NEET MDS Synopsis
Autism in Pedodontics
PedodonticsAutism in Pedodontics
Autism Spectrum Disorder (ASD) is a complex developmental disorder that
affects communication, behavior, and social interaction. In the context of
pediatric dentistry (pedodontics), understanding the characteristics and
challenges associated with autism is crucial for providing effective dental
care. Here’s an overview of autism in pedodontics:
Characteristics of Autism
Developmental Disability:
Autism is classified as a lifelong developmental disability that
typically manifests during the first three years of life. It is
characterized by disturbances in mental and emotional development,
leading to challenges in learning and communication.
Diagnosis:
Diagnosing autism can be difficult due to the variability in
symptoms and behaviors. Early intervention is essential, but many
children may not receive a diagnosis until later in childhood.
Symptoms:
Poor Muscle Tone: Children with autism may exhibit
low muscle tone, which can affect their physical coordination and
ability to perform tasks.
Poor Coordination: Motor skills may be
underdeveloped, leading to difficulties in activities that require fine
or gross motor skills.
Drooling: Some children may have difficulty with
oral motor control, leading to drooling.
Hyperactive Knee Jerk: This may indicate
neurological differences that can affect overall motor function.
Strabismus: This condition, characterized by
misalignment of the eyes, can affect visual perception and coordination.
Feeding Behaviors:
Children with autism may exhibit atypical feeding behaviors, such as
pouching food (holding food in the cheeks without swallowing) and a
strong preference for sweetened foods. These behaviors can lead to
dietary imbalances and increase the risk of dental caries (cavities).
Dental Considerations for Children with Autism
Communication Challenges:
Many children with autism have difficulty with verbal communication,
which can make it challenging for dental professionals to obtain a
medical history, understand the child’s needs, or explain procedures.
Using visual aids, simple language, and non-verbal communication
techniques can be helpful.
Behavioral Management:
Children with autism may exhibit anxiety or fear in unfamiliar
environments, such as a dental office. Strategies such as
desensitization, social stories, and positive reinforcement can help
reduce anxiety and improve cooperation during dental visits.
Oral Health Risks:
Due to dietary preferences for sweetened foods and potential
difficulties with oral hygiene, children with autism are at a higher
risk for dental caries. Dental professionals should emphasize the
importance of oral hygiene and may need to provide additional support
and education to caregivers.
Special Accommodations:
Dental offices may need to make accommodations for children with
autism, such as providing a quiet environment, allowing extra time for
appointments, and using calming techniques to help the child feel more
comfortable.
Dental Terms
Dental Anatomy
CONTACT POINT.:-The point on the proximal surface where two adjacent teeth actually touch each other is called a contact point.
INTERPROXIMAL SPACE.:-The interproximal space is the area between the teeth. Part of the interproximal space is occupied by the interdental papilla. The interdental papilla is a triangular fold of gingival tissue. The part of the interproximal space not occupied is called the embrasure.
EMBRASURE. :-The embrasure occupies an area bordered by interdental papilla, the proximal surfaces of the two adjacent teeth, and the contact point (fig 4-18). If there is no contact point between the teeth, then the area between them is called a diastema instead of an embrasure.
OCCLUSAL
The occlusal surface is the broad chewing surface found on posterior teeth (bicuspids and molars).
OCCLUSION.:-Occlusion is the relationship between the occlusal surfaces of maxillary and mandibular teeth when they are in contact. Many patterns of tooth contact are possible. Part of the reason for the variety is the mandibular condyle's substantial range of movement within the temporal mandibular joint.
Malocclusion occurs when any abnormality in occlusal relationships exist in the dentition. Centric occlusion, is the centered contact position of the chewing surfaces of mandibular teeth on the chewing surface (occlusal) of the maxillary teeth.
OCCLUSAL PLANE.:-Maxillary and mandibular teeth come into centric occlusion and meet along anteroposterior and lateral curves. The anteroposterior curve is called the Curve of Spee in which the mandibular arch forms a concave (a bowl-like upward curve). The lateral curve is called the Curve of Wilson . The composite (combination) of these curves form a line called the occlusal plane, and is created by the contact of the upper and lower teeth
VERTICAL AND HORIZONTAL OVERLAP. :-Vertical overlap is the extension of the maxillary teeth over the mandibular counterparts in a vertical direction when the dentition is in centric occlusion Horizontal overlap is the projection of maxillary teeth over antagonists (something that opposes another) in a horizontal direction.
