ORAL MICRO FLORA

Introduction
The mouth harbours many microorganisms is an ecosystem of
considerable complexity, that has not been fully investigated yet and is far
from completely understood.
Recently the mouth was regarded as a single habitant for
microorganisms but it is how realized that the teeth, gingival crevice, tongue,
other mucosal surfaces and saliva all from different habitat or sites when
microorganisms multiply.
Each habitat contains its characteristic population with many different
microbial species.
Bacteria are the most predominant type of microorganisms present in
human oral cavity.
More than ! genera of bacteria have been detected in human mouth.
"# of which are regular members of the oral flora.
These belong to both aerobic and anaerobic groups of bacteria. Bacteria
present in the oral cavity are both gram $ve and gram %ve. &n average '#!
million microorganisms are present in each ml of saliva.
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Development of the oral flora
The divided into 4 categories
(. )t birth
". *nfancy and early child hood
. )dolescence
+. )dult hood
(. Birth, the mouth of the full term foetus is usually sterile although
organisms which are only transient may be a-uired from mother and also
from environment. .everal streptococcal and staphylococcal species may
be isolated either with colitumns lactobacilli, bacillus spp, neisseria spp
and yeasts.
.treptococcus salivarious is the most common isolate from the mouth
of young babies and together with staphylococcus albus.
&ccasionally candida albicans multiply rapidly in the mouth and in low
p/ it prevents the normal growth of other commensals and overgrowth of
yeasts produces what is 0nown as oral thrush.
2. Infancy and early child hood
The infants comes into contact with an ever increasing range of
microorganisms and some of these will become established as part of
commensal flora of the individual.
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The eruption of deciduous teeth provides a different surface for
microbial attachment.
1haracterized by the appearance of streptococcus sanguis and
mutants.
2ith increasing to teeth and changes in the diet the overall
properties of organisms in the mouth will change.
)ctinomycetes, lactobacilli and Rothia are tuned regularly.
3. Adolecence
The greatest increase in number of organisms in the mouth occurs when
the permanent teeth erupt.
These teeth have deep tissues in their surfaces interproximal spaces are
much larger in these in deciduous dentition.
The gingival crevice is deeper than in deciduous teeth and allows for a
great increase in anaerobic organisms.
Bacteroids spp become established in large number as well as
leptofrichia spp, fusobacterium spp and spirochetes.
The lesion of dental caries will create a new involvement for organisms
especially streptococci will furnish.

!. Adult hood
3arying amount of dental pla-ue may be present and the degree of
chronic periodontal disease will also govern the number and types of
microorganisms found.
1arious lesion and unsatisfactory restoration will provide environment
for bacteria.
There is increase in bacteroids spp and spirochetes superfacial pla-ue
contains many streptococci mostly streptococcus mutans, mitior and
sanguis.
)ctinomycetes are also regularly isolated.
Edentulous patients harbour few spirochetes or bacteriods but their
carriage of yeasts increases.
4easts are normally found in the dorsum of tongue.
5enture provide proved environment in which yeasts can multiply.
Benefit of oral microflora
The beneficial aspects of resident microbial flora of oral cavity for the
host includes
(. .upply of certain nutrients.
". )id in food digestion and profection against involving and endodontic
pathogens.
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. &ral bacteria li0e intestinal flora produce certain vitamins and cofactors
which are needed by humans. These include vitamin 6, biotin and
riboflavin.
+. 7roduction of digestive enzymes such as amylase, lipase and protease.
#. *n the presence of resident flora it is difficult for exogenous organisms
to establish themselves and produce disease. 8rowth of organisms such
as cornybacterium diptheria, streptococcus pyrogens, staphylococcus
aureus has been shown to be inhibitated in vitro by streptococcus
mitior.
9. /elps in maturation of host immune system.
Factor affectin" the development of the oral flora
*n order to become established in the mouth an organism must
(. Be introduced
". Be retained
. Be able to multiply in the conditions present in the mouth
(. Introduction# :rom birth wide variety of microorganisms are
introduced into the mouth only certain species are able to become
established in oral cavity.
". Retention# Retention of microorganisms is usually continued to a
particular site in mouth.
