Symposium oral micro flora /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


SYMPOSIUM
ON
ORAL MICRO FLORA
DEPT OF PROSTHODONTICS

INTRODUCTION
Oral cavity is situated at the beginning of the
gastrointestinal tract. Because the mouth is warm
and moist and has a regular supply of fresh food ,it
makes an ideal environment for the growth of
microorganisms. The oral cavity contains several
hundred different bacteria, fungi and protozoans, in
time , an ecological balance is reached
these

organisms

throughout life.

that

remains


fairly

amoung
stable

The ecological condition with in the mouth will vary
during the change from the primary to the
permanent dentition, following extraction of teeth,
the

insertion

treatment,

of

prosthesis,

and

any

dental

including scaling polishing and filling.

Transient fluctuations in the stability of the oral ecosystem may be induced by the frequency and type of
food ingested, variation in the salivary flow and
periods of antibiotic therapy.

The complexity of the oral flora of the adult is
perhaps its chief characteristics this is due to the
following reasons.
Dental plaque
Chronic periodontal disease
Caries lesion
Unsatisfactory restoration


As teeth are lost so the number of available sites
for

microbial

bacteria

colonization

decreases

decreases

disproportionately.

,number

of

Edentulous

patients harbor few spirochetes and bacteriods but
their carriage for yeast increases. Yeast is normally
found on the dorsum of the tongue and upper buccal
sulcus. Denture provides a protected environment in
which yeast can multiply, covering the soft palate and
the acrylic denture surface.

INTRODUCTION OF MICRO
ORGANISMS DUE TO VARIOUS
CLINICAL PROCEDURES


IMPRESSION PROCEDURES


According to the studies conducted to asses
the carriage and persistence of oral flora on
irreversible

hydrocolloide

and

elastomeric

impression material, it was documented that,
Retention

of

bacteria

on

the

irreversible

hydrocolloide was two to five fold more than
elastomeric impression surface.


The number of viable cocci ,rods and spirocheates
retained, within five hours decreased 65% to 98%.

lactobacilli

streptococci

In case of disinfected irreversible hydrocolloid
the organisms were totally destroyed in less than
three minutes.
It is concluded that the total bacterial load of
impression surface is relatively low and decreases
rapidly after impression making.
How ever disinfection of the impression surface
is mandatory to prevent cross-infection.

Based on the studies conducted to identify and
enumerate viable bacteria in unopened containers of
irreversible hydrocolloide impression materials and
gingival retraction cords.
It was found that contamination frequency of
irreversible hydro colloids was found to be 50%
which was significantly higher than retraction cord
which was found to be contaminated in 5%.


The organisms which were isolated were mainly
bacillus

species

70%,

gram

positive

cocci

staphylococci 30%, streptococci10%, mould10%.
Most

organisms

isolated

were

commonly

environmental contaminants which during routine
use, may present a hazard to immuno-compromised
patients .


SUBGINGIVAL MICROFLORA
DURING FIXED PROSTHODONTIC
PROCEDURE


In

a

study

to

asses

subgingival/marginal

micro

the
flora

changes

in

during

the
fixed

prosthodontic procedures and the effect of adjunctive
rinsing with 0.12% chlorhexidine.
Subgingival and marginal plaque were analyzed at
baseline, before crown preparation (2 weeks), before
crown cementation (5 weeks), and 2 weeks after
cementation (7 weeks).
The fixed prosthodontic procedures did not alter the
normal subgingival and marginal micro biota .

Adjunctive

rinsing

twice

daily

with

0.12%

chlorhexidine had a significantly greater effect in
reducing putative periodontal pathogens compared
with the control regimen.
 This medication was a useful adjunct to regular oral
hygiene during fixed prosthodontic procedures by
permitting the establishment and maintenance of a
microflora compatible with periodontal health.

TOOTH
PREPARATION


oThe quality of dental unit water is of
considerable
patients

importance

and

regularly

dental

exposed

to

since

personal
water

are
and

aerosols generated from the dental
unit.
oDental water may be ingested in the
form

of

aerosols

or

directly

contaminated surgical wounds .

oDental aerosol ,irrigants and coolant water entering the
patients mouth during dental procedure often contain
large number of organisms in the range of 104 to 108
colony forming units .
oThe organisms found in the dental unit water are fungi,
free living amoeba, protozoa, nematods ,saprophytes,
opportunistic gram negative pathogens.


oOf concern is the respiratory pathogens that cause
pneumonia, a mild flu like respiratory infections .
oMycobacterium species can cause disseminated
infections in HIV seropositive

patients following

ingestion and colonization in the gut.
oHigh number of non tuberculosis mycobacterium
may have a potential for colonization , infection or
immunization.

oAbnormal nasal flora in dental personal has been
linked to water system contamination. As a result of
inhalation of aerosols generated by the dental
equipments on a daily and long term basis.
oClinical

dental

team

experience

an

increase

incidence of respiratory infection than the general
population.

