Talk to us?

- NEETMDS- courses
NEET MDS Lessons
Periodontology

Papillon-Lefevre Syndrome

Classic Triad

  1. Plantar Hyperkeratosis: Thickening of palms and soles
  2. Early-Onset Periodontitis: Severe periodontal destruction in primary and permanent dentition
  3. Dural Calcification: Intracranial calcifications

Genetics and Pathogenesis

  • Inheritance: Autosomal recessive
  • Gene: CTSC gene mutation affecting cathepsin C

Drug-Induced Gingival Hyperplasia

Most Common Causative Drug

  • Primary Agent: Phenytoin (anti-seizure medication)
  • Other Drugs: Cyclosporine, nifedipine, amlodipine

Grading System

  • Grade III: Three-quarters of tooth crown covered by hyperplastic tissue
  • Management: Drug substitution when possible, surgical reduction

⚙️ Renal Disorders

  • Acute Kidney Injury:
    • Pre-renal causes: Dehydration, blood loss
    • Post-renal: Obstruction (e.g., stones, tumors)
  • Nephrotic Syndrome:
    • ↑ susceptibility to CAD
    • Hallmarks: Proteinuria, hypoalbuminemia, edema, hyperlipidemia

🧪 Electrolytes & Acid-Base

  • Hyperkalemia:
    • Side effect of: ACE inhibitors
    • ECG: Tall T waves, widened QRS
  • Hyponatremia:
    • Watch for CNS symptoms
    • SIADH common cause in small cell lung CA

💉 Drugs & Renal Impact

Drug Renal Impact
ACE inhibitors Hyperkalemia
Thiazides Contraindicated in diabetic HTN
Aliskiren Renin antagonist – lowers BP

High-Yield Numbers

  • FBS ≥126 mg/dL (DM diagnosis)
  • HbA1C >6.5% (DM diagnosis)
  • IGT: 140-199 mg/dL (2-hr GTT)
  • Sleep apnea: ≥10 seconds
  • Cortisol <3 mg/dL (Addison's)
  • ACTH >200 pg/mL (Addison's)
  • Nebulizer droplets <2.5 μm

Remember the "Onlys"

  • Telmisartan: Only ARB with PPAR-γ activity
  • Microalbuminuria: Most reliable diabetic nephropathy marker
  • TB: Most common cause of adrenal insufficiency in India
  • Melanoma: Most common primary tumor → adrenal mets

Classic Associations

  • Type 1 DM: HLA-DR3/DR4, Anti-GAD antibodies
  • Aspirin asthma: Nasal polyps
  • Emphysema: Weight loss, pneumothorax, ↓DLCO
  • Chronic bronchitis: Polycythemia, Reid's index

  • Budd-Chiari:
    • Cause: PNH or Polycythemia vera
    • Common site: Hepatic veins
  • Wilson Disease:
    • Autosomal recessive < age 40
    • Excess copper in liver + brain

Plaque Formation

Dental plaque is a biofilm that forms on the surfaces of teeth and is a key factor in the development of dental caries and periodontal disease. The process of plaque formation can be divided into three major phases:

1. Formation of Pellicle on the Tooth Surface

  • Definition: The pellicle is a thin, acellular film that forms on the tooth surface shortly after cleaning.
  • Composition: It is primarily composed of salivary glycoproteins and other proteins that are adsorbed onto the enamel surface.
  • Function:
    • The pellicle serves as a protective barrier for the tooth surface.
    • It provides a substrate for bacterial adhesion, facilitating the subsequent stages of plaque formation.

2. Initial Adhesion & Attachment of Bacteria

  • Mechanism:
    • Bacteria in the oral cavity begin to adhere to the pellicle-coated tooth surface.
    • This initial adhesion is mediated by specific interactions between bacterial adhesins (surface proteins) and the components of the pellicle.
  • Key Bacterial Species:
    • Primary colonizers, such as Streptococcus sanguis and Actinomyces viscosus, are among the first to attach.
  • Importance:
    • Successful adhesion is crucial for the establishment of plaque, as it allows for the accumulation of additional bacteria.

3. Colonization & Plaque Maturation

  • Colonization:
    • Once initial bacteria have adhered, they proliferate and create a more complex community.
    • Secondary colonizers, including gram-negative anaerobic bacteria, begin to join the biofilm.
  • Plaque Maturation:
    • As the plaque matures, it develops a three-dimensional structure, with different bacterial species occupying specific niches within the biofilm.
    • The matrix of extracellular polysaccharides and salivary glycoproteins becomes more pronounced, providing structural integrity to the plaque.
  • Coaggregation:
    • Different bacterial species can adhere to one another through coaggregation, enhancing the complexity of the plaque community.

Composition of Plaque

  • Matrix Composition:
    • Plaque is primarily composed of bacteria embedded in a matrix of salivary glycoproteins and extracellular polysaccharides.
  • Implications for Removal:
    • The dense and cohesive nature of this matrix makes it difficult to remove plaque through simple rinsing or the use of sprays.
    • Effective plaque removal typically requires mechanical means, such as brushing and flossing, to disrupt the biofilm structure.

Sharpening Stones

  • Natural: India, Arkansas
  • Artificial: Ruby, Carborundum, Ceramic

Surgical Equipment

  • Dental loupes: 1.5 – 6× magnification
  • Coe – pak working time: 15 – 20 minutes

Preventive Measures

  • Calculus control toothpastes: Contain pyrophosphates
  • Antibiotic prophylaxis: Amoxicillin 2.0g, 30 – 60 min before procedure

Abrasion Rates

  • Dentin: 25× faster than enamel
  • Cementum: 35× faster than enamel

  • Steroids, Thiazides, Niacin, Phenytoin
  • Protease inhibitors, Alpha IF, Clozapine, Beta agonists

🧠 Endocrine-Related DM

  • Cushing’s, Acromegaly, Pheochromocytoma
  • Thyroid disorders, Glucagonoma, Somatostatinoma
  • (Note: Hypoglycemia in Addison's disease)

💓 Cardiovascular & Renal

  • ↑GFR → Earliest sign of diabetic nephropathy
  • Microalbuminuria → Most reliable marker
  • ACEIs → Nephroprotective, but contraindicated in CRF (hyperkalemia)

👁️‍🗨️ Complications

  • Wet gangrene, Blindness, Amputation (2nd most common after trauma)

💊 Special Drug Mention

  • Telmisartan → Only ARB acting on PPAR-γ → preferred in DM

Explore by Exams