NEET MDS Synopsis
Garre’s Osteomyelitis
Oral Pathology
Garre’s Osteomyelitis (Chronic Osteomyelitis with Proliferative Perosteitis)
Chronic Non Suppurative Sclerosing Osteitis/ Periostitis Ossificans.
Non suppurative productive disease characterized by a hard swelling.
Occurs due to low grade infection and irritation
The infectious agent localizes in or beneath the periosteal covering of the cortex & spreads only slightly into the interior of the bone.
Occurs primarily in young persons who possess great osteogenic activity of the periosteum.
Clinical Features
Uncommonly encountered, described in tibia and in the head and neck region, in the mandible.
Typically involves the posterior mandible & is usually unilateral.
Patients present with an asymptomatic bony, hard swelling with normal appearing overlying skin and mucosa.
On occasion slight tenderness may be noted
pain is most constant feature
The increase in the mass of bone may be due to mild toxic stimulation of periosteal osteoblasts by attenuated infection.
Radiographic features
Laminations vary from 1 – 12 in number, radiolucent separations often are present between new bone and original cortex. (“onion skin appearance”)
Trabeculae parallel to laminations may also be present.
Histologic Features
Reactive new bone.
Parallel rows of highly cellular & reactive woven bone in which the individual trabeculae are oriented perpendicular to surface.
Osteoblasts predominate in this area.
D/D for Garre’s Osteomyelitis
Ewing's sarcoma
Caffey’s disease
Fibrous dysplasia
Osteosarcoma
Treatment
Removal of the offending cause.
Once inflammation resolves, layers of the bone consolidate in 6 – 12 months, as the overlying muscle helps to remodel.
If no focus of infection evident, biopsy recommended.
Antihypertensives drugs -DIURETICS
Pharmacology
DIURETICS
The basis for the use of diuretics is to promote sodium depletion (and thereby water) which leads to a decrease in extracellular fluid volume.
An important aspect of diuretic therapy is to prevent the development of tolerance to other antihypertensive drugs.
TYPES OF DIURETICS
A. Thiazide Diuretics examples include chlorothiazide
hydrochlorothiazide
a concern with these drugs is the loss of potassium as well as sodium
B. Loop Diuretics (High Ceiling Diuretics) examples include
furosemide (Lasix)
bumetanide
these compounds produce a powerful diuresis and are capable of producing severe derangements of electrolyte balance
C. Potassium Sparing Diuretics examples include
triamterene
amiloride
spironolactone
unlike the other diuretics, these agents do not cause loss of potassium
Mechanism of Action
Initial effects: through reduction of plasma volume and cardiac output.
Long term effect: through decrease in total peripheral vascular resistance.
Advantages
Documented reduction in cardiovascular morbidity and mortality.
Least expensive antihypertensive drugs.
Best drug for treatment of systolic hypertension and for hypertension in theelderly.
Can be combined with all other antihypertensive drugs to produce synergetic effect.
Side Effects
Metabolic effects (uncommon with small doses): hypokalemia,hypomagnesemia, hyponatremia, hyperuricemia, dyslipidemia (increased total
and LDL cholesterol), impaired glucose tolerance, and hypercalcemia (with thiazides).
Postural hypotension.
Impotence in up to 22% of patients.
Considerations
- Moderate salt restriction is the key for effective antihypertensive effect of diuretics and for protection from diuretic - induced hypokalaemia.
- Thiazides are not effective in patients with renal failure (serum creatinine > 2mg /dl) because of reduced glomerular filtration rate.
- Frusemide needs frequent doses ( 2-3 /day ).Thiazides can be given once daily or every other day.
- Potassium supplements should not be routinely combined with thiazide or loop diuretics. They are indicated with hypokalemia (serum potassium < 3.5 mEq/L) especially with concomitant digitalis therapy or left ventricular hypertrophy.
- Nonsteroidal antiinflammatory drugs can antagonize diuretics effectiveness.
Special Indications
Diuretics should be the primary choice in all hypertensives.
They are indicated in:
- Volume dependent forms of hypertension: blacks, elderly, diabetic, renal and obese hypertensives.
- Hypertension complicated with heart failure.
- Resistant hypertension: loop diuretics in large doses are recommended.
