INFECTION IN ORAL CAVITY

Definitions
• Disease and Infectious Disease
• INFECTION-- a condition in which pathogenic
microbes penetrate host defenses, enter tissues &
multiply.
– Disease
• Any deviation from a condition of good
health and well-being
– Infectious Disease
 A disease condition caused by the
presence or growth of infectious
microorganisms
 Microbes and humans

Very few microbes are

always pathogenic

Many microbes are

potentially pathogenic
(oportunistic pathogen

Most microbes are

never pathogenic
(Komensal)
Definitions
• Pathogenicity and Virulence
– Pathogenicity
– Virulence
 Respon
Respon terhadap
terhadap Infeksi
Infeksi

Innate no
infection immuni dise o n
ty cti no
ase fe disea
-i n
x re se

ry
o ve
adapt x
c
re ive
disease immu
nity
 Keseimbangan
Keseimbangan antara
antara Infeksi
Infeksi dan
dan
Host
Host defence
defence

Microorga Host defence

nism

Bolus of infection x virulence

Disease=
Host defence
 FACTORS THAT INFLUENCE
IMMUNITY
• Genetic
• Age
• Metabolic
• Environment
• Anatomc
• Fisiologic
• Microorganism Factor :
• Virulence factor
Stage of infection

1. Entry of Pathogen
Portal of Entry
2. Colonization
– Usually at the site of entry
3. Incubation Period
– Asymptomatic period
• Between the initial contact with the
microbe
• and the appearance of the first symptoms
4. Prodromal Symptoms
– Initial Symptoms
5. Invasive period
– Increasing Severity of Symptoms
– Fever
– Inflammation and Swelling
– Tissue Damage
– Infection May Spread to Other Sites
– decline of infection
– Convalescent
 Definitions
• Acute infection vs. chronic infection
– Acute Infection
– Chronic Infection
Definitions
• Primary infection vs. secondary
infection
– Primary Infection
• An infection that develops in an
otherwise healthy individual
– Secondary Infection
• An infection that develops in an
individual who is already infected with a
different pathogen
 EXTENT OF HOST INVOLVEMENT
• LOCALIZED INFECTION– microbes enters
body & remains confined to a specific tissue.
• SYSTEMIC INFECTION– infection spreads to
several sites and tissue fluids usually in the
bloodstream.
• FOCAL INFECTION– when infectious agent
breaks loose from a local infection and is carried
to other tissues.

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 Definitions
• Clinical infection vs. subclinical infection
– Clinical Infection
– Subclinical Infection
Definitions
• Opportunistic infection
– An infection caused by microorganisms
that are commonly found in the host’s
environment This term is often used to
refer to infections caused by organisms in
the normal flora
• BACTEREMIA—the presence of bacteria in
the blood.
• SEPTICEMIA—if bacteria are multiply in the
blood.
• TOXEMIA—presence of toxins in the blood.
• VIREMIA—presence of viruses in the blood.
• FUNGEMIA Presence of infectious fungus

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18
 infection in oral cavity
• Periodontitis
• Dental caries
• Peri-implantitis
• Mucosal Infections
• - Oral Candidiasis
• - Viral infection
INFECTIOUS DESEASE IN ORAL CAVITY

• From : Endogen → oral microflora

systemic
Exogen

• >> Endogen → Opportunistic infection

• Microorganism : Bacteria, yeast, virus
JALUR INFEKSI ODONTOGEN
• jalur periapikal, sebagai hasil dari nekrosis
pulpa/gangren dari pulpa yang mati dan
invasi bakteri ke jaringan periapikal
• jalur periodontal, sebagai hasil dari
inokulasi bakteri pada periodontal poket
• jalur perikoronal, yang terjadi akibat
terperangkapnya makanan di bawah
operkulum tetapi hal ini terjadi hanya pada
gigi yang tidak/belum dapat tumbuh
sempuna.
 The oral cavity is a complex ecosystem in which a
rich and diverse microbiota has evolved.
→ Oral Microflora
• Major portal of microbial contamination at the
entrance to the alimentary tract.
• Moist environment through which microorganisms
pass to distal sites → not able to adhere to or be
retained on one of the diverse oral surfaces.
↓
• Can be contaminated by any infected object it
contacts, either intentionally or accidentally.
- microorganisms colonize
- others pass through as transients
• Bath in saliva
- protecting the host from microbial infections.
* Antimicrobial (mucin, glycoproteins; lysozyme
histatins, transferrin, lactoferrin, lactoperoxidase etc)
* Competitively block access of bacteria
* Salivary immunoglobulins
* Buffering systems
- Soluble bacterial products
serve as bacterial receptors that initiate the
formation of the biofilm / dental plaque.
• - Repository for populations of shed
microorganisms and their metabolites and
enzymes (such proteinases ,sialidases)
→ can degrade salivary and epithelial surface
molecules and affect the colonization of non
- oral pathogens.

