NEET MDS Synopsis
B-Oxidation Pathway:
Biochemistry
Step 1. Acyl-CoA Dehydrogenase catalyzes oxidation of the fatty acid moiety of acyl-CoA, to produce a double bond between carbon atoms 2 and 3.
There are different Acyl-CoA Dehydrogenases for short (4-6 C), medium (6-10 C), long and very long (12-18 C) chain fatty acids. Very Long Chain Acyl-CoA Dehydrogenase is bound to the inner mitochondrial membrane. The others are soluble enzymes located in the mitochondrial matrix.
FAD is the prosthetic group that functions as electron acceptor for Acyl-CoA Dehydrogenase.
A glutamate side-chain carboxyl extracts a proton from the a-carbon of the substrate, facilitating transfer of 2 e- with H+ (a hydride) from the b position to FAD. The reduced FAD accepts a second H+, yielding FADH2
The carbonyl oxygen of the thioester substrate is hydrogen bonded to the 2'-OH of the ribityl moiety of FAD, giving this part of FAD a role in positioning the substrate and increasing acidity of the substrate a-proton
The reactive glutamate and FAD are on opposite sides of the substrate at the active site. Thus the reaction is stereospecific, yielding a trans double bond in enoyl-CoA.
FADH2 of Acyl CoA Dehydrogenase is reoxidized by transfer of 2 electrons to an Electron Transfer Flavoprotein (ETF), which in turn passes the electrons to coenzyme Q of the respiratory chain.
Step 2. Enoyl-CoA Hydratase catalyzes stereospecific hydration of the trans double bond produced in the 1st step of the pathway, yielding L-hydroxyacyl-Coenzyme A
Step 3. Hydroxyacyl-CoA Dehydrogenase catalyzes oxidation of the hydroxyl in the b position (C3) to a ketone. NAD+ is the electron acceptor.
Step 4. b-Ketothiolase (b-Ketoacyl-CoA Thiolase) catalyzes thiolytic cleavage.
A cysteine S attacks the b-keto C. Acetyl-CoA is released, leaving the fatty acyl moiety in thioester linkage to the cysteine thiol. The thiol of HSCoA displaces the cysteine thiol, yielding fatty acyl-CoA (2 C shorter).
A membrane-bound trifunctional protein complex with two subunit types expresses the enzyme activities for steps 2-4 of the b-oxidation pathway for long chain fatty acids. Equivalent enzymes for shorter chain fatty acids are soluble proteins of the mitochondrial matrix.
Summary of one round of the b-oxidation pathway:
fatty acyl-CoA + FAD + NAD+ + HS-CoA →
fatty acyl-CoA (2 C shorter) + FADH2 + NADH + H+ + acetyl-CoA
The b-oxidation pathway is cyclic. The product, 2 carbons shorter, is the input to another round of the pathway. If, as is usually the case, the fatty acid contains an even number of C atoms, in the final reaction cycle butyryl-CoA is converted to 2 copies of acetyl-CoA
ATP production:
FADH2 of Acyl CoA Dehydrogenase is reoxidized by transfer of 2 e- via ETF to coenzyme Q of the respiratory chain. H+ ejection from the mitochondrial matrix that accompanies transfer of 2 e- from CoQ to oxygen, leads via chemiosmotic coupling to production of approximately 1.5 ATP. (Approx. 4 H+ enter the mitochondrial matrix per ATP synthesized.)
NADH is reoxidized by transfer of 2 e- to the respiratory chain complex I. Transfer of 2 e- from complex I to oxygen yields approximately 2.5 ATP.
Acetyl-CoA can enter Krebs cycle, where the acetate is oxidized to CO2, yielding additional NADH, FADH2, and ATP.
