Concentration Requirements

• Minimum Effective: 0.12%
• Optimum Concentration: 0.2%
• Duration: Typically used for 2-4 weeks

Side Effects

• Staining: Yellowish-brown stains on teeth and restorations
• Taste Alteration: Temporary metallic taste
• Soft Tissue Irritation: Rare but possible

Delivery Systems

• Chip Degradation: 7-10 days for chlorhexidine chips
• Sustained Release: Provides extended antimicrobial effect

Pathophysiology

• Enzyme defect: Glucose-6-phosphate dehydrogenase deficiency
• Result: Impaired NADPH production → reduced glutathione → oxidative damage
• Inheritance: X-linked recessive (affects males predominantly)

Key Clinical Features

• Heinz bodies: Characteristic finding (precipitated denatured hemoglobin)
• Hemolytic episodes: Triggered by oxidative stress
• Chronic hemolysis: Usually absent between episodes
• Neonatal jaundice: May be severe

Important Clinical Points

• Estrogen does NOT induce hemolysis (unlike other conditions)
• Favism: Hemolysis after eating fava beans
• Drug-induced: Most common trigger for hemolytic crisis

Oxidative Stressors to Avoid

Medications

• Antimalarials: Primaquine, chloroquine
• Antibiotics: Sulfonamides, nitrofurantoin, chloramphenicol
• Analgesics: Aspirin (high doses), phenazopyridine
• Others: Methylene blue, naphthalene (mothballs)

Infections

• Bacterial infections
• Viral hepatitis
• Pneumonia
• Typhoid fever

Other Triggers

• Fava beans (favism)
• Diabetic ketoacidosis
• Severe illness/stress

Classification of Cementum According to Schroeder

Cementum is a specialized calcified tissue that covers the roots of teeth and plays a crucial role in periodontal health. According to Schroeder, cementum can be classified into several distinct types based on its cellular composition and structural characteristics. Understanding these classifications is essential for dental professionals in diagnosing and treating periodontal conditions.

Classification of Cementum

1. Acellular Afibrillar Cementum:

   • Characteristics:
     • Contains neither cells nor collagen fibers.
     • Present in the coronal region of the tooth.
     • Thickness ranges from 1 µm to 15 µm.
   • Function:
     • This type of cementum is thought to play a role in the attachment of the gingiva to the tooth surface.

2. Acellular Extrinsic Fiber Cementum:

   • Characteristics:
     • Lacks cells but contains closely packed bundles of Sharpey’s fibers, which are collagen fibers that anchor the cementum to the periodontal ligament.
     • Typically found in the cervical third of the roots.
     • Thickness ranges from 30 µm to 230 µm.
   • Function:
     • Provides strong attachment of the periodontal ligament to the tooth, contributing to the stability of the tooth in its socket.

3. Cellular Mixed Stratified Cementum:

   • Characteristics:
     • Contains both extrinsic and intrinsic fibers and may contain cells.
     • Found in the apical third of the roots, at the apices, and in furcation areas.
     • Thickness ranges from 100 µm to 1000 µm.
   • Function:
     • This type of cementum is involved in the repair and adaptation of the tooth root, especially in response to functional demands and periodontal disease.

4. Cellular Intrinsic Fiber Cementum:

   • Characteristics:
     • Contains cells but no extrinsic collagen fibers.
     • Primarily fills resorption lacunae, which are areas where cementum has been resorbed.
   • Function:
     • Plays a role in the repair of cementum and may be involved in the response to periodontal disease.

5. Intermediate Cementum:

   • Characteristics:
     • A poorly defined zone located near the cementoenamel junction (CEJ) of certain teeth.
     • Appears to contain cellular remnants of the Hertwig's epithelial root sheath (HERS) embedded in a calcified ground substance.
   • Function:
     • Its exact role is not fully understood, but it may be involved in the transition between enamel and cementum.

Clinical Significance

• Importance of Cementum:

  • Understanding the different types of cementum is crucial for diagnosing periodontal diseases and planning treatment strategies.
  • The presence of various types of cementum can influence the response of periodontal tissues to disease and trauma.

• Cementum in Periodontal Disease:

  • Changes in the thickness and composition of cementum can occur in response to periodontal disease, affecting tooth stability and attachment.

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

• Mobility Tests: Perio test, Fremitus test.
• Bone Evaluation: Transgingival probing.
• Halitosis Detection: Gold standard = Organoleptic analysis.
• Indices:
  • PMA Index: Gingival disease.
  • Ramfjord Index Teeth: 16, 21, 24, 36, 41, 44.
  • Merin’s Classification: Patient recall.
  • Surrogate Endpoint: Reduction in probing depth.

• Junctional Epithelium: Attached to enamel via hemidesmosomes; to connective tissue via external basal lamina.
• Corneocyte Formation: Keratinohyalin granules disappear, forming filaggrin.
• Langerhans Cells: Suprabasal level; antigen-presenting with Birbeck granules.
• Keratinization: Oral epithelium is 0.2 – 0.3 mm thick; may be keratinized or parakeratinized.