The Oral Microbiome & Systemic Disease

Question 1

The human genome project was conducted from ___-___ and sequenced the ___ billion base pairs of human DNA and identified all ___ genes in the human DNA.

Answer 1

1993-2003; 3; 20,000

Question 2

___ are pathogenic invaders shifted to “___-___ ___-___” which states that microbes are essential and we are adapted to each other.

Answer 2

Germs; Human-microbiome super-organism

Question 3

Microbes are beneficial because they are ___ against pathogens, have ___ functions and are ___ activators.

Answer 3

resistant; metabolic; immune

Question 4

T/F. In the past, the goal was to manage and preserve native microbes, but now we need a sterile environment.

Answer 4

False, In the past the goal was a STERILE environment but now we want to manage and preserve native microbes.

Question 5

T/F. In the past Koch’s postulates and single-species caused acute diseases but now chronic diseases caused by microbial community disruptions and loss of health species.

Answer 5

True.

Question 6

T/F. In the past, therapies focused on broad eradication thru the use of antibiotics and antiseptics but now therapies encourage healthy communities.

Answer 6

True.

Question 7

___ give you a good organism. ___ encourage the growth of bacteria (a substrate - like carbs for growth).
___will only kill certain microbes.

Answer 7

Probiotics; Prebiotics; targeted antimicrobials

Question 8

What disease provided new evidence for connections between oral infections and systemic disease?

Answer 8

cardiovascular disease

Question 9

Explain how the translocation of bacteria and the translocation of toxins provide evidence for direct mechanisms of oral connections.

Answer 9

1. Translocation of bacteria - distant site infection seeded by oral bacteria (example: oral bac gain entry into circulatory system (IE) or airway (pneumonia))
2. Translocation of toxin - distant site effect from toxin produced by oral bacteria (example: endotoxin from gram negative bac in perio pocket enters circulatory system and promotes inflammation)

Question 10

Host ___-___ phenotype is a common pathway to disease. for example, ___-1 gene polymorphisms associated with increase in periodontitis and system diseases.

Answer 10

hyper-inflammatory; interleurkin-1 (IL-1)

Question 11

T/F. Epidemiologic studies show association and causation.

Answer 11

False, they show association but NOT causation

Question 12

What type of evidence shows causation of oral systemic effects?

Answer 12

1. human trials showing disease treatment prevents systemic disease or lowers inflammation
2. presence of bac at disease site
3. demonstration in animal models

Question 13

In infective endocarditis, ___ and ___ adhere to exposed ___ tissues producing nonbacterial thrombotic endocarditis (NBTE). Bacteria from oral cavity enter ___ stream and adhere to ___ and multiply, infiltrate heart tissue and cause cardiac and valvular injury.

Answer 13

platelets; fibrin; connective; blood; NBTE

Question 14

Can can infective endocarditis lead to stroke?

Answer 14

Bacterial chunk dislodges into circulation producing emboli and stroke.

Question 15

What oral bacteria contribute to microbiology of infective endocarditis? Skin bacteria?

Answer 15

Streptococci (60+%) - sanguis, mitis, mutans
A. actinomycetemcomitans
Gemella

Skin - Staphylococci (25+%)

Question 16

T/F. In theory antibiotic prophylaxis prevents hematogenous spread of bacteria (bacteremia) but this is not the case in practice.

Answer 16

True

Question 17

Antibiotics carry risk and costs such as ___ and ___.

Answer 17

allergy; resistance

Question 18

T/F. There is NO solid evidence that dental procedures are associated with IE and therefore, antibiotic prophylaxis is unlikely to prevent many cases of IE.

Answer 18

True.

Question 19

What dental routine events cause bacteremia?

Answer 19

1. routine events (chewing, toothbrushing)

2. poor oral hygiene and gingival disease increase the risk of bacteremia

Question 20

T/F. Random bacteremia from routine activities are less likely to cause IE than dental procedures.

Answer 20

False, Random bacteremia from routine activities are MORE likely to cause IE than dental procedures.

Question 21

How can one reduce the risk of infective endocarditis.

Answer 21

Good oral health and hygiene may reduce bacteremia.

Question 22

T/F. It is more important to optimize regular oral hygiene measures to keep bacterial load low than to give antibiotic prophylaxis.

Answer 22

True.

Question 23

In 2007, IE guidelines shifted from ___ prophylaxis to access to ___ care and oral health.

Answer 23

antibiotic; dental

Question 24

What are reduced indications for antibiotics based on? What antibiotic is given and in what dose?

Answer 24

invasiveness of procedure
high risk of IE
single high dose of amoxicillin

Question 25

Aspiration pneumonia is caused by aspiration or oral ___ and oral ___. This is common when airway protective reflexes are compromised. What type of patients would this be seen in?

Answer 25

secretions; bacteria

physically handicapped and elderly

Question 26

Oral hygiene measures prevent lung infection by reducing ___ pneumonia by 40%. It could prevent 10% of death in elderly in ___ homes.

