NORMAL FLORA

Normal flora is the term used to describe the various bacteria and fungi that are permanent
residents of certain body sites, especially the skin, oropharynx, colon, and vagina.Viruses and
parasites (protozoa and helminths), which are the other major groups of microorganisms, are usually
not considered members of the normal flora, although they can be present in asymptomatic
individuals. The normal flora organisms are often referred to as commensals. Commensals are
organisms that derive benefit from another host but do not damage that host.

The mixture of organisms regularly found at any anatomical site is referred to as the normal flora,

 The normal flora of humans consists of a few eukaryotic fungi and protists, but bacteria are the most
numerous and obvious microbial components of the normal flora.

NORMAL FLORA OF THE ORAL CAVITY

The presence ofnutrients,epithelial debris,and secretions makes the mouth favourable habitat for a
great variety of bacteria.

Oral bacteria include :

Streptococci(S.Mitis, S.Salivarius, S.Mutans, S.Pneumoniae, S.Pyogenes,S.viridans), lactobacilli,

staphylococci (S.Aureus, S.Epidermidis), corynebacteria,bacteriodes, Neisseria(N.meningitidis),
Enterobacteriaceae (E.coli), pseudomonas aeruginosa, haemophilius influenza, clostridium,
Actinomycetes, spirochetes,
mycoplasmas.Peptococcus ,Veillonella ,Bacteroides,Enterococcus,Eubacterium,Fusobacterium,Bacteroid
es melaninogenicus,Bacteroides gingivalis,Bacteroides intermedius,Candida albicans,Haemophilus
parainfluenzae,Mycoplasma

BACTERIAS IN OROPHARYNX

Mycoplasma orale, Streptococcus constellatus,Streptococcus intermedius

BIRTH:
Sterile mouth

NEONATE:

-within 4-12 hours (lactobacilli, streptococci)

-colonized from environment(especially first feeding)

(S.salivarius, staphylococci, Neisseria, Moraxella catarrhalis.)

IMPORTANCE OF ORAL BACTERIA

1. Gram Positive organisms:

  Bulk of oral bacteria
 Rods (bacilli), cocci or irregular shape (pleomorphic)
 Oxygen tolerance varies from aerobes to strict anaerobes
 Most are fermentative
 Cell wall has thick peptidoglycan layer (penicillin has effect by interfering production of
this layer) Three important genera:
(i) Actinomyces, facultative anaerobe

(ii) Lactobacillus, produce lactic acid, facultative anaerobe, role in dentine caries rather
than enamel caries

(iii) Streptococcus facultative anaerobic cocci, produce lactic acid some implicated in
caries.

Streptococci:
• Isolated from all sights of the mouth

• Large proportion of resident microflora

• Majority α-haemolytic

Strep mutans:

• Associated with caries

• Associated with bacterial endocarditis

Strep salivarius:

• Colonise mucosal surfaces especially the tongue

Strep angiosus:

• Isolated dental plaque & mucosal surfaces

• Seen in maxillofacial infections, brain, liver etc

Strep mitis:

• Opportunistic pathogens e.g. endocarditis

Actinomyces:
• Short pleomorphic rods with branching

• Major proportion of plaque

• Increase in gingivitis

• Associated with root caries

2. Gram Negative organisms:

Many Gram-negative bacteria found in the mouth, especially in established/subgingival plaque
 Cocci, rods, filamantous rods, spindle shaped or spiral shaped
 Range of oxygen tolerance but most important strict or facultative anaerobes Some
fermentative,
 produce acids which other organisms use acids as an energy source,
 others produce enzymes which break down tissue
 Cell wall different to Gram positive with a thin peptidoglycan layer,
 has B-lactamase which breaks down penicillin,
 also has LPS/endotoxin
Most important Gram negative bacteria:
• Porphyromonas: P. gingivalis major periodontal pathogen
• Prevotella: P. intermedia a periodontal pathogen
• Fusobacterium: F. nucleatum periodontal pathogen
• Actinobacillus/Aggregatibacter: A.actinomycetemcomitans associated with aggressive
periodontitis
•Treponema: group important in acute periodontal conditions i.e ANUG
• Neisseria
• Veillonella
Bacterial endocarditis
Infective endocarditis (IE) is a rare condition with significant morbidity and mortality. It may arise
following bacteraemia in a patient with a predisposing cardiac lesion. In an attempt to prevent this
disease, over the past 50 years, at-risk patients have been given antibiotic prophylaxis before dental and
certain non-dental interventional procedures. Bacterial endocarditis is an infection in the lining of the
heart or heart valves, that could damage or destroy these valves. According to the American Heart
Association, bacterial endocarditis happens when bacteria in the bloodstream, called bacteraemia, lodge
on heart tissue that has been damaged or on abnormal heart valves.

Causative organisms in infective endocarditis: Strep. viridans , Strep faecalis ,Microaerophilic

Streptococci, Anaerobic Streptococci, Staph. aureus Staph. Epidermidis.

Managing infection
Investigate and treat promptly any episodes of infection in people at risk of infective endocarditis to
reduce the risk of endocarditis developing. Offer an antibiotic that covers organisms that cause infective
endocarditis if a person at risk of infective endocarditis is receiving antimicrobial therapy because they
are undergoing a gastrointestinal or genitourinary procedure at a site where there is a suspected
infection.

OPPORTUNISTIC PATHOGENS

Most of the activities of the normal flora benefit their host,some of the normal flora are parasitic(live at
the expense of their host) and some are pathogenic(capable of producing disease). Diseases that are
produced by normal flora in their host may be called endogenous diseases. Most endogenous bacterial
diseases are opportunistic infections, meaning that the organism must be given a special opportunity of
weakness or letdown in the host defences in order to infect

Commensal flora and the host interact in a balanced fashion and oral infections are considered to
appear following an imbalance in the oral resident microbiota, leading to the emergence of potentially
pathogenic bacteria  cellular interaction between immune factors and commensal bacteria and the
disturbance in homeostasis in the oral cavity facilitates oral colonization by opportunistic pathogens.

Eg: Candida Albicans,Staphylococcus aureus,Pseudomonas aeruginosa, Campylobacter, Flavobacterium,

Haemophilus, Mycobacterium,Nocardia, Pseudomonas, Rhodococcus,Salmonella, Shigella,
Staphylococcus,Streptococcus,Treponema,Yersinia ,C. glabrata, C. krusei and subspecies of
staphylococci, particularly Methicillin-resistant S. aureus (MRSA), S. epidermidis and S. haemolyticus. 

OPPORTUNISTIC CONDITIONS:

When the immune system isn’t working properly, normal flora can overpopulate or move into areas of
the body where they do not normally occur.

When the balance of normal microbes is disrupted, for example when a person takes broad spectrum
antibiotics.

Disease can result when normal flora are traumatically introduced to an area of the body that is axenic
or that they do not normally occur in.
Firmicutes and Actinobacteria in the nostril and Firmicutes, Proteobacteria, and Bacteroidetes in the
oropharynx.

 Staphylococcaceae family (Firmicutes), whose members include important pathogens, and

the Corynebacteriaceae and Propionibacteriaceae  families (both Actinobacteria), whose members are
more commonly benign commensals

 The nostril and oropharynx are distinct habitats. While the pathogen Staphylococcus
aureuscolonizes both sites 
The nostrils are known to harbor bacteria from the genera Corynebacterium, Propionibacterium,
and Staphylococcus, including the important pathogen Staphylococcus aureus (1). The adjacent nasal
cavity appears dominated (at least by cultivation) by Corynebacterium spp. and Staphylococcus spp.
(7). The oropharynx harbors species from the genera Streptococcus, Haemophilus, Neisseria, and to
a lesser extent Staphylococcus and various anaerobic bacteria (1). It is the site of carriage of many
important human pathogens, including Streptococcus pneumoniae, Streptococcus