Snapshot A 32-year-old man presents to his primary care physician for a wellness examination. He reports to currently feeling well; however, he notices severe discomfort and pain in his mouth. He denies any trauma to the area but endorses infrequently brushing his teeth. Medical history is significant for a ventricular septal defect that has not required repair. Physical examination is remarkable for dental caries leading to pulpitis. He is referred to a dentist for immediate dental care. Prior to tooth extraction, he will require prophylactic amoxicillin. Introduction Classification gram-positive, optochin-resistant α-hemolytic cocci Streptococcus mitis S. sanguis S. mutans Reservoir normal flora of the oropharynx and live in close association with the teeth and gingiva Microbiology transmission endogenous reservoir normal flora of oropharynx molecular biology biofilm mediates adherence to login to view 2 more bullets forms vegetations dextran mediated login to view 2 more bullets Pathogenesis transient viridans streptococcal bacteremia caused by eating, toothbrushing, flossing, or any other cause of minor trauma to the oropharynx dental caries localized dental hard tissue destruction caused by bacteria containing the ability to produce acid and grow in acidic environments such as S. mutans and S. mitis periodontal disease microorganisms in the subgingival dental plaque penetrate the gingival epithelium, leading to a host inflammatory response, damaging the periodontium endocarditis manipulation of the gingiva or periapical region of the oral mucosa (such as in dental procedures) can lead to bacteremic seeding of the heart valves and prosthetic devices such as in S. sanguinis Presentation Odontogenic infections (e.g., dental caries, gingivitis, and periodontitis) symptoms pain and discomfort physical exam pits and fissures on tooth surfaces and staining of teeth discolored defect on tooth surfaces gingival swelling Endocarditis symptoms chills anorexia weight loss patients may have tooth pain or related symptoms physical exam fever new heart murmur Studies α-hemolytic growth pattern Optochin resistant differentiates from S. pneumoniae, which is also α-hemolytic but optochin sensitive Differential Other causes of endocarditis S. aureus catalase-positive, coagulase-positive, gram-positive cocci Treatment Medical antibiotic prophylaxis indication login to view 5 more bullets medications login to view 2 more bullets Complications Sepsis Abscess