KEY TO OCCLUSION.:-The occlusal surfaces of opposing teeth bear a definite relationship to each other. In normal jaw relations and when teeth are of normal size and in the correct position, the mesiofacial cusp of the maxillary first molar occludes in the facial groove of the mandibular first molar. This normal relationship of these two teeth is called the key to occlusion.
PERMANENT DENTITION
The permanent dentition consists of 32 teeth. Each tooth in the permanent dentition is described in this section. It should be remembered that teeth show considerable variation in size, shape, and other characteristics from one person to another. Certain teeth show a greater tendency than others to deviate from the normal. The descriptions that follow are of normal teeth.
Immunoglobulins.
General Pathology
Immunoglobulins. (Ig)
These are made up of polypeptide chains. Each molecule is constituted by two heavy and two light chains, linked by disulfide (S-S) bonds. The h~ chains are of 5 types, with corresponding, types or immunoglobulin. IgG (gamma), IgM (mu µ ), IgA(alpha α), IgD(delta ), IgE(epsilon)
Each of these can have light chains of either kappa (k) or lambda type.Each chain has a constant portion (constant for the subtype) land a variable portion (antigen specific).
Enzyme digestion can split the Ig molecule into.2 Fab (antibody binding) fragments and one Fc (crystallisable, complement binding ) fragment.
Characteristics of Immunoglobulin subclasses
I. Ig G:
(i) Predominant portion (80%) of Ig.
(ii) Molecular weight 150, 000
(iii) Sedimentation coefficient of 7S.
(iv) Crosses placental barrier and to extra cellular fluid.
(v) Mostly neutralising effect. May be complement fixing.
(vi) Half life of 23 days.
2.IgM :
(i) Pentamer of Ig.
(ii) Molecular weight 900, 000
(iii) 19S.
(iv) More effective complement fixation and cells lysis
(v) Earliest to be produced in infections.
(vi) Does not cross placental barrier.
(vii) Halflife of 5 days.
3. Ig A :
Secretory antibody. Found in intestinal, respiratory secretions tears, saliva and urine also.
Secreted usually as a dinner with secretory piece.
Mol. weight variable (160,000+)
7 S to 14 S.
Half life of 6 days.
4.Ig D :
Found in traces.
7 S.
Does not cross placenta.
5. Ig E
Normally not traceable
7-8 S (MoL weight 200,000)
Cytophilic antibody, responsible for some hypersensitivity states,
Clinical significance PTH secretion
Biochemistry
Clinical significance
Primary hyperparathyroidism is due to autonomous, abnormal hypersecretion of PTH in the parathyroid gland
Secondary hyperparathyroidism is an appropriately high PTH level seen as a physiological response to hypocalcemia.
A low level of PTH in the blood is known as hypoparathyroidism and is most commonly due to damage to or removal of parathyroid glands during thyroid surgery.
MAXILLARY LATERAL INCISORS
Dental Anatomy
MAXILLARY LATERAL INCISORS
it is shorter, narrower, and thinner.
Facial: The maxillary lateral incisor resembles the central incisor, but is narrower mesio-distally. The mesial outline resembles the adjacent central incisor; the distal outline--and particularly the distal incisal angle is more rounded than the mesial incisal angle (which resembles that of the adjacent central incisor. The distal incisal angle resembling the mesial of the adjacent canine.
Lingual: On the lingual surface, the marginal ridges are usually prominent and terminate into a prominent cingulum. There is often a deep pit where the marginal ridges converge gingivally. A developmental groove often extends across the distal of the cingulum onto the root continuing for part or all of its length.
Proximal: In proximal view, the maxillary lateral incisor resembles the central except that the root appears longer--about 1 1/2 times longer than the crown. A line through the long axis of the tooth bisects the crown.
Incisal: In incisal view, this tooth can resemble either the central or the canine to varying degrees. The tooth is narrower mesiodistally than the upper central incisor; however, it is nearly as thick labiolingually.
