periodontal disease classification pathogenesis treatment MBBS dental

Detailed labeled diagram of periodontal disease progression showing 4 stages: 1) Healthy periodontium with gingiva, periodontal ligament, cementum, alveolar bone, enamel, crown and sulcus depth less than 3mm, 2) Gingivitis with inflamed red swollen gingiva, plaque and calculus buildup, bleeding on probing, sulcus 1-3mm, 3) Early periodontitis with periodontal pocket formation, bone loss beginning, plaque biofilm, pocket depth 4-5mm, 4) Advanced periodontitis with deep pocket more than 6mm, severe alveolar bone loss, tooth mobility, subgingival calculus. Medical education diagram style, clean labels, cross-section view of tooth and surrounding tissues

Medical diagram showing the pathogenesis of periodontal disease: dental plaque biofilm on tooth surface with gram-negative anaerobic bacteria (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia labeled as 'Red Complex'), bacterial endotoxins triggering host immune response with neutrophils and macrophages, cytokines (IL-1, TNF-alpha, PGE2) causing inflammation, osteoclast activation leading to alveolar bone resorption, matrix metalloproteinases destroying periodontal ligament. Flow chart style with arrows showing disease progression. Educational medical illustration

mkdir -p /home/daytona/workspace/periodontal-ppt && node /home/daytona/skills/sh…

~/periodontal-ppt/create_pptx.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ── Fetch images ──────────────────────────────────────────────────────────────
const imgData = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ` +
    `"https://cdn.orris.care/image-gen/efda714bea384d3e9010286e6b1ce1d4.png" ` +
    `"https://cdn.orris.care/image-gen/1912dee948be427ab9a4eda7656e1f93.png" ` +
    `"https://cdn.orris.care/cdss_images/e4049e57bdbde5c93587687f30fad16d0b5fee605d7cb4671f8a7adc7532bb5e.png"`
  ).toString()
);
const imgProgression  = imgData[0].base64;  // 4-stage progression diagram
const imgPathogenesis = imgData[1].base64;  // pathogenesis flowchart
const imgAnug         = imgData[2].base64;  // ANUG clinical photo

// ── Palette ───────────────────────────────────────────────────────────────────
// Deep teal dominant, warm coral accent, white + light-grey fill slides
const C = {
  dark:    "0D3D4A",   // deep teal/navy  (title, section headers)
  mid:     "1A7A8A",   // medium teal     (sub-headers, shapes)
  accent:  "E8624A",   // coral red       (highlights, key points)
  accent2: "F4A261",   // warm amber      (secondary accent)
  light:   "EAF4F6",   // very light teal (content slide bg)
  white:   "FFFFFF",
  text:    "1E2D30",   // near-black
  subtext: "4A7280",   // muted teal-grey
};

// ── Presentation setup ────────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout   = "LAYOUT_16x9";
pres.author   = "MBBS 3rd Year Student";
pres.title    = "Periodontal Disease";
pres.subject  = "Dental Posting Seminar Presentation";

// ════════════════════════════════════════════════════════════════════════════
// HELPER FUNCTIONS
// ════════════════════════════════════════════════════════════════════════════

/** Full-slide dark background with decorative teal stripe */
function darkBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.dark }, line: { color: C.dark } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.1, w: 10, h: 0.525, fill: { color: C.mid }, line: { color: C.mid } });
}

/** Light-bg content slides: white with left teal sidebar & top bar */
function lightBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.white }, line: { color: C.white } });
  // Top accent bar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.dark }, line: { color: C.dark } });
  // Left sidebar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.12, w: 0.12, h: 5.505, fill: { color: C.mid }, line: { color: C.mid } });
  // Footer bar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.35, w: 10, h: 0.275, fill: { color: C.light }, line: { color: C.light } });
}

/** Slide title on light bg slides */
function addSlideTitleLight(slide, title, subtitle = "") {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0.12, y: 0.12, w: 9.88, h: 0.85, fill: { color: C.dark }, line: { color: C.dark } });
  slide.addText(title, {
    x: 0.3, y: 0.15, w: 9.4, h: 0.78,
    fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0,
    fontFace: "Calibri"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.3, y: 0.9, w: 9.4, h: 0.28,
      fontSize: 11, color: C.subtext, italic: true, margin: 0, fontFace: "Calibri"
    });
  }
}

/** Footer label on light slides */
function addFooter(slide) {
  slide.addText("Periodontal Disease  |  Dental Posting Seminar", {
    x: 0.2, y: 5.36, w: 9.5, h: 0.22,
    fontSize: 8, color: C.subtext, align: "right", margin: 0, fontFace: "Calibri"
  });
}

