🧂 Sodium Imbalance

• SIADH: Hyponatremia, convulsions
• Osmotic demyelination syndrome → too rapid correction
• Pseudohyponatremia: Seen in hyperlipidemia

⚖️ Acid-Base Disorders

• Normal pH: 7.36 – 7.44
• Metabolic alkalosis seen in mineralocorticoid excess

Alveolar Process

The alveolar process is a critical component of the dental anatomy, providing support for the teeth and playing a vital role in periodontal health. Understanding its structure and composition is essential for dental professionals in diagnosing and treating various dental conditions.

Components of the Alveolar Process

1. External Plate of Cortical Bone:

   • Description: The outer layer of the alveolar process is composed of cortical bone, which is dense and forms a protective outer shell.
   • Composition:
     • Formed by Haversian bone, which consists of organized structures called osteons.
     • Compacted bone lamellae contribute to the strength and stability of the alveolar process.

2. Alveolar Bone Proper:

   • Description: The inner socket wall of the alveolar process is known as the alveolar bone proper.
   • Radiographic Appearance:
     • It is seen as the lamina dura on radiographs, appearing as a radiopaque line surrounding the tooth roots.
   • Histological Features:
     • Contains a series of openings known as the cribriform plate.
     • These openings allow neurovascular bundles to connect the periodontal ligament with the central component of the alveolar bone, which is the cancellous bone.

3. Cancellous Bone:

   • Description: Located between the external cortical bone and the alveolar bone proper, cancellous bone consists of trabecular structures.
   • Function:
     • Acts as supporting alveolar bone, providing strength and flexibility to the alveolar process.
   • Interdental Septum:
     • The interdental septum consists of cancellous supporting bone enclosed within a compact border, providing stability between adjacent teeth.

Structural Characteristics

• Facial and Lingual Portions:
  • Most of the facial and lingual portions of the tooth socket are formed by compact bone alone, providing robust support for the teeth.
• Cancellous Bone Distribution:
  • Cancellous bone surrounds the lamina dura in specific areas:
    • Apical Areas: The region at the tip of the tooth root.
    • Apicolingual Areas: The area where the root meets the lingual surface.
    • Interradicular Areas: The space between the roots of multi-rooted teeth.

🫁 Respiratory Physiology & Pathology

Diagnosis Criteria

• FBS ≥ 126 mg/dL
• HbA1C > 6.5%
• eAG based on HbA1C
• Oral GTT 2-hr post-load: 140–199 mg/dL → Impaired Glucose Tolerance
• HbA1C 5.7–6.4% → Pre-diabetic range

• Attached Gingiva Width:
  • Maxillary incisors: 3.5 – 4.5 mm
  • Mandibular incisors: 3.3 – 3.9 mm
  • Least in premolars (~1.8 – 1.9 mm)
• Cementum:
  • Thickest in apical third and furcation (150 – 200 µm)
  • Acellular cementum: cervical third
  • Cellular cementum: forms after occlusal contact
• PDL Fibres:
  • Principal: Type I collagen
  • Reticular: Type III collagen
  • Oblique fibres: Largest group, resist vertical forces
  • Transseptal fibres: Reconstructed post bone loss
  • Alveolar crest fibres: Prevent extrusion

Classification and Function

Collagenases

• MMP-8 (Neutrophil Collagenase): Most abundant in GCF
• MMP-1 (Interstitial Collagenase): Targets type I collagen

Gelatinases

• MMP-2 (Gelatinase A): 72 kDa enzyme
• MMP-9 (Gelatinase B): 92 kDa enzyme, neutrophil-derived

Bone Destruction

• Most Potent Destroyer: Interleukin-1β (IL-1β)
• Mechanism: Stimulates osteoclast activity and inhibits osteoblast function
• Clinical Relevance: Target for anti-inflammatory therapy