NEET MDS Synopsis
Nursing Bottle Caries
Conservative DentistryNursing Bottle Caries
Nursing bottle caries, also known as early childhood caries (ECC), is a
significant dental issue that affects infants and young children. Understanding
the etiological agents involved in this condition is crucial for prevention and
management. .
1. Pathogenic Microorganism
A. Streptococcus mutans
Role: Streptococcus mutans is the primary
microorganism responsible for the development of nursing bottle caries. It
colonizes the teeth after they erupt into the oral cavity.
Transmission: This bacterium is typically transmitted
to the infant’s mouth from the mother, often through saliva.
Virulence Factors:
Colonization: It effectively adheres to tooth
surfaces, establishing a foothold for caries development.
Acid Production: S. mutans produces large
amounts of acid as a byproduct of carbohydrate fermentation, leading to
demineralization of tooth enamel.
Extracellular Polysaccharides: It synthesizes
significant quantities of extracellular polysaccharides, which promote
plaque formation and enhance bacterial adherence to teeth.
2. Substrate (Fermentable Carbohydrates)
A. Sources of Fermentable Carbohydrates
Fermentable carbohydrates are utilized by S. mutans to form
dextrans, which facilitate bacterial adhesion to tooth surfaces and
contribute to acid production. Common sources include:
Bovine Milk or Milk Formulas: Often high in
lactose, which can be fermented by bacteria.
Human Milk: Breastfeeding on demand can expose
teeth to sugars.
Fruit Juices and Sweet Liquids: These are often
high in sugars and can contribute to caries.
Sweet Syrups: Such as those found in vitamin
preparations.
Pacifiers Dipped in Sugary Solutions: This practice
can introduce sugars directly to the oral cavity.
Chocolates and Other Sweets: These can provide a
continuous source of fermentable carbohydrates.
3. Host Factors
A. Tooth Structure
Host for Microorganisms: The tooth itself serves as the
host for S. mutans and other cariogenic bacteria.
Susceptibility Factors:
Hypomineralization or Hypoplasia: Defects in enamel
development can increase susceptibility to caries.
Thin Enamel and Developmental Grooves: These
anatomical features can create areas that are more prone to plaque
accumulation and caries.
4. Time
A. Duration of Exposure
Sleeping with a Bottle: The longer a child sleeps with
a bottle in their mouth, the higher the risk of developing caries. This is
due to:
Decreased Salivary Flow: Saliva plays a crucial
role in neutralizing acids and washing away food particles.
Prolonged Carbohydrate Accumulation: The swallowing
reflex is diminished during sleep, allowing carbohydrates to remain in
the mouth longer.
5. Other Predisposing Factors
Parental Overindulgence: Excessive use of sugary foods
and drinks can increase caries risk.
Sleep Patterns: Children who sleep less may have
increased exposure to cariogenic factors.
Malnutrition: Nutritional deficiencies can affect oral
health and increase susceptibility to caries.
Crowded Living Conditions: These may limit access to
dental care and hygiene practices.
Decreased Salivary Function: Conditions such as iron
deficiency and exposure to lead can impair salivary function, increasing
caries susceptibility.
Clinical Features of Nursing Bottle Caries
Intraoral Decay Pattern: The decay pattern associated
with nursing bottle caries is characteristic and pathognomonic, often
involving the maxillary incisors and molars.
Progression of Lesions: Lesions typically progress
rapidly, leading to extensive decay if not addressed promptly.
Management of Nursing Bottle Caries
First Visit
Lesion Management: Excavation and restoration of
carious lesions.
Abscess Drainage: If present, abscesses should be
drained.
Radiographs: Obtain necessary imaging to assess the
extent of caries.
Diet Chart: Provide a diet chart for parents to record
the child's diet for one week.
Parent Counseling: Educate parents on oral hygiene and
dietary practices.
Topical Fluoride: Administer topical fluoride to
strengthen enamel.
Second Visit
Diet Analysis: Review the diet chart with the parents.
Sugar Control: Identify and isolate sugar sources in
the diet and provide instructions to control sugar exposure.
Caries Activity Tests: Conduct tests to assess the
activity of carious lesions.
Third Visit
Endodontic Treatment: If necessary, perform root canal
treatment on affected teeth.
Extractions: Remove any non-restorable teeth, followed
by space maintenance if needed.
Crowns: Place crowns on teeth that require restoration.
Recall Schedule: Schedule follow-up visits every three
months to monitor progress and maintain oral health.
Dautrey Procedure
General SurgeryDautrey Procedure
The Dautrey procedure is a surgical intervention aimed at
preventing dislocation of the temporomandibular joint (TMJ) by creating a
mechanical obstacle that restricts abnormal forward translation of the condylar
head. This technique is particularly beneficial for patients who experience
recurrent TMJ dislocations or subluxations, especially when conservative
management strategies have proven ineffective.
Indications:
The Dautrey procedure is indicated for patients with a history of
recurrent TMJ dislocations. It is particularly useful when conservative
treatments, such as physical therapy or splint therapy, have failed to
provide adequate stabilization of the joint.
Surgical Technique:
Osteotomy of the Zygomatic Arch: The procedure
begins with an osteotomy, which involves surgically cutting the
zygomatic arch, the bony structure that forms the prominence of the
cheek.
Depressing the Zygomatic Arch: After the osteotomy,
the zygomatic arch is depressed in front of the condylar head. This
depression creates a physical barrier that acts as an obstacle to the
forward movement of the condylar head during jaw opening or excessive
movement.
Stabilization: The newly positioned zygomatic arch
limits the range of motion of the condylar head, thereby reducing the
risk of dislocation during functional activities such as chewing or
speaking.
