NEET MDS Synopsis
SEQUENCE OF ERUPTION OF DECIDUOUS TEETH
Orthodontics
SEQUENCE OF ERUPTION OF DECIDUOUS TEETH
Upper/Lower A B D C E
SEQUENCE OF ERUPTION OF PERMAMENT TEETH
Upper: 6 1 2 4 3 5 7 Lower: 6 1 2 3 4 5 7
or 6 1 2 4 5 3 7 or 6 1 2 4 3 5 7
ANTHROPOID SPACE / PRIMATE SPACE / SIMIEN’S SPACE
The space mesial to upper deciduous canine and distal to lower deciduous canine is characteristically found in primates and hence it is called primate space.
INCISOR LIABILITY
When the permanent central incisor erupt, these teeth use up specially all the spaces found in the normal dentition. With the eruption of permanent lateral incisor the space situation becomes tight. In the maxillary arch it is just enough to accommodate but in mandibular arch there is an average 1.6 mm less space available. This difference between the space present and space required is known as incisor liability.
These conditions overcome by;
1. This is a transient condition and extra space comes from slight increase in arch width.
2. Slight labial positioning of central and lateral incisor.
3. Distal shift of permanent canine.
LEE WAY SPACE (OF NANCE)
The combined mesiodistal width of the permanent canines and pre molars is usually less that of the deciduous canines and molars. This space is
called leeway space of Nance.
Measurement of lee way space:
Is greater in the mandibular arch than in the maxillary arch It is about 1.8mm [0.9mm on each side of the arch] in the maxillary arch.
And about 3.4mm [1.7 mm on side of the arch] in the mandibular arch.
Importance:
This lee way space allows the mesial movement of lower molar there by correcting flush terminal plane.
LWS can be measure with the help of cephalometry.
FLUSH TERMINAL PLANE (TERMINAL PLANE RELATIONSHIP)
Mandibular 2nd deciduous molar is usually wider mesio-distally then the maxillary 2nd deciduous molar. This leads to the development of flush terminal plane which falls along the distal surface of upper and lower 2nd deciduous molar. This develops into class I molar relationship.
Distal step relationship leads to class 2 relationship.
Mesial step relationship mostly leads to class 3 relationship.
FEATURE OF IDEAL OCCLUSION IN PRIMARY DENTITION
1. Spacing of anterior teeth.
2. Primate space is present.
3. Flush terminal plane is found.
4. Almost vertical inclination of anterior teeth.
5. Overbite and overjet varies.
UGLY DUCKLING STAGE
Definition:
Stage of a transient or self correcting malocclusion is seen sometimes is called ugly duck ling stage.
Occurring site: Maxillary incisor region
Occuring age: 8-9 years of age.
This situation is seen during the eruption of the permanent canines. As the developing p.c. they displace the roots of lateral incisor mesially this results is transmitting of the force on to the roots of the central incisors which also gets displaced mesially. A resultant distal divergence of the crowns of the two central incisors causes midline spacing.
This portion of teeth at this stage is compared to that of ugly walk of the duckling and hence it is called Ugly Duckling Stage.
Described by Broad bent. In this stage children tend to look ugly. Parents are often apprehensive during this stage and consult the dentist.
Corrects by itself, when canines erupt and the pressure is transferred from the roots to the coronal area of the incisor.
IMPORTANCE OF 1ST MOLAR
1. It is the key tooth to occlusion.
2. Angle’s classification is based on this tooth.
3. It is the tooth of choice for anchorage.
4. Supports occlusion in a vertical direction.
5. Loss of this tooth leads to migration of other tooth.
6. Helps in opening the bite.
Liver Diseases
General Pathology
1. Pyogenic liver abscesses may be caused by E. coli, Klebsiella, Streptococcus, Staphylococcus, Bacteroides, Pseudomonas, and fungi.
Parasitic infections
1. Schistosomiasis is caused by different organisms in different parts of the world.
a. Clinical features include splenomegaly, portal hypertension, and ascites. Lesions are caused by the immune response to ova.
