Trachoma – Key Points

Introduction

• Definition: A chronic
  infectious eye disease caused by
  Chlamydia trachomatis.
• Transmission: Spread
  through direct contact with infected secretions, contaminated objects, and
  flies.
• Symptoms: Eye redness,
  irritation, discharge, photophobia, and progressive corneal scarring.
• Complications: Corneal
  opacity, trichiasis (inward-growing eyelashes), and blindness.
• Epidemiology: Leading cause
  of infectious blindness globally, prevalent in poor hygiene and low-income
  regions.

Stages of Trachoma (WHO Grading System)

1. TF (Trachomatous Inflammation – Follicular): Presence of five or more follicles (>0.5 mm) in the upper tarsal
   conjunctiva.
2. TI (Trachomatous Inflammation – Intense): Thickened, inflamed upper tarsal conjunctiva with pronounced redness.
3. TS (Trachomatous Scarring):
   Visible scarring of the tarsal conjunctiva.
4. TT (Trachomatous Trichiasis): Inturned eyelashes rubbing against the eyeball.
5. CO (Corneal Opacity):
   Opacity leading to significant visual impairment or blindness.

SAFE Strategy for Trachoma Control
(WHO)

1. S – Surgery: For
   trichiasis to prevent corneal damage.
2. A – Antibiotics: To treat
   active infection and reduce transmission.
3. F – Facial cleanliness:
   Encouraging hygiene to prevent spread.
4. E – Environmental improvement: Ensuring clean water supply and sanitation.

Antibiotics for Trachoma

1. Azithromycin (preferred
   drug)

   • Dose:
     • Adults: 1 g orally, single dose
     • Children: 20 mg/kg (maximum 1 g), single dose
   • Duration: Single-dose treatment, repeated annually in endemic areas.

2. Tetracycline (1%) ophthalmic ointment

   • Dose: Apply to both eyes twice daily
   • Duration: 6 weeks

3. Erythromycin
   (alternative to azithromycin)

   • Dose:
     • Adults: 500 mg orally twice daily
     • Children: 12.5 mg/kg orally four times daily
   • Duration: 14 days

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TI (Trachomatous Inflammation – Intense): Thickened, inflamed upper tarsal conjunctiva with pronounced redness.
TS (Trachomatous Scarring): Visible scarring of the tarsal conjunctiva.
TT (Trachomatous Trichiasis): Inturned eyelashes rubbing against the eyeball.
CO (Corneal Opacity): Opacity leading to significant visual impairment or blindness.
Mnemonic is FISTO.”
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A – Antibiotics: To treat active infection and reduce transmission.
F – Facial cleanliness: Encouraging hygiene to prevent spread.
E – Environmental improvement: Ensuring clean water supply and sanitation.”
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Contraindications of Tooth Extraction

Introduction

Tooth extraction is a medical procedure that may not be suitable for all patients, especially those with certain health conditions. Below is a categorized list of general, local, absolute, and relative contraindications.

1. General Contraindications

These are conditions where tooth extraction should be avoided due to overall health concerns:

• Cardiac Diseases:

  • Valvular, Rheumatic, or Ischemic heart disease
  • Congestive heart failure
  • Hypertension
  • Patients on anticoagulation therapy

• Blood Diseases:

  • Severe anemia
  • Leukemia
  • Hemophilia
  • Agranulocytosis

• Addison’s Disease

• Patients on Corticosteroids:

  • Requires dose adjustment

• Liver Diseases:

  • Jaundice and liver disease
  • Vitamin K deficiency
  • Blood clotting factor deficiencies (Prothrombin, Fibrinogen)

• Diabetes Mellitus:

  • Poor wound healing due to decayed healing processes

• Thyrotoxicosis

• Pregnancy:

  • Especially during the first and third trimesters
  • Risks of abortion, premature delivery
  • Gravid uterus causing discomfort
  • Reduced stamina for opening the mouth

• Very Old Age:

  • Decreased physiological response
  • Non-healing tissues and increased risk of infection

• Epileptic Patients

• Presence of Fever:

  • Infections can complicate healing

• Debilitating Diseases:

  • Tuberculosis
  • Car pulmonale
  • Asthma
  • Nephritis

• Psychosis/Neurosis:

  • Mental health conditions affecting cooperation

• Allergy to Local Anesthetics (LA)

• Incorporative Patients:

  • Conditions where patient cooperation is compromised

• During Menstruation:

  • Hormonal changes may affect healing and tolerance

2. Local Contraindications

These are conditions that affect the immediate area of the tooth that may cause complications:

• Acute Infections:

  • Presence of infection at the extraction site

• Malignancy:

  • Growth may spread rapidly after the procedure

• Irradiated Jaw:

  • Risk of acute osteoradionecrosis due to lack of blood supply (endarteritis obliterans)

3. Absolute Contraindications

Certain conditions make tooth extraction entirely inappropriate:

