NEET MDS Synopsis
Necrotizing Ulcerative Gingivitis (NUG)
PeriodontologyNecrotizing Ulcerative Gingivitis (NUG)
Necrotizing Ulcerative Gingivitis (NUG), also known as Vincent's disease or
trench mouth, is a severe form of periodontal disease characterized by the
sudden onset of symptoms and specific clinical features.
Etiology and Predisposing Factors
Sudden Onset: NUG is characterized by a rapid onset of
symptoms, often following debilitating diseases or acute respiratory
infections.
Lifestyle Factors: Changes in living habits, such as
prolonged work without adequate rest, poor nutrition, tobacco use, and
psychological stress, are frequently noted in patient histories .
Smoking: Smoking has been identified as a significant
predisposing factor for NUG/NDP .
Immune Compromise: Conditions that compromise the
immune system, such as poor oral hygiene, smoking, and emotional stress, are
major contributors to the development of NUG .
Clinical Presentation
Symptoms: NUG presents with:
Punched-out, crater-like depressions at the crest of interdental
papillae.
Marginal gingival involvement, with rare extension to attached
gingiva and oral mucosa.
Grey, pseudomembranous slough covering the lesions.
Spontaneous bleeding upon slight stimulation of the gingiva.
Fetid odor and increased salivation.
Microbiology
Mixed Bacterial Infection: NUG is caused by a complex
of anaerobic bacteria, often referred to as the fusospirochetal complex,
which includes:
Treponema vincentii
Treponema denticola
Treponema macrodentium
Fusobacterium nucleatum
Prevotella intermedia
Porphyromonas gingivalis
Treatment
Control of Acute Phase:
Clean the wound with an antibacterial agent.
Irrigate the lesion with warm water and 5% vol/vol hydrogen
peroxide.
Prescribe oxygen-releasing mouthwash (e.g., hydrogen peroxide DPF,
sodium perborate DPF) to be used thrice daily.
Administer oral metronidazole for 3 to 5 days. If sensitive to
metronidazole, prescribe penicillin; if sensitive to both, consider
erythromycin or clindamycin.
Use 2% chlorhexidine in select cases for a short duration.
Management of Residual Condition:
Remove predisposing local factors (e.g., overhangs).
Perform supra- and subgingival scaling.
Consider gingivoplasty to correct any residual gingival deformities.
Maternal Attitudes and Child Behaviors
PedodonticsMaternal Attitudes and Corresponding Child Behaviors
Overprotective:
Mother's Behavior: A mother who is overly
protective tends to shield her child from potential harm or discomfort,
often to the point of being controlling.
Child's Behavior: Children raised in an
overprotective environment may become shy, submissive, and anxious. They
may struggle with independence and exhibit fearfulness in new situations
due to a lack of opportunities to explore and take risks.
Overindulgent:
Mother's Behavior: An overindulgent mother tends to
give in to the child's demands and desires, often providing excessive
affection and material rewards.
Child's Behavior: This can lead to children who are
aggressive, demanding, and prone to temper tantrums. They may struggle
with boundaries and have difficulty managing frustration when they do
not get their way.
Under-affectionate:
Mother's Behavior: A mother who is
under-affectionate may be emotionally distant or neglectful, providing
little warmth or support.
Child's Behavior: Children in this environment may
be generally well-behaved but can struggle with cooperation. They may be
shy and cry easily, reflecting their emotional needs that are not being
met.
Rejecting:
Mother's Behavior: A rejecting mother may be
dismissive or critical of her child, failing to provide the emotional
support and validation that children need.
Child's Behavior: This can result in children who
are aggressive, overactive, and disobedient. They may act out as a way
to seek attention or express their frustration with the lack of
nurturing.
Authoritarian:
Mother's Behavior: An authoritarian mother enforces
strict rules and expectations, often without providing warmth or
emotional support. Discipline is typically harsh and non-negotiable.
Child's Behavior: Children raised in authoritarian
environments may become evasive and dawdling, as they may fear making
mistakes or facing punishment. They may also struggle with self-esteem
and assertiveness.
Factors to Design a Spring for Appliances
OrthodonticsFactors to Consider in Designing a Spring for Orthodontic Appliances
In orthodontics, the design of springs is critical for achieving effective
tooth movement while ensuring patient comfort. Several factors must be
considered when designing a spring to optimize its performance and
functionality. Below, we will discuss these factors in detail.
1. Diameter of Wire
Flexibility: The diameter of the wire used in the
spring significantly influences its flexibility. A thinner wire will yield a
more flexible spring, allowing for greater movement and adaptability.
Force Delivery: The relationship between wire diameter
and force delivery is crucial. A thicker wire will produce a stiffer spring,
which may be necessary for certain applications but can limit flexibility.