/** Section divider slide */
function sectionSlide(title, sub) {
  const s = pres.addSlide();
  darkBg(s);
  // Large accent blob
  s.addShape(pres.shapes.OVAL, { x: 7.2, y: -0.8, w: 4, h: 4, fill: { color: C.mid, transparency: 70 }, line: { color: C.mid, transparency: 70 } });
  s.addShape(pres.shapes.OVAL, { x: -0.5, y: 3.5, w: 2.5, h: 2.5, fill: { color: C.accent, transparency: 75 }, line: { color: C.accent, transparency: 75 } });
  // Section number strip
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 2.2, w: 0.45, h: 1.3, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText(title, {
    x: 0.7, y: 1.9, w: 8.8, h: 1.1,
    fontSize: 32, bold: true, color: C.white, valign: "middle", fontFace: "Calibri"
  });
  s.addText(sub, {
    x: 0.7, y: 3.1, w: 8.8, h: 0.6,
    fontSize: 14, color: C.accent2, italic: true, fontFace: "Calibri"
  });
  return s;
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  // Decorative circles
  s.addShape(pres.shapes.OVAL, { x: 6.8, y: -1, w: 5, h: 5, fill: { color: C.mid, transparency: 65 }, line: { color: C.mid, transparency: 65 } });
  s.addShape(pres.shapes.OVAL, { x: 8.2, y: 3.5, w: 2.5, h: 2.5, fill: { color: C.accent, transparency: 55 }, line: { color: C.accent, transparency: 55 } });
  s.addShape(pres.shapes.OVAL, { x: -0.3, y: 3.8, w: 1.8, h: 1.8, fill: { color: C.accent2, transparency: 60 }, line: { color: C.accent2, transparency: 60 } });
  // Coral accent bar
  s.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 1.3, w: 0.08, h: 2.2, fill: { color: C.accent }, line: { color: C.accent } });
  // Main title
  s.addText("PERIODONTAL DISEASE", {
    x: 0.8, y: 1.05, w: 7.5, h: 1.0,
    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri",
    charSpacing: 4
  });
  // Subtitle
  s.addText("A Comprehensive Seminar for Dental Posting", {
    x: 0.8, y: 2.1, w: 7.5, h: 0.55,
    fontSize: 15, color: C.accent2, italic: true, fontFace: "Calibri"
  });
  // Divider line
  s.addShape(pres.shapes.RECTANGLE, { x: 0.8, y: 2.72, w: 5, h: 0.04, fill: { color: C.mid }, line: { color: C.mid } });
  // Presenter info
  s.addText([
    { text: "Presenter: ", options: { bold: true } },
    { text: "MBBS 3rd Year Student  |  Dental Posting" }
  ], {
    x: 0.8, y: 2.85, w: 7, h: 0.4,
    fontSize: 12, color: C.white, fontFace: "Calibri"
  });
  s.addText("Guided by: Department of Dentistry", {
    x: 0.8, y: 3.3, w: 7, h: 0.35,
    fontSize: 11, color: C.subtext, italic: true, fontFace: "Calibri"
  });
  // Bottom tag
  s.addText("Goldman-Cecil Medicine  |  Harrison's 22E  |  Tintinalli's Emergency Medicine", {
    x: 0, y: 5.26, w: 10, h: 0.28,
    fontSize: 8, color: C.subtext, align: "center", fontFace: "Calibri"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Overview of Topics");
  addFooter(s);

  const topics = [
    ["01", "Anatomy of the Periodontium"],
    ["02", "Definition & Epidemiology"],
    ["03", "Etiology & Risk Factors"],
    ["04", "Pathogenesis"],
    ["05", "Classification & Clinical Features"],
    ["06", "Special Types (ANUG, Abscess)"],
    ["07", "Systemic Associations"],
    ["08", "Diagnosis & Investigations"],
    ["09", "Treatment & Prevention"],
  ];

  const cols = [topics.slice(0, 5), topics.slice(5)];
  const colX = [0.3, 5.2];

  cols.forEach((col, ci) => {
    col.forEach((t, i) => {
      const y = 1.2 + i * 0.75;
      const x = colX[ci];
      // Number badge
      s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
        x: x + 0.1, y: y, w: 0.5, h: 0.45,
        fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.07
      });
      s.addText(t[0], {
        x: x + 0.1, y: y, w: 0.5, h: 0.45,
        fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", margin: 0, fontFace: "Calibri"
      });
      s.addText(t[1], {
        x: x + 0.7, y: y + 0.02, w: 4.0, h: 0.42,
        fontSize: 13, color: C.text, valign: "middle", fontFace: "Calibri"
      });
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — ANATOMY
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Anatomy of the Periodontium", "The four supporting structures of the tooth");
  addFooter(s);

