TP5DIP+-+Oral+mikrobiologi+artiklar

Etiologi och mikrobiologisk diagnostik av orala infektioner > > > > > > > > > > > __Den orala mikrofloran__ > > > > > >
 * Mikrobiologisk diagnostik görs vid slemhinneinfektioner och djupa infektioner (parodontit, periimplantit , endodontiska  infektioner, abscesser).
 * Indikation kan vara terapival (resistensbestämning och val av ab), beh.kontroll och riskutvärdering.
 * Staph <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Aureus <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Enterococcus faecalis <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">enterobakterier <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> och jästsvamp ( <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Candida <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">) kan påvisas.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Djupa orala infektioner är <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">polymikrobiella <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> och anaeroba.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">P. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">gingivalis <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, T. forsythia och T. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">denticola <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> (kronisk <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">parod <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">) och <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">A.A <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> (aggressiv <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">parod <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> hos unga).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Prov tagna i öppna system (slemhinna, tandköttsficka) kontamineras och försvårar tolkningen.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Lättare att tolka om <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> man begränsar kontamination från saliv och slemhinna eller jobbar aseptiskt ( <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">endodontiska <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> infektioner och abscesser).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Orala infektioner = slemhinneinfektioner + djupa infektioner.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Virusdiagnostik används sällan, då virusinfektioner oftast är systemiska.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Orala viruslesioner har ett tydligt kliniskt utseende, en mikrobiologisk diagnostik behövs inte.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">700 olika <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">bakteriarter <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> i munnen. Tillväxt sker främst på tungryggen.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Tillväxt mellan tänderna ökar om det finns kronor, broar, implantat och proteser.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Vid gingivit och parodontit ökar tillväxt i tandköttsfickorna.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Begränsad tillväxt i saliven, den speglar tillväxten i munhålan.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Residenta <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> floran domineras av alfa-streptokocker ( <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">viridansstreptokocker <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">), <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Actinomyces <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, Neisseria, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Haemophilus <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Veillonella <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">aneroba <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> streptokocker, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Prevotella <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> och <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Fusobacterium <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Ökad inflammation runt tänderna leder till anaeroba arter: <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Porph <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">., <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Campylobacter <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, spiroketer ( <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Trep <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">).

<span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 14pt;">__Diagnostik av infektioner i den orala slemhinnan__ <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mikrobiell flora <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> > > > > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Provtagning > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analys och tolkning > > >
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Om <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">viridansstreptokocker <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;"> inte förekommer från ett prov är provet dåligt taget eller så har dem trängts undan av någon annan mikroorganism (opportunistisk infektion).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Orala slemhinneinfektioner är ofta opportunistiska – hos <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">pat <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> med <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">immunosuprimerande <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> behandling (cancer, transplantationer, blodsjukdomar, RA).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Candida <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Staph <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Aureus <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Enterococcus faecalis <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, gram-negativa aeroba stavar ( <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Enterobacter <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Psuedomonas <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">) <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;"> är vanliga. Leder till inflammation och sveda.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Svårläkta läppsprickor/ <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">munvinkelragader <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> är infekterade med C. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">albicans <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;"> eller <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Staph <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">. <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Aureus <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Sängliggande <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">pat <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">, i respirator eller med KOL <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">får opportunistiska infektioner i luftvägarna som har sitt ursprung i munhålan. Mikrobiologisk diagnostik håller koll på dessa.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">Skrapprov med vasst instrument (amalgam <span class="SpellingError SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">carver <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 12pt;">) till transportmedium och odling.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Komplettera med skrapprov för mikroskopi - analys av svamphyfer (svampinfektion).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Kända opportunister – Candida, Staph. Aureus, E. faecalis, GR- tramstavar.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Gemensamt för dessa är att de har en multiresistens – antibiotika verkningslöst.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Rapportskyldighet vid MRSA (resistenta S. aureus), VRE (enterokocker) och ESBL (enterobakterier)

<span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 14pt;">__Diagnos av endodontiska infektioner__ <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mikrobiell flora > > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Provtagning > > > <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analys och tolkning >
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Akuta eller kroniska infektioner. Rotkanalen nekrotisk och infekterad.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Akuta (symtom) – polymikrobiella, anaeroba orala bakterier: aneroba streptokocker, Prevotella, Fusobacterium, Porphyromonas, Campylobacter, Treponema.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Kroniska (asymtom) – persistenta (kvarstående) bakterier under och efter behandling: GR+ och fakultativa bakterier – Streptokocker, Lactobaciller, Actinomyces.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Prov görs aseptiskt – minimera risk för kontamination. Kofferdam och desinfektion.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Prov med papperspoint och förs till lab med transportmedium.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Ingen djupare mikrobiologisk identifiering. Kollar bara växt/icke växt.

