Microbiological basis of oral infections and sensitivity to antibiotics.
Because oral infections are common, the physician must understand the underlying etiology, pathogeny, and other variables that determine how these processes evolve in order to choose the most appropriate antibiotic drug. The special characteristics of the oral cavity determine the make-up of the microflora that lives there. Different anaerobic species belonging to the Peptostreptococcus, Prevotella, Fusobacterium, Gemella, and Porphyromonas genera are of particular interest, as are the aerobic species Streptococcus, Staphylococcus, and Corynebacterium. Each of these microorganisms occupies a different microniche within the oral cavity, and the prevailing balance is upset when conditions become modified as a result of illness or due to dental interventions such as tooth extraction or tooth scaling and polishing. Pathogenic or opportunistic bacteria (Actinomyces, Prevotella intermedia species, etc.) can develop in these conditions, as can yeasts (Candida sp., Histoplasma capsulatum), virus (herpes simplex, papilomavirus), and parasites (Entamoeba gingivalis, Trichomonas tenax). When infection occurs, the patients s immune system reacts by means of inborn immunity (non-specific) and acquired immunity (specific). Empirical treatment is administered that should be based on etiological data and on the antimicrobial sensitivity of the pathogen that is causing the infection. However, oral microflora sensitivity to different antibiotics is currently declining and there is a noticeable trend towards resistances. As a consequence of all this, the treatment of oral infections must also aim to restore the ecological balance of the oral cavity and to minimize the emergence of resistance in the microorganisms present in the mouth. Hence, epidemiological oral pathogen sensitivity studies must be conducted, fostering the administration of appropriate antibiotics at proper doses and keeping specialists abreast of the latest trends. In recent decades, oral infections comprise one of the most common pathologies in the general population, due in large part to infectious complications associated with poor oral hygiene. This in turn, translates into an increased need and demand for dental care, while at the same time, it requires that the professional accurately understand the etiological factors involved, as well as the pathogeny and different variables that determine the specificity of these kinds of infections, so as to be able to choose the appropriate antimicrobial drugs for proper treatment.
Prieto-Prieto
José
J
Departamento de Microbiología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid. jprieto@med.ucm.es
Calvo
Almudena
A
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001420:Bacteria, Aerobic / Q000187:drug effects / Q000472:pathogenicity; D001421:Bacteria, Anaerobic / Q000187:drug effects / Q000472:pathogenicity; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D007109:Immunity; D008826:Microbial Sensitivity Tests; D009059:Mouth Diseases / Q000188:drug therapy* / Q000382:microbiology*
D000900:Anti-Bacterial Agents