ORAL MICROBIOLOGY PROGRAM 2020-2021 1. Oral ecosystem. Lecture (2h) Conditionings of ecological occurrences in the oral cavity: environment, age, factors contributing to bacterial growth, mechanisms of oral colonization. Acquisition of oral microbiota. Oral microbiota: oral mucosa, tongue, saliva, gingival crevice. Dental plaque: formation, distribution, composition – supragingival plaque, subgingival plaque, calculus. Significance of oral microbiota in different infections. Practical part (2h): Preparation of Gram staining smears from buccal mucosa, tongue, dental plaque, gingival crevice. Sampling of specimens from the oral environments and their cultivation. Measurement of saliva pH. 2. Microbiology of dental caries and dentoalveolar infections Lecture (1h) Caries aetiology: host factors, diet, microorganisms. Microbiology of dental caries: importance of dental plaque and microorganisms: oral streptococci, lactobacilli, Actinomyces. Different kinds of dental caries, specific microbiota in different localizations of dental caries. Microbiological tests for determination of dental caries risk in population Prophylaxis and treatment of dental caries. Antimicrobial activity of anti-caries compounds. Dentine and dental pulp infections –purulent and gangrenous (necrotic) pulpitis. Periapical abscesses. Ludwig’s angina. Alveolar abscesses. Osteomyelitis of the jaws. Practical part (2h): Microscopic evaluation of smears from dental caries foci. Evaluation of culture from specimens taken from oral environments 3. Microbiology of periodontal diseases and their complications – students’ presentations Defense mechanisms in the oral cavity. Classification of gingival and periodontal infections. Importance of microbiota in periodontal infections, virulence of microorganisms. Dental plaque hypothesis (ecological, specific, non-specific). Immunopathology of periodontal infections. Acute ulcerative-necrosis periodontitis. Microbiological examination in periodontal diseases. Molecular diagnostics in periolontal diseases. Periodontal abscesses. Treatment of periodontal infections and rational antimicrobial therapy. Dry and infected socket. Dental implants infections. Practical part (4h): Microbiological diagnosis of anaerobes Microscopic evaluation of smears and observation of culture from different types of periodontal diseases. Presentation PET(MIP Pharma) kits. 4. Blood and CNS infections Lecture (2h) Bacteriaemia, septicaemia (sepsis), infections from contagious focus (abscesses), infective endocarditis, organ complications - predisposing factors, clinical sequela, causative agents, prophylaxis. Routes of infections’ spread within oral cavity, head and neck Catheter (prostheses) infections. Meningitis and encephalitis Blood and cerebrospinal fluid (CSF) collection for culture (timing, volume, number of blood specimens). Antimicrobial therapy of meningitis and sepsis Practical part (2h): Demonstration of devices and media for blood and CSF collection. Evaluation of Gram-stained smears from blood and CSF. 5. Oral mucosal and salivary gland infections. Other oral infections Lecture (1h): Oral mycoses: pseudomembraneous (thrush), erythematous, hyperplastic candidiasis, systemic fungal infections. General scheme of fungal diagnostics and treatment of fungal infections. Viral infections: HIV-1, HIV-2, VZV, EBV, HHV-5, HHV-8, Paramyxoviridae (Parainfluenza, Mumps, Measles, RSV), enteroviruses (Picornaviridae): CoxackieA. Angular cheilitis. Denture stomatitis. Bacterial infections: Actinomycosis, Diphtheria, Tuberculosis, Pertussis ( whooping cough ). Oral symptoms in the course of gonorrhoea (Neisseria gonorrhoeae) and syphilis (Treponema pallidum). Atrophic rhinitis (Klebsiella ozenae) and scleroma (Klebsiella rhinoscleromatis). Differences in microbiological investigation and treatment of above mentioned infections. Practical part (3h): Evaluation of fungal morphology in Gram – stained smears and in slide microculture Evaluation of colonial morphology on Sabouraud agar. Examination of germ- tube test – Candida albicans. Identification of yeast -biochemical tests: Candifast, Vitek 2 YST ID Antifungal