  // Info box left
  const components = [
    { name: "Gingiva", desc: "Pink gum tissue surrounding the tooth. Free gingiva forms the gingival sulcus (<3 mm normal).", color: C.accent },
    { name: "Periodontal Ligament (PDL)", desc: "Dense fibrous connective tissue connecting cementum to alveolar bone. Absorbs occlusal forces.", color: C.mid },
    { name: "Cementum", desc: "Calcified layer covering the tooth root. PDL fibers (Sharpey's fibers) insert here.", color: C.accent2 },
    { name: "Alveolar Bone", desc: "Jaw bone forming the tooth socket (alveolus). Resorbs progressively in periodontitis.", color: "2D8A5E" },
  ];

  components.forEach((c, i) => {
    const y = 1.15 + i * 1.04;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.22, y: y, w: 0.06, h: 0.85, fill: { color: c.color }, line: { color: c.color } });
    s.addText(c.name, {
      x: 0.35, y: y, w: 4.8, h: 0.38,
      fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
    });
    s.addText(c.desc, {
      x: 0.35, y: y + 0.36, w: 4.8, h: 0.52,
      fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
    });
  });

  // Key fact box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.35, y: 4.55, w: 4.4, h: 0.65,
    fill: { color: C.accent }, line: { color: C.accent }, rectRadius: 0.08
  });
  s.addText("KEY FACT: Normal gingival sulcus = <3 mm. Greater than 3 mm = Pathological pocket!", {
    x: 5.4, y: 4.58, w: 4.3, h: 0.58,
    fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
  });

  // Anatomy diagram placeholder with label
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.35, y: 1.1, w: 4.4, h: 3.3,
    fill: { color: C.light }, line: { color: C.mid, pt: 1.5 }, rectRadius: 0.1
  });
  s.addText([
    { text: "TOOTH ANATOMY\n", options: { bold: true, fontSize: 13, breakLine: true } },
    { text: "Crown\n", options: { fontSize: 10, breakLine: true } },
    { text: "Enamel  |  Dentin  |  Pulp\n\n", options: { fontSize: 9, color: C.subtext, breakLine: true } },
    { text: "Neck (Cervix)\n", options: { fontSize: 10, breakLine: true } },
    { text: "Cemento-enamel junction (CEJ)\n\n", options: { fontSize: 9, color: C.subtext, breakLine: true } },
    { text: "Root\n", options: { fontSize: 10, breakLine: true } },
    { text: "Cementum  -->  PDL  -->  Alveolar Bone\n", options: { fontSize: 9, color: C.subtext, breakLine: true } },
  ], {
    x: 5.5, y: 1.2, w: 4.1, h: 3.0,
    color: C.dark, fontFace: "Calibri", valign: "top"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — SECTION DIVIDER: Definition & Epidemiology
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("Definition & Epidemiology", "Understanding the scope of the disease worldwide");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — DEFINITION + EPIDEMIOLOGY
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Definition & Epidemiology");
  addFooter(s);

  // Definition box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 1.08, w: 9.56, h: 1.0,
    fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.1
  });
  s.addText([
    { text: "DEFINITION: ", options: { bold: true, color: C.accent2 } },
    { text: "Periodontal diseases are a group of oral infections affecting the PERIODONTIUM — the hard and soft tissues that support and maintain teeth in the jaws. The most common cause of tooth loss worldwide.", options: { color: C.white } }
  ], {
    x: 0.4, y: 1.1, w: 9.2, h: 0.94,
    fontSize: 12, valign: "middle", fontFace: "Calibri", margin: 0
  });

  // Epi stats as cards
  const stats = [
    { val: "11th", label: "Most prevalent disease\nglobally (WHO, 2016)", color: C.accent },
    { val: "50%+", label: "Adults affected by\nsome form of periodontitis", color: C.mid },
    { val: "#1", label: "Leading cause of\ntooth loss worldwide", color: C.accent2 },
    { val: "2 risk\nfactors", label: "Poor oral hygiene +\nTobacco use (primary)", color: "2D8A5E" },
  ];

  stats.forEach((st, i) => {
    const x = 0.22 + i * 2.42;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 2.25, w: 2.28, h: 2.85,
      fill: { color: C.white }, line: { color: st.color, pt: 2 }, rectRadius: 0.12,
      shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.1 }
    });
    s.addShape(pres.shapes.RECTANGLE, { x, y: 2.25, w: 2.28, h: 0.9, fill: { color: st.color }, line: { color: st.color } });
    s.addText(st.val, {
      x: x + 0.05, y: 2.28, w: 2.18, h: 0.84,
      fontSize: 22, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
    });
    s.addText(st.label, {
      x: x + 0.1, y: 3.2, w: 2.08, h: 1.75,
      fontSize: 11, color: C.text, align: "center", valign: "top", fontFace: "Calibri"
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — ETIOLOGY & RISK FACTORS
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Etiology & Risk Factors");
  addFooter(s);

