Blade Angulation Protocols

Scaling & Root Planing

• Angulation: 45-90 degrees to tooth surface
• Purpose: Effective calculus removal and root surface debridement

Gingival Curettage

• Angulation: >90 degrees
• Technique: Removal of infected soft tissue from pocket wall

Curette Sharpening

• Optimal Angle: 100-110 degrees
• Maintenance: Critical for effective instrumentation

Curette Design

Gracey Curettes

• Offset Angle: 60 degrees
• Specificity: Area-specific design for different tooth surfaces

Universal Curettes

• Angle: 90 degrees
• Application: Suitable for all tooth surfaces

After-Five Curettes

• Modification: Terminal shank extended by 3mm
• Purpose: Access to deep pockets (>5mm)

Probing Systems

CPITN Probe

• Tip Diameter: 0.5mm
• Markings: 3.5, 5.5, 8.5, 11.5mm
• Use: Community periodontal index assessment

Florida Probe

• Tip Diameter: 0.4mm (more precise)
• Technology: Computerized probing system

Implant Probing

• Maximum Force: 25N
• Probe Type: Plastic probes recommended to prevent implant surface damage

Pathophysiology

• Enzyme defect: Glucose-6-phosphate dehydrogenase deficiency
• Result: Impaired NADPH production → reduced glutathione → oxidative damage
• Inheritance: X-linked recessive (affects males predominantly)

Key Clinical Features

• Heinz bodies: Characteristic finding (precipitated denatured hemoglobin)
• Hemolytic episodes: Triggered by oxidative stress
• Chronic hemolysis: Usually absent between episodes
• Neonatal jaundice: May be severe

Important Clinical Points

• Estrogen does NOT induce hemolysis (unlike other conditions)
• Favism: Hemolysis after eating fava beans
• Drug-induced: Most common trigger for hemolytic crisis

Oxidative Stressors to Avoid

Medications

• Antimalarials: Primaquine, chloroquine
• Antibiotics: Sulfonamides, nitrofurantoin, chloramphenicol
• Analgesics: Aspirin (high doses), phenazopyridine
• Others: Methylene blue, naphthalene (mothballs)

Infections

• Bacterial infections
• Viral hepatitis
• Pneumonia
• Typhoid fever

Other Triggers

• Fava beans (favism)
• Diabetic ketoacidosis
• Severe illness/stress

• Mineral Sources:
  • Supragingival: Saliva
  • Subgingival: GCF
• Crystal Composition:

  Crystal Type	Percentage
  Hydroxyapatite	58%
  Magnesium whitlockite	21%
  Octacalcium phosphate	12%
  Brushite	8%

• Color:
  • Supragingival: White/yellow
  • Subgingival: Dark brown/green-black
• Stains:
  • Green: Chromogenic bacteria
  • Yellow-brown: Chlorhexidine

🗣 Speech & Language

😵‍💫 Headache & Migraine

• Pain-sensitive meningeal layer: Dura
• Ophthalmoplegic migraine: III nerve palsy
• Telcagepant: New anti-migraine drug

🧠 Stroke & Hemorrhage

• Stroke in young women (India): Cortical vein thrombosis
• Commonest CVA cause: Embolism
• ICH most commonly due to: Intracerebral hemorrhage (trauma)
• Infarction site → hemiplegia: MCA territory
• Thrombolytic for stroke: Tissue plasminogen activator (tPA)
• Carotid stenosis management: Aspirin reduces TIA risk

🧠 Cranial Nerves

• Trigeminal nerve disorder: Tic Douloureux
• UMN VII palsy: Contralateral lower face paresis
• Ramsay – Hunt syndrome: Herpes virus
• Griesinger’s sign: Sigmoid sinus thrombosis

🧠 Parkinsonism

• Cause: Wilson disease (Copper accumulation)
• Lazabemide: MAO-B inhibitor

Causes

• Volatile sulfur compounds: H₂S, methyl mercaptan, dimethyl sulfide

Detection Methods

• Gold standard: Organoleptic rating (easiest)
• Most sensitive: Gas chromatography

• ANUG Staging:
  • Stage 1 – 2: NUG/NUP
  • Stage 3 – 4: NUP
  • Stage 5 – 6: Necrotizing stomatitis
  • Stage 7: Noma
• Bone Defects:
  • 3-wall: Intrabony
  • 2-wall: Crater
  • 1-wall: Hemiseptum
• Radiographic Signs: Fuzziness in lamina dura is earliest sign.
• TFO (Trauma from Occlusion): Widened PDL, thickened lamina dura.
• Most Susceptible Area: Furcation.