NEET MDS Synopsis
DIAGNOSIS
Pharmacology
DIAGNOSIS
Affective disorders:
I. unipolar depression – depression alone
bipolar affective disorder – alternating II. bipolar affective disorder – alternating depression and mania
Diagnosis is based on
At least five of the following for 2 weeks
I. Depressed mood most of the day
II. Markedly diminished interest or pleasureII. Markedly diminished interest or pleasure
III. Significant weight loss or weight
IV. Insomnia or hypersomnia
V. Psychomotor agitation or retardation
VI. Fatigue or loss of energy
VII. Feelings of worthlessness or excessive guilt
VIII. Diminished ability to think or concentrate,
IX. Recurrent thoughts of death
Underlying biological basis for depression is a deficiency of the monoamine neurotransmitters norepinephrine and/or serotonin in the brain.
COMPOSITE RESINS -Pit-and-Fissure Dental Sealants
Dental Materials
Pit-and-Fissure Dental Sealants
Applications/Use
Occlusal surfaces of newly erupted posterior teeth
Labial surfaces of anterior teeth with fissures
Occlusal surfaces of teeth in older patients with reduced saliva flow (because low saliva increases the susceptibility to caries)
Types
Polymerization method
Self-curing (amine accelerated)
Light curing (light accelerated)
Filler content
Unfilled-most systems are unfilled because filler tends to interfere with wear away from self-cleaning occlusal areas(sealants are designed to wear away, except where there is no self-cleaning action a common misconception is that sealants should be wear resistant)
Components
Monomer-BIS-GMA with TEGDM diluent to facilitate flow into pits and fissures prior to cure
Initiator-benzoyl peroxide (in self-cured) and diketone (in light cured)
Accelerator-amine (In light cured)
Opaque filler-I % titanium dioxide. or other colorant to make the material detectable on tooth surfaces
Reinforcing filler-generally not added because wear resistance is not required within pits and fissures
Reaction-free radical reaction
Manipulation
Preparation
Clean pits and fissures of organic debris. Do not apply fluoride before etching because it will tend to make enamel more acid resistant. Etch occlusal surfaces, pits, and fissures for 30 seconds (gel) or 60 seconds (liquid) with 37% phosphoric acid . Wash occlusal surfaces for 20 seconds. Dry etched area for 20 seconds with clean air spray. Apply sealant and polymerize
Mixing or dispensing
Self-cured-mix equal amounts of liquids in Dappen dish for 5 seconds with brush applicator. Light cured-dispense from syringe tips
Placement
-pits, fissures, and occlusal surfaces --> Allow 60 seconds for self-cured materials to set.
Finishing
Remove unpolymerized and excess material .Examine hardness of sealant. Make occlusal adjustments where necessary in sealant; some sealant materials are self-adjusting
Properties
Physical
Wetting-low-viscosity sealants wet acid etched tooth structure the best
Mechanical
Wear resistance should not be too great because sealant should be able to wear off of self-cleaning areas of tooth
Be careful to protect sealants during polishing procedures with air abrading units to prevent sealant loss
Clinical efficacy
Effectiveness is 100% if retained in pits and fissures .Requires routine clinical evaluation for resealing of areas of sealant loss attributable to poor retention .
Sealants resist effects of topical fluorides
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.
Enzymes
General Microbiology
Enzymes:
Serum lysozyme:
Provides innate & nonspecific immunity
Lysozyme is a hydrolytic enzyme capable of digesting bacterial cell walls containing peptidoglycan
• In the process of cell death, lysosomal NZs fxn mainly to aulolyse necrotic cells (NOT “mediate cell degradation”)
• Attacks bacterial cells by breaking the bond between NAG and NAM.
• Peptidoglycan – the rigid component of cell walls in most bacteria – not found in archaebacteria or eukaryotic cells
• Lysozyme is found in serum, tears, saliva, egg whites & phagocytic cells protecting the host nonspecifically from microorganisms
Superoxide dismutase: catalyzes the destruction of O2 free radicals protecting O2-metabolizing cells against harmful effects
Catalase:
- catalyzes the decomposition of H2O2 into H2O & O2
- Aerobic bacteria and facultative anaerobic w/ catalase are able to resist the effects of H2O2
- Anaerobic bacteria w/o catalase are sensitive to H2O2 (Peroxide), like Strep
- Anaerobic bacteria (obligate anaerobes) lack superoxide dismutase or catalase
- Staph makes catalase, where Strep does not have enough staff to make it
Coagulase
- Converts Fibronogen to fibrin
• Coagulase test is the prime criterion for classifying a bug as Staph aureus – from other Staph species
• Coagulase is important to the pathogenicity of S. aureus because it helps to establish the typical abscess lesion
• Coagulase also coats the surface w/ fibrin upon contact w/ blood, making it harder to phagocytize
Intraligamentary Injection
Oral and Maxillofacial SurgeryIntraligamentary Injection and Supraperiosteal Technique
Intraligamentary Injection
The intraligamentary injection technique is a simple and effective
method for achieving localized anesthesia in dental procedures. It
requires only a small volume of anesthetic solution and produces rapid
onset of anesthesia.
