🗣 Speech & Language

😵‍💫 Headache & Migraine

• Pain-sensitive meningeal layer: Dura
• Ophthalmoplegic migraine: III nerve palsy
• Telcagepant: New anti-migraine drug

🧠 Stroke & Hemorrhage

• Stroke in young women (India): Cortical vein thrombosis
• Commonest CVA cause: Embolism
• ICH most commonly due to: Intracerebral hemorrhage (trauma)
• Infarction site → hemiplegia: MCA territory
• Thrombolytic for stroke: Tissue plasminogen activator (tPA)
• Carotid stenosis management: Aspirin reduces TIA risk

🧠 Cranial Nerves

• Trigeminal nerve disorder: Tic Douloureux
• UMN VII palsy: Contralateral lower face paresis
• Ramsay – Hunt syndrome: Herpes virus
• Griesinger’s sign: Sigmoid sinus thrombosis

🧠 Parkinsonism

• Cause: Wilson disease (Copper accumulation)
• Lazabemide: MAO-B inhibitor

Necrotizing Ulcerative Gingivitis (NUG)

Necrotizing Ulcerative Gingivitis (NUG), also known as Vincent's disease or trench mouth, is a severe form of periodontal disease characterized by the sudden onset of symptoms and specific clinical features.

Etiology and Predisposing Factors

• Sudden Onset: NUG is characterized by a rapid onset of symptoms, often following debilitating diseases or acute respiratory infections.
• Lifestyle Factors: Changes in living habits, such as prolonged work without adequate rest, poor nutrition, tobacco use, and psychological stress, are frequently noted in patient histories .
• Smoking: Smoking has been identified as a significant predisposing factor for NUG/NDP .
• Immune Compromise: Conditions that compromise the immune system, such as poor oral hygiene, smoking, and emotional stress, are major contributors to the development of NUG .

Clinical Presentation

• Symptoms: NUG presents with:
  • Punched-out, crater-like depressions at the crest of interdental papillae.
  • Marginal gingival involvement, with rare extension to attached gingiva and oral mucosa.
  • Grey, pseudomembranous slough covering the lesions.
  • Spontaneous bleeding upon slight stimulation of the gingiva.
  • Fetid odor and increased salivation.

Microbiology

• Mixed Bacterial Infection: NUG is caused by a complex of anaerobic bacteria, often referred to as the fusospirochetal complex, which includes:
  • Treponema vincentii
  • Treponema denticola
  • Treponema macrodentium
  • Fusobacterium nucleatum
  • Prevotella intermedia
  • Porphyromonas gingivalis

Treatment

1. Control of Acute Phase:

   • Clean the wound with an antibacterial agent.
   • Irrigate the lesion with warm water and 5% vol/vol hydrogen peroxide.
   • Prescribe oxygen-releasing mouthwash (e.g., hydrogen peroxide DPF, sodium perborate DPF) to be used thrice daily.
   • Administer oral metronidazole for 3 to 5 days. If sensitive to metronidazole, prescribe penicillin; if sensitive to both, consider erythromycin or clindamycin.
   • Use 2% chlorhexidine in select cases for a short duration.

2. Management of Residual Condition:

   • Remove predisposing local factors (e.g., overhangs).
   • Perform supra- and subgingival scaling.
   • Consider gingivoplasty to correct any residual gingival deformities.

🔬 Key Features & Forms

• Most infective form: Cavitary lesion
• Primary TB Presentation: Unilateral hilar lymphadenopathy
• Rich focus: Meninges (associated with TB meningitis)
• Cavitation: Absent in HIV-associated or primary TB

💡 Special Manifestations

• Hypersensitivity to Mycobacteria: Phlyctenular conjunctivitis
• Poncet’s disease: Joint pains without active arthritis
• Miliary TB: Mantoux test negative
• Recurrent hemoptysis source: Bronchial artery

💊 Drug Details

• Streptomycin: Not used in TB meningitis
• Bedaquiline: New drug for MDR-TB

• Bence Jones Proteins: Mostly gamma chains
• Commonest lytic lesion site: Vertebral column
• Russell bodies: Found in plasma cells
• Bone scan not useful
• No ALP elevation
• High ESR: Often seen
• Prognostic marker: Beta-2 microglobulin

Treatment Phases

1. Phase 1: Non – surgical
2. Phase 2: Surgical
3. Phase 3: Restorative
4. Phase 4: Maintenance Must progress through Phase 1 → 4 before Phase 2 or 3

Merin's Classification

• Class A: 6 months – 1 year recall
• Class B: 3 – 4 months recall
• Class C: 1 – 3 months recall

• Drugs in GCF: Tetracycline, Metronidazole
• Probes:
  • Conventional: Williams, Naber’s, CPITN
  • Pressure-sensitive: Foster Miller
  • Automated: Florida, Toronto
  • CPITN: 0.5 mm tip; markings at 3.5, 5.5, 8.5, 11.5 mm
• Scaling & Curettage:
  • Blade angulation: 45 – 90° (scaling); >90° (curettage)
  • Curette sharpening: 100 – 110°
  • Chisel scaler: Push motion
  • Hoe scaler: Blade bent at 99°, used for ledges/rings