The oral microflora is permanent, contains nearly 30 mic-
robial species, it forms a stable and fairly complex ecosystem of
the oral cavity. Thus, the mouth is a type of ecological system,
which is closely related to the internal medium of the organism
and its environment. An integral part of micro-ecosystem of
the oral cavity is normal microflora that provides colonization
resistance, which is seen as the primary target for any factor
which directly or indirectly affects the non-specific resistance
of this ecosystem. Permanent microflora of the human oral
cavity is formed as a result of mutual adaptation of the orga-
nism and microbes. Adaptive and related biological changes
lead to «balance» between a human body and the microbial
flora, and between the components of its species of microorga-
nisms. This «equilibrium» is of dynamic type.
Disorders of salivation, chewing and swallowing always
lead to an increase in the number of microorganisms in the oral
cavity. The same effect is observed in a variety of anomalies,
defects and diseases that hinder leaching micro-organisms by
saliva flow (carious lesions, periodontal pockets, poorly manu-
factured non-removable dentures, admaxillary inflammatory
processes, etc.).
The composition of the microbial flora of the oral cavity is
not uniform. In different areas the various quantitative and
qualitative composition of microorganisms are defined. The
microflora of the oral cavity varies extremely and includes bac-
teria, actinomycetes, fungi, protozoa, spirochetes, rickettsia,
viruses. It should be noted that some part microflora of oral
cavity of adults are anaerobic species. There are obligate and
facultative anaerobes. Obligate anaerobes are killed in the pre-
sence of free oxygen in the environment. Facultative anaero-
bes can persist and proliferate in oxygen or in oxygen-free
environment. The facultative anaerobes are E. coli, staphylo-
coccus, streptococcus and other bacteria. Obligate anaerobes
can be divided into two groups: bacteria, spores forming (clo-
stridium) and bacteria (non-clostridial) anaerobes. Among the
bacteria which form spores, anaerobic pathogens clostridial
infections are distinguished, i.e., gas gangrene. The non-clo-
stridial anaerobes include: Bacteroides, Fusobacteria, Veilo-
nellas, Peptococcus, Peptostreptococcus, Eubacteria, etc.
In the mouth, the saliva affects microorganisms, mechani-
cally washing out bacteria and by containing antimicrobial
agents (lysozyme). But in the oral cavity, there are always
areas easily colonized by microorganisms (gingival pockets,
gaps between teeth, teeth eruption). The highest concentra-
tions of microbial colonies in adults are formed in the inter-
dental spaces, physiological gingival pockets (gingival sulcus),
dental plaque, in the retromolar space, in the area of the ton-
sils and back of the tongue, especially in its posterior parts.
The composition of oral microflora includes microorga-
nisms, some of which are forms of autochthonous flora, while
others – allochthonous (inherent in other areas). Autochtho-
nous flora consists of local microorganisms which are charac-
teristic of the oral cavity. Among the autochthonous micro-
organisms the resident (obligate) and transient species are dis-
tinguished. Allochthonous microflora of the mouth is repre-
sented by microbes inherent in other areas (it is composed of
species that normally live in the intestines, nose and throat
and other parts of the human body).
Microflora of the mouth also can be divided into two gro-
ups: a constant (physiological or normal) microflora, i.e. set of
different species of microorganisms, which is characteristic of
a healthy person; random (transient) microflora is a saprophy-
tic and pathogenic microorganisms which enter the oral cavi-
ty from the outside (after surgery, etc.).
The qualitative composition of the resident microflora of
the mouth of every healthy person varies in a limited extent. It
is known that among the bacterial flora of the oropharynx the
streptococci dominate. The majority of Gram-positive cocci
oral represented a heterogeneous group of low virulence viri-
dans Streptococci, which are actively involved in the proces-
ses that lead to lesions of dental hard and periodontal tissues.
This group includes Streptococcus mutans, S. sanguis, S. mitis,
S. salivarium. Often they are found jointly with Fusobacteria
and Spirochetes during caries, pulpitis, periodontitis, absces-
ses of the maxillofacial region. The second group of Gram-
positive cocci are peptococci.
Less aerated areas are colonized by anaerobes – Acti-
nomycetes, Bacteroides, Fusobacteria Veilonellas. The genus
Fusobacterium is bacteroids with autochthonous flora of the
mouth. Fusobacteria live in gingival pockets with Spirochetes
association. Gram-negative anaerobic cocci are represented by
genus Veillonella and are permanent inhabitants of the oral
cavity of man. Veillonella concentration in saliva is approxi-
mately the same as that of Streptococci viridans. Most often
there are two types of Bacteroides – V. melaninogenicus, B.
gingivalis. B. melaninogenicus is a regular inhabitant of the
gingiva in adults and has a great pathogenetic importance in
the development of periodontal diseases.
In oral cavity, there are the Spirochaetes genera of Lep-
tospira, Borrelia and Treponemas, Mycoplasmas (M. orale, M.
salivarium), Candida species and a variety of Protozoa (Enta-
moeba buccalis and E. dentalis, Trichomonas buccalis). In the
oral cavity, there are also genera Actinomyces and Bifidobac-
terium. Actinomycetes are on the oral mucosa, may participa-
te in the formation of dental plaque and caries and periodontal
diseases. Very often in these pathological processes A. viscosus
and A. israelii are found. A. viscosus is involved in the forma-
tion of subgingival calculus.
In the oral cavity, bacteria genus Corynebacterium is
found. A characteristic feature of Corynebacterium is its abili-
ty to reduce the redox potential, thereby creating conditions
for the growth of anaerobes. In case of periodontal diseases
they are found in association with fusobacteria and spiroche-
tes. Thus, the composition of microbial species, which are in
oral cavity is complex one.
Relative ease of ingress of bacteria from the oral mucosa
or other local purulent lesions in the blood stream determines
the relatively high incidence of oral sepsis. The presence in the
oral cavity of poorely cleaned cavities, gingival pockets and
other areas contributes to the persistence of pathogenic mic-
roorganisms and causes the formation of a sufficiently high
rate of chronic infection foci (staphylococcal, streptococcal,
etc.) with following allergization of the body.
The main measures for reducing the number of posto-
perative inflammatory complications are as follows:
–
Before carrying out operations it is necessary to sanitize
the oral and nasal cavities;
–
Special attention should be paid to the reduction of both
exogenous and endogenous infections of surgical wounds
during the operation, i.e. performing aseptic;
–
During an operation it is necessary to take care of the tis-
sues, which reduces the probability of formation of zones of
ischemia, necrobiosis and necrosis in the surgical wound;
–
Should be a rational and targeted preoperative antimicro-
bial prophylaxis.
Taking account of the leading role of microorganisms in
causing inflammatory processes in maxillofacial area, the pre-
scription of antibacterial therapy no one questiones. Antibiotic
therapy is carried out both during the treatment of patients
with already arisen abscesses and phlegmons, and for the pre-
vention of inflammatory complications after a «clean», «condi-
tionally clean» and «contaminated» («potentially infected»)
surgical interventions. Routes of administration of antimicro-
bial drugs, their dosage and duration of prophylactic antibiotic
therapy depends on the reactivity of the patient, the volume of
the surgery, the presence of concomitant diseases, etc.
Rational prescribing of antibiotic prophylaxis, in terms of
reducing the risk of postoperative inflammatory complications
during the surgery, no one questiones. The choice of anti-
microbial drug for the prevention of postoperative infectious
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ЧЕЛЮСТНО]ЛИЦЕВАЯ ХИРУРГИЯ И ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ
СОВРЕМЕННАЯ СТОМАТОЛОГИЯ 3/2016