2. Force Delivered by the Spring
Formula: The force (F) delivered by a spring can be
expressed by the formula: [ $$F \propto \frac{d^4}{l^3} $$] Where:
( F ) = force applied by the spring
( d ) = diameter of the wire
( l ) = length of the wire
Implications: This formula indicates that the force
exerted by the spring is directly proportional to the fourth power of the
diameter of the wire and inversely proportional to the cube of the length of
the wire. Therefore, small changes in wire diameter can lead to significant
changes in force delivery.
3. Length of Wire
Flexibility and Force: Increasing the length of the
wire decreases the force exerted by the spring. Longer springs are generally
more flexible and can remain active for extended periods.
Force Reduction: By doubling the length of the wire,
the force can be reduced by a factor of eight. This principle is essential
when designing springs for specific tooth movements that require gentler
forces.
4. Patient Comfort
Design Considerations: The design, shape, size, and
force generation of the spring must prioritize patient comfort. A
well-designed spring should not cause discomfort or irritation to the oral
tissues.
Customization: Springs may need to be customized to fit
the individual patient's anatomy and treatment needs, ensuring that they are
comfortable during use.
5. Direction of Tooth Movement
Point of Contact: The direction of tooth movement is
determined by the point of contact between the spring and the tooth. Proper
placement of the spring is essential for achieving the desired movement.
Placement Considerations:
Palatally Placed Springs: These are used for labial
(toward the lips) and mesio-distal (toward the midline) tooth movements.
Buccally Placed Springs: These are employed when
the tooth needs to be moved palatally and in a mesio-distal direction.
Early Childhood Caries (ECC) Classification
Conservative DentistryEarly Childhood Caries (ECC) Classification
Early Childhood Caries (ECC) is a significant public health concern
characterized by the presence of carious lesions in young children. It is
classified into three types based on severity, affected teeth, and underlying
causes. Understanding these classifications helps in diagnosing, preventing, and
managing ECC effectively.
Type I ECC (Mild to Moderate)
A. Characteristics
Affected Teeth: Carious lesions primarily involve the
molars and incisors.
Age Group: Typically observed in children aged 2
to 5 years.
B. Causes
Dietary Factors: The primary cause is usually a
combination of cariogenic semisolid or solid foods, such as sugary snacks
and beverages.
Oral Hygiene: Lack of proper oral hygiene practices
contributes significantly to the development of caries.
Progression: As the cariogenic challenge persists, the
number of affected teeth tends to increase.
C. Clinical Implications
Management: Emphasis on improving oral hygiene
practices and dietary modifications can help control and reverse early
carious lesions.
Type II ECC (Moderate to Severe)
A. Characteristics
Affected Teeth: Labio-lingual carious lesions primarily
affect the maxillary incisors, with or without molar caries, depending on
the child's age.
Age Group: Typically seen soon after the first tooth
erupts.
B. Causes
Feeding Practices: Common causes include inappropriate
use of feeding bottles, at-will breastfeeding, or a combination of both.
Oral Hygiene: Poor oral hygiene practices exacerbate
the condition.
Progression: If not controlled, Type II ECC can
progress to more advanced stages of caries.
C. Clinical Implications
Intervention: Early intervention is crucial, including
education on proper feeding practices and oral hygiene to prevent further
carious development.
Type III ECC (Severe)
A. Characteristics
Affected Teeth: Carious lesions involve almost all
teeth, including the mandibular incisors.
Age Group: Usually observed in children aged 3
to 5 years.
B. Causes
Multifactorial: The etiology is a combination of
various factors, including poor oral hygiene, dietary habits, and possibly
socio-economic factors.
Rampant Nature: This type of ECC is rampant and can
affect immune tooth surfaces, leading to extensive decay.
C. Clinical Implications
Management: Requires comprehensive dental treatment,
including restorative procedures and possibly extractions. Education on
preventive measures and regular dental visits are essential to manage and
prevent recurrence.
Thalassemia
Pathology
Thalassemias are a heterogeneous group of hereditary blood disorders characterized by faulty globin chain synthesis resulting in defective hemoglobin, which can lead to anemia
Thalassemia provides partial resistance against malaria.
Beta thalassemia
- most commonly seen in people of Mediterranean descent
Etiology
usually due to point mutations in promoter sequences or splicing sites
β-globin locus - short arm of chromosome 11
In a normal cell, the β-globin chains are coded by a total of two alleles . Thus, there are two forms of the disease.