Answer 26

nosocomial; nursing

Question 27

Periodontitis is associated with ___ birth, low ___ and __-___.

Answer 27

preterm; birthweight; pre-eclampsia

Question 28

Bacteria in ___ fluid are common oral species associated with ___ birth.

Answer 28

amniotic; preterm

Question 29

T/F. Randomized clinical trials does NOT show that periodontal treatment reduces risk of preterm birth or low birthweight. The current evidence for a causal relationship is not strong.

Answer 29

True.

Question 30

T/F. There is a substantial amount of evidence to support the use of dental treatment and/or antibiotics in immunosuppressed patients.

Answer 30

False, there is LACK of evidence to support the use of dental treatment and/or antibiotics in immunosuppressed patients.

Question 31

What is the focus in immunosuppressed patients?

Answer 31

focus on achieving / maintaining good oral health

Question 32

What must one consider when dealing with immunosuppressed patients?

Answer 32

invasiveness of the procedure; bacterial load; degree of immunosuppression (if the ANC is

Question 33

T/F. There is increased prevalence of periodontitis in diabetics and the treatment of periodontitis improves glycemic control.

Answer 33

True.

Question 34

T/F. There is a strong causative relationship that coronary heart disease, stroke, and peripheral vascular disease are associated with periodontitis.

Answer 34

False, the association is modest and there is a link but not a causative relationship

Question 35

What evidence shows causality of oral diseases and cardiovascular disease?

Answer 35

1. Perio Tx trials show favorable responses on laboratory markers but do not show reduction in CVD
2. P. gingivalis and other perio pathogens found in atherosclerotic lesions
3. P. gingivalis exacerbates CVD in animal models
4. Plausible biologic pathways for causation demonstrated in animal models

Question 36

There is an increased risk of ___ cancer in patients with periodontitis.

Answer 36

pancreatic

Question 37

What is the cause of cardiovascular implantable electronic device (CCIED) infections?

Answer 37

caused by bacteria from the skin of patients or hands of hospital workers or environment BUT NOT oral species

Question 38

Is antibiotic prophylaxis recommended for dental treatment in patients with non-valvular cardiovascular device related infections?

Answer 38

No

Question 39

Most infections (___%) on vascular grafts/stents caused by bacteria native to ___ or ___.

Answer 39

90%; skin; bowel

Question 40

What causes infections of intravascular access devices?

Answer 40

Staph or other skin or environmental bacteria

Question 41

What is the CDC guideline for the prevention of intravascular catheter-related infections?

Answer 41

NO antibiotic prophylaxis for any reason

good infection control practices and monitoring key

Question 42

1-2% of joint ___ become infected usually during the perioperative period from ___ contamination and has a ___ morbidity.

Answer 42

prostheses; wound; high

Question 43

There is evidence for ___ antibiotic prophylaxis at the time of device placement but there is lack of evidence supporting ___ prophylaxis to reduce dental procedure-related ___ and ___ site infections.

Answer 43

primary; secondary; bacteremia; distant

Question 44

Late joint prosheses infections occur from ___ seeding and ___ form on the surface. It is difficult to diagnose, treat and identify the causative bacteria. Most often the bacteria is ___ but ~___% by bacteria found in oral cavity.

Answer 44

hematogenous; biofilms; Staphylococci; 5%

Question 45

T/F. Evidence does not demonstrate an association with joint prosthesis and dental procedures. Therefore, prophylactic antibiotics when undergoing dental procedures are NOT generally recommended.

Answer 45

True.

Question 46

T/F. Orthopedic hardware that is not within the synovial joint is not at increased risk for hematogenous seeding by microorganisms.

Answer 46

True.

Question 47

The is ___ indication for antibiotic to prevent oral bacteria in patients with pins. plates and screws.

Answer 47

NO

Question 48

IS prophylaxis recommended in patients with ventriculo-peritoneal shunts?

Answer 48

NO

Question 49

Is there evidence that microorganisms associated with dental procedures cause infection of ventriculo-atria shunts?

Answer 49

NO

Question 50

What diseases discussed are associated with a direct transfer of oral bacteria? What is the primary preventive strategy?

Answer 50

Infective endocarditis
Pneumonia in compromised airway
Immunosuppression
Preterm birth

Primary preventive strategy
• improve oral health and reduce bacterial load
• antibiotic prophylaxis indicated in specific high risk situations

Question 51

What diseases discussed are associated with transfer or oral bacteria or toxin, or common inflammatory pathway? What is the primary preventive strategy?

Answer 51

Type 2 diabetes
Cardiovascular disease
Pancreatic cancer

Primary preventive strategy
• treat periodontal disease to improve microbial profile
• improve overall health by addressing risk factors

Question 52

What diseases were discussed that are not associated with oral bacteria but instead skin bacteria? What precautions should be taken?

Answer 52

Cardiovascular implantable electronic devices (CIED)
Vascular grafts / stents
Intravascular access devices
Prosthetic joints
Bone pins, plates & screws
Renal dialysis shunts
Cerebrospinal fluid (CSF) shunts

No special oral precautions