Desquamative Gingivitis

• Characteristics: Desquamative gingivitis is characterized by intense erythema, desquamation, and ulceration of both free and attached gingiva.
• Associated Diseases:
  • Lichen Planus
  • Pemphigus
  • Pemphigoid
  • Linear IgA Disease
  • Chronic Ulcerative Stomatitis
  • Epidermolysis Bullosa
  • Systemic Lupus Erythematosus (SLE)
  • Dermatitis Herpetiformis

Calculus Composition

• Brushite: More common in mandibular anterior
• Magnesium whitlockite: More common in posterior
• Ca:P ratio: Higher subgingivally
• Mineralization: 50% in 2 days, 60 – 90% in 12 days

Microbiology

• First colonizers: S. salivarius and S. mitis
• Red complex: P. gingivalis, T. denticola, T. forsythia (cause BOP)
• Growth enhancement: P. gingivalis grows better with succinate (C. ochracea) and protoheme (C. rectus)

Pellicle Structure

• Basal layer: Thin, difficult to remove
• Globular layer: 1 μm thick, easier to detach

Bacterial Recognition

• Gram positive: Activate TLR2 → IL – 8
• Gram negative: Activate TLR4 → TNF – α

COPD

• Reid's index: Used in chronic bronchitis
• Emphysema features: ↓DLCO, weight loss, pneumothorax risk
• Chronic bronchitis: Polycythemia
• GOLD criteria: COPD severity assessment
• BODE index: Lung transplant evaluation

Sleep Apnea

Definition: Breathing pause ≥10 seconds during sleep

ASTHMA

Diagnosis & Pathophysiology

• Best diagnostic test: Demonstration of reversible obstruction
• Small airways involved
• Idiosyncratic asthma: Normal IgE levels
• Aspirin-sensitive asthma: Associated with nasal polyps

Key Points

• Charcot-Leyden crystals: Eosinophil granules
• Nebulizer droplet size: <2.5 μm
• Most severe attack indicator: Bradycardia
• Montelukast: NOT useful in acute bronchial asthma

• Mineral Sources:
  • Supragingival: Saliva
  • Subgingival: GCF
• Crystal Composition:

  Crystal Type	Percentage
  Hydroxyapatite	58%
  Magnesium whitlockite	21%
  Octacalcium phosphate	12%
  Brushite	8%

• Color:
  • Supragingival: White/yellow
  • Subgingival: Dark brown/green-black
• Stains:
  • Green: Chromogenic bacteria
  • Yellow-brown: Chlorhexidine

🧬 Risk Factors

• Increased homocysteine levels
• Raised lipoprotein(a)
• Nephrotic syndrome increases CAD risk
• Unsaturated fatty acid intake: Protective
• Best probability predictor in elderly: LDL/HDL ratio

⚕️ Diagnosis & Presentation

🧪 Enzymes & Drugs

• Enzyme ↑ at 4 – 6 hrs, ↓ in 3 – 4 days: CPK
• Stress ECHO agent: Dobutamine
• Intervention of choice: Streptokinase + Heparin
• Thrombolytics window: Within 12 hrs of MI

🚨 Prognosis & Complications

• Day 1: Maximum MI mortality
• Post-MI valvular lesion: Mitral regurgitation
• Best predictor of morbidity: LVEF
• Fatal thrombolysis complication: Intracranial hemorrhage
• LAD artery nicknamed: Widow’s artery

Pathogens Implicated in Periodontal Diseases

Periodontal diseases are associated with a variety of pathogenic microorganisms. Below is a list of key pathogens implicated in different forms of periodontal disease, along with their associations:

General Pathogens Associated with Periodontal Diseases

• Actinobacillus actinomycetemcomitans:

  • Strongly associated with destructive periodontal disease.

• Porphyromonas gingivalis:

  • A member of the "black pigmented Bacteroides group" and a significant contributor to periodontal disease.

• Bacteroides forsythus:

  • Associated with chronic periodontitis.

• Spirochetes (Treponema denticola):

  • Implicated in various periodontal conditions.

• Prevotella intermedia/nigrescens:

  • Also belongs to the "black pigmented Bacteroides group" and is associated with several forms of periodontal disease.

• Fusobacterium nucleatum:

  • Plays a role in the progression of periodontal disease.

• Campylobacter rectus:

  • These organisms include members of the new genus Wolinella and are associated with periodontal disease.

Principal Bacteria Associated with Specific Periodontal Diseases

1. Adult Periodontitis:

   • Porphyromonas gingivalis
   • Prevotella intermedia
   • Bacteroides forsythus
   • Campylobacter rectus

2. Refractory Periodontitis:

   • Bacteroides forsythus
   • Porphyromonas gingivalis
   • Campylobacter rectus
   • Prevotella intermedia

3. Localized Juvenile Periodontitis (LJP):

   • Actinobacillus actinomycetemcomitans
   • Capnocytophaga

4. Periodontitis in Juvenile Diabetes:

   • Capnocytophaga
   • Actinobacillus actinomycetemcomitans

5. Pregnancy Gingivitis:

   • Prevotella intermedia

6. Acute Necrotizing Ulcerative Gingivitis (ANUG):

   • Prevotella intermedia
   • Intermediate-sized spirochetes