NEET MDS Synopsis
Bruxism
OrthodonticsBruxism
Bruxism is the involuntary grinding or clenching of teeth,
often occurring during sleep (nocturnal bruxism) or while awake (awake bruxism).
It can lead to various dental and health issues, including tooth wear, jaw pain,
and temporomandibular joint (TMJ) disorders.
Etiology
Central Nervous System (CNS):
Bruxism has been observed in individuals with neurological
conditions such as cerebral palsy and mental retardation, suggesting a
CNS component to the phenomenon.
Psychological Factors:
Emotional disturbances such as anxiety, stress, aggression, and
feelings of hunger can contribute to the tendency to grind teeth.
Psychological stressors are often linked to increased muscle tension and
bruxism.
Occlusal Discrepancy:
Improper interdigitation of teeth, such as malocclusion or
misalignment, can lead to bruxism as the body attempts to find a
comfortable bite.
Systemic Factors:
Nutritional deficiencies, particularly magnesium (Mg²⁺) deficiency,
have been associated with bruxism. Magnesium plays a role in muscle
function and relaxation.
Genetic Factors:
There may be a hereditary component to bruxism, with a family
history of the condition increasing the likelihood of its occurrence.
Occupational Factors:
High-stress occupations or activities, such as being an
overenthusiastic student or participating in competitive sports, can
lead to increased clenching and grinding of teeth.
Clinical Features
Tooth Wear: Increased wear on the occlusal surfaces of
teeth, leading to flattened or worn-down teeth.
Jaw Pain: Discomfort or pain in the jaw muscles,
particularly in the masseter and temporalis muscles.
TMJ Disorders: Symptoms such as clicking, popping, or
locking of the jaw, as well as pain in the TMJ area.
Headaches: Tension-type headaches or migraines may
occur due to muscle tension associated with bruxism.
Facial Pain: Generalized facial pain or discomfort,
particularly around the jaw and temples.
Gum Recession: Increased risk of gum recession and
periodontal issues due to excessive force on the teeth.
Management
Adjunctive Therapy:
Psychotherapy: Aimed at reducing emotional
disturbances and stress that may contribute to bruxism. Techniques may
include cognitive-behavioral therapy (CBT) or relaxation techniques.
Pain Management:
Ethyl Chloride: A topical anesthetic that can
be injected into the TMJ area to alleviate pain and discomfort.
Occlusal Therapy:
Occlusal Adjustment: Adjusting the occlusion to
improve the bite and reduce bruxism.
Splints:
Volcanite Splints: These are custom-made
occlusal splints that cover the occlusal surfaces of all teeth. They
help reduce muscle tone and protect the teeth from wear.
Night Guards: Similar to splints, night guards
are worn during sleep to prevent grinding and clenching.
Restorative Treatment: Addressing any existing
dental issues, such as cavities or misaligned teeth, to improve overall
dental health.
Pharmacological Management:
Vapo Coolant: Ethyl chloride can be used for pain
relief in the TMJ area.
Local Anesthesia: Direct injection of local
anesthetics into the TMJ can provide temporary relief from pain.
Muscle Relaxants: Medications such as muscle
tranquilizers or sedatives may be prescribed to help reduce muscle
tension and promote relaxation.
Neurotransmitters
Pharmacology
Neurotransmitters can be classified into:
1. Biogenic amines:
ACh, NA, DA, 5-HT, Histamine
2. Amino acids:
Excitatory (glutamate & asparate)
Inhibitory (GABA& glycine)
3. Others:
Adenosine, melatonin
Anti Anginal Drugs
Pharmacology
Anti-Anginal Drugs
Nitrates
- It include nitroglycerin (glyceryl trinitrate) or pentaerythritol tetranitrate, isosorbide dinitrate and isosorbide mononitrate.
- Liberation of NO
- Cause venodilation, decrease VR and ventricular filling pressure and wall tension; therefore decrease O2 consumption
- Problem with Tolerance – fix with intermittent administration (patch 12hrs on 12hrs off)
- Often offered sublingually or transdermally
Beta-Blockers
- It include either cardioselectives such as acebutolol or metoprolol, or non-cardioselectives such as oxprenolol or sotalol.
- Reduce myocardial O2 demand by decreasing HR and contractility; blocking B1
- Contraindicated in variant angina, good for chronic prophylaxis of stable angina
Calcium Channel Blockers
-It include Class I agents (e.g., verapamil), Class II agents (e.g., amlodipine, nifedipine), or the Class III agent diltiazem.
