Bacterial infections of the oral mucosa

Bacterial infections of the oral mucosa constitute an increasing problem, especially among older people in most countries. The increasing age of most populations and an increasing rate of diseases, medications and other treatments that impair the host have increased the susceptibility to various types of mucosal infections. In the diagnosis of oral mucosal lesions, it is important to determine if the lesions are of infectious origin and if it is likely that the microorganisms identified in fact are causally related to the pathosis. Detection of a few cells (sparse growth) of 'pathogenic' microorganisms is of little relevance, whereas moderate or heavy growth raises the probability of an etiological importance. This consideration is particularly important for the most commonly occurring bacteria in oral mucosal infections (e.g. S. aureus, E. faecalis and aerobic gram-negative bacilli, including E. coli, Enterobacter spp., Klebsiella spp. and Pseudomonas spp.). These bacteria occur in the transient oral flora but may be more constantly present in a carrier state of some individuals. The organisms are usually recovered in low levels compared with streptococci and other resident oral bacteria. A number of systemic and local factors can lead to an immunocompromised state, which changes the oral ecology and may permit an opportunistic infection to develop. Bacterial opportunistic infections in the oral cavity can be difficult to treat as a result of the impaired host defense and because of the antibiotic multiresistance commonly present in opportunistic bacterial pathogens. Strict oral hygiene measures are of great importance in immunocompromised patients to prevent opportunistic infections. Patients in whom clinical infections have already developed should be treated symptomatically as long as the immunocompromised situation prevails. © 2009 Blackwell Munksgaard.