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NEET MDS Synopsis - Lecture Notes
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📖 Periodontology

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Gracey Curettes
Periodontology

Gracey Curettes

Gracey curettes are specialized instruments designed for periodontal therapy, particularly for subgingival scaling and root planing. Their unique design allows for optimal adaptation to the complex anatomy of the teeth and surrounding tissues. This lecture will cover the characteristics, specific uses, and advantages of Gracey curettes in periodontal practice.

  • Gracey curettes are area-specific curettes that come in a set of instruments, each designed and angled to adapt to specific anatomical areas of the dentition.

  • Purpose: They are considered some of the best instruments for subgingival scaling and root planing due to their ability to provide excellent adaptation to complex root anatomy.

Specific Gracey Curette Designs and Uses

  1. Gracey 1/2 and 3/4:

    • Indication: Designed for use on anterior teeth.
    • Application: Effective for scaling and root planing in the anterior region, allowing for precise access to the root surfaces.

  2. Gracey 5/6:

    • Indication: Suitable for anterior teeth and premolars.
    • Application: Versatile for both anterior and premolar areas, providing effective scaling in these regions.

  3. Gracey 7/8 and 9/10:

    • Indication: Designed for posterior teeth, specifically for facial and lingual surfaces.
    • Application: Ideal for accessing the buccal and lingual surfaces of posterior teeth, ensuring thorough cleaning.

  4. Gracey 11/12:

    • Indication: Specifically designed for the mesial surfaces of posterior teeth.
    • Application: Allows for effective scaling of the mesial aspects of molars and premolars.

  5. Gracey 13/14:

    • Indication: Designed for the distal surfaces of posterior teeth.
    • Application: Facilitates access to the distal surfaces of molars and premolars, ensuring comprehensive treatment.

Key Features of Gracey Curettes

  • Area-Specific Design: Each Gracey curette is tailored for specific areas of the dentition, allowing for better access and adaptation to the unique contours of the teeth.

  • Offset Blade: Unlike universal curettes, the blade of a Gracey curette is not positioned at a 90-degree angle to the lower shank. Instead, the blade is angled approximately 60 to 70 degrees from the lower shank, which is referred to as an "offset blade." This design enhances the instrument's ability to adapt to the tooth surface and root anatomy.

Advantages of Gracey Curettes

  1. Optimal Adaptation: The area-specific design and offset blade allow for better adaptation to the complex anatomy of the roots, making them highly effective for subgingival scaling and root planing.

  2. Improved Access: The angled blades enable clinicians to access difficult-to-reach areas, such as furcations and concavities, which are often challenging with standard instruments.

  3. Enhanced Efficiency: The design of Gracey curettes allows for more efficient removal of calculus and biofilm from root surfaces, contributing to improved periodontal health.

  4. Reduced Tissue Trauma: The precise design minimizes trauma to the surrounding soft tissues, promoting better healing and patient comfort.

Necrotizing Ulcerative Gingivitis (NUG)
Periodontology

Necrotizing Ulcerative Gingivitis (NUG)

Necrotizing Ulcerative Gingivitis (NUG), also known as Vincent's disease or trench mouth, is a severe form of periodontal disease characterized by the sudden onset of symptoms and specific clinical features.

Etiology and Predisposing Factors

  • Sudden Onset: NUG is characterized by a rapid onset of symptoms, often following debilitating diseases or acute respiratory infections.
  • Lifestyle Factors: Changes in living habits, such as prolonged work without adequate rest, poor nutrition, tobacco use, and psychological stress, are frequently noted in patient histories .
  • Smoking: Smoking has been identified as a significant predisposing factor for NUG/NDP .
  • Immune Compromise: Conditions that compromise the immune system, such as poor oral hygiene, smoking, and emotional stress, are major contributors to the development of NUG .

Clinical Presentation

  • Symptoms: NUG presents with:
    • Punched-out, crater-like depressions at the crest of interdental papillae.
    • Marginal gingival involvement, with rare extension to attached gingiva and oral mucosa.
    • Grey, pseudomembranous slough covering the lesions.
    • Spontaneous bleeding upon slight stimulation of the gingiva.
    • Fetid odor and increased salivation.

Microbiology

  • Mixed Bacterial Infection: NUG is caused by a complex of anaerobic bacteria, often referred to as the fusospirochetal complex, which includes:
    • Treponema vincentii
    • Treponema denticola
    • Treponema macrodentium
    • Fusobacterium nucleatum
    • Prevotella intermedia
    • Porphyromonas gingivalis

Treatment

  1. Control of Acute Phase:

    • Clean the wound with an antibacterial agent.
    • Irrigate the lesion with warm water and 5% vol/vol hydrogen peroxide.
    • Prescribe oxygen-releasing mouthwash (e.g., hydrogen peroxide DPF, sodium perborate DPF) to be used thrice daily.
    • Administer oral metronidazole for 3 to 5 days. If sensitive to metronidazole, prescribe penicillin; if sensitive to both, consider erythromycin or clindamycin.
    • Use 2% chlorhexidine in select cases for a short duration.