Contact Points: The mesial contact is at the junction of the incisal third and the middle third. The distal contact is is located at the center of the middle third of the distal surface.
Root Surface:-The root is conical (cone-shaped) but somewhat flattened mesiodistally.
Leukaemias
General Pathology
Leukaemias
Uncontrolled proliferation of leukocyte precursors (may be with associated red cell and platelet series proliferation).
Factors which may playa causal role are.
- Viral
- Radiation.
- Genetic.
Classification
1. Acule leukaemia:
a. Lymphocytic (lymphoblastic).
b. Myelocytic and promyelocytic (myeloblastic).
c. Monocytic.
d. Myelomonocytic.
e. Undifferentiated (Stem cell).
2. Chronic leukaemia:
a. Lymphocytic
b. Myelocytic
3. Miscellaneous:
a. Erythroleukaemia (De Guglielmo's disease).
b. Eosinophilic leukaemia.
c. Megakaryocytic leukaemia.
Extrinsic Muscles of the Tongue
AnatomyExtrinsic Muscles of the Tongue (p. 746)
The Genioglossus Muscle
This is a bulky, fan-shaped muscle that contributes to most of the bulk of the tongue.
It arises from a short tendon from the genial tubercle (mental spine) of the mandible.
It fans out as it enters the tongue inferiorly and its fibres attach to the entire dorsum of the tongue.
Its most inferior fibres insert into the body of the hyoid bone.
The genioglossus muscle depresses the tongue and its posterior part protrudes it.
The Hyoglossus Muscle
This is a thin, quadrilateral muscle.
It arises from the body and greater horn of the hyoid bone and passes superoanteriorly to insert into the side and inferior aspect of the tongue.
It depresses the tongue, pulling its sides inferiorly; it also aids in retrusion of the tongue.
The Styloglossus Muscle
This small, short muscle arises from the anterior border of the styloid process near its tip and from the stylohyoid ligament.
It passes inferoanteriorly to insert into the side and inferior aspect of the tongue.
The styloglossus retrudes the tongue and curls its sides to create a trough during swallowing.
The Palatoglossus Muscle
Superior attachment: palatine aponeurosis.
Inferior attachment: side of tongue.
Innervation: cranial part of accessory nerve (CN XI) through the pharyngeal branch of vagus (CN X) via the pharyngeal plexus.
This muscle, covered by mucous membrane, forms the palatoglossal arch.
The palatoglossus elevates the posterior part of the tongue and draws the soft palate inferiorly onto the tongue.
DIPHTHERIA
General Pathology
DIPHTHERIA
An acute, contagious disease caused by Corynebacterium diphtheriae, characterized by the formation of a fibrinous pseudomembrane, usually on the respiratory mucosa, and by myocardial and neural tissue damage secondary to an exotoxin.
Cutaneous diphtheria (infection of the skin) can occur when any disruption of the integument is colonized by C. diphtheriae. Lacerations, abrasions, ulcers, burns, and other wounds are potential reservoirs of the organism. Skin carriage of C. diphtheriae is also a silent reservoir of infection.
Pathology
C. diphtheriae may produce exotoxins lethal to the adjacent host cells. Occasionally, the primary site is the skin or mucosa elsewhere. The exotoxin, carried by the blood, also damages cells in distant organs, creating pathologic lesions in the respiratory passages, oropharynx, myocardium, nervous system, and kidneys.
The myocardium may show fatty degeneration or fibrosis. Degenerative changes in cranial or peripheral nerves occur chiefly in the motor fibers
In severe cases, anterior horn cells and anterior and posterior nerve roots may show damage proportional to the duration of infection before antitoxin is given. The kidneys may show a reversible interstitial nephritis with extensive cellular infiltration.
The diphtheria bacillus first destroys a layer of superficial epithelium, usually in patches, and the resulting exudate coagulates to form a grayish pseudomembrane containing bacteria, fibrin, leukocytes, and necrotic epithelial cells. However, the areas of bacterial multiplication and toxin absorption are wider and deeper than indicated by the size of the membrane formed in the wake of the spreading infection.