- Strongest link between oral and systemic

health. Salivary function is extremely
sensitive to changes in our general well-being
The oral cavity is a complex ecosystem in which
a rich and diverse microbiota has evolved.
→ Oral Microflora
 Oral Flora in healthy Condition

Oral Microbiology: PD Marsh & MV Martin

FLORA NORMAL RONGGA MULUT
• The wide range in pH, Eh, nutrient availability,
shedding and non-shedding surfaces, salivary
and crevicular fluids select for localized, discrete
microbial climax communities which may
fluctuate in composition and metabolic activity
but reach a kind of homeostasis in balance with
the host.
• Oral flora may be affected by changes in
salivary flow, administration of antibiotics,
and changes in the immune system →
• Changes in the environment, whether
imposed by illness, debility, behavior, diet,
or medications
↓
• disturb the homeostasis and lead to
endogenous infections or susceptibility
to exogenous infections.
Opportunistic infection in oral cavity
• Opportunistic infection:
When an organism that usually is
nonpathogenic causes disease
• most problems of infection and immunity in
the oral cavity is the imbalance of
established homeostasis due to
opportunistic emergence of pathogenic
species within the mixed microbiota in
susceptible hosts.
immunosuppressed patients, and patients
receiving antineoplastic agents and
radiation therapy.

These may be caused by overgrowth of

opportunistic oral organism

Opportunistic infection
• Reduction in salivary flow or reduction in
immune competence can lead to serious
fungal and viral infections

The oral cavity may be the primary site of

involvement of an infectious disease, or a
systemic infection may have oral
manifestations
• •
The oral cavity may be the primary site of
involvement of an infectious disease, or a
systemic infection may have oral manifestations
Microorganisms invading oral tissue can cause
local infection, systemic infection, or both.

• Microorganisms in the bloodstream can cause

lesions in the oral cavity.
• Microorganisms causing infection in systemic
can be transferred to oral tissue and be present
in saliva.
 Microorganisms may penetrate epithelial surfaces
as foreign bodies.
• Stimulate the inflammatory response.
- Non-specific response
edema
accumulation of white blood cells.
• Stimulate the immune system
- specific response → production of antibodies
to microorganism as an antigen
Oral Manifestations of bacterial Infections

Tonsillitis and Pharyngitis Scarlet fever (Group B

Streptococcus)
Tuberculosis Diphtheria (Corynebacterium diphtheriae)
• Actinomycosis Tularemia (Francisella tularensis)

• Syphilis Lepromatous leprosy

• Necrotizing Ulcerative Gingivitis Granuloma inguinale

 Viral Infections
• Human Papillomavirus Infection
• Herpes Simplex Infection
• Varicella-Zoster Virus
• Epstein-Barr Virus
• Coxsackie virus Infections
Hepatitis
HIV
Dental caries and Periodontitis
Microorganism as an antigen entry into
gingival tissue through :
Microorganisme
. Ulceration of sulcular epithelial
cell
. Penetration of damaged basement
membrane
.passive entry via damaged
junctional eithelium
Bacterial product
. Via intercellular spaces between
epithelium
Bacterial product
. Via intercellular spaces
between epithelium
↓
Colonization and multiplication
- adesin-specific reseptor
- coagregate with other
microorganism
 ↓
Evasion and/or inactivation host defence
Leukotoxin Capsul
Protease immunosu-
inhibit chemotaxis pressive efect
↓
Invasion
↓
Periodontitis
Microorganism in oral cavity
as a focal infection ~ spreading
↓
Microorganism/product
local - * sirkulasi
* connective tissue
* Mucosal immune system
↓

sistemic desease
Mecanism
1. Metastatic infection.
Bacterial metastase
2. Metastatic injury.
Toxin & cytolitic enzym metastase
3. Metastatic inflamation
 Oral Disease and Systemic Disorders

Periodontitis has an association

with:
• Infective Endocarditis
• Diabetes
• Cardiovascular Disease
• Pre-Term, Low Birth Weight Infants
• Pulmonary Disease
• Importance of Oral Health – Oral Systemic Links

Diabetes

Heart Disease

Pregnancy

Osteoporosis
Bacterial spreading from
Root Canal Infection:
HUBUNGAN ANTARA GIGI dan ORGAN DALAM TUBUH