the risk factors of periodontal disease?

Answer 15

Poor oral hygiene
Smoking
Poorly controlled DM
Stress
Underlying immunodeficiencies
Dry mouth

Question 16

What is uncomplicated gingivitis?

Answer 16

• An inflammation of the gum margin causing the gums to separate from the teeth.
• Pockets (recesses) form between the gums and the teeth.
• Pus and bacteria can collect in these pockets, eventually causing
  periodontitis.

Question 17

What are the characteristics of uncomplicated gingivitis?

Answer 17

Pain
* Redness
* Bleeding
* Swollen gums
* Gum recession may occur

Question 18

What is the prophylaxis and general measures for gingivitis

Answer 18

Oral hygiene after each meal
Brush teeth twice daily
Floss teeth at least once daily
Rinse mouth with home made salt water for 2mins twice daily.

Question 19

Tx of gingivitis

Answer 19

Chlorhexidine, 15 mL as a mouthwash, twice daily, after brushing
teeth, for 5 days.

Question 20

Pt counselling regarding Chlorhexidine

Answer 20

Do not swallow.
* Note: Do not eat or drink immediately after this. Chlorhexidine is inactivated
by organic material

Question 21

What is necrotising periodontitis? State its characteristics

Answer 21

It is an acute, very painful infection of the gingival margin. It is characterised by:

Foul smelling breath
* Necrosis and sloughing of the gum margin, especially of the
interdental papillae
* Loss of gingiva and supporting bone around teeth

Associated with underlying disease like HIV

Question 22

What are the complications of untreated necrotising periodontitis?

Answer 22

May lead to disease of surrounding lips and cheeks if not adequately
treated.

Question 23

Tx of necrotising periodontitis

Answer 23

Metronidazole
Oral hygiene
Chlorhexidine 0.2%, 15 mL as a mouthwash, twice daily, for 5 days.
Pain: Paracetamol

Question 25

State the 3 general measures used in the mx of aphthous ulcers

Answer 25

Avoid substances that can worsen or trigger episodes and on ways to
alleviate painful or bothersome symptoms.
* Eliminating nuts, chocolate, acidic food and drink, salty and/or spicy
foods, alcoholic and/or carbonated beverages from diet
* Avoiding oral products containing sodium lauryl sulfate (SLS). These
may trigger the formation or delay healing.

Question 26

What are the goals of Tx of minor ulcers?

Answer 26

reduce pain, inflammation and frequency of
recurrent episodes

Question 27

List the drugs used in the treatment of minor ulcers

Answer 27

Paracetamol,
* Children > 6 years of age and adults
* Tetracaine topical, applied every 6 hours.
* Apply a thin layer on the affected areas only (may be used inside
mouth).

Question 28

What to do when the ulcers don’t heal after 10 days?

Answer 28

refer for further diagnostic evaluation

Question 29

What are herpes simplex infections of the mouth and lips?

Answer 29

Acute, painful vesicular eruptions of
the lips or ulcerations of the lips
and mouth caused by Herpes
simplex virus and characterised by:
* shallow, painful ulcers on the lips,
gingiva, tongue and pharynx
* pain exacerbated by eating
It is a self-limiting infection with
symptoms subsiding within 10 days.

Question 30

What are the general measures for the treatment of HSV 1 ulcers

Answer 30

Rinse mouth with homemade salt mouthwash for one minute twice
daily (i.e. ½ medicine measure of table salt in a glass of lukewarm
water).
* Ensure adequate hydration.
* Fluid diet for children.
* Avoid acidic drinks, e.g. orange juice or soft drinks as they may cause
pain

Question 31

What is the Tx of Herpes simplex infection

Answer 31

Cover lesions on the lips with petroleum jelly.
* Pain: Paracetamol
Extensive oral herpes:
* For children > 6 years and adults:
* Tetracaine topical, applied every 6 hours.
* Apply a thin layer on the affected areas only (may be used inside mouth)

Question 32

What is the medical tx for serious herpes simplex infection in children and HIV pts?

Answer 32

Antiviral treatment: acyclovir for 7 days

Question 33

When to refer herpes simplex pts?

Answer 33

Severe condition.
* Dehydrated patients.
* No improvement after 1 week of treatment