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  <head>
    <title>057-02 Oral ecology, odontogenic infection, mucosal diagnosis, and medically complex dental care</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Oral ecology, infection, mucosa, and complex care">
      <outline text="The mouth as a vulnerable interface">
        <outline text="Cavitated enamel cannot repair"/>
        <outline text="Pulp lies in a rigid chamber"/>
        <outline text="Infection tracks to orbit, neck, mediastinum, airway"/>
        <outline text="Localise pain by structure and urgency"/>
      </outline>
      <outline text="Saliva and caries ecology">
        <outline text="Saliva is an active protective fluid">
          <outline text="Bicarbonate buffers, calcium and phosphate remineralise"/>
          <outline text="Immunoglobulin, lysozyme, lactoferrin limit organisms"/>
        </outline>
        <outline text="Subjective dryness precedes measured flow loss"/>
        <outline text="Caries is a biofilm-mediated ecological disease">
          <outline text="Frequent sugar selects acid-tolerant organisms"/>
          <outline text="Each exposure adds an acidic interval"/>
          <outline text="Sipped sweet drink worse than same with meal"/>
        </outline>
        <outline text="Cavitation forms a sheltered niche">
          <outline text="Restoration needed, fluoride cannot rebuild"/>
        </outline>
      </outline>
      <outline text="Pulpitis and antibiotic stewardship">
        <outline text="Inflammation inside non-compliant dentine"/>
        <outline text="Brief resolving pain: reversible"/>
        <outline text="Spontaneous, nocturnal, lingering pain: irreversible"/>
        <outline text="Necrosis may ease pain as infection spreads"/>
        <outline text="Percussion tenderness: ligament inflammation"/>
        <outline text="Antibiotics penetrate necrotic pulp poorly">
          <outline text="Repeated courses mask symptoms, breed resistance"/>
        </outline>
        <outline text="Culture only for severe, immune, failed, unusual"/>
        <outline text="Discharge with return signs and dental date"/>
      </outline>
      <outline text="Deep-space spread and Ludwig angina">
        <outline text="Spread follows muscle attachments and fascia">
          <outline text="Maxillary: canine space, sinus, orbit"/>
          <outline text="Mandibular molars: sublingual, submandibular, masticator"/>
        </outline>
        <outline text="Trismus signals masticator or deep space"/>
        <outline text="Red flags need surgical and airway assessment">
          <outline text="Not another outpatient antibiotic course"/>
        </outline>
        <outline text="Ludwig angina: bilateral cellulitis">
          <outline text="Firm floor pushes tongue up and back"/>
          <outline text="Stridor and desaturation are late"/>
          <outline text="Sedation or supine can cause obstruction"/>
        </outline>
        <outline text="Airway planning precedes imaging"/>
      </outline>
      <outline text="Periodontal disease">
        <outline text="Starts with plaque at gingival margin"/>
        <outline text="Gingivitis confined to soft tissue, reversible"/>
        <outline text="Dysregulated inflammation destroys ligament and bone"/>
        <outline text="Smoking masks bleeding, accelerates destruction"/>
        <outline text="Diabetes and inflammation worsen each other"/>
        <outline text="Remove biofilm and calculus, clean interdentally"/>
      </outline>
      <outline text="Examination and ulcer diagnosis">
        <outline text="Lesions hide under tongue and dentures">
          <outline text="Remove dentures, palpate bimanually"/>
        </outline>
        <outline text="Traumatic ulcers heal once irritant removed"/>
        <outline text="Aphthae on non-keratinised mucosa"/>
        <outline text="Recurrent herpes on keratinised attached mucosa"/>
        <outline text="Persistent or indurated ulcer needs urgent biopsy"/>
      </outline>
      <outline text="Cancer, mucositis, and white lesions">
        <outline text="Carcinoma risk not excluded without exposure">
          <outline text="Invades muscle, jaw, nerves, lymphatics"/>
          <outline text="Biopsy diagnoses, imaging stages"/>
        </outline>
        <outline text="Mucositis severe in neutropenia despite mild look">
          <outline text="Gentle hygiene, rinses, analgesia, nutrition"/>
          <outline text="Check platelets and immunity before procedures"/>
        </outline>
        <outline text="Wipe test for white lesions">
          <outline text="Candidal pseudomembrane wipes off, leaves erythema"/>
          <outline text="Keratosis and leukoplakia cannot be removed"/>
        </outline>
        <outline text="Rinse after inhaled steroids, remove dentures"/>
      </outline>
      <outline text="Dry mouth and salivary obstruction">
        <outline text="Review drugs, radiation, Sjogren, graft disease"/>
        <outline text="Water, sugar-free chewing, substitutes, fluoride"/>
        <outline text="Acidic sweets worsen erosion and caries"/>
        <outline text="Sjogren gland swelling raises lymphoma concern"/>
        <outline text="Stone or stricture causes meal-related swelling">
          <outline text="Long duct, mucous mineral-rich saliva"/>
        </outline>
        <outline text="Facial weakness with parotid mass warns malignancy"/>
      </outline>
      <outline text="Trauma, extraction bleeding, and jaw pain">
        <outline text="Avulsed tooth loses ligament viability as it dries">
          <outline text="Replant or store in suitable medium"/>
          <outline text="Primary teeth damage developing successor"/>
        </outline>
        <outline text="Local measures control extraction bleeding">
          <outline text="Anticoagulants not stopped reflexively"/>
        </outline>
        <outline text="Dry socket: clot loss, exposed bone"/>
        <outline text="Clicking alone needs no imaging or bite change"/>
        <outline text="Neuralgia versus giant-cell arteritis"/>
      </outline>
      <outline text="Medically complex care">
        <outline text="Remove infection before radiation or chemotherapy"/>
        <outline text="Radiation raises caries and osteoradionecrosis risk"/>
        <outline text="Pregnancy rarely precludes needed treatment"/>
        <outline text="Antiresorptive osteonecrosis: dose, infection, extraction">
          <outline text="Preserve teeth, do not avoid care indefinitely"/>
          <outline text="Stopping drug decided with prescriber"/>
        </outline>
        <outline text="Endocarditis prophylaxis for highest-risk hearts">
          <outline text="Daily hygiene reduces repeated bacteraemia"/>
        </outline>
      </outline>
    </outline>
  </body>
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