Factor coverin" thee are
i; Adherence# .ome bacteria have the ability to adhere to soft
tissues. .treptococcus salivarius can adhere to the mucosa of dorsum of
tongue. &ther in particular streptococcus mutans, mitior and sanguis to
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enamel as the result of production of extracellular polysaccharide.
.ome oral actinomycetes adhere through a hyaluronic acid mediated
mechanism.
ii; $rotected ite# 5ental pla-ue will provide a protected
environment for bacteria. The largest protected site is gingival crevice
where species such as melaniogenicus and sphirochetes can survive.
iii; Detachment force# salivary flow the movement of tongue.
)brasive action of diet serve to remove bacteria.
. Multiplication# To become established as a measure of the oral flora
an organism must be able to multiply in the particular site in which it can
be retained.
The factors govern this are
i; )vailability of substrates in order to grow bacteria must be
able to metabolic the availability substrates which come in diet. *ncreased
carbohydrates in diet probably has the greatest effects in increasing the
number of oral bacteria especially streptococci.
ii; p%# the metabolism of microorganisms is often dependent on
p/ and bacteria inhibit by low p/ may not survive in the acid conditions
of dental pla-ue or under the base of denture.
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Bacteroids melaninagericus and veillanella spp are inherent if
p/ below #.#.
<actobacillus spp and candida albicans can tolerate very low p/
values.
iii; O&idation or reduction of urroundin"# The oxidation
reduction potentional of the site is often crucial in determining the nature
of the flora in that site.
)naerobic organisms such as bacteroids fusobacteria,
spirochetes actinomyctes will only multiply in reduced surroundings.
<ow oxidation reduction potential can only be achieved radily in
the gingival crevice and in the deeper layer of dental pla-ue.
iv; Micro'ial Interaction# The complexity of communities of
microorganisms is the result of a mucosa of microbial interactions.
.ome of these are nutritional such as provision of para amino
benzoic acid by streptococcus sanguis for streptococcus mutans in
reduced conditions.
7rovision of vitamin 6 for bacteroids melanegenious which in
turn produce format for cariopylobacteria sputorum.
p%# members of the oral flora grow best in vitro at about '!.
/owever, the pla-ue p/ can drop to below #.! during eating this
low p/ could select for aciduric organisms.
2hen the p/ was dropped to #.! only strep mutans and <. 1asei
were capable of growth.
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Diet a a nutrient ource
Three factors influences the effectiveness of the diet as a
microbial nutrient sources.
These are the (; 1hemical composition of the diet "; The
physical consistency of its components ; )nd the fre-uency of its
presentation.
The macromolecular nutrients such as starches, proteins and
lipids are normally not available to the oral flora because their transit
time through the oral cavity is too short for then to be degraded to
usuable nutrients.
*t physical consistency of the food that contain them permits
retention such as fibrous food between the teeth or stic0y foods in
tissures pits and contact points then some utilization of starches and
proteins could occur.
<ow molecular weight soluble carbohydrates such as sucrose
and lactose are radially metabolized by the oral flora.
*t is this bioavailability of these simple sugars that ma0e them
cariogenic.
*n dental decay the consistency of the diet and the fre-uency of
ingestion may be more important than diet composition.
Both consistency and fre-uency influence the length of time that
food remains in contact with the pla-ue and thus is available for bacterial
use.
2hen snac0s are inter porsed between meals they augment the
time of nutrient availability.
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The consistency of food also influences the pla-ue flora li-uid foods
such as fruit >uices and tonics are usually swallowed -uic0ly and for this
reason they are not readily available to oral flora.
Thus for those sub>ects who eat between meals, sugar could be defected
in their salivas during most of the day. This meant that some microbial
fermentation was ongoing in the pla-ue the most of the day.
The p/ at pla-ue enamel interface probably was below p/ #.# this is
the critical p/ for enamel demineralization.
(aliva a a nutrient ource
.aliva is hameostatic fluid that buffers the pla-ue, saliva can provide
nutrients to flora it contains about (? solids, which include glycoproteins
inorganic salts, aminoacids, glucose.
)in"ival crevice fluid
8ingival crevice contain serum transudate that contains tissue and
serum proteins as well as free amino acid, vitamins, glucose.
