Oral infections review 4 nina

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Oral Infections

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Oral Infection

• Periodontitis

• Pulpitis with periapical abscess

• Pericoronitis

• Periimplantitis

Infections process Predominant

odontopathogens

Periodontitis

Porphiromonas gingivalis Tennerella

forsythensis

Actinobacillus actinomycetemcomitans

Prevotella intermedia

Fusobacterium nucleatum Veionella parvula

Treponema denticola Streptocossus spp.

Pulpitis with

periapical abscess

Fusobacterium nucleatum


Peptostretococcus micros

Capnociytophaga ochracea

Selenomonas sputigena

Porphiromonas endodontalis

Streptocossus spp.

Pericoronitis


Veionella parvula Prevotella melaninogenica


Actinomyces israelii / odontolyticus

Streptocossus spp.

Periimplantitis



Pseudomona aeruginosa

Staphylococcus spp

Actinomyces actinomycetemcomitans

Dental Extraction

• Tooth decay that has destroyed enough tooth

structure to prevent restoration is the must

frequent indication for extraction of teeth

• Extraction of impacted or problematic wisdom

teeth are routinely performed

• Extractions are categorized as

Simple or Surgical

Dental Extraction

• Infection, although

rare, occurs on

occasion; the dentist

may opt to prescribe

antibiotics pre-and

/or post-operatively

if he / she

determines the

patient to be at risk

Oral Infection

Pereodontal Diseases

Destruction in the

conjunctive attachment

system and in the alveolar

bone.

Periodontal Diseases

Gingivitis Periodontitis

Inflammation confined

to the gingiva (gum)

Dental Plaque

• A biofilm of a clear color that builds up on the

teeth. If not removed regularly, it can lead to

dental cavities (caries) or periodontal problems

(such as gingivitis)

• The microorganisms that form the biofilm are

almost entirely bacteria (mainly streptococcus

and anaerobes), with the composition varying

by location in the mouth

Dental Plaque

• The microorganisms present in DP are all naturally present in the oral cavity, and are normally harmless. Failure to remove plaque by regular tooth brushing means that they are allowed to build up in a thicker layer.

• Those nearest the tooth surface convert to anaerobic respiration; it is in this state that they start to produce acids which consequently lead to demineralization of the adjacent tooth surface, and dental caries.

Dental Plaque

• Saliva is also unable to penetrate the build up of

plaque and thus cannot act to neutralize the acid

produced by the bacteria and remineralize the

tooth surface

• The microorganisms change as the plaque ages

• Plaque which is 12 hours old is much less

damaging than plaque which has not been

removed in days

Dental Plaque

• A biofilm is a complex aggregation of

microorganisms marked by the excretion of a

protective and adhesive matrix

Odontogenic infection

Polymicrobial , result of “biofilm maturing”:

a change in the predominant bacterial species

(from predominantly gram -, facultative and

saccharolytic flora to predominantly gram +,

anaerobic and proteolytic flora).

Fusobacterium nucleatum is considered as the

central structural component of biofilm : co-

aggregates with other harmless components and

with periodontal pathogens, permitting biofilm

evolution into infection.

Gingivitis• Usually caused by bacterial plaque that

accumulates in the spaces between the gums

and the teeth and in calculus (tartar) that forms

on the teeth

• Over the years, the inflammation causes deep

pockets between the teeth and gums and loss of

bone around teeth otherwise known

as periodontitis

Gingivitis

• Since the bone in the jaws holds the teeth into the jaws, the loss of bone can cause teeth over years to become loose

• Regular cleaning disrupts this plaque biofilm and removes tartar to help prevent inflammation

• It takes approximately 3 months for the pathogenic type of bacteria (G- anaerobes and spirochetes) to grow back into deep pocket

Gingivitis

• People with healthy periodontium (gums, bone and ligament) or people with gingivitis only require periodontal debridement every 6 months

• When the teeth are not cleaned properly by regular brushing, bacterial plaque accumulates, and becomes mineralized by calcium and other minerals and other minerals in the saliva transforming it into a hard material called calculus (tartar) which harbors bacteria and irritates the gingiva (gums)

Gingivitis

• Association with low calcium intake is particularly evident for people in their 20s and 30s

• Gingivitis complications:

- Recurrence of gingivitis

- Periodontitis

- Infection or abscess of the gingiva or the jaw bones

- Trench mouth

Periodontitis

• Inflammatory disease affecting the tissues that surround and support the teeth

• It involves progressive loss of the bone around teeth which may lead to loosening and eventual loss of teeth if untreated

• Caused by bacteria that adhere to and grow on tooth surfaces (microbial plaque or biofilms), particularly in areas under the gum line

Periodontitis

Inflammation of the periodontium, or one of the tissues that support the teeth (AROUND THE TOOTH)

• Gingiva, or gum tissue

• Cementum, or outer layer of the roots of teeth

• Alveolar bone, or the bony sockets into which the teeth are anchored

• Periodontal ligaments which are the connective tissue fibers that connect the cementum and the gingiva to the alveolar bone

Periodontitis

• Although the different forms of periodontitis are bacterial diseases, important risk factors include: - Smoking

- Poorly controlled diabetes

- Inherited susceptibility

• Treatment and prevention: Periodontal debridement; bacteria and plaque tend to grow back to pre cleaning level

• Check up each 6 months

Periodontitis

• Systemic antibiotic therapy can provide greatest benefit to periodontitis patients who do not respond well to mechanical periodontal therapy or who are experiencing fever or lymphadenopathy.

