Common infections and oral health – Kate Scheer W&H UK

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  Posted by: The Probe      6th October 2019

The human mouth teems with microbial life, sometimes harmoniously, other times less so. Common infections can affect patients’ oral health or, in the long term, predispose them to caries or even cancer.

Chlamydia

Chlamydia is the most common bacterial sexually transmitted infection in existence. When present in the pharynx, it can cause pharyngitis or lymphadenitis, but in the majority of cases it is asymptomatic (only 14% of men experience symptoms).[1]Chlamydia trachomatis has been recorded within the epithelial lining of periodontal pockets and within the gingival sulcus of patients with periodontitis.[2]WhetherC. trachomatiscan influence the development of periodontitis has not yet been established.

However, research has found that C. trachomatiscan occupy other biofilms (such as those produced by Candida albicans (a fungal yeast which can cause infections of the mouth, throat and esophagus).[3]Biofilms containing these bacteria can develop in the oral cavity, and on inorganic surfaces such as medical devices. Not only can biofilms harbour and, to some degree, protect C. trachomatis (reducing the efficacy of antibiotic therapy, for example), it can retain its infectious properties for up to 72 hours following exposure. Biofilms can serve as a reservoir for the pathogen, leading to reinfection. C. trachomatisis capable of replicating within epithelial cells, and can infect them following release from biofilm. Dispersing/detaching biofilm can actually provide an opportunity for C. trachomatis to spread.[4]

Yeast

Candida albicansis a common fungal yeast, present in low concentrations in the mouths of more than half of the population (between 50-70% of healthy individuals).[5]When an imbalance in the flora occurs, C. albicans can overgrow, causing candidiasis (more commonly known as thrush).[6]However, while common even among healthy patients, it can significantly influence other bacteria, not just the aforementioned C. trachomatis,but also Streptococcusspecies, which are known for causing strep throat infections and for the well-established cariogenic bacteria, Streptoccus mutans.[7)

The relationship between C. albicans and S. mutans is complex and a continuing area of study. Studies have reported that the two synergise well, increasing the onset and progression of caries.[8] 

This relationship seems to be particularly destructive during childhood–where it is believed to be a significant contributor to early childhood caries – and with C. albicans being observed to be generally absent in caries-free children.[9]Other research paints a more complex picture, where the co-existence of the two provide additional adhesion for S. mutans(increasing the number of sites where it can successfully attack) and, in the short-term, increases acidity. However, where biofilm containing both survive for a longer period, the acidity may actually be less than in biofilms not containing C. albicans.[10],[11]

C.albicans also facilitate Porphyromonas gingivalis,which has been established as cause of chronic periodontitis. Where S. gordoniiis also present, a three-way interaction occurs which further exacerbates P. gingivalis’ pathogenic potential.[12]Finally, the surface characteristics of prostheses can influence bacterial colonisation – for example, C. albicans have been found to more readily adhere to denture surfaces with a soft lining (the same study also found higher concentrations of staphylococcus when such materials were used).[13]

HPV

The human papilloma virus (HPV) is the most common sexually transmitted virus, though it can be spread in other ways, including on improperly sterilized surgical instruments and other objects.[14]Approximately 20% of oral cancers and 60-80% of oropharyngeal cancer cases are believed to be attributable to HPV infection, and the rate of prevalence of head and neck cancers is increasing (despite a reduction in tobacco usage, another major risk factor).[15],[16]HPV is well established as the leading cause of cervical cancer, which has lead to widespread immunisation of young women in the UK against the most carcinogenic strains. Recently, this programme has been expanded to cover men who have sex with men. However, because the programme requires men to request inoculation at a GUM clinic, coverage will almost certainly be less thorough than the programme for girls which occurs during compulsory education.[17]

 

Preventing cross-contamination

While patients are not unlikely to become infected with one or more of the above at some point during their lives, minimising the risk of contamination between patients is a critical duty of care and can help prevent both major and minor health repercussions. Following disinfection and sterilization protocols carefully and thoroughly prevents the spread of harmful microbial agents between patients, and protects your staff in the instance of sharps injuries. 

With integrated traceability, the new Lisa sterilizer – and its sister, Lina and Lara – from W&H can be used to handle your practice’s sterilization needs reliably and with great efficiency. W&H can also provide ECPD training, helping clinicians and their teams in obtaining a thorough understanding of the theory and practice of handpiece maintenance and decontamination, and ensuring they are confident in reprocessing handpieces in accordance with HTM 01-05.

The oral cavity is never going to be a perfectly sterile environment, and every mouth harbours countless species of bacteria, fungi and viruses. Where these gain a foothold, there can be significant oral health consequences, but by helping patients maintain their oral hygiene and by minimising the risk of contamination, we can help protect patients.