  // Left: Primary causes
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 1.1, w: 4.5, h: 3.9,
    fill: { color: C.light }, line: { color: C.mid, pt: 1 }, rectRadius: 0.1
  });
  s.addText("PRIMARY CAUSE", {
    x: 0.3, y: 1.15, w: 4.3, h: 0.38,
    fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
  });
  const primary = [
    "Dental PLAQUE — microbial biofilm on teeth (gram-negative anaerobes)",
    "CALCULUS (Tartar) — mineralized plaque, cannot be removed by brushing",
    "Key bacteria — 'Red Complex':\n  • Porphyromonas gingivalis\n  • Treponema denticola\n  • Tannerella forsythia",
    "LPS (endotoxins) from gram-negative bacteria trigger host immune response",
  ];
  primary.forEach((p, i) => {
    s.addShape(pres.shapes.OVAL, { x: 0.35, y: 1.67 + i * 0.77, w: 0.2, h: 0.2, fill: { color: C.accent }, line: { color: C.accent } });
    s.addText(p, { x: 0.62, y: 1.63 + i * 0.77, w: 4.0, h: 0.68, fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0 });
  });

  // Right: Risk factors
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.0, y: 1.1, w: 4.8, h: 3.9,
    fill: { color: C.light }, line: { color: C.accent, pt: 1 }, rectRadius: 0.1
  });
  s.addText("RISK FACTORS", {
    x: 5.1, y: 1.15, w: 4.5, h: 0.38,
    fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
  });
  const risks = [
    { icon: "★", label: "Poor oral hygiene", note: "(PRIMARY)" },
    { icon: "★", label: "Tobacco use", note: "5-7x increased risk" },
    { icon: "●", label: "Diabetes mellitus", note: "Bidirectional relationship" },
    { icon: "●", label: "Hormonal changes", note: "Pregnancy, puberty" },
    { icon: "●", label: "Medications", note: "Phenytoin, Cyclosporine, Amlodipine" },
    { icon: "●", label: "HIV / Immunosuppression", note: "Severe, rapid progression" },
    { icon: "○", label: "Stress, malnutrition, poor sleep", note: "" },
    { icon: "○", label: "Genetics", note: "Family history" },
  ];
  risks.forEach((r, i) => {
    const isKey = r.icon === "★";
    s.addText([
      { text: r.label + " ", options: { bold: isKey, color: isKey ? C.accent : C.text } },
      { text: r.note, options: { color: C.subtext, italic: true } }
    ], { x: 5.25, y: 1.64 + i * 0.43, w: 4.3, h: 0.38, fontSize: 11, fontFace: "Calibri", margin: 0 });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — SECTION: PATHOGENESIS
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("Pathogenesis", "How plaque transforms into tissue destruction");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — PATHOGENESIS with diagram
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Pathogenesis of Periodontal Disease");
  addFooter(s);

  // Pathogenesis steps as flow arrows
  const steps = [
    { num: "1", text: "Dental PLAQUE accumulates on tooth surface", color: C.dark },
    { num: "2", text: "Gram-negative bacteria release LPS / endotoxins", color: C.mid },
    { num: "3", text: "Neutrophils & macrophages recruited → release IL-1β, TNF-α, PGE2", color: C.mid },
    { num: "4", text: "MMPs destroy periodontal ligament collagen", color: C.accent2 },
    { num: "5", text: "Osteoclast activation → ALVEOLAR BONE RESORPTION", color: C.accent },
    { num: "6", text: "Pocket deepens → more anaerobes → progressive bone loss", color: C.accent },
  ];

  steps.forEach((st, i) => {
    const row = Math.floor(i / 3);
    const col = i % 3;
    const x = 0.22 + col * 3.27;
    const y = 1.12 + row * 1.9;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y, w: 3.0, h: 1.62,
      fill: { color: C.white }, line: { color: st.color, pt: 2 }, rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 6, offset: 2, angle: 135, opacity: 0.12 }
    });
    s.addShape(pres.shapes.OVAL, {
      x: x + 0.08, y: y + 0.08, w: 0.45, h: 0.45,
      fill: { color: st.color }, line: { color: st.color }
    });
    s.addText(st.num, {
      x: x + 0.08, y: y + 0.08, w: 0.45, h: 0.45,
      fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
    });
    s.addText(st.text, {
      x: x + 0.1, y: y + 0.62, w: 2.8, h: 0.9,
      fontSize: 10.5, color: C.text, align: "center", valign: "top", fontFace: "Calibri"
    });
    // Arrow between steps within same row
    if (col < 2) {
      s.addShape(pres.shapes.RECTANGLE, { x: x + 3.0, y: y + 0.71, w: 0.27, h: 0.12, fill: { color: C.mid }, line: { color: C.mid } });
    }
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — PATHOGENESIS DIAGRAM IMAGE
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Pathogenesis Diagram");
  addFooter(s);
  s.addImage({ data: imgPathogenesis, x: 0.4, y: 1.05, w: 9.2, h: 4.1 });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — SECTION: Classification
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("Classification & Clinical Features", "From healthy gingiva to tooth loss");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — DISEASE PROGRESSION DIAGRAM
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Disease Progression: 4 Stages");
  addFooter(s);
  s.addImage({ data: imgProgression, x: 0.2, y: 1.05, w: 9.6, h: 4.1 });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — GINGIVITIS vs PERIODONTITIS
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Gingivitis vs Periodontitis", "The key distinction: reversible vs irreversible");
  addFooter(s);

