• Mobility Tests: Perio test, Fremitus test.
• Bone Evaluation: Transgingival probing.
• Halitosis Detection: Gold standard = Organoleptic analysis.
• Indices:
  • PMA Index: Gingival disease.
  • Ramfjord Index Teeth: 16, 21, 24, 36, 41, 44.
  • Merin’s Classification: Patient recall.
  • Surrogate Endpoint: Reduction in probing depth.

Morphological Classification

Three-Wall Defect (Intrabony Defect)

• Description: Defect contained by three bony walls
• Prognosis: Best regenerative potential
• Treatment: Ideal candidate for GTR procedures

Two-Wall Defect (Crater)

• Description: Defect between two adjacent teeth
• Characteristics: Interdental bone loss
• Prevalence: Most common osseous defect in chronic periodontitis

One-Wall Defect (Hemiseptum)

• Description: Defect with only one remaining bony wall
• Prognosis: Poorest regenerative potential
• Treatment: Often requires resective therapy

Bone Loss Patterns

Horizontal Bone Loss

• Associated Pocket Type: Suprabony pocket
• Pattern: Uniform reduction in alveolar bone height
• Radiographic Appearance: Horizontal radiolucency

Vertical/Angular Bone Loss

• Associated Pocket Type: Infrabony pocket
• Pattern: Uneven bone destruction
• Clinical Significance: More complex treatment requirements

• Drugs in GCF: Tetracycline, Metronidazole
• Probes:
  • Conventional: Williams, Naber’s, CPITN
  • Pressure-sensitive: Foster Miller
  • Automated: Florida, Toronto
  • CPITN: 0.5 mm tip; markings at 3.5, 5.5, 8.5, 11.5 mm
• Scaling & Curettage:
  • Blade angulation: 45 – 90° (scaling); >90° (curettage)
  • Curette sharpening: 100 – 110°
  • Chisel scaler: Push motion
  • Hoe scaler: Blade bent at 99°, used for ledges/rings

Periodontal Medicaments

Periodontal diseases often require adjunctive therapies to traditional mechanical treatments such as scaling and root planing. Various medicaments have been developed to enhance the healing process and control infection in periodontal tissues.

1. Elyzol

• Composition:
  • Elyzol is an oil-based gel containing 25% metronidazole. It is formulated with glyceryl mono-oleate and sesame oil.
• Clinical Use:
  • Elyzol has been found to be equivalent to scaling and root planing in terms of effectiveness for treating periodontal disease.
  • However, no adjunctive effects beyond those achieved with mechanical debridement have been demonstrated.

2. Actisite

• Composition:

  • Actisite consists of tetracycline-containing fibers.
  • Each fiber has a diameter of 0.5 mm and contains 12.7 mg of tetracycline per 9 inches of fiber.

• Clinical Use:

  • The fibers are placed directly into periodontal pockets, where they release tetracycline over time, helping to reduce bacterial load and promote healing.

3. Arestin

• Composition:

  • Arestin contains minocycline, which is delivered as a biodegradable powder in a syringe.

• Clinical Use:

  • Arestin is indicated for the treatment of periodontal disease and is applied directly into periodontal pockets, where it provides localized antibiotic therapy.

4. Atridox

• Composition:

  • Atridox contains 10% doxycycline in a syringeable gel system that is biodegradable.

• Clinical Use:

  • The gel is injected into periodontal pockets, where it solidifies and releases doxycycline over time, aiding in the management of periodontal disease.

5. Dentamycin and Periocline

• Composition:

  • Both Dentamycin and Periocline contain 2% minocycline hydrochloride.

• Clinical Use:

  • These products are used similarly to other local delivery systems, providing localized antibiotic therapy to reduce bacterial infection in periodontal pockets.

6. Periochip

• Composition:

  • Periochip is a biodegradable chip that contains chlorhexidine.

• Clinical Use:

  • The chip is placed in the gingival crevice, where it releases chlorhexidine over time, providing antimicrobial action and helping to control periodontal disease.

Papillon-Lefevre Syndrome

Classic Triad

1. Plantar Hyperkeratosis: Thickening of palms and soles
2. Early-Onset Periodontitis: Severe periodontal destruction in primary and permanent dentition
3. Dural Calcification: Intracranial calcifications

Genetics and Pathogenesis

• Inheritance: Autosomal recessive
• Gene: CTSC gene mutation affecting cathepsin C

Drug-Induced Gingival Hyperplasia

Most Common Causative Drug

• Primary Agent: Phenytoin (anti-seizure medication)
• Other Drugs: Cyclosporine, nifedipine, amlodipine

Grading System

• Grade III: Three-quarters of tooth crown covered by hyperplastic tissue
• Management: Drug substitution when possible, surgical reduction

🔁 Pulse Patterns

🔊 Heart Sounds

• Loud S1: Short PR interval, tachycardia, mitral stenosis
• Fourth Heart Sound (S4): Heard during ventricular filling
• Opening snap: High-pitched, diastolic sound