🔁 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

• Blood transfusion: Always consider FNHTR first for fever during transfusion
• G6PD deficiency: Heinz bodies are pathognomonic; estrogen is safe
• BMT infections: HSV earliest, interstitial pneumonitis at 7 weeks
• Prevention: Patient education and prophylaxis are crucial in all three conditions

• Least risk site: Atrial septal defect
• IV drug user: Tricuspid valve affected
• Common organism: Staph aureus
• Late prosthetic valve endocarditis: CoNS
• Signs:
  • Osler’s nodes – Palms & soles
  • Roth spots – Retinal hemorrhage
• Best test: Echocardiography
• Criteria: Duke’s
• Dental prophylaxis: Amoxicillin

• Perinatal transmission (90%)
• Window phase: HBsAg ↓, anti-HBs ↑
• Infectivity: HBsAg + HBeAg
• First marker post-infection: HBsAg
• IgM anti-HBc = acute infection
• Reverse transcriptase → P gene
  | Hepatitis C | Most chronic & linked to liver disease
  | Hepatitis A | Prophylaxis: Human IgG
  | Hepatitis E | Most epidemic-prone in India
  | Councilman bodies | Seen in acute viral hepatitis

Bone grafting is a critical procedure in periodontal and dental surgery, aimed at restoring lost bone and supporting the regeneration of periodontal tissues. Various materials can be used for bone grafting, each with unique properties and applications.

A. Osseous Coagulum

• Composition: Osseous coagulum is a mixture of bone dust and blood. It is created using small particles ground from cortical bone.
• Sources: Bone dust can be obtained from various anatomical sites, including:
  • Lingual ridge of the mandible
  • Exostoses
  • Edentulous ridges
  • Bone distal to terminal teeth
• Application: This material is used in periodontal surgery to promote healing and regeneration of bone in areas affected by periodontal disease.

B. Bioactive Glass

• Composition: Bioactive glass consists of sodium and calcium salts, phosphates, and silicon dioxide.
• Function: It promotes bone regeneration by forming a bond with surrounding bone and stimulating cellular activity.

C. HTR Polymer

• Composition: HTR Polymer is a non-resorbable, microporous, biocompatible composite made from polymethyl methacrylate (PMMA) and polyhydroxymethacrylate.
• Application: This material is used in various dental and periodontal applications due to its biocompatibility and structural properties.

D. Other Bone Graft Materials

• Sclera: Used as a graft material due to its collagen content and biocompatibility.
• Cartilage: Can be used in certain grafting procedures, particularly in reconstructive surgery.
• Plaster of Paris: Occasionally used in bone grafting, though less common due to its non-biological nature.
• Calcium Phosphate Biomaterials: These materials are osteoconductive and promote bone healing.
• Coral-Derived Materials: Natural coral can be processed to create a scaffold for bone regeneration.

Gingival crevicular fluid is an inflammatory exudate found in the gingival sulcus. It plays a significant role in periodontal health and disease.

A. Characteristics of GCF

• Glucose Concentration: The glucose concentration in GCF is 3-4 times greater than that in serum, indicating increased metabolic activity in inflamed tissues.
• Protein Content: The total protein content of GCF is much less than that of serum, reflecting its role as an inflammatory exudate.
• Inflammatory Nature: GCF is present in clinically normal sulci due to the constant low-grade inflammation of the gingiva.

B. Drugs Excreted Through GCF

• Tetracyclines and Metronidazole: These antibiotics are known to be excreted through GCF, making them effective for localized periodontal therapy.

C. Collection Methods for GCF

GCF can be collected using various techniques, including:

1. Absorbing Paper Strips/Blotter/Periopaper: These strips absorb fluid from the sulcus and are commonly used for GCF collection.
2. Twisted Threads: Placing twisted threads around and into the sulcus can help collect GCF.
3. Micropipettes: These can be used for precise collection of GCF in research settings.
4. Intra-Crevicular Washings: Flushing the sulcus with a saline solution can help collect GCF for analysis.