  const cols = [
    {
      title: "GINGIVITIS",
      sub: "REVERSIBLE",
      color: C.mid,
      points: [
        "Inflammation CONFINED to gingiva only",
        "NO bone or ligament destruction",
        "Red, swollen, shiny gingiva (normally pale pink)",
        "Bleeding on brushing / probing (cardinal sign)",
        "Sulcus depth < 3 mm (normal)",
        "Plaque / calculus visible",
        "NO pain (usually)",
        "100% REVERSIBLE with good oral hygiene",
      ]
    },
    {
      title: "PERIODONTITIS",
      sub: "IRREVERSIBLE",
      color: C.accent,
      points: [
        "Extends beyond gingiva to ALL periodontium",
        "Periodontal POCKET formation (>3 mm)",
        "ALVEOLAR BONE LOSS (visible on X-ray)",
        "Periodontal ligament destroyed",
        "Gingival recession (teeth appear longer)",
        "Tooth mobility (late sign)",
        "Halitosis (bad breath)",
        "IRREVERSIBLE tissue destruction",
      ]
    }
  ];

  cols.forEach((c, ci) => {
    const x = 0.22 + ci * 4.9;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 1.1, w: 4.55, h: 4.15,
      fill: { color: C.white }, line: { color: c.color, pt: 2.5 }, rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.1 }
    });
    s.addShape(pres.shapes.RECTANGLE, { x, y: 1.1, w: 4.55, h: 0.75, fill: { color: c.color }, line: { color: c.color } });
    s.addText(c.title, {
      x: x + 0.1, y: 1.12, w: 4.35, h: 0.38,
      fontSize: 16, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0
    });
    s.addText(c.sub, {
      x: x + 0.1, y: 1.5, w: 4.35, h: 0.3,
      fontSize: 10, color: C.white, align: "center", italic: true, fontFace: "Calibri", margin: 0
    });
    c.points.forEach((p, i) => {
      s.addText([
        { text: "• ", options: { color: c.color, bold: true } },
        { text: p }
      ], {
        x: x + 0.15, y: 2.0 + i * 0.39, w: 4.25, h: 0.36,
        fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — 2017 WHO STAGING
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "2017 WHO/AAP Classification: Staging & Grading");
  addFooter(s);

  // Table header
  const headers = ["Stage", "Severity", "CAL Loss", "Pocket Depth", "Bone Loss", "Tooth Loss"];
  const hW      = [0.7,     1.5,        1.4,         1.5,            1.5,         1.5];
  let cx = 0.22;
  headers.forEach((h, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: cx, y: 1.1, w: hW[i], h: 0.4, fill: { color: C.dark }, line: { color: C.dark } });
    s.addText(h, { x: cx, y: 1.1, w: hW[i], h: 0.4, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 });
    cx += hW[i];
  });

  // Table rows
  const rows = [
    { stage: "I\nInitial",   cal: "1-2 mm",  pd: "≤4 mm",  bone: "<15%",   teeth: "None",    color: "2D8A5E" },
    { stage: "II\nModerate", cal: "3-4 mm",  pd: "≤5 mm",  bone: "15-33%", teeth: "None",    color: C.mid },
    { stage: "III\nSevere",  cal: "≥5 mm",   pd: "≥6 mm",  bone: ">33%",   teeth: "≤4",      color: C.accent2 },
    { stage: "IV\nAdvanced", cal: "≥5 mm",   pd: "≥6 mm",  bone: "Extend", teeth: "≥5",      color: C.accent },
  ];
  const complexities = [
    "Probing ≤4 mm, horizontal bone loss",
    "Probing ≤5 mm, horizontal bone loss",
    "Probing ≥6 mm, vertical bone loss ≥3 mm, furcation Class II/III",
    "Masticatory dysfunction, secondary occlusal trauma, severe ridge defect",
  ];

  rows.forEach((r, ri) => {
    const y = 1.52 + ri * 0.82;
    const bg = ri % 2 === 0 ? C.white : C.light;
    const rowData = [r.stage, complexities[ri], r.cal, r.pd, r.bone, r.teeth];
    let rx = 0.22;
    rowData.forEach((cell, ci) => {
      s.addShape(pres.shapes.RECTANGLE, { x: rx, y, w: hW[ci], h: 0.78, fill: { color: ci === 0 ? r.color : bg }, line: { color: "D0DCE0", pt: 0.5 } });
      s.addText(cell, {
        x: rx + 0.04, y, w: hW[ci] - 0.08, h: 0.78,
        fontSize: ci === 0 ? 11 : 9.5,
        bold: ci === 0, color: ci === 0 ? C.white : C.text,
        align: "center", valign: "middle", fontFace: "Calibri", margin: 0
      });
      rx += hW[ci];
    });
  });