(hed cell
The epithelial surfaces of oral cavity shedding their surface cells, also
phagocytic cells enter the oral cavity.
These memamalian cells can be lysed by the hypotonicity of saliva and
their contents are than available for microbial nutrients.
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Bacteria
The bacteria them selves can provide nutrients for each other. <actic
acid producing bacteria such as streptococcus and lactate utilizing species such
as veillonella al0alescens.
*he +ormal Micro'ial Flora of Different (ite of the Mouth
Lip# &n the lips there is a transition from s0in to oral mucosa and is also
changes in the bacterial population. .taphylococcus albus with large number
of streptococci typical of the mouth. *f the commisures are moistened by saliva
an angular chilitis may develop from which candida albicans staphylococcus
aurius and streptococcus pyrogens are isolated.
Chee,# 7redominant chee0 bacterium is streptococcus mitior with
streptococcus sanguis and salivaries yeasts may be isolated from the chee0s.
$alate# /ard palate supports a streptococcus flora haemophili are found
regularly and lactobacilli are common.
:ew anaerobes found in exposed mucosal surface.
4easts and lactobacilli will increase dramatically in some
denture wearers.
The soft palate will harbour respiratory tract bacteria such as
hemophillus, comebacterium, Aeisseria.
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*on"ue# The 0eratinized dorsal surface of the tongue is an ideal site for the
retention of microorganisms streptococcus salivarious is the predominant
organisms.
.treptococcus mitior and /emophillus spp are also common.
5orsum of the tongue is fre-uently colonized by small number
of candida albicans.
)in"ival crevice
The bacterial population of the gingival crevice is perhaps the most
numerous of any site in the mouth.
The gingival crevice is relatively well protected from the forces
that dislodge bacteria and the cervicular fluid transudate provides a rich
nutrients for some fastidious organisms.
:acultative 8ram $ve cocci, )naerobic gram tye cocci are
recovered from gingival crevice.
*eeth# )ll erupted teeth have microorganisms attached usually in the deposits
termed dental pla-ue.
These bacterias are depositioned in the occlusal tissues and in
enamel defects and in interproximal spaces, close to gingival margin.
&ral streptococci gram $ve rods and some gram %ve anaerobic
are always present.
)in"ival# .alivary samples can be used in detecting caries of candida albicans
or beta hemolytic streptococci.
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3eillonella spp, streptococcus oralis, streph salivarius, strept, mutans,
strept sangins are isolated from saliva.
Denture and other intra oral appliance
4easts and lactobacilli will multiply on any mucosal surfaces protected
from the flow of saliva.
1andida albicans can be cultured in large numbers from the fitting
surfaces of acrylic dentures.
*he $rinciple Microor"anim of the Mouth
.ome organisms described below are present in all mouths in large
number.
)rame -ve cocci
Streptococci
The oral streptococci comprise a group of bacteria that are either non
hemolytic or produce various hemolytic patterns.
:or many years they were termed streptococcus viridans but it has been
realized that this group consists at least five distinct species. .treptococcus
sanguis, mitior, mutans, salivarius and mitieri.
These are 0nown as the viridans streptococci they dominate the oral
flora in early life. They represent about half of bacteria on the tongue other
mucosal surfaces and saliva.
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They occupy about !? of the flora of dental pla-ue and gingival
crevice.
.treptococcus .arguis, *t is a common constituent of dental pla-ue
because it adheres readily to the tooth surface through the production of
extracellular gluean.
.trephicoccus mitior, is also a common constituent of dental pla-ue and
some strains produce extracellular glucan.
.treptococcus mutans, *s the bacterium widely regarded as causing the
initial carious lesion on a tooth.
.everal serotypes li0e types BcC and BdC are most commonly implicated
in dental caries.
These polymers from dietary sucrose including mutan and glucan.
These polymers can attach firmly to the tooth and the bacteria attach to
the polymers.
.treptococcus salivarius, *s mostly found attached to epithelial surfaces
particularly the dorsum of the tongue.
*t produces fraction from dietary sucrose.
2hen grown on sucrose containing agar the colonies are
characteristically mucoid.
&ther aerobic streptococci isolated from the mouth include
streptococcus faccalis and bouis.
