Oral bacteria and systemic disease

Question 1

what is a “super organism”

Answer 1

co-evolution of the host and microbe

Question 2

why do we need beneficial microbes? (4 reasons)

Answer 2

1. the produce metabolic activity
2. they inhibit pathogens
3. they produce a balanced ecosystem
4. they activate the immune response

Question 3

T/F: there is a systemic and oral connection

Answer 3

True

bacteria in the mouth interact with the host in complex ways

Question 4

What used to be thought about microbes and what do we think now? (paradigm shift)

Answer 4

“germs”–>”human-microbe super-organism”

We used to think all bacteria were pathogens; now we know certain microbes (native ones) are essential

Question 5

what is Koch’s postulate?

Answer 5

that a single species pathogenic microbe causes disease

PROVEN WRONG: it is disruption of microbial community that causes chronic disease

Question 6

paradigm has shifted to microbial ecology…what does this mean?

Answer 6

instead of using broad spectrum drugs (antibiotics and antiseptics) to eradicate large amounts of bacteria–>

use probiotics, prebiotics, and TARGETED antimicrobials to maintain a good microbial community

Question 7

What is functional redundancy

Answer 7

different bacteria in a microbiome can carry out the same function

Question 8

what are the two projects called that sequenced human genes and bacterial genes?

Answer 8

Human Genome Project

Human Microbiome Project

Question 9

What did we learn about the human and microbiome genes from the projects conducted?

Answer 9

Microbiome has much more genetic information than the human genome (20,000-25,000 human genes)

Question 10

what is biogeography

Answer 10

explains that we have a variety of bacteria in our body and each has a specific site(s) it likes to colonize

environments wet vs dry would attract different microbes

Question 11

how does biogeography help us with investigating infection?

Answer 11

if find bacteria in heart that doesn’t usually live in heart but lives in mouth, then we can infer that infection started in the mouth

Question 12

what bacteria is prominent in the oral cavity?

Answer 12

streptococcus

Question 13

there has been new evidence that suggests a connection between oral infection (periodontal disease) and what 2 systemic diseases?

Answer 13

CVD

Diabetes

Question 14

Theory of focal infection

Answer 14

removing the “focus of infection” (oral infection) can resolve a systemic disease

(been around since Hippocrates!)

Question 15

what is “therapeutic edentulation”

Answer 15

used to think that removing teeth and tonsils could cure systemic diseases including mental illness

Question 16

epidemiologic studies can show association but do not show…..

Answer 16

CAUSATION

Question 17

three mechanisms for oral connections with systemic

Answer 17

1. infection presents in distant site seeded by oral bacteria (aspirate or enter into circulatory system)
2. injury presents from toxin produced by bacteria in the oral cavity (if endotoxin from gram negative bacteria enter circulatory system)
3. if host is very susceptible to inflammation, it creates common pathway to disease (if genetically susceptible can increase risk in getting systemic disease including periodontitis)

Question 18

what is meant by hematogenous spread

Answer 18

spread through blood (bacteremia)

Question 19

how can bacteremia be prevented

Answer 19

antibiotic prophylaxis

improve oral health

Question 20

what is used for antibiotic prophylaxis (dose)

Answer 20

high dose of amoxicillin 1 hr prior to dental tx

bacteriocidal

Question 21

infective endocarditis

• definition
• course of infection
• concerns

Answer 21

infective endocarditis is a bacterial infection of the heart that starts at a distant site (oral cavity) and spreads through the blood

platelets and fibrin bind to exposed connective tissues which attract bacteria and form clots-bacteria multiply and enter heart tissue

special considerations in dental chair
concerned with emboli or stroke

Question 22

T/F: there is no evidence that dental procedures are associated with infective endocarditis (IE)

Answer 22

TRUE!

in practice, antibiotic prophylaxis actually does not prevent bacteremia and unlikely will prevent IE

Question 23

what is better to prevent IE….antibiotic prophylaxis or good oral health?

Answer 23

good oral health

Question 24

which strains of streptococci are in the oral microbiome?

Answer 24

mutans
mitis
sanguis

make up 60% of oral bacteria

Question 25

what are the three major strains of bacteria found in the mouth

Answer 25

streptococcus Aa Gemella SAG (first letter is most prominent group)

Question 26

what can cause IE more than dental procedures?