  // Grading note
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 4.84, w: 9.56, h: 0.45,
    fill: { color: C.dark }, line: { color: C.dark }, rectRadius: 0.06
  });
  s.addText("GRADING:  Grade A = Slow progression  |  Grade B = Moderate  |  Grade C = Rapid progression (worst prognosis)", {
    x: 0.3, y: 4.86, w: 9.3, h: 0.4,
    fontSize: 10.5, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — SECTION: Special Types
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("Special Types of Periodontal Disease", "ANUG, Periodontal Abscess, HIV-Associated Disease");

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — ANUG
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Acute Necrotizing Ulcerative Gingivitis (ANUG)", "Also known as Vincent's Disease or Trench Mouth");
  addFooter(s);

  // Clinical photo
  s.addImage({ data: imgAnug, x: 0.22, y: 1.12, w: 3.8, h: 3.85, altText: "ANUG clinical photo" });
  s.addText("Clinical Photo: ANUG — severely inflamed, bleeding gums with punched-out interdental papillae\n(Source: Tintinalli's Emergency Medicine)", {
    x: 0.22, y: 4.95, w: 3.8, h: 0.35,
    fontSize: 7.5, color: C.subtext, italic: true, fontFace: "Calibri"
  });

  // Right panel
  const rightX = 4.3;
  // Diagnostic triad
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: rightX, y: 1.12, w: 5.5, h: 1.4,
    fill: { color: C.accent }, line: { color: C.accent }, rectRadius: 0.1
  });
  s.addText("DIAGNOSTIC TRIAD", {
    x: rightX + 0.15, y: 1.15, w: 5.2, h: 0.38,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const triad = ["1. PAIN (acute onset)", "2. Punched-out ulcerated interdental papillae", "3. Gingival BLEEDING"];
  triad.forEach((t, i) => {
    s.addText(t, {
      x: rightX + 0.2, y: 1.55 + i * 0.31, w: 5.1, h: 0.28,
      fontSize: 11, bold: i === 0 || i === 1, color: C.white, fontFace: "Calibri", margin: 0
    });
  });

  // Secondary features
  s.addText("Secondary Signs:", {
    x: rightX + 0.05, y: 2.65, w: 5.0, h: 0.3,
    fontSize: 11, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
  });
  const sec = ["Fetid halitosis (foul breath)", "Pseudomembrane formation", "Foul metallic taste", "Fever, malaise, lymphadenopathy", "Tooth mobility"];
  sec.forEach((f, i) => {
    s.addText("• " + f, {
      x: rightX + 0.1, y: 2.96 + i * 0.3, w: 5.2, h: 0.28,
      fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
    });
  });

  // Organisms
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: rightX, y: 4.52, w: 5.5, h: 0.62,
    fill: { color: C.light }, line: { color: C.mid, pt: 1 }, rectRadius: 0.08
  });
  s.addText([
    { text: "KEY ORGANISMS: ", options: { bold: true, color: C.dark } },
    { text: "Treponema, Fusobacterium, Prevotella, Selenomonas (anaerobes)", options: { color: C.text } }
  ], {
    x: rightX + 0.1, y: 4.55, w: 5.3, h: 0.55,
    fontSize: 10.5, valign: "middle", fontFace: "Calibri", margin: 0
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — ANUG Treatment & Periodontal Abscess
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "ANUG Treatment + Periodontal Abscess");
  addFooter(s);

  // ANUG treatment
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 1.1, w: 4.55, h: 4.15,
    fill: { color: C.white }, line: { color: C.mid, pt: 2 }, rectRadius: 0.1
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.22, y: 1.1, w: 4.55, h: 0.52, fill: { color: C.mid }, line: { color: C.mid } });
  s.addText("ANUG — TREATMENT", {
    x: 0.32, y: 1.12, w: 4.35, h: 0.46,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const anugTx = [
    "Chlorhexidine 0.12% oral rinses — TWICE DAILY (mainstay)",
    "Professional debridement and scaling",
    "Metronidazole — adjunctive (immunocompromised or systemic infection)",
    "Pain relief expected within 24 hrs of treatment",
    "Soft diet rich in protein, vitamins, fluids",
    "Identify and eliminate predisposing factors",
    "Treat HIV / control DM if underlying",
    "Reduce stress, quit smoking",
  ];
  anugTx.forEach((t, i) => {
    s.addText([
      { text: "✓ ", options: { color: C.mid, bold: true } },
      { text: t }
    ], {
      x: 0.32, y: 1.73 + i * 0.42, w: 4.25, h: 0.38,
      fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
    });
  });

