Chapter 15- Infections

Infectious conditions/ diseases are caught by the infected person from someone or something.
They are caused by micro-organisms [micro- can only see with a microscope, organism- living thing] or microbes for short. Micro- organisms capable of producing disease are called pathogens.
There are 4 types of organism that cause diseases, Bacteria, Viruses, Fungi and Protozoa.
Only the first 3 concern us in the mouth.
Protozoa are tiny amoeba like organisms that cause things like amoebic dysentery.
There is another type of infectious ‘thing’ called a Prion, this is not strictly speaking an organism but an infectious protein capable of causing disease. Prions cause CJD/ Creutzfeldt-Jakob disease otherwise known as ‘mad cow disease’ and other rare diseases, more of which no doubt will be discovered.
Bacteria.
We have lots of bacteria in our mouths [and all over our bodies] naturally, some are good, some are helpful and some given the right conditions cause disease.
They come in lots of different shapes, for example:- cocci- little bobbles, streptococci- lines of little bobbles, staphylococci- clumps of little bobbles, spirochaetes- spirally ones a bit like fuselli pasta and bacilli- little rod shaped ones of various shapes and sizes.
Some bacteria produce pus.
Some produce gasses which smell.
Some need oxygen to survive- aerobic bacteria and some can survive at very low levels of oxygen- anaerobic bacteria.
Your immune system is there to get rid of these bacteria but should the infection be very severe or you be immune suppressed or vulnerable in some other way you may need ANTIBIOTICS.
Antibiotics work on the bacteria, they don’t work on you.
Different antibiotics are needed for different bacteria and different types of bacteria.
Some bacteria cause specific diseases and some conditions are associated with lots of different bacteria.
Conditions in the mouth which are associated with bacteria are;-
• Caries/ tooth decay.
• Periodontal disease/ gum disease.
• Apical abscess [an abscess at the end of the root of your tooth caused by the nerve in your tooth dying from infection from severe tooth decay].
• Periodontal abscess [what your granny would call a gum boil], severe infection in the bottom of a deep periodontal pocket around a tooth caused by gum disease.
• Syphilitic Ulcers this is a particular shape of ulcer [snail track] associated with the sexually transmitted disease Syphilis caused by the bacteria Treponema pallidum.
• Periocoronitis- infection around a partially erupted tooth such as a wisdom tooth.
Most infections in the mouth can be treated by what is known as ‘local measures’. Antibiotics should only be used as a last resort when all else has failed. As you no doubt know there is an increasing worldwide problem with the development of antibiotic resistant organisms due to over prescription of antibiotics in the past.
Viruses.
These are much smaller micro-organisms than bacteria and can only be seen with a very powerful microscope called an electron microscope. Viruses are a protein capsule which gets inside a cell in our body, the capsule contains all the information/ chemicals it needs to reproduce itself inside the call it has taken over. Every type of virus has a different shape and a different protein capsule.
Most common viral infections will last 7-14 days and our immune systems will deal with it.
They are treated by;-
• Rest.
• Lots of fluids.
• Analgesics [pain killers].
• Antipyretics [take your temperature down]. The drug used for this is Paracetamol.
• A viral infection in the mouth is often relieved by an antimicrobial mouthwash.
• Viruses are treated if necessary with ANTIVIRAL AGENTS.
Dentally related Viral infections are;-
• Herpes Simplex 1 [above the belt]. This starts as a primary infection called Primary Herpetic Gingivo Stomatitis. It usually occurs in babies or young children, the mouth is covered in lots of little painfull blisters. The virus then stays living in one of your big nerves for ever. This nerve is the Trigeminal nerve in your face and when you are run down, tired, ill, exposed to too much sunlight, have immune problems it re-emerges as a secondary infection- Herpes Labalis more commonly known as a cold sore which is highly infectious. If you do get a cold sore it is very important that you try not to touch it as you will spread it around your face and even into your eye. It is also very important that you do not kiss anyone anywhere!
• Herpes Simplex 2 [below the belt]. This is genital herpes which is transferable to the mouth.
• Varicella Zoster. This is the virus that causes Chicken Pox. This also may stay in a nerve branch forever and re-emerge in adult hood as Herpes Zoster or Shingles. The person will get one sided [unilateral] rash and ulceration along the path of the infected nerve. In the mouth and face this will be the sensory Trigeminal nerve. As anyone will tell you this is a horrible condition to have and often the person is left with lasting Neuralgia [continuous burning pain] afterwards. It is especially dangerous if it affects the eye and such patients should be referred to an ophthalmologist.
• HPV- Human Papilloma Virus, this is dealt with in more detail in the previous chapter on Oral Cancer.
• HIV/ Aids.
• Glandular Fever- This is caused by the Epstein-Barr virus. The person has painful swollen lymph glands all over the body including the neck.
• Mumps- This is caused by the Paramyxovirus where usually both Parotid salivary glands [in front of your ears] swell up.
• Hand, Foot and Mouth disease. This is caused by the Coxsakievirus. This is a fairly common infection in children where the patient gets painful blistering in the mouth, on the palms of the hands and the soles of the feet.
None of these are particularly nice things to have and more difficult to cure than other infections as there are very few antiviral agents. Thankfully there are more and more vaccinations being developed to combat them.
Fungi.
These are plant like organisms and tend to live on the surface of the body not within it. Most oral infections are caused by Candida usually Candida albicans.
Candida lives on us normally but sometimes it gets out of hand and makes a nuisance of itself.
Predisposing factors to Oral Candidosis [oral thrush] are;-
• Patient on antibiotics.
• Patient on steroids either systemic or inhaled [very important to rinse your mouth out after you have used your steroid asthma inhaler].
• Patient on immunosuppressants.
• Patient immunosuppressed.
• Patient anaemic.
• Endocrine disorders [endocrine glands produce hormones] such as Diabetes.
• Salivary glands not working properly [Hypofunction].
• Very young people and very old people [extremes of age].
Candida infection is often due to the fact that the patient has an underlying medical condition which is why it is known as ‘the disease of the diseased’.
Conditions in the mouth caused by Candida;-
• Thrush- usually seen as a white layer that rubs off with underlying red sore patches.
• Denture sore mouth- which is rarely sore, just looks like it is. People get this under dentures and orthodontic braces [appliances] that cover the roof of the mouth. It will follow the pattern of the denture or the appliance and is caused by poor cleaning of the denture or the brace leading to colonisation of Candida underneath it and in the case of dentures not taking them out at night.
• Angular cheilitis- this is where the patient gets inflamed and cracked skin at the corners of the mouth. It sometimes is a mixed infection with staphylococcal bacteria. It is often seen in patients with candida under their denture, deficiency anaemias, eating disorders, eczema, Chrons disease, immune deficiencies and very worn dentures.
TO SUM UP.
Eat a proper balanced diet with plenty of fruit and veg.
Get enough sleep.
Keep your immune system healthy.
Practice good oral hygiene and go to the dentist regularly.
Antibiotics treat bacteria.
Anti-viral agents treat viruses.
Anti-fungal agents treat fungi.
The condition must be diagnosed by a suitably qualified person so the correct agent may be used on the organism concerned!