GOUT Definition, Causes, Signs,Symptoms,Diagnosis,Prevention, Treatment

What is Arthritis?

There are 127 different kinds of arthritis.

Rheumatoid Arthritis - Severe inflammation that involves many joints and moves beyond musculoskeletal system.

Gout - Very painful form of arthritis characterized by the formation of uric acid crystals and severe inflammation.

Osteoarthritis - Progress be generation of joint cartilage. Minor degree of inflammation.

https://youtu.be/EU-6XcbRyzM



What is GOUT ?

Gout is a metabolic disease in which crystals of uric acid ( monosodium urate) gets deposited in joints and surrounding soft tissues.

Clinical features -

1) Peak age of Onset in Men is 45years.

2) usually after 2230 years of sustained Hyperuricemia.

3) Usually single joint involvement at first , common in 1st Metatarsophalangeal Joint of Great Toe.

4) Other Joints - Ankle,Midfoot,Knee,Small joints of hands and wrist.

5) Severe pain and extreme tenderness.

6) the joints are red hots swollen with shiny overlying skin and dilated veins.

7) Fever , Malaise.

8) Pruritis, Desquamation

9) Initial attacks are Usually self initiated over 5-14 days.



Diagnosis Of Gouty Arthritis.

Diagnosis is confirmed by synovial fluid Aspiration.

The definative diagnosis of gouty arthritis requires aspiration and examination of synovial  fluid from an affected joint using polarized light microscopy to confirm the presence of the needle shaped monosodium urate crystal.


Arthrocentesis - Joint aspiration, is a procedure whereby a sterile needle and syringe are used to drain fluid from a joint.

Prevention -

Once you are diagnostics with Gout , you are a patient of gout for your whole life.

Avoid protein rich diet.

Avoid dehydration - especially in hot weather.

Avoid unaccustomed strenuous exercise.

Care should be taken in patients on long term diuretics and low dose aspirin.



Drug Treatment -


Given to Control levels of uric acid in blood.

To prevent long term complications.

Drug dosage to be adjust according to level of uric acid.


Allopurinol

Is one of the oldest and comment drive use to control the levels of uric acid in blood. This drug inhibits xanthine oxidase which converts xanthine into uric acid.

Probenicid - Promotes excretion of uric acid through kidneys.

Sulphinpyrazone - Promotes excretion of uric acid through kidneys.



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What is UGLY DUCKLING STAGE ? What is Broadbent's Phenomenon? Explanation

UGLY DUCKLING STAGE

EXPLANATION GIVEN ON THE VIDEO.

DEFINATION 

EXPLANATION POINT TO POINT.

TREATMENT

Ugly Duckling Stage

The Ugly duckling stage is a transient or self  correcting malocclusion seen in maxillary
Incisor region between 8 to 9 years of age.


https://youtu.be/f3ETwuLYgHQ

This is a particular situation seen during the eruption of permanent canines.

Eruption of permanent Canines

Radiographic Interpretation of Ugly Duckling Stage

As the developing permanent canine that

displace the root of the Lateral Incisor mesially.

UGLY DUCKLING STAGE

This results in transmitting of force on the root of the Central Incisor which also get displaced mesially.


As a resultant distal divergence of the grounds of two Central Incisor causes a midline spacing. 


This situation has been described by

 Broadbent as Ugly duckling stage.

PARENTS RUSH TO DOCTORS

During this stage children tend to look ugly during the face of development.


Parents are often apprehensive during this stage and consult a dentist.

Self correcting malocclusion

The condition usually correct by itself when the canine erupts and the pressure is transferred from the roots to the coronal area of the incisors.




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"ANUG" Definition, Synonyms, predisposing factors , signs symptoms ,Treatment.

ACUTE NECROTISING ULCERATIVE GINGIVITIS.

What is ANUG ?


Acute disease with repeated remission exacerbation seen with impaired host characterized by death and sloughing of gingival tissue .


Nicknames for ANUG ?

Trench mouth.

Vincent angina.

Vincent's stomatitis.

Fetid stomatitis.

Purid stomatitis.