CHANGE IN THE BACERIAL FLORA IN
SUBGINGIVAL RESTORATION DUE TO
VARIOUS RESTORATIVE MATERIAL


The

relationship

between

subgingival

dental

restorations and periodontal health was investigated
for

three

different

restorative

material

namely

amalgam, GIC, and composite.
 No significant changes in the composition of the
subgingival microflora were observed in amalgam,
glass ionomer cement, and control groups.

Conversely, in the composite resin group, there
was a significant increase in the total bacterial
counts, and a significant (p<0.05) decrease in Grampositive, aerobic bacteria, which was associated with
a significant (p<0.05) increase in the Gram-negative,
anaerobic microbiota.
Which indicates that composite resin restorations
may have some negative effects on the quantity and
quality of subgingival plaque.


CONCLUSION
The oral cavity is one of the sites of the body which
contains a vast variety of microorganisms. The
organisms present at any one time exist in balance
with one another, and any change in this balance
may result in disease. Care should be taken not to
disturb
the
ecological
balance
of
these
microorganism
during
the
various
clinical
procedures.
‘AN OUNCE OF PREVENTION IS BETTER THAN A
POUND OF CURE’


REFERENCES
1. Oral Microbiology 4 th edition Philip Marsh, Michael V
Martin.
2. Carriage of oral flora on irreversible hydrocollid and
elastomeric
impression
materialLakshman
P,
Samaranayake, Meena Hunjan & kelvin j jennings. JPD
1991;65:244-9
3. Bacterial contamination in irreversible hydrocollid
impression material and gingival retraction cordChristopher D Rice, Mark A, Dykstra and Ronald E Gier
JPD 1991; 65:496-9.
4. Microbial contamination in four brands of irreversible
hydrocollid impression material-Christopher D Rice, Mark A,
Dykstra and Ronald E Gier. JPD 1991; 65:419-23.

5. Clinical and microbiological effects of different restorative
materials on the periodontal tissues adjacent to subgingival
class

V

D'ercole,

restorations-

Michele

Giuseppe

Perinetti.

Paolantonio,
Journal

Of

Simonetta
Clinical

Periodontology 2004; 31(3): 200.
6. Gingival enhancement in fixed prosthodontics. Part II:
Microbiologic findings. Flemmig TF; Sorensen JA; Newman
MG; Nachnani S, JPD 1991 Mar, 65(3):365-72.


7. Microbial contamination of dental unit
waterlines : the scientific argument .Caroline L and
Johnson International dental journal 1998;48:35968
8. Antibictorial property of one convention and
three high coper and dental amalgams JPD
1984;52:199-203.
9. The gingival response to well finished composite
resin restoration JPD 1978;42:626-32.


HUMAN ORAL FLORA
Gram-positive facultative
cocci

Gram-negative facultative
rods

Staphylococcus
epidermidis
Staph. aureus
Streptococcus mutans
Strep. sanguis
Strep. Mitis
Strep. Salivarius
Strep. Faecalis
Beta-hemolytic streptococci

Enterobacteriaceae
Hemophilus influenzae
Eikenella corrodens
Actinobacillus
Actinomycetemcomitans


Gram-positive
anaerobic cocci

Gram-positive anaerobic
rods

Peptostreptococcus sp

Actinomyces israelii
A. odonotolyticus
A. Viscosus
Lactobacillus

Gram- negitive
anaerobic cocci

Gram-negative aerobic
or facultative cocci

Diphtheroids
Corynebacterium

Eubacterium
Neisseria sicca
N. Flavescens

Gram-negative
anaerobic cocci

Gram-negative anerobic rods

Veillonella alcaescens Bacteroides asaccharolyticus
V. parvula
B. Gingivalis
B. Fragilis
Fusobacterium periodonticum
F.nucleatum


Spirochetes

Yeasts

Treponema denticola
T. Microdentium

Candida albicans
Geotrichum sp.

Protozoa

Mycoplasma

Entamoeba gingivalis
Tirchomonas tenax

Mycoplasma orale
M. pneumoniae


BACTERIA IN GINGIVITIS


BACTERIA IN CHRONIC PERIODONTITIS


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