• Chlorhexidine:
  • Minimum: 0.12%; Optimum: 0.2%.
  • Chip degrades in 7 – 10 days.
• Floss & Brushes:
  • Preferred floss: Unwaxed thin.
  • Floss length: 12 – 18 inches.
  • Toothbrush: 2 – 4 rows, 5 – 12 tufts per row.
  • Soft bristle diameter: 0.2 mm.
• Powered Brushes: Invented in 1939; use oscillating/rotating motion.
• Fones Technique: Circular brushing method.
• Antiplaque Agents:
  • Bisbiguanides: 2nd generation.
  • Pyrophosphate: Inhibits calculus formation.

• Alpha Thalassemia: Caused by deletion of alpha genes
• HbH Disease: Deletion of 3 alpha chains

• Most common ALL: Pre – B-cell type
• L-asparaginase: Used in ALL
• CNS prophylaxis: Intrathecal methotrexate

Localized Aggressive Periodontitis and Necrotizing Ulcerative Gingivitis

Localized Aggressive Periodontitis (LAP)

Localized aggressive periodontitis, previously known as localized juvenile periodontitis, is characterized by specific microbial profiles and clinical features.

• Microbiota Composition:
  • The microbiota associated with LAP is predominantly composed of:
    • Gram-Negative, Capnophilic, and Anaerobic Rods.
  • Key Organisms:
    • Actinobacillus actinomycetemcomitans: The main organism involved in LAP.
    • Other significant organisms include:
      • Porphyromonas gingivalis
      • Eikenella corrodens
      • Campylobacter rectus
      • Bacteroides capillus
      • Spirochetes (various species).
  • Viral Associations:
    • Herpes viruses, including Epstein-Barr Virus-1 (EBV-1) and Human Cytomegalovirus (HCMV), have also been associated with LAP.

Necrotizing Ulcerative Gingivitis (NUG)

• Microbial Profile:
  • NUG is characterized by high levels of:
    • Prevotella intermedia
    • Spirochetes (various species).
• Clinical Features:
  • NUG presents with necrosis of the gingival tissue, pain, and ulceration, often accompanied by systemic symptoms.

Microbial Shifts in Periodontal Disease

When comparing the microbiota across different states of periodontal health, a distinct microbial shift can be identified as the disease progresses from health to gingivitis to periodontitis:

1. From Gram-Positive to Gram-Negative:

   • Healthy gingival sites are predominantly colonized by gram-positive bacteria, while diseased sites show an increase in gram-negative bacteria.

2. From Cocci to Rods (and Later to Spirochetes):

   • In health, cocci (spherical bacteria) are prevalent. As the disease progresses, there is a shift towards rod-shaped bacteria, and in advanced stages, spirochetes become more prominent.

3. From Non-Motile to Motile Organisms:

   • Healthy sites are often dominated by non-motile bacteria, while motile organisms increase in number as periodontal disease develops.

4. From Facultative Anaerobes to Obligate Anaerobes:

   • In health, facultative anaerobes (which can survive with or without oxygen) are common. In contrast, obligate anaerobes (which thrive in the absence of oxygen) become more prevalent in periodontal disease.

5. From Fermenting to Proteolytic Species:

   • The microbial community shifts from fermentative bacteria, which primarily metabolize carbohydrates, to proteolytic species that break down proteins, contributing to tissue destruction and inflammation.

ANUG symptoms: Metallic taste, Pasty saliva, Punched – out papilla

Red complex: Porphyromonas, Treponema denticola, Tannerella forsythia

Drug enlargement: Phenytoin = Fibrotic, Cyclosporine = Vascular

Healing times: 2 – 7 (epithelialization), 21 (collagen), 1 week (flap attachment)

Bone graft memory: FDBA = Conductive, DFDBA = Inductive

🧬 Risk Factors

• Increased homocysteine levels
• Raised lipoprotein(a)
• Nephrotic syndrome increases CAD risk
• Unsaturated fatty acid intake: Protective
• Best probability predictor in elderly: LDL/HDL ratio

⚕️ Diagnosis & Presentation

🧪 Enzymes & Drugs

• Enzyme ↑ at 4 – 6 hrs, ↓ in 3 – 4 days: CPK
• Stress ECHO agent: Dobutamine
• Intervention of choice: Streptokinase + Heparin
• Thrombolytics window: Within 12 hrs of MI

🚨 Prognosis & Complications

• Day 1: Maximum MI mortality
• Post-MI valvular lesion: Mitral regurgitation
• Best predictor of morbidity: LVEF
• Fatal thrombolysis complication: Intracranial hemorrhage
• LAD artery nicknamed: Widow’s artery