- All existing CCBs block L-Type channels
- 1st Generation; 3 Classes: - Phenylalkalamines (ex: Verapamil) , - Benzothiazepinones (ex: Diltiazem) , - Dihydropyridines (ex: nifedipime)
- Less depressant activity on heart than the other
- Associated with reflex-tachycardia from baroreceptors
- Problem in pts with angina
Nifedipine is more a potent vasodilator and more effective in angina. It is in the class of dihydropyridines and does not affect refrectory period on SA node conduction.
Neutropenia
General Pathology
Neutropenia: Neutropenia is an abnormally low number of neutrophils
Causes
-Typhoid, paratyphoid. .
-Viral and ricketseal infections.
-Malaria, Kala azar.
-Hypersplenism.
-Aplastic and megaloblastic anaemia.
-Marrow infiltration by malignancies, lymphomas etc.
-SLE.
DIURETICS
Pharmacology
DIURETICS
Specific Therapeutic Objective
Clinical State(s)
Drug(s) (Class)
Draw fluid from tissue to vascular space reduce tissue edema
Cerebral edema
glaucoma
Mannitol (Osmotic)
Glucose (Osmotic)
Glycerin (Osmotic)
Decrease renal swelling
expand tubular volume
Renal shutdown
Glucose (Osmotic)
Mannitol (Osmotic)
Modest and/or sustained decrease in venous hydrostatic pressure
Congestive heart failure
Hepatic cirrhosis
Udder edema
Hydrochlorothiazide (thiazide)
Chlorothiazide (thiazide)
Aggressive and/or short-term decrease in venous hydrostatic pressure
Congestive heart failure
Hepatic cirrhosis
Udder edema
Furosemide (loop)
Inhibit aldosterone action
Hepatic cirrhosis
Congestive heart failure
triamterene (K+ sparing)
spironolactone (K+ sparing - competitive)
Reduce potassium wasting 2o to other diuretic
Hepatic cirrhosis
Congestive heart failure
triamterene (K+ sparing)
spironolactone (K+ sparing - competitive)
Inhibit ADH action
Inappropriate ADH secretion
lithium (aquaretic)
demeclocycline (aquaretic
Increase calcium secretion
Malignant hypercalcemia
Paraneoplastic
Hypervitaminosis D
Furosemide (loop)
Reduce urine output
Diabetes insidpidus
Hydrochlorothiazide (thiazide)
Chlorothiazide (thiazide)
Urine alkalinization
Various
Carbonic anhydrase inhibitors
CLASSIFICATION OF LIPIDS
Biochemistry
CLASSIFICATION OF LIPIDS
Lipids are classified as follows:
1. Simple lipids: Esters of fatty acids with various alcohols.
(a) Fats: Esters of fatty acids with glycerol. Oils are fats in the liquid state. A long-chain carboxylic acid; those in animal fats and vegetable oils often have 12–22 carbon atoms.
(b) Waxes: Esters of fatty acids with higher molecular weight monohydric alcohols. Waxes are carboxylic acid esters, RCOOR’ ,with long, straight hydrocarbon chains in both R groups
2. Complex lipids: Esters of fatty acids containing groups in addition to an alcohol and a fatty acid.
(a) Phospholipids: Lipids containing, in addition to fatty acids and an alcohol, a phosphoric acid residue. They frequently have nitrogen containing bases and other substituents,
Eg glycerophospholipids the alcohol is glycerol
sphingophospholipids the alcohol is sphingosine.
(b) Glycolipids (glycosphingolipids): Lipids containing a fatty acid, sphingosine, and carbohydrate. These lipids contain a fatty acid, carbohydrate and nitrogenous base. The alcohol is sphingosine, hence they are also called as glycosphingolipids. Clycerol and phosphate are absent
e.g., cerebrosides, gangliosides.
(c) Other complex lipids: Lipids such as sulfolipids and aminolipids. Lipoproteins may also be placed in this category.
3. Precursor and derived lipids: These include fatty acids, glycerol, steroids, other alcohols, fatty aldehydes, and ketone bodies, hydrocarbons, lipid soluble vitamins, and hormones. Because they are uncharged, acylglycerols (glycerides), cholesterol, and cholesteryl esters are termed neutral lipids
4. Miscellaneous lipids: These include a large number of compounds possessing the characteristics of lipids e.g., carotenoids, squalene, hydrocarbons such as pentacosane (in bees wax), terpenes etc.
NEUTRAL LIPIDS: The lipids which are uncharged are referred to as neutral lipids. These are mono-, di-, and triacylglycerols, cholesterol and cholesteryl esters.
Antimicrobial Proteins
PedodonticsMajor Antimicrobial Proteins of Human Whole Saliva
Human saliva contains a variety of antimicrobial proteins that play crucial
roles in oral health by protecting against pathogens, aiding in digestion, and
maintaining the balance of the oral microbiome. Below is a summary of the major
antimicrobial proteins found in human whole saliva, their functions, and their
targets.
