Dental / Oral

Bacterial infections of the mouth

The microenvironment of the mouth contains a rich variety of microorganisms, including bacteria that do not cause any harm under normal conditions.  If the natural balance is tipped, harmful bacteria can grow to excess and cause harm to the gums and teeth. This can be due to hormonal changes such as pregnancy or menopause, as a side effect of medication, stress or a medical condition such as diabetes or simply to poor oral hygiene.  The most important and effective way of keeping harmful bacteria at bay and protecting the teeth and gums is good oral hygiene including regular tooth-brushing and flossing of teeth.

If bacterial growth builds around the teeth this can lead to gingivitis, which is inflammation of the gums, or periodontitis, which is a chronic bacterial infection of the supporting structures surrounding the teeth.  This can cause destruction of the tooth structure and also allow bacteria into the circulation, resulting in increased risk of systemic conditions such as cardiovascular disease and diabetes.¹

The body’s response to such a chronic infection can also influence the progression of periodontal disease and its interaction with other chronic diseases such as diabetes.  This can also happen in the reverse, whereby the body’s immune and inflammatory response mediates the severity of periodontal disease.

Use of antibiotics

Severe bacterial infections of the teeth and gums can be treated by oral antibiotics that inhibit growth and replication of the bacteria and thereby prevent further spread of the bacteria.

Antibiotics used for dental and oral bacterial infections include:

• Clindamycin, a lincosamide antiobiotic that inhibits bacterial protein synthesis
• Metronidazole that is effective against a wide range of bacteria and other microorganisms, and works by inhibiting DNA synthesis

References

1. Preshaw PM. Diabetes and periodontal disease.  Int Dental J. 2008;S237-s243. 

What is thrush?

Oral thrush is caused by the yeast fungus candida albicans, which is normally present in small amounts on the mucus membranes of the mouth and tongue.  However, under certain conditions this fungus can become overgrown and form white patches in the mouth and throat.  These patches are colonies of candida and can produce a cottony feel in the mouth, which can affect taste and also cause the underlying tissues to become inflamed and to bleed, causing discomfort and sometimes, difficulty swallowing.

Thrush is common in in conditions like diabetes and in those who are immunocompromised such as with cancer or HIV/AIDS; also prolonged use of antibiotics or drugs like corticosteroids can allow the yeast to thrive and grow resulting in a thrush infection.  

Use of antifungals

Oral thrush can be treated by use of topical and oral antifungals.  These include:

• Topical gel containing miconazole that can be applied directly to the site of infection
• Oral drops containing nystatin
• Oral tablets/capsules to treat the fungal infection systemically, including the antifungals fluconazole, Itracomazole and nystatin 

What is a mouth ulcer?

A mouth ulcer is also known as a canker sore or aphthous stomatitis (inflammation of the mouth).  A mouth ulcer begins as a lesion or break in the mucous membrane on the lining of the cheeks, lips or throat.  It then forms a small shallow crater with a rim and can be painful, affecting eating and drinking. Mouth ulcers can heal themselves in time but often recur and can be caused as a result of injury or irritation to the inside of the mouth or tongue; when vulnerable such as at times of stress or hormonal changes; after eating certain foods or due to a nutritional deficiency, such as vitamin B12, folic acid or iron. 

Treatment for mouth ulcers

Although mouth ulcers usually heal themselves within two weeks, there are medications available to relieve symptoms.  The corticosteroid triamcinolone is available in a topical dental paste that can be applied directly to the mouth ulcer to help reduce pain and inflammation.