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  <head>
    <title>057-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Oral and dental disease foundations">
      <outline text="Orientation">
        <outline text="Oral health shapes nutrition, speech, infection, chronic disease"/>
        <outline text="Dental disease can reach deep neck, sepsis, airway"/>
        <outline text="Oral lesions reveal systemic disease"/>
        <outline text="Respect pain, anxiety, trauma, disability, culture"/>
      </outline>
      <outline text="Structure, saliva, and microbiome">
        <outline text="Enamel over dentine around vascular pulp"/>
        <outline text="Periodontal ligament anchors roots to alveolar bone"/>
        <outline text="Glands secrete water, mucus, bicarbonate, minerals, amylase"/>
        <outline text="Parasympathetic: abundant watery saliva"/>
        <outline text="Sympathetic: altered protein composition"/>
        <outline text="Saliva buffers, remineralises, clears, restrains microbes">
          <outline text="Low flow: caries, candidiasis, periodontal disease"/>
          <outline text="Causes: anticholinergics, opioids, radiation, polypharmacy"/>
        </outline>
        <outline text="Plaque is an organised biofilm">
          <outline text="Frequent fermentable carbohydrate demineralises enamel"/>
          <outline text="Repeated low pH produces cavitation"/>
          <outline text="Fluoride promotes remineralisation"/>
        </outline>
      </outline>
      <outline text="History and examination">
        <outline text="Pain site, triggers, night pain, swelling, discharge"/>
        <outline text="Immediately check airway, drooling, voice, neck, toxicity"/>
        <outline text="Inspect face, palpate joints, nodes, glands, neck"/>
        <outline text="Measure mouth opening"/>
        <outline text="Inspect every mucosal surface to posterior pharynx"/>
        <outline text="Note induration, fixation, mobility, fluctuance, pus"/>
      </outline>
      <outline text="Caries, pulpitis, and abscess">
        <outline text="Early caries may be painless"/>
        <outline text="Reversible pulpitis: brief provoked pain"/>
        <outline text="Irreversible pulpitis: spontaneous or lingering pain">
          <outline text="Root-canal treatment or extraction"/>
        </outline>
        <outline text="Necrosis permits apical infection">
          <outline text="Periapical abscess may drain through a sinus"/>
        </outline>
        <outline text="Source control central, antibiotics selective">
          <outline text="Repeated courses delay cure and select resistance"/>
        </outline>
        <outline text="NSAIDs and paracetamol often beat opioids"/>
        <outline text="Ludwig angina from mandibular molar infection">
          <outline text="Bilateral submandibular and sublingual cellulitis"/>
          <outline text="Floor swelling, tongue elevation, drooling"/>
          <outline text="Airway planning precedes supine imaging"/>
        </outline>
      </outline>
      <outline text="Periodontal disease">
        <outline text="Gingivitis: superficial, no attachment loss, reversible"/>
        <outline text="Periodontitis: pockets, attachment and bone loss">
          <outline text="Risk: smoking, diabetes, immune dysfunction, genetics"/>
          <outline text="Recession, mobility, tooth loss"/>
        </outline>
        <outline text="Plaque removal, debridement, risk-factor control"/>
        <outline text="Glycaemia and periodontal health interact"/>
        <outline text="Brushing bleeding signals inflammation">
          <outline text="Disproportionate bleeding: platelets, clotting, liver, marrow"/>
        </outline>
      </outline>
      <outline text="Oral mucosal disease">
        <outline text="Aphthae: recurrent shallow ulcers, no vesicles">
          <outline text="Severe forms: deficiency, coeliac, bowel disease"/>
        </outline>
        <outline text="Recurrent herpes on keratinised mucosa"/>
        <outline text="Candidiasis: removable plaques, erythema, cheilitis">
          <outline text="Treat predisposing factors too"/>
        </outline>
        <outline text="Red lesions carry greater dysplasia risk"/>
        <outline text="Persistent lesion needs urgent review and biopsy"/>
        <outline text="Carcinoma: tobacco, alcohol, papillomavirus"/>
        <outline text="Widespread blistering with systemic signs is urgent"/>
        <outline text="New focal pigmentation needs evaluation"/>
      </outline>
      <outline text="Salivary-gland disease">
        <outline text="Bacterial sialadenitis: painful gland, fever, pus">
          <outline text="Hydrate, stimulate, massage, antibiotics, drain"/>
        </outline>
        <outline text="Stones mostly in submandibular duct">
          <outline text="Meal-related pain and swelling"/>
        </outline>
        <outline text="Bilateral persistent enlargement has systemic causes"/>
        <outline text="Sjogren: dry mouth and eyes, caries, lymphoma"/>
        <outline text="Parotid tumours mostly benign">
          <outline text="Pain, fixation, facial weakness suggest malignancy"/>
          <outline text="Specialist sampling preserves surgical planning"/>
        </outline>
      </outline>
      <outline text="Dental trauma and bleeding">
        <outline text="Start with airway, spine, haemorrhage, vision"/>
        <outline text="Avulsed permanent tooth: hold crown, replant">
          <outline text="Never replant primary teeth"/>
        </outline>
        <outline text="Malocclusion, lip numbness, diplopia suggest fracture">
          <outline text="Avoid blind nasal instrumentation"/>
        </outline>
        <outline text="Post-extraction bleeding: pressure, packing, sutures">
          <outline text="Check antithrombotic indication before reversal"/>
        </outline>
        <outline text="Dry socket: clot loss, no spreading infection"/>
      </outline>
      <outline text="Temporomandibular and facial pain">
        <outline text="Joint or muscle pain, clicking, restricted opening"/>
        <outline text="Explanation, physiotherapy, non-opioid analgesia"/>
        <outline text="Locking, trauma, asymmetry prompt imaging"/>
        <outline text="Trigeminal neuralgia: brief electric attacks"/>
        <outline text="Jaw claudication with visual symptoms: arteritis"/>
      </outline>
      <outline text="Prevention and complex care">
        <outline text="Fluoride, interdental cleaning, less frequent sugar"/>
        <outline text="Treat oral disease before radiation or antiresorptives"/>
        <outline text="Osteonecrosis risk: oncology doses plus extraction"/>
        <outline text="Endocarditis prophylaxis only for high-risk cardiac cases"/>
        <outline text="Complexity rarely justifies neglecting care"/>
      </outline>
    </outline>
  </body>
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