Fatty acid oxidation is a major source of cellular ATP
b-Oxidation of very long chain fatty acids also occurs within peroxisomes
FAD is electron acceptor for peroxisomal Acyl-CoA Oxidase, which catalyzes the first oxidative step of the pathway. The resulting FADH2 is reoxidized in the peroxisome producing hydrogen peroxide FADH2 + O2 à FAD + H2O2
The peroxisomal enzyme Catalase degrades H2O2 by the reaction:
2 H2O2 → 2 H2O + O2
These reactions produce no ATP
Once fatty acids are reduced in length within the peroxisomes they may shift to the mitochondria to be catabolized all the way to CO2. Carnitine is also involved in transfer of fatty acids into and out of peroxisomes
SALIVARY GLANDS -Structure
Dental Anatomy
Structure
There are 3 pairs
The functional unit is the adenomere.
The adenomere consists of secreting units and an intercalated duct, which opens, in a striated duct.
An secreting unit can be:
- mucous secreting
- serous secreting
THE SECRETING UNIT
THE CELLS
Serous cells
(seromucus cells=secrete also polysaccharides), They have all the features of a cell specialized for the synthesis, storage, and secretion of protein
Pyramidal, Nuclei are rounded and more centrally placed, In the basal 1/3 there is an accumulation of Granular EPR, In the apex there are proteinaceous secretory granules, Cells stain well with H & E (red), Between cells are intercellular secretory capillaries
Rough endoplasmic reticulum (ribosomal sites-->cisternae)
Prominent Golgi-->carbohydrate moieties are added
Secretory granules-->exocytosis
The secretory process is continuous but cyclic
There are complex foldings of cytoplasmic membrane
The junctional complex consists of: 1) tight junctions (zonula occludens)-->fusion of outer cell layer, 2) intermediate junction (zonula adherens)-->intercellular communication, 3)desmosomes-->firm adhesion
Mucus cells
Pyramidal, Nuclei are flattened and near the base, Have big clear secretory granules
Cells do not stain well with H & E (white)
Production, storage, and secretion of proteinaceous material; smaller enzymatic component
-more carbohydrates-->mucins=more prominent Golgi
-less prominent (conspicuous) rough endoplasmic reticulum, mitochondria
-less interdigitations
Myoepithelial cells
Star-shaped, Centrally located nucleus, Long cytoplasmic arms - bound to the secretory cells by desmosomes, Have fibrils like smooth muscle, Squeeze the secretory cell
One, two or even three myoepithelial cells in each salivary and piece body, four to eight processes
Desmosomes between myoepithelial cells and secretory cells myofilaments frequently aggregated to form dark bodies along the course of the process. The myoepithelial cells of the intercalated ducts are more spindled-shaped and fewer processes
Ultrastructure very similar to that of smooth muscle cells (myofilaments, desmosomal attachments)
Functions of myoepithelial cells
-Support secretory cells
-Contract and widen the diameter of the intercalated ducts
-Contraction may aid in the rupture of acinar cells of epithelial origin
Ductal system
Three classes of ducts:
Intercalated ducts
They have small diameter; lined by small cuboidal cells; nucleus located in the center. They have a well-developed RER, Golgi apparatus, occasionally secretory granules, few microvilli. Myoepithelial cells are also present. Intercalated ducts are prominent in salivary glands having a watery secretion (parotid).
Striated ducts
They have columnar cells, a centrally located nucleus, eosinophilic cytoplasm. Prominenty striations that refer to indentations of the cytoplasmic membrane with many mitochondria present between the folds. Some RER and some Golgi. The cells have short microvilli.
The cells of the striated ducts modify the secretion (hypotonic solution=low sodium and chloride and high potassium). There is also presence of few basal cells.
Terminal excretory ducts
Near the striated ducts they have the same histology as the striated ducts. As the duct reaches the oral mucosa the lining becomes stratified. In the terminal ducts one can find goblet cells, basal cells, clear cells. The terminal ducts alter the electrolyte concentration and add mucoid substance.
Connective tissue
Presence of fibroblasts, inflammatory cells, mast cells, adipose cells
Extracellular matrix (glycoproteins and proteoglycans)
Collagen and oxytalan fibers
Nerve supply
The innervation of salivary glands is very complicated. There is no direct inhibitory innervation. There are parasympathetic and sympathetic impulses, the parasympathetic are more prevalent.