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*solation of beta hemolytic streptococci is possible from the posterior
soft palate and the tonsillar region.
Micrococcus mucilaginous is a regular isolate from the dorsum of
tongue.
)rame .ve cocci
Neisseria and Branilanella
Aumber of grame %ve diplococci are found in the mouth.
Aeisseria magnitudes may be isolated from the throat.
The remaining 8ram %ve diplococci belong to the genus Branhamella
mostly Branhamella catarrhalis these are isolated from dental pla-ue as
well as from most mucosal surfaces.
/eillonella
This group of gram %ve anaerobic cocci consists two species.
3eillonella parvula and al0alescens.
They found principally in dental pla-ue and are the earliest anaerobic to
colonize the mouth.
)ram -ve rod and filament
There are numerous genera of gram $ve rods and filaments represents
in the mouth mostly found in dental pla-ue. They are
Lacto'acillu
These organisms appear as early colonizers of the mouth and remain as
or a commensally.
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Two species are commonly found in the mouth, lactobacillus casei and
acidophilus.
Coryne'acterium
Member of this genus are found in almost all sites of the body where
there is a commensal flora.
*n the D.6. isolations of toxigenic and on toxigenic corybacterium dipth
theroid from the throat and soft palate are isolated.
Bacillu# These sporing gram $ve rods are occasionally isolate from the
mouth but are regarded as transient bacteria.
Actinomyce# )ctinomyces are generally isolated from the mouth.
They are generally found in dental pla-ue.
The oral species are mostly facultative anaerobes with only
actinomyces *sraeli regarded as a true anaerobe.
)ctinomyces odontolyticus was first isolated from carious dentin and it
may be partly responsible for the progression of the lesion.
)ctinomyces viscous and naeslundii are found in dental pla-ue.
0u'acterium# &rganisms of this genus colonize dental pla-ue and much of
the digestive tract.
Eubacterium alactolyticum and saburram are the dominant oral species.
They are non sporing anaerobic rods.
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$ropioni'acterium# They are anaerobic diptheroids.
They are characterized by the production of propionic acid from the
brea0down of carbonhydrates.
They are isolated predominantly from dental pla-ue.
)ram .ve rod and filament
%aemophilu# *n saliva the predominant species are /aemophillus influenzae
and para influenzae but in dental pla-ue /aemophillus sings is mostly
commonly isolated.
Fuo'acterium# are gram %ve strietly anaerobic filamentous bacteria whose
filaments generally have pointed ends.
*nitially two species were recognized in the mouth. :usobacterium
nuc0leatum and polymorphus and they are isolated from pla-ue.
Actino'acillu# )ctinobacillus actinomycetemitans is found as a commensal
in the gingival crevice.
(pirochete
These strictly anaerobic organisms are isolated from the deeper parts of
the gingival crevice.
.pirochetes being dependent for growth on the lowest oxidation
reduction potential of any oral bacteria.
Two gluer are present in the mouth Borrelia and Trepohema.
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&ral spirochetes are narrow halically coiled with pointed ends. They are
motile and stain gram %ve but are difficult to see unless stained by a
silver impregnation method.
The larger and less tightly coiled spirochetes seen in oral specimens are
termed Borrelia vincenti and Borrelia buccate.
4easts about !? of the adult population carry yeasts as part of their
normal flora.
These are usually situated on the hard palate, dorsum of tongue and in
the upper buccal sulens.
5enture wearers may have an increased carriage rate of yeasts.
The most common yeast isolated from the mouth is candida albicans
but candida tropicalis 0rusei have also been isolated.
Mycoplam# Two mycoplasms mycoplasma orale and solivaries are found in
the mouth usually in the gingival crevice and also in dental pla-ue.
$roto1oa# Two protozoons Entamoeba gingivalis and trichomonas tenax are
regularly isolated from the mouth particularly from gingival crevice.
Concluion
The microbial flora of mouth is highly complex containing a wide
variety of bacterial species the most common type of oral disease, dental caries
and periodontal disease are both related to dental pla-ue and seen to occur in
the normal balance between the microorganisms and lost is altered application
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of modern molecular techni-ues to the study of this microbiology of oral
disease should allow rapid progress in their diagnosis, ris0 assessment and
treatment.
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