The ecology of Staphylococcus species in the oral cavity

Whilst the diversity of organisms present in the oral cavity is well accept ed, there remains considerable controversy as to whether Staphylococcus spp . play a role in the ecology of the normal oral flora. Surprisingly little detailed work has been performed on the quantitative and qualitative aspect s of colonisation or infection either by coagulase-negative staphylococci ( CNS) or S. aureus. The latter is especially interesting in the light of pre sent difficulties in eradicating carriage of methicillin-resistant S. aureu s (MRSA) from the oropharynx in affected individuals. This paper reviews th e current knowledge of staphylococcal colonisation and infection of the ora l cavity in health and disease. S. aureus has been isolated from a wide ran ge of infective oral conditions, such as angular cheilitis and parotitis. M ore recently, a clinical condition classified as staphylococcal mucositis h as emerged as a clinical problem in many debilitated elderly patients and t hose with oral Crohn's disease. Higher carriage rates of both CNS or S. aur ens, or both, in patients prone to joint infections raises the interesting possibility of the oral cavity serving as a potential source for bacteraemi c spread to compromised joint spaces. In conclusion, there is a surprising paucity of knowledge regarding the role of oral staphylococci in both healt h and disease. Further work in this area may lead to benefits, such as impr oved decolonisation regimens for eradication of MRSA and acknowledgement of the mouth as a source of bacteraemic staphylococci.