2. Amebiasis is caused by Entamoeba histolytica.
a. Clinical features include bloody diarrhea, pain, fever, jaundice, and hepatomegaly.
Drug-induced liver damage may be caused by agents that are direct hepatotoxins, such as carbon tetrachloride, acetaminophen, methotrexate, anabolic steroids, and oral contraceptive pills.
DEGENERATION
General Pathology
DEGENERATION
Definition: Reversible cell injury.
(1) Water accumulation in the form of
(i) Cloudy swelling.
(ii) Vacuolar degeneration.
.(ill) Hydropic degeneration.
This change is commonly seen in parenchymal cells e.g. kidneys.
Gross appearance: The organ is swollen, soft and pale.
Microscopic appearance: Cells show varying degrees of swelling. Cytoplasm may be granular, vacuolated, homogenously pale and ballooned out.
(2) Fatty change An excessive, demonstrable accumulation of fat is common in parenchymal cells of liver and heart
In the liver, it can be due to: .
(i) Excess fat entry into the liver as occurs in starvation and in steroid excess due to mobilization from stores.
(ii) Excess triglyceride formation
(iii) Reduced phosphorlyation of fat.
(iv) Decreased release as lipoprotein due to protein deficiency.
Causes
(i) Hypoxia as in severe anaemia and venous stasis
(ii) Protein malnutrition.
(iii) Hepatotoxins like CCl4.
(iv) Alcoholism
(v) Metabolic defects like Diabetes mellitus
(vi) Infections.
Gross appearance: The organ is enlarged, soft and greasy, with a pale yellowish colour. It may involve the organ uniformly or patchily ( thrush breast or tabby cat heart)
Microscopic appearance: The cells contain clear vacuoles (stainable by fat-sudan stains on frozen sections). These may be small and dispersed or large, displacing the nucleus peripherally. Several such cells may fuse to form fat cysts.
(3) Hyaline degeneration
In alcoholic liver damage, the cytoplasmic organelles are damaged and give the cytoplasm a deep eosinophilic staining-Mallory hyaline.
The Submandibular Glands
AnatomyThe Submandibular Glands
Each of these U-shaped salivary glands is about the size of a thumb and lies along the body of the mandible.
It is partly superior and partly inferior to the posterior 1/2 of the base of the mandible.
It is partly superficial and partly deep to the mylohyoid muscle.
The submandibular duct arises from the portion of the gland that lies between the mylohyoid and hyoglossus muscle.
The duct passes deep and then superficial to the lingual nerve.
It opens by one to three orifices on a small sublingual papilla beside the lingual frenulum.
The submandibular gland is supplied by parasympathetic, secretomotor fibres from the submandibular ganglion (preganglionic fibres from the chorda tympani via the lingual nerve).
Clinical importance of cementum
Dental Anatomy
Clinical importance of cementum
1) Deposition of cementum continues throughout life.
The effects of the continuous deposition of cementum are the maintenance of total length of the tooth (good) and constriction of the apical foramen (bad).
2) With age, the smooth surface of cementum becomes more irregular due to calcification of some ligament fiber bundles. This is referred to as spikes.
Behavior of cementum in pathologic conditions
Cells of the Nervous System
Pharmacology
Cells of the Nervous System
1-Neurons (Nerve Cells):function units of the nervous system by conducting nerve impulses, highly specialized and amitotic. Each has a cell body (soma), one or more dendrites, and a single axon.
• Cell Body: it has a nucleus with at least one nucleolus and many of the typical cytoplasmic organelles, but lacks centriolesfor cell division.
• Dendrites:Dendrites and axons are cytoplasmic extensions (or processes), that project from the cell body. They are sometimes referred to as fibers. Dendrites (afferent processes) increase their surface area to receive signals from other neurons, and transmit impulses to the neuron cell body.
• Axon: There is only one axon (efferent process) that projects from each cell body.
It carries impulses away from the cell body.