1. Non-Immunoglobulin (Innate) Proteins
These proteins are part of the innate immune system and provide immediate
defense against pathogens.
Lysozyme
Major Target/Function:
Targets gram-positive bacteria and Candida.
Functions by hydrolyzing the peptidoglycan layer of bacterial
cell walls, leading to cell lysis.
Lactoferrin
Major Target/Function:
Targets bacteria, yeasts, and viruses.
Functions by binding iron, which inhibits bacterial growth (iron
sequestration) and has direct antimicrobial activity.
Salivary Peroxidase and Myeloperoxidase
Major Target/Function:
Targets bacteria.
Functions in the decomposition of hydrogen peroxide (H2O2) to
produce antimicrobial compounds.
Histatin
Major Target/Function:
Targets fungi (especially Candida) and bacteria.
Functions as an antifungal and antibacterial agent, promoting
wound healing and inhibiting microbial growth.
Cystatins
Major Target/Function:
Targets various proteases.
Functions as protease inhibitors, helping to protect tissues
from proteolytic damage and modulating inflammation.
2. Agglutinins
Agglutinins are glycoproteins that promote the aggregation of microorganisms,
enhancing their clearance from the oral cavity.
Parotid Saliva
Major Target/Function:
Functions in the agglutination/aggregation of a number of
microorganisms, facilitating their removal from the oral cavity.
Glycoproteins
Major Target/Function:
Functions similarly to agglutinins, promoting the aggregation of
bacteria and other microorganisms.
Mucins
Major Target/Function:
Functions in the inhibition of adhesion of pathogens to oral
surfaces, enhancing clearance and protecting epithelial cells.
β2-Microglobulin
Major Target/Function:
Functions in the enhancement of phagocytosis, aiding immune
cells in recognizing and eliminating pathogens.
3. Immunoglobulins
Immunoglobulins are part of the adaptive immune system and provide specific
immune responses.
Secretory IgA
Major Target/Function:
Targets bacteria, viruses, and fungi.
Functions in the inhibition of adhesion of pathogens to mucosal
surfaces, preventing infection.
IgG
Major Target/Function:
Functions similarly to IgA, providing additional protection
against a wide range of pathogens.
IgM
Major Target/Function:
Functions in the agglutination of pathogens and enhancement of
phagocytosis.
Pulpotomy
PedodonticsPulpotomy Techniques
Pulpotomy is a dental procedure performed to treat a tooth with a compromised
pulp, typically in primary teeth. The goal is to remove the diseased pulp tissue
while preserving the vitality of the remaining pulp. This procedure is commonly
indicated in cases of carious exposure or trauma.
Vital Pulpotomy Technique
The vital pulpotomy technique involves the removal of the coronal portion of
the pulp while maintaining the vitality of the radicular pulp. This technique
can be performed in a single sitting or in two stages.
1. Single Sitting Pulpotomy
Procedure: The entire pulpotomy procedure is completed
in one appointment.
Indications: This approach is often used when the pulp
is still vital and there is no significant infection or inflammation.
2. Two-Stage Pulpotomy
Procedure: The pulpotomy is performed in two
appointments. The first appointment involves the removal of the coronal
pulp, and the second appointment focuses on the placement of a medicament
and final restoration.
Indications: This method is typically used when there
is a need for further evaluation of the pulp condition or when there is a
risk of infection.
Medicaments Used in Pulpotomy
Several materials can be used during the pulpotomy procedure, particularly in
the two-stage approach. These include:
Formocresol:
A commonly used medicament for pulpotomy, formocresol has both
antiseptic and devitalizing properties.
It is applied to the remaining pulp tissue after the coronal pulp is
removed.
Electrosurgery:
This technique uses electrical current to remove the pulp tissue and
can help achieve hemostasis.
It is often used in conjunction with other materials for effective
pulp management.
Laser:
Laser technology can be employed for pulpotomy, providing precise
removal of pulp tissue with minimal trauma to surrounding structures.
Lasers can also promote hemostasis and reduce postoperative
discomfort.
Devitalizing Pastes
In addition to the above techniques, various devitalizing pastes can be used
during the pulpotomy procedure:
Gysi Triopaste:
A devitalizing paste that can be used to manage pulp tissue during
the pulpotomy procedure.
Easlick’s Formaldehyde:
A formaldehyde-based paste that serves as a devitalizing agent,
often used in pulpotomy procedures.
Paraform Devitalizing Paste:
Another devitalizing agent that can be applied to the pulp tissue to
facilitate the pulpotomy process.