Technique:
Needle Placement:
The needle is inserted into the gingival sulcus, typically on
the mesial surface of the tooth.
The needle is then advanced along the root surface until
resistance is encountered, indicating that the needle is positioned
within the periodontal ligament.
Anesthetic Delivery:
Approximately 0.2 ml of anesthetic solution is deposited into
the periodontal ligament space.
For multirooted teeth, injections should be made both mesially
and distally to ensure adequate anesthesia of all roots.
Considerations:
Significant pressure is required to express the anesthetic solution
into the periodontal ligament, which can be a factor to consider during
administration.
This technique is particularly useful for localized procedures where
rapid anesthesia is desired.
Supraperiosteal Technique (Local Infiltration)
The supraperiosteal injection technique is commonly used for
achieving anesthesia in the maxillary arch, particularly for
single-rooted teeth.
Technique:
Anesthetic Injection:
For the first primary molar, the bone overlying the tooth is
thin, allowing for effective anesthesia by injecting the anesthetic
solution opposite the apices of the roots.
Challenges with Multirooted Teeth:
The thick zygomatic process can complicate the anesthetic
delivery for the buccal roots of the second primary molar and first
permanent molars.
Due to the increased thickness of bone in this area, the
supraperiosteal injection at the apices of the roots of the second
primary molar may be less effective.
Supplemental Injection:
To enhance anesthesia, a supplemental injection should be
administered superior to the maxillary tuberosity area to block the
posterior superior alveolar nerve.
This additional injection compensates for the bone thickness and
the presence of the posterior middle superior alveolar nerve plexus,
which can affect the efficacy of the initial injection.
Speech
Anatomyo English: all speech sounds produced by making exhaled air audible
o Two ways of producing sound
at larynx
further up in vocal tract (tongue, lips)
o How to produce sound at larynx
changes in breathing: regulate airstream from lungs to atmosphere by changing movements of vocal folds, pharynx, soft-palate, tongue, lips and jaws
• inhalation: take in greater volume more quickly, abduct folds
• expiration: variable force; use muscles of inhalation to control rate of expiration, adduct
How to vibrate vocal cords
• NOT rhythmic contraction of laryngeal muscles: would be impossible b/c frequenceies of virbration
• Changes in air pressure cause vibrations
o Adduct folds increase in subglottal pressure force folds apart folds sucked back together (Bernouilli effect)
• The vibration of vocal cords disturbs airareas of low pressure (rarefaction) alternating with areas of high pressure (compression)
• Changes in pressure sound at ears
• Sine waves
o Changes in amplitudes: loudness
o Changes in frequency: pitch
o Normal sounds have fundamental frequency, overtones or harmonics
o Mass of folds: critical in voice
Low pitch of lion’s roar: due to massive fibrous pad that forms part of vocal cords
Men: more massive vocal cords
Larger foldsslow vibrationdeeper voice
o Producing vowels and constants
Most vowels are “voiced”: vocal folds produce sounds
Consonants: can be “voiced” (Z) or “non-voiced” (S)
• Use higher regions of vocal tract to control by stopping, restricting airflow from vocal folds; use lips, teethaperiodic sound
o Vocal folds and resonators emphasize and deemphasize certain frequencies
Never hear sounds produced at vocal foldsevery sound changed by passage thru vocal tract: sinuses/resonating chambers
Howling monkeys: large hyoid bonepowerful resonator
o Age-related changes in voice
Infant larynx is smaller, different proportions
• Arytenoids are proportionately larger
• Smaller vocal apparatushigher pitch
• Larynx sits higher easier to breathe thru nose
Abrupt change in larynx at pubertycan’t control voice
Older adult: normal degenerative changes in lamina propria, ossification of thyroid cartilagechanges in fundamental frequency
Lose your voice vocal fold are irritated
• Can’t adduct foldsair escapes
o Singing v. speaking
Singing: greater thoracic pressure and uneven breathing with changes in resonators
o Whispering
Intercartilaginous portions of vocal folds: open to allow air to escapelesser subglottal pressureslittle vibration of foldslittle tonal quality, low volume
o Falsetto
Allowing only part of vocal folds to vibrate
Increase range by training which part of vocal folds to vibrate
o Colds
Mucus secretions add mass to folds—decrease in pitch, can’t adduct folds as well
o Surgeryscars, fibrotic changes can interfere with voice
Other drugs Used
Pharmacology
Anticonvulsants: include carbamazepine (use when lithium not tolerated; may not be as effective) .
valproic acid (use when lithium not tolerated; rapid onset)
Carbamazepine
Pharmacology
Carbamazepine (Tegretol): most common; for generalized tonic-clonic and all partial seizures; especially active in temporal lobe epilepsies
Mechanism: ↓ reactivation of Na channels (↑ refractory period, blocks high frequency cell firing, ↓ seizure spread)
Side effects: induces hepatic microsomal enzymes (can enhance metabolism of other drugs)