The parasympathetic impulses may occur in isolation, evoke most of the fluid to be excreted, cause exocytosis, induce contraction of myoepithelial cells (sympathetic too) and cause vasodialtion. There are two types of innervation: epilemmal and hypolemmal. There are beta-adrenergic receptors that induce protein secretion and L-adrenergic and cholinergic receptors that induce water and electrolyte secretion.
Hormones can influence the function of the salivary glands. They modify the salivary content but cannot initiate salivary flow.
Age changes
Fibrosis and fatty degenerative changes
Presence of oncocytes (eosinophilic cells containing many mitochondria)
Clinical considerations
Role of drugs, systemic disorders, bacterial or viral infections, therapeutic radiation, obstruction, formation of plaque and calculus.
- Rich capillary networks surround the adenomeres.
Relationship Classification
Dental Anatomy
Angle classified these relationships by using the first permanent molars
Normal or neutral occlusion (ideal):
Mesiobuccalgroove of the mandibular first molar align with the mesiobuccal cusp of the max laxy first permanent molar
ClassI malocclusion normal molar relationships with alterations to other characteristics of the occlusion such as versions, crossbites, excessive overjets, or overbites
Class II malocclusion a distal relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary first permanent molar
Division I: protruded maxillary anterior teeth
Division II: one or more maxillary anterior teeth retruded
Class III malocclusion a mesial relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary molar
Nucleic Acids
PhysiologyNucleic Acids:
Two major types: DNA
RNA (including mRNA, tRNA, & rRNA)
Both types have code which specifies the sequence of amino acids in proteins
DNA = archival copy of genetic code, kept in nucleus, protected
RNA = working copy of code, used to translate a specific gene into a protein, goes into cytoplasm & to ribosomes, rapidly broken down
Nucleic acids are made of 5 nucleotide bases, sugars and phosphate groups
The bases make up the genetic code ; the phosphate and sugar make up the backbone
RNA is a molecule with a single strand
DNA is a double strand (a double helix) held together by hydrogen bonds between the bases
A = T; C= G because:
A must always hydrogen bond to T
C must always hydrogen bond to G
Needle selection
Pharmacology
Needle selection
Nerve blocks:
Inferior alveolar- 25 G short (LLU technique)
PSA- 25 G short
Mental/Incisive- 25 G short
Palatal- 27/30 G short/ultrashort
Gow-Gates/Akinosi- 25 G long
Infraorbital- 25 G long
Field Block:
ASA 25/27 short
Infiltration:
Infiltration/SP 25/27 short
PDL/Intraosseous
PDL 27/30 short
Intraosseous 30 short/ultrashort
EPHEDRINE
Pharmacology
EPHEDRINE
It act indirectly and directly on α and β receptors. It increases blood pressure both by peripheral vasoconstriction and by increasing the cardiac output. Ephedrine also relaxes the bronchial smooth muscles.
Ephedrine stimulates CNS and produces restlessness, insomnia, anxiety and tremors.
Ephedrine produces mydriasis on local as well as systemic administration.
Ephedrine is useful for the treatment of chronic and moderate type of bronchial asthma, used as nasal decongestant and as a mydriatic without cycloplegia. It is also useful in preventing ventricular asystole in Stokes Adams syndrome.
Fourth Generation:
Pharmacology
Fourth Generation:
These are extended spectrum antibiotics. They are resistant to beta lactamases.
Cefipime
Mercury Exposure and Safety
Conservative DentistryMercury Exposure and Safety
Concentrations of Mercury in Air
Typical Levels: Mercury concentrations in air can vary
significantly:
Pure air: 0.002 µg/m³
Urban air: 0.05 µg/m³
Air near industrial parks: 3 µg/m³
Air in mercury mines: 300 µg/m³
Threshold Limit Value (TLV): The generally accepted TLV
for exposure to mercury vapor for a 40-hour work week is 50 µg/m³.
Understanding these levels is crucial for ensuring safety in dental
practices where amalgam is used.