How to remove tonsil stones or tonsilloliths?

 Tonsil stones, also known as tonsilloliths, are small, white or yellowish formations that can form on or in the tonsils. They are caused by debris, including bacteria and food particles, getting trapped in the tonsils' crevices and hardening over time.

There are several ways to remove tonsil stones, and the best method for you will depend on the size and location of the stones, as well as your overall health and any other symptoms you may be experiencing.

Here are a few methods to remove tonsil stones:

• Gently cough: This method is effective for small tonsil stones that are located near the surface of the tonsils. Try to gently cough up the stones using a deep, hacking cough.
• Use a water pick or oral irrigator: A water pick or oral irrigator can be used to gently flush out tonsil stones. The water pressure can help to loosen the stones and wash them out of the tonsils.
• Use a cotton swab: Gently press a clean cotton swab against the tonsil stone to push it out of the tonsil crevice.
• Use a toothbrush: You can use a toothbrush to gently brush the surface of the tonsil and dislodge the tonsil stones.
• Surgery: If your tonsil stones are recurring or large, a procedure called tonsillectomy (removal of tonsils) can be done.

It's important to note that, home remedies are effective when the tonsil stones are small and accessible. If the stones are large, recurrent or cause difficulty in swallowing or breathing, it's best to seek professional medical help. A doctor or an ear, nose, and throat (ENT) specialist can help diagnose and remove the tonsil stones and also check for any underlying condition that may be causing them.

What is Ludwig's angina?

 Ludwig's angina is a serious and potentially life-threatening infection that affects the tissues of the floor of the mouth. It is a type of cellulitis, which is a spreading infection of the skin and subcutaneous tissues. The condition is named after Carl Friedrich Wilhelm Ludwig, a German physician who described the condition in 1836.

The infection usually starts with inflammation and infection of the submandibular salivary glands, which are located just below the jawbone but can quickly spread to the surrounding tissues, including the tongue, the floor of the mouth, and the neck.

Symptoms of Ludwig's angina can include:

• severe pain and swelling in the jaw, tongue, and neck
• difficulty swallowing and speaking
• drooling
• fever and chills
• swollen lymph nodes in the neck
• difficulty breathing (due to the swelling in the neck)

Ludwig's angina is considered a medical emergency, and prompt treatment is essential to prevent potentially life-threatening complications, such as airway obstruction or sepsis. Treatment typically includes antibiotics to fight the infection, along with surgical drainage of any abscesses that may have formed.

Ludwig's angina typically starts as an infection in the submandibular salivary glands, which are located just below the jawbone. However, it can also be caused by an infection in the teeth, gums, or other oral structures that spreads to the floor of the mouth.

A common cause of Ludwig's angina is a dental abscess, which is a pocket of pus that forms at the tip of a tooth's root due to a bacterial infection. Dental abscesses can be caused by untreated tooth decay, a broken or cracked tooth, or gum disease. The bacteria can spread through the bone and soft tissues of the jaw and into the submandibular space, leading to Ludwig's angina.

Another oral infection that can cause Ludwig's angina is a peritonsillar abscess (quinsy) which is a collection of pus in the tonsils caused by a bacterial infection. This abscess may spread to the floor of the mouth and also cause Ludwig's angina.

In general, Ludwig's angina is considered a rare but serious condition, and if left untreated, it can be life-threatening due to the potential for airway obstruction and sepsis (systemic infection).

The mortality rate associated with Ludwig's angina varies depending on the studies, but it ranges between 2-15%. Early recognition and intervention are critical to improve the outcome. Early identification and appropriate intervention along with the necessary care, will lower the mortality rate.

It's essential to seek professional dental help if you suspect you have a tooth infection or an abscess, or if you experience any of the symptoms associated with Ludwig's angina, such as severe pain and swelling in the jaw, tongue, and neck, difficulty swallowing and speaking, fever, and difficulty breathing.

Signs and symptoms of Anemia and leukemia related to oral cavity

 Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin, the protein in red blood cells that binds to oxygen and carries it to the body's tissues. One of the common signs of anemia is fatigue and weakness, as the body's tissues are not getting enough oxygen. Other signs of anemia can include pale skin, shortness of breath, and a rapid or irregular heartbeat.

Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells.

Oral symptoms associated with anemia can include dry mouth, sore tongue, and a burning or tingling sensation in the tongue and mouth. The gums may appear pale, and there may be small, shallow ulcers or sores on the tongue and inside of the cheeks. Anemia can also cause difficulty swallowing and a loss of taste.

