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Periodontology

Important Periodontal Indices

PMA Index

  • Purpose: Assessment of gingival disease status
  • Components: Papillary (P), Marginal (M), and Attached (A) gingiva scoring

Ramfjord Index

  • Selected Teeth: 16, 21, 24, 36, 41, 44
  • Rationale: Representative sampling of entire dentition

Merin's Classification

  • Application: Patient recall scheduling based on periodontal status
  • Categories: Maintenance intervals based on disease severity

Clinical Measurements

Gingival Sulcus Depth

  • Primary Teeth: 1-2mm (shallower than permanent teeth)
  • Permanent Teeth: 2-3mm in health

Level of Attachment

  • Definition: Distance from cementoenamel junction (CEJ) to pocket base
  • Clinical Significance: True measure of periodontal support loss

Fremitus Test

  • Purpose: Diagnosis of tooth mobility
  • Technique: Palpation during functional movements

Virus Key Info
Hepatitis E Feco-oral spread; pregnancy = high mortality
Hepatitis B
  • Perinatal transmission (90%)
  • Window phase: HBsAg ↓, anti-HBs ↑
  • Infectivity: HBsAg + HBeAg
  • First marker post-infection: HBsAg
  • IgM anti-HBc = acute infection
  • Reverse transcriptase → P gene
    | Hepatitis C | Most chronic & linked to liver disease
    | Hepatitis A | Prophylaxis: Human IgG
    | Hepatitis E | Most epidemic-prone in India
    | Councilman bodies | Seen in acute viral hepatitis

🧪 Glomerular Hematuria

Urine Finding Interpretation
>20% Dysmorphic RBCs Suggests glomerular origin
RBC casts Glomerular pathology
Creatinine clearance Measures GFR

💧 Nephrotic Syndrome

  • Edema cause: Hypoalbuminemia
  • Commonest cause (adults): Diabetes mellitus
  • Lipid profile: ↓ HDL cholesterol
  • Minimal change disease: No change on light microscopy
  • Membranoproliferative GN: Tram-track appearance
  • Membranous GN: Common in renal vein thrombosis
  • Best test for renal vein thrombosis: CT angiography

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

Type Key Feature
Beta Thalassemia ↓ Beta chains, ↑ Alpha chains
Common mutation Intron-1
Diagnosis Hb electrophoresis
Screening test NESTROFT
Radiology sign Hair-on-end skull appearance
  • Alpha Thalassemia: Caused by deletion of alpha genes
  • HbH Disease: Deletion of 3 alpha chains

Gingival Crevicular Fluid (GCF)

Gingival crevicular fluid is an inflammatory exudate found in the gingival sulcus. It plays a significant role in periodontal health and disease.

A. Characteristics of GCF

  • Glucose Concentration: The glucose concentration in GCF is 3-4 times greater than that in serum, indicating increased metabolic activity in inflamed tissues.
  • Protein Content: The total protein content of GCF is much less than that of serum, reflecting its role as an inflammatory exudate.
  • Inflammatory Nature: GCF is present in clinically normal sulci due to the constant low-grade inflammation of the gingiva.

B. Drugs Excreted Through GCF

  • Tetracyclines and Metronidazole: These antibiotics are known to be excreted through GCF, making them effective for localized periodontal therapy.

C. Collection Methods for GCF

GCF can be collected using various techniques, including:

  1. Absorbing Paper Strips/Blotter/Periopaper: These strips absorb fluid from the sulcus and are commonly used for GCF collection.
  2. Twisted Threads: Placing twisted threads around and into the sulcus can help collect GCF.
  3. Micropipettes: These can be used for precise collection of GCF in research settings.
  4. Intra-Crevicular Washings: Flushing the sulcus with a saline solution can help collect GCF for analysis.

Type Features
Unconjugated Absent in urine (bound to albumin); hemolysis
Conjugated Seen in Dubin-Johnson
Diagnosis BSP test (Dubin-Johnson)
Genetics Crigler-Najjar Type II – Autosomal recessive
Cholestasis ↑ 5’-nucleotidase
Hypothyroid ↓ Alk Phos

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