<span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 14pt;">__Diagnos vid parodontit/periimplantit__ <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mikrobiell flora > > > > > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Provtagning > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analys och tolkning > > > <span class="NormalTextRun SCX231600867" style="background-color: inherit; font-family: 'Times New Roman',serif; font-size: 14pt;">__Djupa infektioner (mikrobiell flora, provtagning, analys och tolkning)__ > > > > > <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Mikrobiologisk diagnostik > > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Provtagning > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analys och tolkning > >
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Kronisk och aggressiv parodontit är polymikrobiella aneroba infektioner.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">GR-, proteolytiska bakterier.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Röda komplexet: P. gingivalis, Trep. denticola, Tanner. Forsythia, tyder på sjuk flora.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Orangea komplexet: Prev. Intermedia, Campylobacter rectus, Fusobac. Nucleatum.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">A.A. vid aggressiv parod hos unga. Särskilt JP2-klonen som producerar leukotoxin.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Peri-implantit: liknar parod, dock mer aggressiv (snabbare bennedbrytning och pus) och invasion av bakterier i vävnaden -> ab oftare, också pga implantatgängar som försvårar mekanisk rengöring.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Prov från djup tandköttsficka med papperspoints.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Analys med DNA-prober (checkerboard) eller PCR.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Checkerboard-analys – matchar mot bakterieprober. Hög förekomst = sjuk mikroflora.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Behandlingen är att avlägsna bakterierna mha mekanisk depuration och kirurgi.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Abscesser och beninfektioner (ostoemyelit, infektioner i nekrotiskt ben efter strålning/bifosfonater, infektioner vid frakturer och trauma).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Ofta akuta med risk för spridning och odontogent urspruing – tandköttsficka eller rotkanal.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Domineras av orala bakterier.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Svår, eftersom behandling sätts in tidigt om spridningsrisk finns.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Fördröjs även eftersom man måste odla anaerobt.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Infektionen hinner behandlas innan diagnostiken är klar.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Prov tas med spruta genom slemhinnan eller via rotkanal.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Svår. Särskilt för beninfektioner (mycket liten bakterietillväxt).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Allmänodling det mest informativa.

<span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 16pt;">Indikationer för antibiotikaprofylax i tandvården > > > > > > > > > <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> > > > > > <span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 16pt;">Rekommendationer för antibiotikabehandling i tandvården > > > > > > > > > > >
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Tandläkarnas förskrivning av ab har ökat.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Rekommendationerna syftar till att förhindra ogynsamma effekter av bakteriemi vid ingrepp i mun.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Egenvård som utförs i hemmet har större effekt än ingrepp som sker i tandvården.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">God munhygien leder till lägre antibiotikaanvändning och minskad risk för infektion hos riskpat.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Infektionssanering i munhålan inför medicinska ingrepp samt behandlingar som innebär risk för spridda infektioner.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Antibiotikaprofylax syfte är att förhindra postoperativa infektioner och fjärrinfektioner hos riskpat.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Planerad tandbehandling ska undvikas under perioder med förhöjd risk för infektion – grav leukopeni eller efter omfattande kirurgi.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Patienter med gravt nedsatt infektionsförsvar – vid invasiva ingrepp som medför hög risk för utsådd av bakterier i blodet – tandextraktion, tandstensskrapning och dentoalveolär kirurgi.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Pat med högdosstrålbehandlat käkben och cancerpat med pågående/tidigare bisfosfonatbehandling – ökad risk för käkbensnekros, abprofylax endast vid benskadande ingrepp.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Abprofylax vid käkkirurgi ingen effekt, undantag vid kirurgisk beh. av frakturer och käkanomalier.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Abprofylax ska vara kortvarig - en dos 60 min före ingrepp.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Använd amoxicillin, klindamycin (pc-allergi).
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Diskutera med pat läkare eller infektionsläkare.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Patienter utan riskfaktorer/riskbeteenden utgör majoriteten av akuta patienter.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Vanligaste diagnoser är symtomatisk apikal parodontit, pulpit, abscesser och perikoronit.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">I första hand dränage och avlägsna orsaken till infektionen kirurgiskt.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Antibiotika får inte ersätta korrekt diagnostik, antiseptisk behandling och nödvändig kirurgi.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Vid allmänpåverkan eller infektionsspridning kan dränage av infektion kompl. med systemisk ab.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Penicillin V (PcV) är förstahandsalternativ vid orala infektioner.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Metrodinazol kan användas som tillägg till PcV vid allvarlig infektion med tecken på spridning.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Klindamycin ger risk för svår diarré och ekologisk störning, bör endast användas vid pc-allergi.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Lokal ab-behandling rekommenderas inte vid behandling av orala infektioner.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Aggressiv parod, periimplantit, osteomyelit samt sekundärinfektion vid käkbensnekroser ska behandlas av/i samråd med specialisttandvård.
 * <span style="font-family: 'Times New Roman',serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX231600867" style="font-family: 'Times New Roman',serif; font-size: 12pt;">Antibiotiska ska inte användas vid pulpit.