susceptibility testing – Candifast. Microscopic evaluation of smears and observation of colony morphology of Actinomyces spp., Corynebacterium diphtheriae, Klebsiella spp. 6. Respiratory tract infections. Lecture (1h): Infections caused by streptococci, staphylococci, Haemophilus influenzae. Infections of the upper and lower respiratory tract: external ear, middle ear, paranasal sinusitis, trachea, bronchi and lungs. Microbiology of infections of respiratory tract: diagnostic materials, aetiological factors, identification, treatment. Practical part (2h): Evaluation of direct Gram-stained smears from sputum Examination of staphylococci, streptococci, Haemophilus spp. Observation of antibiogram from above mentioned microorganisms. 7. Rules of infection control. Disinfection and sterilization in dentistry Lecture (2h): Infections associated with dental clinic environment, cross – infections, hospital - acquired infections. Sources (endogenous, exogenous), reservoirs of infection, spread, route of infection (mode of entry). Endogenous and exogenous infections. Colonization, carrier-state, infection. Clinical forms of dental clinic –acquired and hospital-acquired infections. Surveillance and control of infections in ambulant (dental clinic) and in hospital conditions. Specificity of infection control in dentistry. Aetiological agents of cross-infections: bacterial, viral, fungal, characteristics of hospital of hospital microorganisms (variability, antibiotic resistance)- alert pathogens. Chemotherapy of hospital infections Methods of effective elimination of microorganisms – sanitization (hand-washing), disinfection, sterilisation (definition, classification, practical application). Disinfection (classification): physical (thermal - pasteurisation, tyndallization, decoctation – boiling), UV irradiation, chemical (acids, alkali, aldehydes, chlorine or iodine, phenolic derivatives, detergents and soaps, oxidazing and heavy metal compounds, dyes, others), gaseous (chambers with ethylene oxide or formaldehyde). The principles of disinfectants’ selection. Disinfectans and antiseptic agents with application in dentistry. Sterilisation (classification): high – temperature (dry heat - hot-air oven; moist heat - autoclave; incineration; flaming – bacteriological loop), low- temperature (gas –ethylene oxide, formaldehyde; fumigation), chemical: (disinfectants – alcohols, aldehydes, halogens, potassium perborate), mechanical: (filtration), plasmic. Sterilisation control: physical, chemical and biological indicators. Control of air, surface and equipment contamination: sedimentation method, induced air method, environmental swabs. Practical part (2h):. Demonstration of apparatus for sterilisation. Sterilisation control – different indicators. Examination of plates with action of UV and disinfecting agents. The most used disinfectants – prospects. Examination of own fingers, air and surfaces cultures. 8. Chemotherapy in oral infections and soft-tissue infections of the head and neck Lecture (1h): General characteristic of antimicrobial agents applied in dentistry, spectrum of activity, contraindications, side effects, dosage. Antibiotic prophylaxis. Treatment of: orofacial actinomycosis, furuncle of head and neck, furunculosis, Ludwig’s angina, infections of parapharyngeal space, Lemierre’s disease, osteomyelitis of the jaws. The most common mechanisms of antimicrobial drug resistance for microorganisms causing the infections of the head and neck.. Practical part (2h): Clinical interpretation of the microbiological reports for dentists Evaluation of antibiograms for alert pathogens. 9. Make-ups Practical part (1h): Student is obliged to bring the protocol corresponding with the missed class Theoretical make-up is neccesary if student is going to make up a practical part of the class. Recommended textbooks: 1. Oral Microbiology – P.D. Marsh, M.V. Martin, 2016, 6rd ed, ISBN: ISBN 9780702061066 2. Essential Microbiology for Dentistry- L Samaranyake, 2006, 3rd ed, ISBN: 9780443100796 and the new ones 3. Notes on Medical Microbiology – K.N. Ward, K.C. McCartney, B. Thakker, 2008, 2nd ed, ISBN 9780443102844 .