Why it is called Trench mouth ?


The term trench mouth can be tracked during World War 1, where it was very common for the soldiers to experience severe gum problems ,
Because they didn't have access to Dental Care.


https://youtu.be/Xwo4aFYhiT8

Predisposing factors

1) Pre-existing gingivitis

2) Injury to gingiva.

3) Nutritional deficiency.

4) Smoking.

5) Deliberating Disease.


Oral signs and symptoms .

Intraoral features.



1) The lesion is extremely painful.

2) Constant radiating gnawing pain.

3) Metallic foul taste.

4) Secretion of pasty saliva.

5) Spontaneous breathing from gingival tissue.

6) Deep ulceration which involves necrosis of tissue.

7) Teeth are slightly extruded and sensitive to pressure.

8) Patient experience loss of taste and Woody sensation.

9) Punched out crator like depressions, present at the crest of interdental papilla.

10) The craters are caused by pseudomembraneous slough.


Extra oral features.

1) Local lymphadenopathy.

2) Slight elevation of temperature.

3) Leukocytosis.

4) Increase pulse rate.

5) Loss of appetite.


Let's understand the microbiology behind it.

It is a fusospirochetal infection.

According to Horning and Cohan give the stages of necrotising disease.


Stage 1 necrotizing ulcerative gingivitis.

Stage 2 Nug periodontitis.

Stage 3 and 4 correspond to Nug.

Stage 5 and 6 corresponding to necrotising stomatitis.

Stage 7 would be NOMA.


Treatment 

First visit

1) First applied topical anaesthesia on the involve areas.

2) The areas are gently swabbed to remove the pseudo membrane.

3) Superficial calculus is removed with ultrasonic scaler.

4) Rinse mouth everyday in every 2 hours with glass full of equal mixture of warm water and 3% of hydrogen peroxide.

5) Amoxicillin 250 mg for 500 mg 250 QID and metronidazole 250 mg or 500 mg may be taken.

Second visit

Scaling is performed after 1 to 2 days.

Third visit

After one or two days of second visit scaling and root planing are treated with plaque control instruction hydrogen peroxide rinses are discontinued but chlorhexidine rinses is can be maintained for two to three weeks.



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Difference Between Precancerous Lesions and Precancerous Condition of Oral Cavity

Pre-cancerous lesion -



It is Defined as a morphologically altered tissue in which Cancer is more likely to occur, than its apparently moral counter parts.

For example,

1) Leukoplakia -

Leukoplakia white Patches

White Patches

 It is defined as a white patch or plaque in the oral cavity, which cannot be scrappled off or stripped off easily and more over , which cannot be characterized clinically or pathologically as any other disease.

2) Erythroplakia -

Redness in buccal mucosa

Redness in buccal mucosa

It is applied to any area of reddened, velvety texture mucosa that cannot be identified on the basis of clinical and histopathologic examination as being cause by inflammation or any other disease process.

3) Carcinoma in situ -

Combination of Erythroplakia and Leukoplakia

Its also called "Interepithelial carcinoma ".
It is a condition which arises frequently on skin , but occurs also on mucus membrane including those of oral cavity.

4) Actinic keratosis-

It is a cutaneous pre-malignant lesion.
Similarly , Actinic chelitis which is associated with lower lip.


Pre-Cancerous Condition -


It is defined as a genralized state or condition associated with significantly increased risk for cancer development.

For example-

1) Oral Submucous Fibrosis -

OSMF

Bud shaped ovula

 It is aa chronic and high risk precancerous condition. The lesion is characterized by juxta epithelial inflammatory reaction followed by fibroelastic changes of lamina propria with epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.


2) Oral lichen planus-

Oral Lichen Planus

Oral Lichen Planus

It is a chronic inflammatory condition that affects mucous membrane inside your mouth. Oral lichen planus may appear as White lesions patches, red, swollen tissues or open sores. These lesions may cause burning pain or other discomfort.





3) Systemic lupus erythematosus-

Oral lupus erytmatosus

It is characterized by presence of abnormal antibodies and immune system.



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