• Single antimicrobial drug therapies may be able to suppress various periodontal pathogens for a prolonged period of time depending on the effectiveness of the host defense and the oral hygiene efforts

Periodontitis

• Combination drug therapies, which aim at enlarging the antimicrobial spectrum and exploiting synergy between antibiotics, are often indicated with complex mixed periodontal infections.

• Prescription of any systemic antibiotic therapy requires a careful analysis of patients’ medical status and current medications. In severe infections, it may include antimicrobial sensitivity testing.

Periodontitis

• The supragingival biofilm is fundamentally G +,

facultative and saccharolytic, which means that

in the presence of sugars, it produces acids that

demineralise enamel, facilitating biofilm

infiltration of dentin and pulp.

• With the bacterial invasion of the tooth’s internal

tissue, the biofilm evolves, and thus root canals

are infected with predominantly gram-negative,

anaerobic and proteolytic bacteria.

Endodontics

• The most common procedure done in

endodontics is Root-canal therapy.

This procedure aims to save a tooth that would

otherwise be extracted due to infection caused by

decay

• Root canal therapy involves the removal of

diseased pulp tissue inside the tooth

Endodontics

• Once the diseased pulp tissues are removed,

the body’s defense system can then repair the

damage created by disease

• Often, an intra pulpal medicament to inhibit

bacterial growth is placed and the tooth is filled

with a temporary restoration until the second

appointment

Endodontics

• If decay progresses to the first stage, a small

filling will be required

• If decay develops to the third stage depicted,

root canal therapy will be required

1st Stage 2nd Stage 3rd Stage

Apical infection

• Pulpal necrosis is the result of a bacterial,

thermal or traumatic attack. This necrosis is

transformed into an apical infection:

Multibacterial (aero & anaerobic)

• On surface, 28% of bacteria are aerobic and

anaerobic in depth

Peri-apical infection

• Abscess in the alveolar bone regarding a tooth

apex; bacterial infiltration starts from the

bacterial plaque and or the saliva through the

pulp chamber

Peri-apical infection

• Total eradication of bacteria from the radicular

canal,

• Canal preparation,

• Hermetic canal obstruction.

Cellulitis / Abcess

• Infection in the cellular tissue, complicating the

apical infection.

• Radio transparent image in regard of the causal

tooth.

• Streptococcus, Staphylococcus &

peptostreptococcus

Polymicrobial association

65% anaerobic and 35% aerobic

Anaerobia G- Rods

(Bacteroids, Fusobacterium).

Anaerobia G+ Cocci

(Peptostreptococcus, Peptococcus).

Facultative aerobia G+ Cocci

(Streptococcus milleri).

Fusobacterium nucleatum is associated to serious

cases.

Cellulitis / Abcess

Cellulitis / Abcess

• Antibiotic controls the infective bacterial load

• Therapeutic action combines mechanical debridement, and / or surgery, and / or systemic antibiotic therapy, where appropriate.

• The first step in the case of dental abscess is to drain and debride the abscess using mechanical-surgical techniques. Drainage is performed by making an incision in the area of greatest fluctuation.

Cellulitis / Abcess

Cellulitis / Abcess

• Mechanical-surgical techniques have a

quantitative effect on bacterial load giving the

host the opportunity to recover homeostasis

through immune system action.

Osteitis / Alveolitis*

• Acute or chronic inflammatory process in the

connective tissue, the medullar tissue and

Havers canals

• * Osteitis localized in the alveoli of an extracted

tooth (not healing )

Osteitis / Alveolitis*

• Dried alveolitis:

Antibiotherapy is unnecessary.

• Suppurative alveolitis:

Prevotella, Fusobacterium, Staphylococcus

aureus and streptococcus pyogenes

Osteomyelitis

• Requires hospitalization and an additive

treatment other than antibiotics like hyperbaric

oxygen therapy

Sinusitis of dental origin

• The development of an apical infection in antral

teeth ends in the sinusal cavity and we talk

about sinusitis of dental origin.

• Infection of the pericoronal sac within a tooth in the process of eruption and which is partially restrained. In most of the cases it is the wisdom tooth.

• Most frequent organisms are: P. intermedia, P. micros, Veillonella, F. nucleatum

Pericoronitis

• Infection of the tissues that surround the

implant.

• Radiological examination shows a radio

transparency image that surrounds one or

several parts of the implant.

Per implantitis

• Debridement should be the first step in therapy as draining the infection and eliminating necrotic waste will facilitate antimicrobial action

• Antimicrobials alone are indicated when the severity of the infection advises delaying surgical techniques due to the risk of spreading the infection during debridement itself.

• Antibiotic prophylaxis achieves better results if the antimicrobial agent is administered pre-operatively.

• Treatment of chronic asymptomatic infection can

cause an acute exacerbation of the infectious

process.

• Periodontal and endodontic over-instrumentation

can cause bleeding and exudates in periodontal

and periapical tissues, providing bacteria with

nutrients, and thus stimulating proliferation,

which may overcome the host’s immune

resistance.

• This factor should be given special

consideration in immunodepressed patients

and in patients whose microbiological

studies reveal odontopathogens or bacterial

associations that are particularly resistant to

therapy. In these cases, it is essential to

use an effective antimicrobial agent.

• Wide spectrum antibiotics must be used in

view of the polymicrobial, mixed nature of

odontogenic infections, and such antibiotics

must be especially active against the

commonest odontopathogens, made for

natural resistance (e.g. Streptococcus sp.;

Actinomyces sp. and A.

actinomycetemcomitans )

Thanx Nina

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Oral infections review 4 nina