Answer 26

routine chewing, brushing can cause IE!

Question 27

what is most associated with high risk for bacteremia (IE)

Answer 27

poor oral hygiene and gingival disease

Question 28

what is of concern with patients that have compromised airway protective reflexes?

Answer 28

Pneumonia is very common - important to keep the oral hygiene of these people very GOOD! - aspirate bacteria into lung

Question 29

explain the relationship between periodontitis and preterm birth, low birthweight, and pre-eclampsia

Answer 29

periodontitis in the mother is associated with PTB, LBW and pre-eclampsia but there is NO evidence to prove CAUSAL relationship bacteria has been found in amniotic fluid (common to oral cavity) that is associated with preterm birth

Question 30

what three things need to be considered before treating an immunosupressive patient

Answer 30

1. bacterial load 2. how invasive is the procedure 3. degree of immunosuppresion

Question 31

what do we know about immunosuppression and its relationship to dental treatment

Answer 31

there is lack of evidence to show connection between dental treatment or efficacy of antibiotics in immunosuppressive patients

Question 32

immunosuppressive patients are at high risk for what 2 things

Answer 32

disseminated strep | oral candida

Question 33

do we need antibiotic prophylaxis prior to treating patient with an implanted device?

Answer 33

NO

Question 34

what type of bacteria causes infection in an implanted device?

Answer 34

skin bacteria | not oral

Question 35

when should you defer treatment for immunosuppressive patient unless Doc okays

Answer 35

if ANC level is below 1000/m3

Question 36

what type of bacteria is staphylococcus?

Answer 36

skin bacteria

Question 37

do we need antibiotic prophylaxis for vascular grafts/stents?

Answer 37

NO

Question 38

why do we not need to give antibiotic prophylaxis for patients with vascular graft/stent if mortality rate is so high?

Answer 38

infections are caused by skin/bowel bacteria not oral bacteria

Question 39

how to prevent infection in intravascular access device what bacteria usually causes infection?

Answer 39

prevent infection with good infection control and monitoring do not need antibiotic prophylaxis infection usually by staph (skin bacteria)

Question 40

what bacteria primarily infects joint prostheses

Answer 40

staph (skin bacteria)

Question 41

is there evidence shown for antibiotic prophylaxis for joint prostheses

Answer 41

primary antibiotic prophylaxis: evidence shows needed for joint prostheses placement Do not need secondary antibiotic prophylaxis: to prevent infection from distant site later on

Question 42

what type of bacteria causes infection in bone pins, plates and screws

Answer 42

staph not oral bacteria no antibiotic prophylaxis needed

Question 43

AP for cerebralspinal fluid shunt?

Answer 43

No skin bacteria infects vascular structures not involved

Question 44

what is the best way to prevent oral bacterial products and pro-inflammatory molecules from getting into circulation

Answer 44

good oral hygiene

Question 45

T/F: periodontitis and diabetes are linked

Answer 45

True

Question 46

if diabetic patient has periodontal disease (high prevalence)

Answer 46

treating periodontitis can improve glycemic control can increase inflammation since they have synergistic effect

Question 47

oral bacteria and CVS evidence shows...

Answer 47

modest association not causal relationship bacterial toxins could be a mechanism

Question 48

which bacteria has been shown on animal models to exacerbate CVD

Answer 48

p. gingivalis

Question 49

what bacteria has been found on athersclerotic lesions

Answer 49

p. gingivalis

Question 50

peridontitis and pancreatic cancer evidence shows...

Answer 50

patients with periodontitis have increased risk of pancreatic cancer also linked to smoking, obesity, diabetes

Question 51

is AP indicated if have a patient with mitral valve replacement?

Answer 51

YES!

Question 52

systemic diseases that have oral connection by direct transfer of bacteria (4)

Answer 52

1. IE 2. immunosupression 3. pneumonia 4. preterm birth

Question 53

systemic diseases that have oral connection by common pathway (3)

Answer 53

1. pancreatic cancer 2. diabetes (type 2) 3. CVD

Question 54

do we need to do AP for patient undergoing immunosuppressive chemotherapy?

Answer 54

YES case by case but usually we do because patient can easily get infection in the blood