Periodontitis, Pulpitis and Oral Infections: Causes, Microbes and Treatment
Periodontitis
Definition: Infectious destruction of the periodontal ligament and alveolar bone.
Classification
- Early
- Adult
- Refractory
- HIV-associated
- Periodontal lateral abscess
- Systemic pathology
Developing Periodontal Lesion
The process begins with an initial injury and cellular activity in the attached gingiva, causing inflammation. Early lesions and further cellular activity ignite connective tissue collagen destruction, initiating the lesion. The lesion sets, and a pocket epithelium is formed.
Host Factors
The immune system (lymphocytes B and T, macrophages, and others) plays a key role.
Bacterial Factors in Periodontitis
Bacterial factors include adhesion, multiplication, evasion of host defenses, enzymes, endotoxins, leukotoxins, proteases, IgA and IgG-degrading enzymes, cytotoxins, indirect effects, and superoxide dismutase.
Hypothesis of Plaque Formation
Specific plaque hypothesis (a specific pathogen is responsible) versus non-specific plaque hypothesis (disease results from the ecological balance of the whole flora).
Analysis of Oral Flora
- Detection 1: Viable bacteria and microbial enzymes, including Treponema denticola, Porphyromonas gingivalis, Bacteroides forsythus, and Capnocytophaga.
- Detection 2: Microbial DNA and RNA.
Pulpitis
Definition: Inflammation of the dental pulp, with intense pain and possible necrosis.
Microorganisms in Pulpitis
- Gram-positive cocci: Peptostreptococcus, Streptococcus
- Gram-negative cocci: Veillonella
- Gram-positive bacilli: Eubacterium, Propionibacterium, Actinomyces, Lactobacillus
- Gram-negative bacilli: Porphyromonas, Prevotella, Fusobacterium, Campylobacter, Wolinella, Eikenella, Capnocytophaga
Salivary Gland Viral Infections
- Mumps: Inflammation of the salivary glands (particularly the submandibular glands).
- HIV: Associated with salivary gland involvement.
Bacterial Infections
Mumps may present in acute, chronic, and infantile forms, as well as submaxillary sialadenitis.
Oral Fungal Infections
Oral candidiasis presents as pseudomembranous, erythematous, angular cheilitis, or chronic hyperplastic forms.
Predisposing Factors
- Malignant disease
- Prostheses
- Sjögren syndrome
- Radiotherapy
- Cytotoxic drugs
- High sugar intake
- Antibiotics
Antifungal Drugs
- Topical use: Nystatin, amphotericin B, miconazole
- Systemic use: Fluconazole and itraconazole
Bacterial and Viral Infections of the Oral Mucosa
Bacterial Infections
- Scarlet fever, pharyngitis: Caused by streptococci.
- Gonorrhea: Diagnosis by semi-selective culture media and positive oxidase test.
- Syphilis: Diagnosis by microscopy and serology. Treatment: penicillin.
- Tuberculosis (TB): Diagnosis by Ziehl-Neelsen staining, Mantoux test, and histologic examination.
- Mucositis: Treatment includes frequent washing and oral antibiotics; Staphylococcus aureus may be involved.
Viral Infections
Caused by herpes virus, coxsackievirus, and papillomavirus.