In the case of leukemia, oral symptoms can include the following:

• Petechiae: Tiny red or purple spots on the gums, the roof of the mouth, and the buccal mucosa caused by bleeding under the surface of the skin.
• Gum hypertrophy: Enlarged or swollen gums
• Oral infections: Leukemia can impair the body's ability to fight infections, leading to frequent mouth sores, ulcers, and infections in the gums, tongue, and other parts of the mouth.
• Taste changes: Some people with leukemia may experience changes in their sense of taste.
• Excessive bleeding from the oral cavity
• Mouth pain
• Loose teeth

In addition to these symptoms, individuals with anemia or leukemia may also experience difficulty swallowing, sore mouth or tongue, and unexplained weight loss.

It is important to remember that these symptoms may also be caused by other conditions and to seek professional medical help to diagnose and treat them. A thorough examination of the oral cavity, together with laboratory and imaging tests, will be done by a dentist or oral surgeon to establish the diagnosis.

PGCEE MDS 2022: The dentin desensitizing agents that acts by precipitating proteins in the dentinal tubular fluid is:

 # The dentin desensitizing agent that acts by precipitating proteins in the dentinal tubular fluid is:

a) Strontium Chloride 

b) Potassium oxalate

c) Fluoride 

d) Hydroxyethyl methacrylate

The correct answer is A. Strontium chloride.

Dentin Desensitizers act by:

i) Desensitization of intradental nerves or inhibit or prevent transmission of the stimulus itself.

Eg: Potassium salts like nitrate, chloride and citrate.

ii) Occlusion of the dentinal tubules

a) Precipitation of proteins:

• Silver nitrate

• Zinc chloride

• Strontium chloride

b) Plugging of dentinal tubules

• Salts of fluorides and oxalates

• Bioglass

c) Dentin adhesive sealers

• Varnish

• GIC

• Composites

• Dentin bonding agents

iii) Lasers:

• Nd-YAG-act by occlusion of tubules

• GaAlA (Gallium Aluminium Arsenide laser act by affecting the neural transmission)

PGCEE MDS 2022: Bald tongue due to vitamin B12 deficiency is called as:

 # Bald tongue due to vitamin B12 deficiency is called as:

A. Moeller’s glossitis

B. Benign migratory glossitis

C. Strawberry tongue

D. Gingivostomatitis

The correct answer is A. Moeller's glossitis.

Pernicious Anemia, or Addison's anemia or Biermer's anemia

• Seen due to deficiency of Vit. B12 or Erythrocyte maturation factor or extrinsic factor.

• Peripheral neuropathy due to degeneration of posterior and lateral tracts of the spinal cord with loss of nerve fibers and degeneration of myelin sheath is seen.

• Tongue is "beefy red" in color and characteristically shows glossitis, glossodynia, and glossopyrosis.

• There is gradual atrophy of papillae of the tongue resulting in a "bald" tongue which is often referred to as Hunter's glossitis or Moeller's glossitis which is similar to the "bald tongue of sandwith" seen in pellagra.

 • RBC count of < 1 million, macrocytosis, poikilocytosis, polychromatophilic cells, stippled cells, nucleated cells, Howell-Jolloy bodies, and Cabot's ring are the laboratory findings.

• Bone marrow studies reveal immature red cells or MEGALOBLASTS. Polymacrocytes (macropolyps) are large polymorphonuclear leukocytes with large poly-lobed nuclei are also found.

• Achlorhydria or lack of HCL secretion is a constant feature of the disease.

• The oral and general manifestations of "sprue" are closely related to pernicious anemia.

PGCEE MDS 2022: Enzyme responsible for breakdown of ground substance is:

 # Enzyme responsible for breakdown of ground substance is:

a) Hyaluronidase 

b) Coagulase

c) Phosphorylase 

d) Acid phosphatase

The correct answer is A. Hyaluronidase.

Collagenase is responsible for the breakdown of periodontal fibers in periodontitis. It is released by bacteria (P. gingivalis mostly), polymorpho-nuclear leukocytes, and some populations of fibroblasts. Hyaluronidase causes the breakdown of ground substances and helps in the spread of inflammation (cellulitis).

PGCEE MDS 2022: Rapid maxillary expansion is not indicated after:

 # Rapid maxillary expansion is not indicated after:

a) 6 years 

b) 9 years

c) 12 years 

d) 15 years

The correct answer is D. 15 years.

Rapid maxillary expansion should be initiated prior to the ossification of the mid-palatal suture. The time of ossification of the mid-palatal suture is about 16 years in girls and 18 years in boys with a broad range of 15-27 years.

Contraindications of Rapid maxillary expansion:

• Single tooth crossbites

• In adults with severe anteroposterior skeletal discrepancies.

• Vertical growers

• Periodontally weak conditions

The retention period following rapid maxillary expansion should be at least 3 - 6 months.

In slow expansion, the maxillary arch is expanded at a rate of 0.5 - l mm per week.

The forces generated in slow expansion procedures are 2-4 pounds while it is 10-20 pounds (1 pound = 450 gms) in RME.

In rapid maxillary expansion, the treatment is completed in 1-2 weeks whereas in the slow expansion it may take as much as 2-5 months.