NEET MDS Synopsis
Types of Crying
PedodonticsTypes of Crying
Obstinate Cry:
Characteristics: This cry is loud, high-pitched,
and resembles a siren. It often accompanies temper tantrums, which may
include kicking and biting.
Emotional Response: It reflects the child's
external response to anxiety and frustration.
Physical Manifestation: Typically involves a lot of
tears and convulsive sobbing, indicating a high level of distress.
Frightened Cry:
Characteristics: This cry is not about getting what
the child wants; instead, it arises from fear that overwhelms the
child's ability to reason.
Physical Manifestation: Usually involves small
whimpers, indicating a more subdued response compared to the obstinate
cry.
Hurt Cry:
Characteristics: This cry is a reaction to physical
discomfort or pain.
Physical Manifestation: It may start with a single
tear that runs down the child's cheek without any accompanying sound or
resistance, indicating a more internalized response to pain.
Compensatory Cry
Characteristics:
This type of cry is not a traditional cry; rather, it is a sound
that the child makes in response to a specific stimulus, such as the
sound of a dental drill.
It is characterized by a constant whining noise rather than the
typical crying sounds associated with distress.
Physical Manifestation:
There are no tears or sobs associated with this cry. The child
does not exhibit the typical signs of emotional distress that
accompany other types of crying.
The sound is directly linked to the presence of the stimulus
(e.g., the drill). When the stimulus stops, the whining also ceases.
Emotional Response:
The compensatory cry may indicate a child's attempt to cope with
discomfort or fear in a situation where they feel powerless or
anxious. It serves as a way for the child to express their
discomfort without engaging in more overt forms of crying.
Intravenous Anesthetic Agents
AnaesthesiaIntravenous Anesthetic Agents
Intravenous anesthetic agents are crucial in modern anesthesia practice,
providing rapid onset of sedation and analgesia. This lecture will cover the
most commonly used intravenous anesthetic agents, including their indications,
contraindications, and required doses.
1. Benzodiazepines
Overview
Benzodiazepines are primarily used for their anxiolytic (anxiety-reducing)
and amnesic properties. They are frequently used in procedural sedation and as
adjuncts in general anesthesia.
Common Agents
Diazepam
Dose: 5-10 mg IV (may repeat every 5-15 minutes as
needed)
Indications: Anxiety, sedation, muscle relaxation,
seizure control.
Contraindications: Hypersensitivity, severe
respiratory depression, acute narrow-angle glaucoma.
Lorazepam
Dose: 1-4 mg IV (may repeat every 6-8 hours as
needed)
Indications: Anxiety, sedation, preoperative
medication.
Contraindications: Hypersensitivity, severe
respiratory depression, acute narrow-angle glaucoma.
Midazolam
Dose: 1-5 mg IV (may repeat every 2-5 minutes as
needed)
Indications: Procedural sedation, induction of
anesthesia, anxiety reduction.
Contraindications: Hypersensitivity, severe
respiratory depression, acute narrow-angle glaucoma.
2. Etomidate
Overview
Etomidate is an imidazole derivative used for rapid intravenous induction of
anesthesia. It is known for its minimal cardiovascular effects.
Dose
Dose: 0.2-0.3 mg/kg IV (administered over 30-60
seconds)
Indications
Induction of anesthesia, particularly in patients with cardiovascular
instability.
Contraindications
Hypersensitivity to etomidate, adrenal insufficiency (due to suppression
of adrenal function).
3. Ketamine
Overview
Ketamine is a unique intravenous anesthetic that provides dissociative
anesthesia and analgesia. It is known for its ability to increase cerebral blood
flow.
Dose
Dose: 1-2 mg/kg IV (for induction)
Indications
Induction of anesthesia, analgesia for painful procedures, and in
patients with asthma or reactive airway disease.
Contraindications
Hypersensitivity, severe hypertension, or increased intracranial
pressure.
Additional Notes
Ketamine may offer neuroprotective effects and is often used in
pediatric patients due to its safety profile.
4. Barbiturates
Overview
Barbiturates are central nervous system depressants that have been used for
induction of anesthesia. They act primarily at the GABA receptor.
Common Agents
Thiopental
Dose: 3-5 mg/kg IV (for induction)
Methohexital
Dose: 1-2 mg/kg IV (for induction)
Thiamylal
Dose: 3-5 mg/kg IV (for induction)
Indications
Induction of anesthesia, sedation, and as anticonvulsants.
Contraindications
Hypersensitivity, porphyria, severe respiratory depression.
5. Propofol
Overview
Propofol is an alkylated phenol that provides rapid sedation and is widely
used for induction and maintenance of anesthesia.
