acute pseudo- membranous candidosis acute erythematous candidosis actinomycosis herpes simplex oral...
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Acute pseudo-membranous
candidosis
Acute erythemat
ous candidosis
Actinomycosis
Herpes simplex
Oral Infections
Dr Ian DouglasUniversity of Sheffield
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Acquisition of oral flora
• At birth oral cavity is sterile• Most species acquired during
the first 2 years of life• Flora mainly acquired from
mother
– its all in a kiss!
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Acquisition of mutans streptococci
6 12 18 24 30 36
age (months)
tooth emergence
molars
infectivity
window
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Plaque -in vivo biofilm
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Dental caries
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Stephan Curve
3
4
5
6
7
0 1 2 3 4 5 6 7 8 9 10 11 12 13
NormalSnacking
Hours
pulses
pH in plaque
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Prevalence of some bacteria in caries
% viable count
Progressive Non-progressive
mutans 10 3
S.sanguis 6 9
S.oralis 4 5
Lactobacillus 1 0
Veillonella 11 9
Actinomyces 29 33
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Mechanical removal of plaque?
Toothbrushbristle
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Topical passive immunisation
•Anti S.mutans s-IgA cloned into tobacco
•3 week application eliminated oral S.mutans
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Replacement Therapy -Superbugs
S
•Potent bacteriocin producer
•Stable LDH-deficient mutant
• Produces ethanol & other acids
•Imported adh gene
bacteriocin
bacteriocin
bacteriocin
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Destructive Periodontitis
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Disease Progression
0123456789
10
20 35 45 55
Age (years)
Att
acm
ent
loss
(m
m)
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A.odontolyticusV.parvula
Association of organisms with disease
Pr.intermediaAt.actinomycetemcomitans
Pr.nigrescensF.nucleatum
Pt.microsC.rectus
P.gingivalisTa.forsythusT.denticola
S.mitisS.oralis
S.sanguis
Health Disease
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Periodontal species detected by 16srRNA
DeferribacteresSpirochaetesFusobacterium animalisAtopobium parvulumAtopobium rimaeEubacterium sp.Megasphaera sp.Abiotrophia adiacensCatonella morbiDialister pneumonsintesEubacterium saphenumFilifactor alocisGemella haemolysansSelenomonas sp.Streptococcus constellatusDesulfobulbus sp. R004Campylobacter gracilisCampylobacter rectusHaemophilus parainfluenzaeBacteroides forsythusPrevotella tanneraePorphyromonas endodontalisPorphyromonas gingivalis
• Estimate 415 species
•~40% were novel phylotypes
•Detected in at least four diseased subjects, but not in healthy subjects
Paster B J Bact 2001; 183; 3770-3783
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Periapical disease
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Bacteria associated with endodontic treatment
failureSpecies No.casesE.faecalis 9S.anginosus 2S.constellatus 1S.intermedius 1Pept.micros 2A.israelii 3Prop.acnes 1F.nucleatum 1B.gracilis 3
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Spread of infection from the tooth
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Examples of oral abscesses
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Bacterial genera in periapical abscesses
Anaerobes FacultativesGram-negative Gram-negativePrevotella* EikenellaPorphyromonas* CapnocytophagaFusobacterium* HaemophilusCampylobacter*VeillonellaBacteroidesTreponema
Gram-positiveGram-positive Streptococcus*Peptostreptococcus* EnterococcusEubacterium* LactobacillusPropionibacterium Actinomyces
* most frequently recovered
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Antibiotic sensitivity among oral anaerobes
Prevotella Porphyro Fusobact
Ampicillin 10 83 83
Amp/Sulbact 100 100 100
Cefazolin 38 83 94
Cefotaxime 62 100 100
Imipenem 100 100 100
Clindamycin 100 100 8
Erythromycin 81 94 100
Minocycline 81 100 100
Metronidazole 100 100 100
Kuriyama et al 2001
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ß-lacatmase in Prevotella isolates
Species % positive
P.intermedia 17
P.melaninogenica 78
P.oralis 50
P.buccae 25
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Summary• Oral infections are polymicrobial• Generally caused by endogenous
commensal species• There is relatively little microbial
specificity for the different types of lesion (except dental caries?)
• Some oral infections pose treatment problems due to antimicrobial resistance