y
r
a
r
b
i
Microbes of the LMouth
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Dental plaque
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Localization of the most abundant species in subgingival biofilms.
(A) Overview of the subgingival biofilm with Actinomyces sp. (green bacteria), bacteria (red) and eukaryotic cells
(B) (large green cells on top). (B) Spirochaetes (yellow) outside the biofilm. (C) Detail of Synergistetes (yellow)
(C) in the top layer in close proximity to eukaryotic cells (green). (D) CFB-cluster (yellow) in the top and
(D) intermediate layer. (E) F. nucleatum in the intermediate layer. (F) Tannerella sp. (yellow) in the
(E) intermediate layer. Each panel is double-stained with probe EUB338 labeled with FITC or Cy3.
(F) The yellow color results from the simultaneous staning with FITC and Cy3 labeled probes. Bars are 10 µm.
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Bacterial aggregates in oral plaque. (A) Transversal view of a test-tube brush found in subgingival plaque composed of filamentous cells
from the CFB-cluster. (B) Tannerella sp. (yellow) in a test-tube brush. (C) Longitudinal view of a test-tube brush with Lactobacillus sp.
(red rods) as central structures. F. nucleatum (green) and CFB-cluster filaments radiating from the central structures. (D) Longitudinal and t
ransversal view of a test-tube brush stained with the eubacterial probe. (E) Transversal view of the test-tube brush in panel D, composed
of Synergistetes group A species. (F) Transversal view of Streptococcus sp. (green) aggregation around a central cell (not stained)
in supragingival plaque. (G) Transversal view of supragingival plaque with Streptococcus sp. (green cocci) and Candida albicans (green hyphae)
in the top layer of the biofilm and forming corn cob structures growing outwards. Bars are 10 µm.
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
spirochetes
C
S
E
rods
y
r
a
r
b
i
L
e cocci
y
r
a
r
Talking About Numbers
….
b
i
L
e
r
u
11
t
• 1 gram of dental plaque
contains
+
10
c
e r
bacteria
L
o
e
h
t
n
• 3170 years ofli counting
u
a
n
y
• 1011 = 100Okilometer
b
D
I
13
© versus 1014 bacteria
• 10 Mbody cells
C
S
E
y
r
Diseases of the teeth
a
r
b
i
L
Caries
e
r
Gingivitis
u
t
c
Periodontitis
e
r
L
o
Pulpitis
e
h
t
n
i
u
l
Abscess
a
n
O by
D ©
I
M
C
S
E
Figure 22.11
E
y
r
a
Endodontic infection
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
y
r
a
r
Gingivitis-Periodontitis
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
y
r
a
r
b
i
L
e
Klinische vormen van Parodontitis
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
Local periodontitis
generalized periodontitis
Chronic periodontitis
C
S
E
generalized acute necrotizing periodontitis
Aggressive periodontitis
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Total infected area with necrosis and suppuration = 10-20 cm2
y
r
a
r
Prevalence of periodontitis
b
i
L
20
10
e
r
u
t
c
e r
L
resistant
o
e
h
t
chronic
n
i
u
l
a
n
aggressive
O by
D ©
I
M
C
70
S
E
C
S
E
y
r
Peri-implantitis ra
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
b
i
L
e
Focal Infections
Dental Focal Infections
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
Bacteremia
Sepsis
C
S
E
IL-1
IL-6
IL-10
PGE2
Local immune
response
Bacterial
products
y
r
a
r
b
i
L
e
Sampling
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
Analyses ib
L
e
r
• Culture technique ctu
e
r
L
• PCR
o
e
h
t
n
i
u
l
• Real time qPCR
a
n
O by
• Pyrosequencing
D ©
I
• Whole
genomic sequencing
M
C
S
E
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
Porphyromonas gingivalis
b
i
L
e
r
u
t
c
e r
Stricly oral
L
o
Strict anaerobic
e
h
t
n
Non-fermentative
i
u
l
a
n
Gram negative rod
y
O
b
Proteolytic
D
I
©
Transmittable
M
C
S
E
y
r
Prevotella intermedia
a
r
b
i
L
e
r
u