- Renal impairment: loop diuretics
MORPHOLOGY OF THE DECIDUOUS TEETH
Dental Anatomy
MORPHOLOGY OF THE DECIDUOUS TEETH
Deciduous Anterior Teeth.
-The primary anteriors are morphologically similar to the permanent anteriors.
-The incisors are relatively simple in their morphology.
-The roots are long and narrow.
-When compared to the permanent incisors, the mesiodistal dimension is relatively larger when compared to axial crown length
-At the time of eruption, mamelons are not present in deciduous incisors
-They are narrower mesiodistally than their permanent successors.
Types of Crying
PedodonticsTypes of Crying
Obstinate Cry:
Characteristics: This cry is loud, high-pitched,
and resembles a siren. It often accompanies temper tantrums, which may
include kicking and biting.
Emotional Response: It reflects the child's
external response to anxiety and frustration.
Physical Manifestation: Typically involves a lot of
tears and convulsive sobbing, indicating a high level of distress.
Frightened Cry:
Characteristics: This cry is not about getting what
the child wants; instead, it arises from fear that overwhelms the
child's ability to reason.
Physical Manifestation: Usually involves small
whimpers, indicating a more subdued response compared to the obstinate
cry.
Hurt Cry:
Characteristics: This cry is a reaction to physical
discomfort or pain.
Physical Manifestation: It may start with a single
tear that runs down the child's cheek without any accompanying sound or
resistance, indicating a more internalized response to pain.
Compensatory Cry
Characteristics:
This type of cry is not a traditional cry; rather, it is a sound
that the child makes in response to a specific stimulus, such as the
sound of a dental drill.
It is characterized by a constant whining noise rather than the
typical crying sounds associated with distress.
Physical Manifestation:
There are no tears or sobs associated with this cry. The child
does not exhibit the typical signs of emotional distress that
accompany other types of crying.
The sound is directly linked to the presence of the stimulus
(e.g., the drill). When the stimulus stops, the whining also ceases.
Emotional Response:
The compensatory cry may indicate a child's attempt to cope with
discomfort or fear in a situation where they feel powerless or
anxious. It serves as a way for the child to express their
discomfort without engaging in more overt forms of crying.
Periodontal Medicaments
Periodontology
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. This lecture will discuss several periodontal medicaments,
their compositions, and their clinical applications.
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.
Indices used for dental caries assessment
Public Health Dentistry
Decayed-Missing-Filled Index ( DMF ) which was introduced by Klein, Palmer and Knutson in 1938 and modified by WHO:
1. DMF teeth index (DMFT) which measures the prevalence of dental caries/Teeth.
2. DMF surfaces index (DMFS) which measures the severity of dental caries.
The components are:
D component:
Used to describe (Decayed teeth) which include:
1. Carious tooth.
2. Filled tooth with recurrent decay.
3. Only the root are left.
4. Defect filling with caries.
5. Temporary filling.
6. Filled tooth surface with other surface decayed
M component:
Used to describe (Missing teeth due to caries) other cases should be excluded these are:
1. Tooth that extracted for reasons other than caries should be excluded, which include:
a- Orthodontic treatment.
b- Impaction.
c- Periodontal disease.
2. Unerupted teeth.
3. Congenitally missing.
4. Avulsion teeth due to trauma or accident.
F component:
Used to describe (Filled teeth due to caries).
Teeth were considered filled without decay when one or more permanent restorations were present and there was no secondary (recurrent) caries or other area of the tooth with primary caries.
A tooth with a crown placed because of previous decay was recorded in this category.
Teeth restored for reason other than dental caries should be excluded, which include:
1. Trauma (fracture).
2. Hypoplasia (cosmatic purposes).
3. Bridge abutment (retention).
4. Seal a root canal due to trauma.
5. Fissure sealant.
6. Preventive filling.
1. A tooth is considered to be erupted when just the cusp tip of the occlusal surface or incisor edge is exposed.
The excluded teeth in the DMF index are:
a. Supernumerary teeth.
b. The third molar according to Klein, Palmer and Knutson only.
2. Limitations - DMF index can be invalid in older adults or in children because index can overestimate caries record by cases other than dental caries.