  // Periodontal abscess
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.0, y: 1.1, w: 4.8, h: 4.15,
    fill: { color: C.white }, line: { color: C.accent, pt: 2 }, rectRadius: 0.1
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 5.0, y: 1.1, w: 4.8, h: 0.52, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText("PERIODONTAL ABSCESS", {
    x: 5.1, y: 1.12, w: 4.6, h: 0.46,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const abItems = [
    { label: "Definition", val: "Plaque/debris trapped in periodontal pocket → pus formation" },
    { label: "Symptoms", val: "Severe pain, swelling, purulent discharge, tooth tender to bite" },
    { label: "Small abscess", val: "Warm saline rinses + Chlorhexidine 0.12% + systemic antibiotics" },
    { label: "Large abscess", val: "Incision & Drainage (I&D) required" },
    { label: "Antibiotics", val: "Amoxicillin 250mg TDS x3 days OR Metronidazole" },
    { label: "Analgesia", val: "NSAIDs preferred (over opioids)" },
    { label: "Gingival abscess", val: "Remove foreign body (popcorn, food), irrigate — resolves quickly" },
  ];
  abItems.forEach((ab, i) => {
    s.addText([
      { text: ab.label + ": ", options: { bold: true, color: C.accent } },
      { text: ab.val }
    ], {
      x: 5.1, y: 1.73 + i * 0.49, w: 4.55, h: 0.44,
      fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — SYSTEMIC ASSOCIATIONS
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Systemic Associations of Periodontal Disease");
  addFooter(s);

  // Banner
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 1.08, w: 9.56, h: 0.55,
    fill: { color: C.light }, line: { color: C.mid, pt: 1 }, rectRadius: 0.08
  });
  s.addText("The mouth is the mirror of the body — periodontal inflammation has far-reaching systemic consequences", {
    x: 0.35, y: 1.1, w: 9.2, h: 0.5,
    fontSize: 11, italic: true, color: C.mid, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
  });

  const cards = [
    { disease: "Diabetes Mellitus", relation: "BIDIRECTIONAL", detail: "Periodontitis worsens glycemic control; DM accelerates bone loss. HbA1c control improves periodontal outcomes.", color: C.accent },
    { disease: "Cardiovascular Disease", relation: "ASSOCIATION", detail: "Chronic inflammation → atherogenesis. Epidemiologic association shown; causal role unproven (Harrison's 22E).", color: "C0392B" },
    { disease: "Stroke", relation: "ASSOCIATION", detail: "Moderate but significant epidemiologic link with chronic periodontal inflammation.", color: C.mid },
    { disease: "HIV/AIDS", relation: "DIRECT CAUSE", detail: "ANUG, linear gingival erythema, severe destructive periodontitis (CD4 <200 = highest risk).", color: C.accent2 },
    { disease: "Preterm Birth", relation: "ASSOCIATION", detail: "Bacterial translocation and inflammatory mediators (PGE2) may trigger early labor.", color: "2D8A5E" },
    { disease: "Respiratory Disease", relation: "ASSOCIATION", detail: "Aspiration of oral bacteria can worsen COPD and pneumonia in susceptible patients.", color: C.subtext },
  ];

  const grid = [[0,1,2],[3,4,5]];
  grid.forEach((row, ri) => {
    row.forEach((ci) => {
      const card = cards[ci];
      const x = 0.22 + (ci % 3) * 3.25;
      const y = 1.75 + ri * 1.72;
      s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
        x, y, w: 3.05, h: 1.55,
        fill: { color: C.white }, line: { color: card.color, pt: 2 }, rectRadius: 0.1,
        shadow: { type: "outer", color: "000000", blur: 6, offset: 2, angle: 135, opacity: 0.1 }
      });
      s.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.05, h: 0.45, fill: { color: card.color }, line: { color: card.color } });
      s.addText(card.disease, {
        x: x + 0.08, y: y + 0.02, w: 2.2, h: 0.4,
        fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", margin: 0
      });
      s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
        x: x + 2.28, y: y + 0.06, w: 0.72, h: 0.3,
        fill: { color: C.white }, line: { color: C.white }, rectRadius: 0.05
      });
      s.addText(card.relation, {
        x: x + 2.28, y: y + 0.06, w: 0.72, h: 0.3,
        fontSize: 6.5, bold: true, color: card.color, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
      });
      s.addText(card.detail, {
        x: x + 0.1, y: y + 0.5, w: 2.85, h: 1.0,
        fontSize: 9.5, color: C.text, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — DIAGNOSIS & INVESTIGATIONS
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Diagnosis & Investigations");
  addFooter(s);

  const inv = [
    { title: "Periodontal Probing", icon: "P", detail: "Gold standard. Pocket depth >3 mm = pathological. Use graduated probe at 6 sites per tooth. BOP (bleeding on probing) = active inflammation.", color: C.dark },
    { title: "Intraoral Periapical X-ray (IOPA)", icon: "X", detail: "Assesses alveolar bone height and morphology of bone loss (horizontal vs vertical pattern). Earliest change: loss of lamina dura.", color: C.mid },
    { title: "OPG (Orthopantomogram)", icon: "O", detail: "Full-mouth panoramic view for overall bone level assessment. Used for treatment planning.", color: C.accent2 },
    { title: "Plaque Index / Oral Hygiene Index", icon: "I", detail: "Quantifies plaque and calculus accumulation. OHI-S (Simplified) by Greene & Vermillion widely used.", color: "2D8A5E" },
    { title: "Blood Investigations", icon: "B", detail: "FBS/HbA1c (diabetes), CBC (infection/leukemia), HIV serology (in ANUG or severe disease), Vitamin C levels (scurvy).", color: C.accent },
    { title: "Microbiological Culture", icon: "M", detail: "Rarely needed. Reserved for refractory cases; identifies dominant pathogens for targeted antibiotic therapy.", color: C.subtext },
  ];