  2. Management of Residual Condition:

    • Remove predisposing local factors (e.g., overhangs).
    • Perform supra- and subgingival scaling.
    • Consider gingivoplasty to correct any residual gingival deformities.
Flossing
Periodontology

Flossing Technique

Flossing is an essential part of oral hygiene that helps remove plaque and food particles from between the teeth and along the gumline, areas that toothbrushes may not effectively clean. Proper flossing technique is crucial for maintaining gum health and preventing cavities.

Flossing Technique

  1. Preparation:

    • Length of Floss: Take 12 to 18 inches of dental floss. This length allows for adequate maneuverability and ensures that you can use a clean section of floss for each tooth.
    • Grasping the Floss: Hold the floss taut between your hands, leaving a couple of inches of floss between your fingers. This tension helps control the floss as you maneuver it between your teeth.

  2. Inserting the Floss:

    • Slip Between Teeth: Gently slide the floss between your teeth. Be careful not to snap the floss, as this can cause trauma to the gums.
    • Positioning: Insert the floss into the area between your teeth and gums as far as it will comfortably go, ensuring that you reach the gumline.

  3. Flossing Motion:

    • Vertical Strokes: Use 8 to 10 vertical strokes with the floss to dislodge food particles and plaque. Move the floss up and down against the sides of each tooth, making sure to clean both the front and back surfaces.
    • C-Shaped Motion: For optimal cleaning, wrap the floss around the tooth in a C-shape and gently slide it beneath the gumline.

  4. Frequency:

    • Daily Flossing: Aim to floss at least once a day. Consistency is key to maintaining good oral hygiene.
    • Best Time to Floss: The most important time to floss is before going to bed, as this helps remove debris and plaque that can accumulate throughout the day.

  5. Flossing and Brushing:

    • Order of Operations: Flossing can be done either before or after brushing your teeth. Both methods are effective, so choose the one that fits best into your routine.
Hypercementosis
Periodontology

Hypercementosis

Hypercementosis is a dental condition characterized by the excessive deposition of cementum on the roots of teeth. This condition can have various clinical implications and is associated with several underlying factors. Understanding hypercementosis is essential for dental professionals in diagnosing and managing related conditions.

Characteristics of Hypercementosis

  1. Definition:

    • Hypercementosis is defined as a generalized thickening of the cementum, often accompanied by nodular enlargement of the apical third of the root. It can also manifest as spike-like excrescences known as cemental spikes.

  2. Forms of Hypercementosis:

    • Generalized Type: Involves a uniform thickening of cementum across multiple teeth.
    • Localized Type: Characterized by nodular enlargements or cemental spikes, which may result from:
      • Coalescence of cementicles adhering to the root.
      • Calcification of periodontal fibers at their insertion points into the cementum.

Radiographic Appearance

  • Radiographic Features:
    • On radiographs, hypercementosis is identified by the presence of a radiolucent shadow of the periodontal ligament and a radiopaque lamina dura surrounding the area of hypercementosis, similar to normal cementum.
    • Differentiation:
      • Hypercementosis can be differentiated from other conditions such as periapical cemental dysplasia, condensing osteitis, and focal periapical osteopetrosis, as these entities are located outside the shadow of the periodontal ligament and lamina dura.

Etiology of Hypercementosis

  • Varied Etiology:

    • The exact cause of hypercementosis is not completely understood, but several factors have been identified:
      • Spike-like Hypercementosis: Often results from excessive tension due to orthodontic appliances or occlusal forces.
      • Generalized Hypercementosis: Can occur in various circumstances, including:
        • Teeth Without Antagonists: In cases where teeth lack opposing teeth, hypercementosis may develop as a compensatory mechanism to keep pace with excessive tooth eruption.
        • Low-Grade Periapical Irritation: Associated with pulp disease, where hypercementosis serves as compensation for the loss of fibrous attachment to the tooth.

  • Systemic Associations:

    • Hypercementosis may also be observed in systemic conditions, including:
      • Paget’s Disease: Characterized by hypercementosis of the entire dentition.
      • Other Conditions: Acromegaly, arthritis, calcinosis, rheumatic fever, and thyroid goiter have also been linked to hypercementosis.

Clinical Implications

  1. Diagnosis:

    • Recognizing hypercementosis is important for accurate diagnosis and treatment planning. Radiographic evaluation is essential for distinguishing hypercementosis from other dental pathologies.

  2. Management:

    • While hypercementosis itself may not require treatment, it can complicate dental procedures such as extractions or endodontic treatments. Understanding the condition can help clinicians anticipate potential challenges.

  3. Monitoring:

    • Regular monitoring of patients with known systemic conditions associated with hypercementosis is important to manage any potential complications.