1. DMFT: a. A tooth may have several restorations but it counted as one tooth, F. b. A tooth may have restoration on one surface and caries on the other, it should be counted as D . c. No tooth must be counted more than once, D M F or sound.
2. DMFS: Each tooth was recorded scored as 4 surfaces for anterior teeth and 5 surfaces for posterior teeth. a. Retained root was recorded as 4 D for anterior teeth, 5 D for posterior teeth. b. Missing tooth was recorded as 4 M for anterior teeth, 5 M for posterior teeth. c. Tooth with crown was recorded as 4 F for anterior teeth, 5 F for posterior teeth.
Calculation of DMFT \ DMFS:
1. For individual
DMF = D + M + F
2. For population
Minimum score = Zero
Primary teeth index:
1. dmft / dmfs Maximum scores: dmft = 20 , dmfs = 88
2. deft / defs, which was introduced by Gruebbel in 1944: d- decayed tooth. e- decayed tooth indicated for extraction . f- filled tooth.
3. dft / dfs: In which the missing teeth are ignored, because in children it is difficult to make sure whether the missing tooth was exfoliated or extracted due to caries or due to serial extraction.
Mixed dentition:
Each child is given a separate index, one for permanent teeth and another for primary teeth. Information from the dental caries indices can be derived to show the:
1. Number of persons affected by dental caries (%).
2. Number of surfaces and teeth with past and present dental caries (DMFT / dmft - DMFS / dmfs).
3. Number of teeth that need treatment, missing due to caries, and have been treated ( DT/dt, MT/mt, FT/f t).
ANTIBIOTICS
Pharmacology
ANTIBIOTICS
Chemotherapy: Drugs which inhibit or kill the infecting organism and have no/minimum effect on the recipient.
Antibiotic these are substances produced by microorganisms which suppress the growth of or kill other micro-organisms at very low concentrations.
Anti-microbial Agents: synthetic as well as naturally obtained drugs that attenuate micro-organism.
SYNTHETIC ORGANIC ANTIMICROBIAL DRUGS
Sulfonamides
Trimethoprim-sulfamethoxazole
Quinolones – Ciprofloxacin
ANTIBIOTICS THAT ACT ON THE BACTERIAL CELL WALL
Penicillins
Cephalosporins
Vancomycin
INHIBITORS OF BACTERIAL PROTEIN SYNTHESIS
Aminoglycosides - Gentamicin
Antitubercular Drugs: Isoniazid & Rifampin
Tetracyclines
Chloramphenicol
Macrolides – Erythromycin, Azithromycin
Clindamycin
Mupirocin
Linezolid
ANTIFUNGAL DRUGS
Polyene Antibiotics (Amphotericin B, Nystatin and Candicidin)
Imidazole and Triazole Antifungal Drugs
Flucytosine
Griseofulvin
ANTIPROTOZOAL DRUGS
Antimalarial Drugs – Quinine, Chloroquine, Primaquine
Other Antiprotozoal Drugs – Metronidazole, Diloxanide, Iodoquinol
ANTIHELMINTHIC DRUGS
Praziquantel
Mebendazole
Ivermectin
ANTIVIRAL DRUGS
Acyclovir
Ribavirin
Dideoxynucleosides
Protease inhibitors
LOCATION OF THE TEETH
Dental Anatomy
LOCATION OF THE TEETH
Normally, a human receives two sets of teeth during a lifetime.
The first (deciduous or primary) set consists of 20 teeth ("baby" teeth).
The second (permanent) set usually consists of 32 teeth. In each quadrant, there are eight permanent teeth: two incisors, one cuspid, two bicuspids, and three molars
The tooth positioned immediately to the side of the midline is the central incisor, so called because it occupies a central location in the arch.
To the side of the central incisor is the lateral incisor. Next is the cuspid, then the two bicuspids (the first bicuspid, followed by the second bicuspid). The last teeth are three molars. After the second bicuspid comes the first molar, followed by the second molar, followed by the third molar or more commonly called the "wisdom tooth."
Another method of describing the location of teeth is to refer to them as anterior or posterior teeth .
Anterior teeth are those located in the front of the mouth, the incisors, and the cuspids. Normally, these are the teeth that are visible when a person smiles.
The posterior teeth are those located in the back of the mouth-the bicuspids and molars.