Dose
Dose: 1-2.5 mg/kg IV (for induction)
Indications
Induction and maintenance of anesthesia, sedation for procedures.
Contraindications
Hypersensitivity to propofol or its components, egg or soy allergy.
Additional Notes
Propofol is favored for outpatient procedures due to its rapid recovery
profile and low incidence of nausea and vomiting.
6. Opioid Analgesics
Overview
Opioids are potent analgesics that act centrally on μ-receptors in the brain
and spinal cord. They are often used in conjunction with other anesthetic
agents.
Common Agents
Meperidine
Dose: 25-100 mg IV (for analgesia)
Fentanyl-based compounds
Dose: 25-100 mcg IV (for analgesia)
Morphine
Dose: 2-10 mg IV (for analgesia)
Codeine
Dose: 15-60 mg IV (for analgesia)
Oxymorphone
Dose: 1-5 mg IV (for analgesia)
Indications
Pain management, adjunct to anesthesia.
Contraindications
Hypersensitivity, respiratory depression, severe asthma, or head injury.
Additional Notes
Opioids have differing potencies, and equianalgesic doses can result in
similar degrees of respiratory depression. Therefore, there is no completely
safe opioid analgesic.
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.
Histology of the Periodontal Ligament (PDL)
Dental Anatomy
Histology of the Periodontal Ligament (PDL)
Embryogenesis of the periodontal ligament
The PDL forms from the dental follicle shortly after root development begins
The periodontal ligament is characterized by connective tissue. The thinnest portion is at the middle third of the root. Its width decreases with age. It is a tissue with a high turnover rate.
FUNCTIONS OF PERIODONTIUM
Tooth support
Shock absorber
Sensory (vibrations appreciated in the middle ear/reflex jaw opening)
The following cells can be identified in the periodontal ligament:
a) Osteoblasts and osteoclasts b) Fibroblasts, c) Epithelial cells
Rests of Malassez
d) Macrophages
e) Undifferentiated cells
f) Cementoblasts and cementoclasts (only in pathologic conditions)
The following types of fibers are found in the PDL
-Collagen fibers: groups of fibers
-Oxytalan fibers: variant of elastic fibers, perpendicular to teeth, adjacent to capillaries
-Eluanin: variant of elastic fibers
Ground substance
PERIODONTAL LIGAMENT FIBERS
Principal fibers
These fibers connect the cementum to the alveolar crest. These are:
a. Alveolar crest group: below CE junction, downward, outward
b. Horizontal group: apical to ACG, right angle
c. Oblique group: numerous, coronally to bone, oblique direction
d. Apical group: around the apex, base of socket
e. Interradicular group: multirooted teeth
Gingival ligament fibers
This group is not strictly related to periodontium. These fibers are:
a. Dentogingival: numerous, cervical cementum to f/a gingiva
b. Alveologingival: bone to f/a gingiva
c. Circular: around neck of teeth, free gingiva
d. Dentoperiosteal: cementum to alv. process or vestibule (muscle)
e. Transseptal: cementum between adjacent teeth, over the alveolar crest
Blood supply of the PDL
The PDL gets its blood supply from perforating arteries (from the cribriform plate of the bundle bone). The small capillaries derive from the superior & inferior alveolar arteries. The blood supply is rich because the PDL has a very high turnover as a tissue. The posterior supply is more prominent than the anterior. The mandibular is more prominent than the maxillary.
Nerve supply
The nerve supply originates from the inferior or the superior alveolar nerves. The fibers enter from the apical region and lateral socket walls. The apical region contains more nerve endings (except Upper Incisors)
Dentogingival junction
This area contains the gingival sulcus. The normal depth of the sulcus is 0.5 to 3.0 mm (mean: 1.8 mm). Depth > 3.0 mm is considered pathologic. The sulcus contains the crevicular fluid
The dentogingival junction is surfaced by:
1) Gingival epithelium: stratified squamous keratinized epithelium 2) Sulcular epithelium: stratified squamous non-keratinized epithelium The lack of keratinization is probably due to inflammation and due to high turnover of this epithelium.
3) Junctional epithelium: flattened epithelial cells with widened intercellular spaces. In the epithelium one identifies neutrophils and monocytes.
Connective tissue
The connective tissue of the dentogingival junction contains inflammatory cells, especially polymorphonuclear neutrophils. These cells migrate to the sulcular and junctional epithelium.
The connective tissue that supports the sulcular epithelium is also structurally and functionally different than the connective tissue that supports the junctional epithelium.
