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Dental Caries

Periodontal Disease

Trench Mouth

Symptoms

None until advanced disease. Late: discoloration, roughness, broken tooth, throbbing pain

Most cases asymptomatic until advanced disease. Bleeding, sensitive gums, bad breath, loosening of the teeth. Receding gums with exposed discolored tooth roots

Abrupt onset of fever, painful bleeding gums, and a foul mouth odor

Incubation period

1 to 24 months before cavity is detectable

Months or years

Undetermined

Causative agent

Dental plaque populated with Streptococcus mutans

Dental plaque, cariogenic or not

Probably a spirochete of the genus Treponema acting with Fusobacterium, Prevotella, or other anaerobes

Pathogenesis

Bacteria in plaque produce acid from dietary sugars; slowly dissolves the calcium phosphate crystals composing the tooth; sucrose critical for cariogenic plaque formation

Plaque forms at the gum margins and gradually extends into the gingival crevices. Bacterial products incite an inflammatory response.The crevices widen and deepen, and the proportion of anaerobes increases.Toxins and enzymes weaken the tissues holding the teeth and cause them to become loose

The spirochetes and certain other anaerobes act synergistically to cause death of tissue, ulceration, and tissue invasion by spirochetes

Epidemiology

Worldwide distribution, incidence depending on dietary sucrose, natural or supplemental fluoride.The young are more susceptible than the old

Primarily a disease of those older than 35 years. Immunodeficient individuals are at increased risk of severe disease

All ages are susceptible in association with poor mouth care, malnutrition, or immunodeficiency. It is not contagious

Prevention and treatment

Restriction of dietary sucrose, supplemental fluoride, mechanical removal of plaque, sealing pits and fissures in childhood teeth

Avoid buildup of plaque. Surgical treatment in severe cases to expose tooth roots and remove plaque and calculus

Daily attention to removal of plaque and professional cleaning to remove calculus. Antibiotic treatment acutely, followed by treatment of periodontal disease

Nester-Anderson-Roberts: Microbiology, A Human Perspective, Fourth Edition

IV. Infectious Diseases

24. Alimentary System Infections

© The McGraw-Hill Companies, 2003

Cell wall

Cell wall

CO(NH2)2 Urea

Urease

CO2 + 2NH3 Ammonia

Figure 24.7 Helicobacter pylori This bacterium is unusual in having sheathed flagella with terminal knobs. It produces a powerful urease that allows it to survive stomach acid by converting urea to ammonia, which neutralizes acidity.

CO(NH2)2 Urea

Urease

CO2 + 2NH3 Ammonia

Figure 24.7 Helicobacter pylori This bacterium is unusual in having sheathed flagella with terminal knobs. It produces a powerful urease that allows it to survive stomach acid by converting urea to ammonia, which neutralizes acidity.

Helicobacter pylori Gastritis

Gastritis, meaning inflammation of the stomach, is commonly present in otherwise healthy asymptomatic people. It was not until the early 1980s that a bacterial cause of this condition was identified and its association with ulcers and gastric malignancy became apparent. These ulcers occur in the stomach and uppermost part of the duodenum, and they are localized, roughly circular erosions of the epithelium that can extend deeply into the underlying tissue.

24.3 Bacterial Diseases of the Upper Alimentary System 605

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