Mechanism of Action:
By altering the position of the zygomatic arch, the Dautrey
procedure effectively changes the biomechanics of the TMJ. The new
position of the zygomatic arch prevents the condylar head from
translating too far forward, which is a common cause of dislocation.
Postoperative Care:
Following the procedure, patients may require a period of recovery
and rehabilitation. This may include:
Dietary Modifications: Soft diet to minimize
stress on the TMJ during the healing process.
Pain Management: Use of analgesics to manage
postoperative discomfort.
Physical Therapy: Exercises to restore normal
function and range of motion in the jaw.
Outcomes:
The Dautrey procedure has been shown to be effective in preventing
recurrent TMJ dislocations. Patients often experience improved joint
stability and a better quality of life following the surgery. Successful
outcomes can lead to reduced pain, improved jaw function, and enhanced
overall satisfaction with treatment.
Miscellaneous Non-Neoplastic Diseases - Urticaria
General Pathology
Urticaria (hives) refers to the presence of edema within the dermis and itchy elevations of the skin which may relate to either a Type I (MC) or Type III hypersensitivity reaction.
Type III hypersensitivity reaction.
- exaggerated venular permeability MC related to IgE mediated disease and release of histamine from mast cells.
Benzylpenicillin (penicillin G)
Pharmacology
Benzylpenicillin (penicillin G)
Benzylpenicillin, commonly known as penicillin G, is the gold standard penicillin. Penicillin G is typically given by a parenteral route of administration because it is unstable to the hydrochloric acid of the stomach.
Indications :
bacterial endocarditis, meningitis, aspiration pneumonia, lung abscess,community-acquired pneumonia, syphilis, septicaemia in children
Variant Forms of Bacteria
General Microbiology
Variant Forms of Bacteria
Prortoplast ; surface is completely devoid of cell wall component,
Spheroplast : Some residual cell wall component is present
Autoplast: protoplasts which are produced by the action of organisms’ own autolytic enzymes.
L Form: replicate as pleomorphic filtrable elements with defective or no cell wall These are designated as L forms after the Lister Institute where these were discovered by Klineberger-Nobel.
Bacterial Spores: Gram positive bacilli and actinomycetes form highly resistant and dehydrated forms which are called as endospores. The surrounding mother.cell which give rise to them is known as Sporangium. These endospores are capable of survival under adverse conditions
Structure :smooth walled and ovoid or spherical.
In bacilli, spores usually fit into the normal cell diameter except in Clostridium where these may cause a terminal bulge. (drum stick ) or central. , these look like areas of high refractilitv under light microscope.
Germination : This is the process of converting a spore into the vegetative cell. It occurs in less than 2 hours and has three stages:Activation, Germination, Outgrowth
Smallpox (variola)
General Pathology
Smallpox (variola)
- vesicles are well synchronized (same stage of development) and cover the skin and mucous membranes.
- vesicles rupture and leave pock marks with permanent scarring.
Dental Calculus
Periodontology
Dental Calculus
Dental calculus, also known as tartar, is a hard deposit that forms on teeth
due to the mineralization of dental plaque. Understanding the composition and
crystal forms of calculus is essential for dental professionals in diagnosing
and managing periodontal disease.
Crystal Forms in Dental Calculus
Common Crystal Forms:
Dental calculus typically contains two or more crystal forms. The
most frequently detected forms include:
Hydroxyapatite:
This is the primary mineral component of both enamel and
calculus, constituting a significant portion of the calculus
sample.
Hydroxyapatite is a crystalline structure that provides
strength and stability to the calculus.
Octacalcium Phosphate:
Detected in a high percentage of supragingival calculus
samples (97% to 100%).
This form is also a significant contributor to the bulk of
calculus.
Other Crystal Forms:
Brushite:
More commonly found in the mandibular anterior region of the
mouth.
Brushite is a less stable form of calcium phosphate and may
indicate a younger calculus deposit.
Magnesium Whitlockite:
Typically found in the posterior areas of the mouth.
This form may be associated with older calculus deposits and can
indicate changes in the mineral composition over time.
Variation with Age:
The incidence and types of crystal forms present in calculus can
vary with the age of the deposit.
Younger calculus deposits may have a higher proportion of brushite,
while older deposits may show a predominance of hydroxyapatite and
magnesium whitlockite.
Clinical Significance
Understanding Calculus Formation:
Knowledge of the crystal forms in calculus can help dental
professionals understand the mineralization process and the conditions
under which calculus forms.
Implications for Treatment:
The composition of calculus can influence treatment strategies. For
example, older calculus deposits may be more difficult to remove due to
their hardness and mineral content.
Assessment of Periodontal Health:
The presence and type of calculus can provide insights into a
patient’s oral hygiene practices and periodontal health. Regular
monitoring and removal of calculus are essential for preventing
periodontal disease.
Research and Development:
Understanding the mineral composition of calculus can aid in the
development of new dental materials and treatments aimed at preventing
calculus formation and promoting oral health.
Routes of Drug Administration
Pharmacology
Distribution
Three major controlling factors:
Blood Flow to Tissues: rarely a limiting factor, except in cases of abscesses and tumors.
Exiting the Vascular System: Occurs at capillary beds.
- Typical Capillary Beds - drugs pass between cells
- The Blood-Brain Barrier- Tight junctions here, so drugs must pass through cells. Must then be lipid soluble, or have transport system.
- Placenta - Does not constitute an absolute barrier to passage of drugs. Lipid soluble, nonionized compounds readily pass.
- Protein Binding: Albumin is most important plasma protein in this respect. It always remains in the blood stream, so drugs that are highly protein bound are not free to leave the bloodstream. Restricts the distribution of drugs, and can be source of drug interactions.
Entering Cells: some drugs must enter cells to reach sites of action.