Dental 2011

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Bacterial infections of the mouth & surrounding structures for UWA dental students, 2011.

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Dental 2011

  1. 1. An introduction tobacterial infections of the oral cavityand surrounding structuresTim InglisUWADental 2011
  2. 2. BackgroundPredisposing factors: extreme age, pregnancy, trauma, malignancy, malnutrition, immunosuppression, chronic infection, antibiotics, poor dental hygieneMicroorganisms: polymicrobial, biofilm, affected by nutrients, pH, Oxygen availability, other species, host defencesPathogenesis: change in local conditions including trauma, bacterial overgrowth, direct pressure, inactivation of PMLs, local spread, dissemination via blood stream
  3. 3. CariesBacteria: Streptococcus mutans, Lactobacillus sp.Location: enamelPathogenesis: supra/subgingival plaque, bacterial biofilm, acidic pH, fissures, cavities, vulnerable sites, complicationsManagement: personal dental hygiene, restoration of defects, prophylaxis in selected cases
  4. 4. Dental abscessBacteria: oral streptococci, anaerobic bacteria, Actinomyces sp., othersLocation: periapical, periodontalPathogenesis: localised collection of bacteria, PMLs & tissue breakdown, direct pressure, leading to cellulitis, tracking via line of least resistance & bone destruction, loss of tooth, distant infectionClinical: toothache, pain on chewing, sensitivity, bitter taste, halitosis, increased mobility, tenderness, swelling, erythema, lymphadenopathyManagement: eliminate infection, root canal surgery, preserve tooth if possible, selective use of antibiotics
  5. 5. Vincent’s anginaSynonyms: acute necrotising ulcerative gingivitis, trench mouthBacteria: fusiform & spirochaete bacteriaLocation: gingivaePathogenesis: not fully understoodClinical: rapid onset, pain, altered taste, punched-out ulcers, grey exudate, fever, malaiseManagement: debridement, antibiotics, mouthwash with oxidising agents
  6. 6. Ludwig’s anginaBacteria: anaerobic bacteria & oral streptococciLocation: submandibular & sublingual spacesPathogenesis: rapidly spreading cellulitis without abscess formation, starting in floor of mouthClinical: bilateral, brawny, board-like swelling in submandibular spaces, rapid progression to involve neck & glottis, difficulty swallowing and possibly with breathingManagement: monitor airway, intubate early, intravenous antibiotics, surgical decompression in extreme cases
  7. 7. OsteomyelitisBacteria: variety including oral streptococci, anaerobic bacteria, staphylococci, actinomycetesLocation: mandiblePathogenesis: periodontal disease, dental abscess, other factors e.g. traumaManagement: monitor bony changes, prolonged course of antibiotic therapy, condition of remaining teeth
  8. 8. BacteraemiaBacteria: oral bacteriaLocation: systemic circulationPathogenesis: immediately after dental procedures e.g. scaling, probing, root canal workManagement: selective use of antibiotic prophylaxis in high risk patients/procedures
  9. 9. Other notable infectionsStreptococcal pharyngitis: S. pyogenes (gp A), painful red throat, common; unusual complications including RF, RHD, ASGN, SCTonsillitis: bacterialExudative pharyngitis: EBV (glandular fever), gonococcal infectionSyphilis: chancre, tertiary infectionDiphtheria: painful, exudative, pseudomembranous tonsillar exudate
  10. 10. Summary Background Caries Dental abscess Vincent’s angina Ludwig’s angina Osteomyelitis Bacteraemia Other notable infectionshttp://en.wikipedia.org/wiki/Dental_carieshttp://micrognome.priobe.net

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