• Hemangioma:

  • Increased risk of bleeding

• Arteriovenous Malformation (AV Malformation):

  • Bleeding that cannot be controlled

• In the case of such conditions, if extraction is necessary:

  • Place the tooth back in the socket and apply pressure to control bleeding

4. Relative Contraindications

These are conditions where tooth extraction may be performed with caution or special consideration:

• Diabetes Mellitus:

  • May require special management due to healing concerns

• Valvular Heart Disease:

  • And other similar conditions where dental management requires careful planning and monitoring

Casoni’s Test : Notes for Doctors

E granulosus lifecycle Souce and Copyright: CDC

 Casoni’s test is done to diagnose …

    a. Fascioliasis

    c. Hookworm

    b. Hydatid cyst

    d. Schistoomiasis

Solution

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Click to see answer

Ans: ‘b’
Casoni’s test (intradermal skin test) is an immediate hypersensitivity skin
test used in the diagnosis of hydatid cyst.

Echinococcus cyst cross section

Hydatid cyst

• Pathogenesis infection is acquired by grass/vegetables contaminated with
  dog feces containing larval cyst of E. granulosus.
• Man is dead end host & accidental host
• Dog is definitive host
• Cyst may occur in liver (m/c site in adults); lung (m/c site in
  children)

USG Finding in Hydatid Cyst

• USG is diagnostic (multiloculated cyst)

PAIR procedure for Hydatid cyst: 

Percutaneous puncture (P) of cyst under USG guidance, aspiration (A) of its
content, injection (I) of scolicidal agent & reaspiration (R). (for
small size < 5-6 cm).

Scolicidal agents for Hydatid Cyst

hypertonic 2% saline, sodium hypochloride, cetrimide, chlorhexidine

Common postoperative complications

Chronic Dental Conditions in the Elderly

Conditions that develop over a long period, particularly in older individuals, include attrition, abrasion, and erosion.

Attrition

Attrition refers to the wearing away of tooth substance due to mastication.

Causes:

• Coarse, gritty diet
• Nervous habits (e.g., grinding teeth during anxiety)
• Bruxism (grinding teeth at night)
• Chewing on pipes

Sites Affected:

• Anterior teeth: Incisal edges
• Posterior teeth: Occlusal surfaces

Clinical Features:

• Affected surfaces appear smooth and polished.
• In advanced cases, incisal edges and cusps wear away, appearing peg-like, while the occlusal surface becomes flat or even hollowed.
• Despite severe attrition, pulp exposure is rare due to compensatory dentine formation.
• Attrition is incompatible with caries and periodontal disease since these conditions lead to tooth destruction and mobility, preventing attrition from occurring.
• Attrition may have a protective role against caries by eliminating stagnation areas on occlusal surfaces.

Abrasion

Abrasion is the pathological wearing away of teeth by foreign substances.

Causes:

• Chewing tobacco
• Vigorous tooth brushing, especially with abrasive toothpaste
• Professions involving repetitive biting habits (e.g., cutting thread)
• Hard tooth brushing with a horizontal sweeping action (most common cause)

Sites Affected:

• Cervical region of teeth (near the cementoenamel junction)—most susceptible to abrasion
• Corner teeth—most severely affected

Clinical Features:

• Significant gingival recession is observed, but no gingivitis occurs due to effective plaque removal.
• Progressive exposure of cementum and dentine, leading to grooved defects.

Erosion

Erosion refers to the progressive dissolution of tooth structure, typically caused by acids, though some cases have unknown etiologies.

Causes:

• Occupational exposure (e.g., battery or acid factory workers exposed to acid fumes)
• Dietary factors:
  • Habitual sucking of citrus fruits for prolonged durations
  • Excessive consumption of carbonated soft drinks (high in phosphoric acid), leading to developmental caries
• Gastroesophageal conditions:
  • Chronic regurgitation of acidic gastric juice, as seen in acid peptic disease (APD), gastroesophageal reflux disease (GERD), and early pregnancy, predominantly affecting the palatal surface
• Erosion of unknown origin: Manifests as shallow, highly polished lesions on the labial surface

Treatment:

• Identification and elimination of the cause (occupational, dietary, medical factors)
• Application of protective coatings
• Use of fluoridated toothpaste
• Iontophoresis with sodium fluoride (NaF) for enamel reinforcement

GCS Calculator

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let verbalResponse = parseInt(document.getElementById(“verbalResponse”).value);
let motorResponse = parseInt(document.getElementById(“motorResponse”).value);

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if (totalGCS >= 13) {
severity.innerText = “🟢 Mild Brain Injury”;
} else if (totalGCS >= 9) {
severity.innerText = “🟡 Moderate Brain Injury”;
} else {
severity.innerText = “🔴 Severe Brain Injury”;
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}

Putrefaction versus adipocere formation versus mummification 

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