t
c
e r
Gram negative rod
L
o
e
h
Strict anaerobe
t
n
i
u
l
Fermentative
a
n
Moderately
O by
proteolytic ID
©
Oral & non-oral
M
C
S
E
Tannerella forsythiaary
r
(Bacteroides forsythus)ib
L
e
r
Gram negative fusiform rod
u
t
Strict anaerobic
c
e r
Non-fermentative
L
o
e
h
Proteolytic
t
n
i
u
l
Strictly oral
a
n
Elevated in smoekrs O
y
b
D ©
I
M
C
S
E
y
r
a
r
Parvimonas micra
b
i
L
e
r
u
t
Gram positieve coc
c
e r
Non-fermentative
L
o
Proteolytic
e
h
t
n
i
u
Oral & non-oral
l
a
n
In smokers
O by
D ©
I
M
C
S
E
y
r
a
r
Fusobacterium nucleatum
b
i
L
e
r
u
t
c
Gram negative
e r
L
fusiforme rod
o
e
h
t
Strictly anaerobic
n
i
u
l
a
n
Non-fermentative
O by
Proteolytic
Oral & non-oralID
©
M
Elevated in acute
&
C
chronicS
stress
E
E
y
r
a
r
b
i
L
Local Juvenile
e
r
u
t
c
e r
Periodontitis
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
y
r
Aggregatibacter (Actinobacillus)
a
r
b
i
actinomycetemcomitans
L
e
r
u
t
c
e
r
L
Gram negative rod
o
e
h
t
Capnophilic
n
i
u
l
a
Fermentative
n
O by
Strictly oral
Leukotoxin ID
©
M
Can be transmitted
C
S
E
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Amorobacter cardioformes subsp. rosso
y
r
a
r
Atherosclerosis
b
i
L
ecoronary heart
r
u
t
diseases
c
e r
Periodontitis
L
o
e
Pre-term birth/
h
t
n u low birth weight
i
l
a
n
O by
Preeclampsie
D
I
Focal infections©
M
Diabetes mellitus
C
brain abscesses
S
E endocarditis
eye infection
mediastinitis
osteomyelitis
5 maart 2009
y
Orale pathogens in non-oral
r
a
r
infections Lib
e
r
• Anaerobic Streptococcustuspp.
c
– Parvimonas micra
e
r
L
– S. milleri group
o
e
h
t
n
• Actinomyces spp.
i
u
l
a
n
• Gram negative
anaerobic
rods
y
O
b
– Fusobacterium
spp.
D
I
©
– Prevotella spp.
M
• Facultative
rods and streptococci
C
S
E – Aggregatibacter actinomycetemcomitans
– Eikenella corrodens
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
Clinical manifestations
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
Dacryoporrhoea of the left eye
y
Conjunctivitis in a patient with
r
a
r
periodontitis ib
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
Microbiology
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
P. intermedia,
M
P. micra,
C
S
P. disiens
E
P. intermedia
pocket, tong, oog
C
S
E
y
r
a
r
Clinical result eye
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
Before
After
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
•
•
•
y
r
a
r
Patient
b
i
L
A 42-year-old man was admitted
to the
e
r
u
Medical Centre Leeuwarden
with a 3 days
t
c
history of confusion and
reduced
e
r
L
consciousness. e
o
h
t
n
i
Besides heavy lsmoking
and alcohol abuse
u
a
n
there was no
medical history.
y
Orelevant
b
Slowly reacting
D ©man, who did not respond
I
adequately.
Oral examination showed poor
M
C
dental
condition.
S
E
y
r
a
Patient
r
b
i
• No heart murmur or petechiaee L
r
u
• Elevated white blood count
(17.1 × 10 /l)
t
c
e r protein
• Moderately elevated C-reactive
L
o
(34 mg/l).
e
h
t
n
u
li renal
• Liver enzymesnand
function normal
a
values.
O by
Dtomography
• Computed
(CT) of the brain
I
©
M
showed
multiple
intracerebral
lesions
C
S lesions were initially thought to be brain
• E
The
metastases of an unidentified tumor.
9
C
S
E
y
r
a
r
Orale candidoseib
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
E
y
r
Dentale conditie 42-jarige
a
r
b
i
patiënt met hersenabcessen
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
y
r
CT scan/MRI 42 jarige patiënt
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
C
S
E
y
r
a
r
b
i
L
e
C
S
E
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
D ©
I
M
y
r
a
r
b
i
L
e
r
u
t
c
e r
L
o
e
h
t
n
i
u
l
a
n
O by
Antero-posteriore X-foto van het bekken
D
I
©
Klachten: aambeien
en
jeuk
M
C
S
ELaterale X-foto van het bekken
Kumar M. Don’t forget your tooth brush
Br Dent J 2001; 191: 27-28.