Beta thalassemia minor (trait): one defective allele
Beta thalassemia major (Cooley's anemia): two defective alleles
Pathophysiology
Inefficient erythropoiesis → anemia
Beta thalassemia minor and major: faulty β-globin chain synthesis → ↓ β-chains→ ↑ γ-,δ-chains → ↑ HbF and ↑ HbA2
Alpha thalassemia
most commonly seen in people of Asian and African descent
Etiology
usually due to deletion of at least one out of the four existing alleles
Inheritance pattern: autosomal recessive
In a normal cell, the α-globin chains are coded by a total of four alleles.
Thus, there are four forms of the disease. The severity of alpha thalassemia depends on the number of defective α-globin alleles.
- Silent carrier (minima form): one defective allele (-α/αα)
- Alpha thalassemia trait (minor form) -Two defective alleles ,Cis-deletion is common amongst Asian populations, whereas trans-deletions are more common in African populations
- Hemoglobin H disease: three defective alleles
- Hemoglobin Bart disease (major form): four defective alleles
Pathophysiology
Alpha thalassemia major (HbH disease) and Bart disease: faulty α-globin chain synthesis → ↓ α-chains → ↑ β-, γ-chains → ↑ HbH, ↑ Hb-Bart's
Other Antidepressants
Pharmacology
Serotonin-norepinephrine reuptake inhibitors(SNRIs)
e.g. venlafaxine and duloxetine
- Inhibit the reuptake of both 5-HT and norepinephrine
- Has a more favourable adverse effect profile than TCAs
Norepinephrine reuptake inhibitor
e.g. bupropion, reboxetine
Monoamine receptor antagonists
e.g. mirtazapine, trazodone, mianserin
PRIMARY LYMPHEDEMA
General Pathology
PRIMARY LYMPHEDEMA
can occur as:
1- A congenital defect, resulting from lymphatic agenesis or hypoplasia.
2- Secondary or obstructive lymphedema
- blockage of a previously normal lymphatic; e.g. Malignant tumors
- Surgical procedures that remove lymph nodes
- Postirradiation
- Fibrosis
- Filariasis
- Postinflammatory thrombosis and scarring
Gracey Curettes
PeriodontologyGracey Curettes
Gracey curettes are specialized instruments designed for periodontal therapy,
particularly for subgingival scaling and root planing. Their unique design
allows for optimal adaptation to the complex anatomy of the teeth and
surrounding tissues. This lecture will cover the characteristics, specific uses,
and advantages of Gracey curettes in periodontal practice.
Gracey curettes are area-specific curettes
that come in a set of instruments, each designed and angled to adapt to
specific anatomical areas of the dentition.
Purpose: They are considered some of the best
instruments for subgingival scaling and root planing due to their ability to
provide excellent adaptation to complex root anatomy.
Specific Gracey Curette Designs and Uses
Gracey 1/2 and 3/4:
Indication: Designed for use on anterior teeth.
Application: Effective for scaling and root planing
in the anterior region, allowing for precise access to the root
surfaces.
Gracey 5/6:
Indication: Suitable for anterior teeth and
premolars.
Application: Versatile for both anterior and
premolar areas, providing effective scaling in these regions.
Gracey 7/8 and 9/10:
Indication: Designed for posterior teeth,
specifically for facial and lingual surfaces.
Application: Ideal for accessing the buccal and
lingual surfaces of posterior teeth, ensuring thorough cleaning.
Gracey 11/12:
Indication: Specifically designed for the mesial
surfaces of posterior teeth.
Application: Allows for effective scaling of the
mesial aspects of molars and premolars.
Gracey 13/14:
Indication: Designed for the distal surfaces of
posterior teeth.
Application: Facilitates access to the distal
surfaces of molars and premolars, ensuring comprehensive treatment.
Key Features of Gracey Curettes
Area-Specific Design: Each Gracey curette is tailored
for specific areas of the dentition, allowing for better access and
adaptation to the unique contours of the teeth.
Offset Blade: Unlike universal curettes, the blade of a
Gracey curette is not positioned at a 90-degree angle to the lower shank.
Instead, the blade is angled approximately 60 to 70 degrees from
the lower shank, which is referred to as an "offset blade." This design
enhances the instrument's ability to adapt to the tooth surface and root
anatomy.
Advantages of Gracey Curettes
Optimal Adaptation: The area-specific design and offset
blade allow for better adaptation to the complex anatomy of the roots,
making them highly effective for subgingival scaling and root planing.
Improved Access: The angled blades enable clinicians to
access difficult-to-reach areas, such as furcations and concavities, which
are often challenging with standard instruments.
Enhanced Efficiency: The design of Gracey curettes
allows for more efficient removal of calculus and biofilm from root
surfaces, contributing to improved periodontal health.
Reduced Tissue Trauma: The precise design minimizes
trauma to the surrounding soft tissues, promoting better healing and patient
comfort.