 

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

 

 

 

 

 

References                                                                                                              

[1]Chan P., Robinette A., Montgomery M., Almonte A., Cu-Uvin S., Lonks J., Chapin K., Kojic E., Hardy E. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature.  Infectious Diseases in Obstetrics and Gynecology. 2016; 5758387. https://www.hindawi.com/journals/idog/2016/5758387/April 4, 2019.

[2]Reed S., Lopatin D., Foxman B., Burt B. Oral chlamydia trachomatis in patients with established periodontitis. Clinical Oral Investigations. 2000; 4(4): 226-232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760468/April 4, 2019.

[3]Filardo S., Di Pietro M., Tranquilli G., Sessa R. Biofilm in gential ecosystem: a potential risk factor for chlamydia trachomatis infection. Canadian Journal of Infectious Diseases and Medical Microbiology.2019; 1672109. https://www.hindawi.com/journals/cjidmm/2019/1672109/April 4, 2019.

[4]Filardo S., Di Pietro M., Tranquilli G., Sessa R. Biofilm in gential ecosystem: a potential risk factor for chlamydia trachomatis infection. Canadian Journal of Infectious Diseases and Medical Microbiology.2019; 1672109. https://www.hindawi.com/journals/cjidmm/2019/1672109/April 4, 2019.

[5]Janus M., Crielaard W., Volgenant C., van der Veen M., Brandt B., Krom B. Candida albicans alters the bacterial microbiome of early in vitro oral biofilms. Journal of Oral Microbiology. 2017; 9(1): 1270613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328388/April 4, 2019.

[6]Singh A., Verma R., Murari A., Agrawal A. Oral candidiasis: an overview. Journal of Maxillofacial Pathology. 2014; 18(Suppl.1): S81-S85. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211245/April 4, 2019.

[7]Janus M., Crielaard W., Volgenant C., van der Veen M., Brandt B., Krom B. Candida albicans alters the bacterial microbiome of early in vitro oral biofilms. Journal of Oral Microbiology. 2017; 9(1): 1270613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328388/April 4, 2019.

[8]Falsetta M., Klein M., Colonne P., Scott-Anne K., Gregoire S., Pai C., Gonzalez-Begne M., Watson G., Krysan D., Bowen W., Koo H. Symbiotic relationship between streptococcus mutans and candida albicans synergizes virulence of plaque biofilms in vivo. Infection and Immunity. 2014; 82(5): 1968-1981. https://iai.asm.org/content/82/5/1968.shortApril 4, 2019.

[9]Koo H., Andes D., Krysan D. Candida–streptococcal interactions in biofilm-associated oral diseases. PLoS Pathogens. 2018; 14(12): e1007342. https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1007342April 4, 2019.

[10]Metwalli K., Khan S., Krom B., Jabra-Rizk M. Streptococcus mutans, Candida albicans, and the Human Mouth: A Sticky Situation. PLoS Pathogens. 2013; 9(10): e1003616. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798555/April 4, 2019.

[11]Willems H., Kos K., Jabra-Rizk M., Krom B. Candida albicans in oral biofilms could prevent caries. Pathogens and Disease.2016; 74(5). https://academic.oup.com/femspd/article/74/5/ftw039/2197949April 4, 2019.

[12]Montelongo-Jauregui D., Lopez-Ribot J. Candida interactions with the oral bacterial microbiota. Journal of Fungi. 2018; 4(4): E122. https://www.ncbi.nlm.nih.gov/pubmed/30400279April 4, 2019.

[13]Celakil T., Baca E., Topguoglu E., Rohlig B., Evlioglu G., Özcan M. Prevalence of Candida albicans and Streptococcus aureus on maxillary obturators, maxillary defects and in saliva: a cross-sectional study. Brazilian Dental Science. 2017; 20(3): 44-51. http://ojs.ict.unesp.br/index.php/cob/article/view/1366/1167April 4, 2019.

[14]Sabeena S., Bhat P., Kamath V., Arunkumar G. Possible non-sexual modes of transmission of human papilloma virus. Journal of Obstetrics and Gynaecology Research. 2017; 43(3).  https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/jog.13248April 4, 2019.

[15]Kim S. Human papilloma virus in oral cancer. Journal of The Korean Association of Oral and Maxillofacial Surgeons. 2016; 42(6): 327-336. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206237/April 4, 2019.

[16]Poelman M., Brand H., Forouzanfar T., Daley E., Jager D. Prevention of HPV-related oral cancer by dentists: assessing the opinion of Dutch dental students. Journal of Cancer Education. 2018; 33(6): 1347-1354. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280774/April 4, 2019.

[17]NHS. Who should have the HPV vaccine? NHS.2017. https://www.nhs.uk/conditions/vaccinations/who-should-have-hpv-cervical-cancer-cervarix-gardasil-vaccine/April 4, 2019.

 


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