Histology of the Col (=depression)
The col is found in the interdental gingiva. It is surfaced by epithelium that is identical to junctional epithelium. It is an important area because of the accumulation of bacteria, food debris and plaque that can cause periodontal disease.
Blood supply: periosteal vessels
Nerve supply: periodontal nerve fibers, infraorbital, palatine, lingual, mental, buccal
Immunofluorescence
General MicrobiologyImmunofluorescence
This is precipitation or complement fixation tests. The technique can detect proteins at concentrations of around 1 µg protein per ml body fluid. Major disadvantage with this technique is frequent occurrence of nonspecific fluorescence in the tissues and other material.
The fluorescent dyes commonly used are fluorescein isothocyanate (FITC). These dyes exhibit fluorescence by absorbing UV light between 290 and 495 nm and emitting longer wavelength coloured light of 525 nm which gives shining appearance (fluorescence) to protein labelled with dye. Blue green (apple green) fluorescence is seen with FITC and orange red with rhodamine.
Enzyme Immunoassays
These are commonly called as enzyme linked immunosorbent assays or EL1SA. It is a simple and versatile technique which is as sensitive as radioimmunoassays. It is now the
technique for the detection of antigens, antibodies, hormones, toxins and viruses.
Identification of organisms by immunofluorescence
Type of agent Examples
Bacterial Neisseria gonorrhoeae, H. influenzae ,Strept pyogenes, Treponema pallidum
Viral Herpesvirus, Rabiesvirus, Epstein-Barr virus
Mycotic Candida albicans
Enzymatic activity results in a colour change which can be assessed visibly or quantified in a simple spectrophotometer.
BIOLOGICAL ROLES OF LIPID
Biochemistry
BIOLOGICAL ROLES OF LIPID
Lipids have the common property of being relatively insoluble in water and soluble in nonpolar solvents such as ether and chloroform. They are important dietary constituents not only because of their high energy value but also because of the fat-soluble vitamins and the essential fatty acids contained in the fat of natural foods
Nonpolar lipids act as electrical insulators, allowing rapid propagation of depolarization waves along myelinated nerves
Combinations of lipid and protein (lipoproteins) are important cellular constituents, occurring both in the cell membrane and in the mitochondria, and serving also as the means of transporting lipids in the blood.
Hypnosis
PedodonticsHypnosis in Pediatric Dentistry
Hypnosis: An altered state of consciousness
characterized by heightened suggestibility, focused attention, and increased
responsiveness to suggestions. It is often used to facilitate behavioral and
physiological changes that are beneficial for therapeutic purposes.
Use in Pediatrics: According to Romanson (1981),
hypnosis is recognized as one of the most effective nonpharmacologic
therapies for children, particularly in managing anxiety and enhancing
cooperation during medical and dental procedures.
Dental Application: In the field of dentistry, hypnosis
is referred to as "hypnodontics" (Richardson, 1980) and is also known as
psychosomatic therapy or suggestion therapy.
Benefits of Hypnosis in Dentistry
Anxiety Reduction:
Hypnosis can significantly alleviate anxiety in children, making
dental visits less stressful. This is particularly important for
children who may have dental phobias or anxiety about procedures.
Pain Management:
One of the primary advantages of hypnosis is its ability to reduce
the perception of pain. By using focused attention and positive
suggestions, dental professionals can help minimize discomfort during
procedures.
Behavioral Modification:
Hypnosis can encourage positive behaviors in children, such as
cooperation during treatment, which can reduce the need for sedation or
physical restraint.
Enhanced Relaxation:
The hypnotic state promotes deep relaxation, helping children feel
more at ease in the dental environment.
Mechanism of Action
Suggestibility: During hypnosis, children become more
open to suggestions, allowing the dentist to guide their thoughts and
feelings about the dental procedure.
Focused Attention: The child’s attention is directed
away from the dental procedure and towards calming imagery or positive
thoughts, which helps reduce anxiety and discomfort.
Implementation in Pediatric Dentistry
Preparation:
Prior to the procedure, the dentist should explain the process of
hypnosis to both the child and their parents, addressing any concerns
and ensuring understanding.
Induction:
The dentist may use various techniques to induce a hypnotic state,
such as guided imagery, progressive relaxation, or verbal suggestions.
Suggestion Phase:
Once the child is in a relaxed state, the dentist can provide
positive suggestions related to the procedure, such as feeling calm,
relaxed, and pain-free.
Post-Hypnosis:
After the procedure, the dentist should gradually bring the child
out of the hypnotic state, reinforcing positive feelings and
experiences.
Impression Materials - Reaction
Dental Materials
Physical reaction-cooling causes reversible hardening
Chemical reaction-irreversible reaction during setting