Brook Itzhak
Georgetown University School of Medicine, Washington DC, USA.
J Clin Pediatr Dent. 2003 Fall;28(1):13-7. doi: 10.17796/jcpd.28.1.uwjxq61753506255.
The first step in the origination of caries is the formation of a dental plaque. Dental caries can lead to destruction of enamel and dentin resulting in bacterial invasion of the pulp. Invasion of the pulp and the periapical areas can promote the development of dento-alveolar abscess and spread of the infection to other anatomical areas. Several oral acid producing aerobic and anaerobic bacteria, including Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus, are capable of initiating the carious lesion. The organisms that predominate in pulpitis and dento-alveolar abscess are Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus spp. Treatment of caries involves removal of all affected tooth structure and proper replacement with a restorative material. Once pulpitis has developed the infected tissue should be removed and root canal therapy instituted, or the tooth should be extracted. Extraction, root canal therapy and/or drainage of pus usually are indicated for an abscess. Antimicrobial therapy supplementing the dental care should be considered, especially when local or systemic spread of the infection is suspected. Penicillin or amoxicillin are generally effective against most of the aerobic and anaerobic bacteria recovered. The patient whose oral cavity may harbor penicillin-resistant organisms should be considered for treatment with drugs effective against these organisms. These agents include amoxicillin-clavulanate, clindamycin or the combination of metronidazole plus amoxicillin or a macrolide.
龋齿发生的第一步是牙菌斑的形成。龋齿可导致牙釉质和牙本质破坏，进而使细菌侵入牙髓。牙髓和根尖周区域的感染可促使牙槽脓肿的发展，并使感染扩散至其他解剖区域。几种产酸的需氧和厌氧菌，包括变形链球菌、嗜酸乳杆菌和黏性放线菌，都能够引发龋损。在牙髓炎和牙槽脓肿中占主导地位的微生物是普雷沃菌属、卟啉单胞菌属、梭杆菌属和消化链球菌属。龋齿的治疗包括去除所有受影响的牙体组织并用修复材料进行适当修复。一旦发展为牙髓炎，应去除感染组织并进行根管治疗，或者拔除患牙。对于脓肿通常需要进行拔牙、根管治疗和/或引流脓液。应考虑使用抗菌治疗来辅助牙科治疗，尤其是在怀疑感染有局部或全身扩散时。青霉素或阿莫西林通常对大多数分离出的需氧菌和厌氧菌有效。对于口腔中可能存在耐青霉素菌的患者，应考虑使用对这些菌有效的药物进行治疗。这些药物包括阿莫西林 - 克拉维酸、克林霉素或甲硝唑加阿莫西林或大环内酯类药物的联合使用。