2-Glial cells: do not conduct nerve impulses, but support, nourish, and protect the neurons. They are mitotic, and far more numerous than neurons.
Astrocyte: A glialcell that provides support for neurons of the CNS, provides nutrients regulates the chemical composition of the extracellularfluid.
• Oligodendrocyte: A type of glialcell in the CNS that forms myelin sheaths.
• Microglia:The smallest glialcells; act as phagocytes (cleaning up debris) and protect the brain from invading microorganisms.
• Schwann cell:A cell in the PNS that is wrapped around a myelinatedaxon, providing one segment of its myelin sheath.
APPLICATIONS OF LASERS IN ENDODONTICS
Endodontics
I. VASCULAR VITALITY ASSESSMENT OF PULP
Traditional vitality assessment methods such as heat, cold, and electric pulp testers assess neural vitality and often cause false-positive
errors. As the histological assessment of pulpal status is not feasible clinically, a tool to assess the vascular flow of the pulp would be
very useful.
Laser Doppler flowmetry (LDF) is an accurate method to assess the blood flow in a microvascular
system
II. PULP CAPPING AND PULPOTOMY
Pulp capping and pulpotomy constitute a more conservative form of pulp therapy in comparison to pulpectomy. Although the outcome
of pulp capping procedure is variable ranging from 44 to 97%, the procedure is recommended when the exposure is 1.0 mm or less
and especially when the patient is young. Pulpotomy is recommended in immature permanent teeth, where pulpectomy is not advised.
The most commonly used agents for both the procedures are calcium hydroxide and MTA (mineral trioxide aggregate). The use of a
laser in these procedures leads to a potentially bloodless field as the laser has the ability to coagulate and seal small blood vessels. The
laser-tissue interactions make the treated wound surface sterile and also improve the prognosis of the procedure.
III. DISINFECTION OF ROOT CANALS
The ability of bacterial pathogens to persist after shaping and cleaning is one of the main reasons for endodontic failures. This is
attributed to the complex nature of the root canal system, the presence of a smear layer, and the fact that large areas (over 35%) of the
canal surface area remain unchanged following instrumentation with various Ni-Ti techniques.
IV. OBTURATION
Thermoplasticized gutta-percha obturation systems are one of the most efficient methods is achieving a fluid-impervious seal.
Softening of the gutta-percha has been attempted with various lasers. These include argon, CO
, Nd:YAG, and Er:YAG.
V.APICAL SURGERY
Apical surgery including apical resection is indicated when the previously performed root canal therapy fails and nonsurgical means
are inadequate to ensure the complete removal of the pathological process.
The potential for using lasers is on the basis of the following observations:
• Ability of lasers to coagulate and seal small blood vessels, thereby enabling a bloodless surgical field
• Sterilization of the surgical site
• Potential of lasers (Er:YAG) to cut hard dental tissues without causing elaborate thermal damage to the adjoining tissues .
Sickle Cell Disease
General Pathology
Sickle Cell Disease
Sickle cell anemia is a autosomal recessive genetic disorder. It affects the BETA GLOBIN gene on the CHROMOSOME 16. In sickle cell anemia, the hemoglobin abnormality consists of a point mutation in the beta chain gene for hemoglobin; the resulting abnormal gene product is denoted HbS. If you are heterozygous for the HbS gene you will have what is called sickle trait, which is asymptomatic .
If you are homozygous for the HbS gene you will get sickle cell disease, which is symptomatic in most patients.
The problem with HbS is that as it releases oxygen, it polymerizes and aggregates with other HbS molecules, making the red cell stiff and distorted. These distorted, sickle-shaped red cells are fragile so the patient can end up with a hemolytic anemia.
This can occur as pure disease (homozygous) or trait (heterozygous) or with other haemoglobinopathies. It is common. in Negroes. It is due to Hb-s which is much less soluble than Hb-A hence deoxygenation insoluble form sickling of RBC.
This causes:
• Removal by RE system.
• Blockage of microvessels causing ischaemia.