  inv.forEach((item, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.22 + col * 4.88;
    const y = 1.12 + row * 1.42;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y, w: 4.6, h: 1.28,
      fill: { color: C.white }, line: { color: item.color, pt: 1.5 }, rectRadius: 0.08,
      shadow: { type: "outer", color: "000000", blur: 4, offset: 1, angle: 135, opacity: 0.08 }
    });
    s.addShape(pres.shapes.OVAL, { x: x + 0.1, y: y + 0.1, w: 0.48, h: 0.48, fill: { color: item.color }, line: { color: item.color } });
    s.addText(item.icon, {
      x: x + 0.1, y: y + 0.1, w: 0.48, h: 0.48,
      fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
    });
    s.addText(item.title, {
      x: x + 0.66, y: y + 0.1, w: 3.8, h: 0.38,
      fontSize: 12, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
    });
    s.addText(item.detail, {
      x: x + 0.15, y: y + 0.54, w: 4.3, h: 0.68,
      fontSize: 10, color: C.text, fontFace: "Calibri", margin: 0
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — TREATMENT
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Treatment of Periodontal Disease", "Non-surgical first, then surgical if needed");
  addFooter(s);

  // Non-surgical
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.22, y: 1.1, w: 4.55, h: 4.15,
    fill: { color: C.white }, line: { color: C.mid, pt: 2 }, rectRadius: 0.1
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.22, y: 1.1, w: 4.55, h: 0.55, fill: { color: C.mid }, line: { color: C.mid } });
  s.addText("NON-SURGICAL (First Line)", {
    x: 0.32, y: 1.12, w: 4.35, h: 0.5,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const nonSurg = [
    { step: "1", text: "Oral hygiene instructions (Bass technique brushing, flossing, interdental brushes)" },
    { step: "2", text: "SCALING — removal of supragingival plaque + calculus" },
    { step: "3", text: "ROOT PLANING — subgingival calculus removal + infected cementum debridement" },
    { step: "4", text: "Chlorhexidine 0.12% rinse twice daily (short-term antiseptic)" },
    { step: "5", text: "Antibiotics (Amoxicillin 250mg TDS x3d OR Clindamycin) — ONLY if systemic spread or immunocompromised" },
    { step: "6", text: "Control risk factors: quit smoking, control DM, review medications" },
  ];
  nonSurg.forEach((ns, i) => {
    s.addShape(pres.shapes.OVAL, { x: 0.32, y: 1.77 + i * 0.55, w: 0.32, h: 0.32, fill: { color: C.mid }, line: { color: C.mid } });
    s.addText(ns.step, {
      x: 0.32, y: 1.77 + i * 0.55, w: 0.32, h: 0.32,
      fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0
    });
    s.addText(ns.text, {
      x: 0.72, y: 1.75 + i * 0.55, w: 3.9, h: 0.5,
      fontSize: 10, color: C.text, fontFace: "Calibri", margin: 0
    });
  });

  // Surgical
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.0, y: 1.1, w: 4.8, h: 2.0,
    fill: { color: C.white }, line: { color: C.accent, pt: 2 }, rectRadius: 0.1
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 5.0, y: 1.1, w: 4.8, h: 0.55, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText("SURGICAL (Refractory/Advanced)", {
    x: 5.1, y: 1.12, w: 4.6, h: 0.5,
    fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const surg = [
    "Flap surgery (access for deep pocket cleaning)",
    "Bone grafting (regeneration of lost bone)",
    "Guided tissue regeneration (GTR)",
    "Gingivectomy (for drug-induced hyperplasia)",
    "Extraction of hopeless teeth",
  ];
  surg.forEach((sg, i) => {
    s.addText("• " + sg, {
      x: 5.1, y: 1.75 + i * 0.27, w: 4.55, h: 0.25,
      fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
    });
  });

  // Drug-induced box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 5.0, y: 3.25, w: 4.8, h: 2.0,
    fill: { color: C.light }, line: { color: C.accent2, pt: 1.5 }, rectRadius: 0.1
  });
  s.addText("Drug-Induced Gingival Hyperplasia", {
    x: 5.1, y: 3.28, w: 4.6, h: 0.38,
    fontSize: 12, bold: true, color: C.dark, fontFace: "Calibri", margin: 0
  });
  const drugs = [
    { drug: "Phenytoin", use: "(anti-epileptic)" },
    { drug: "Cyclosporine", use: "(immunosuppressant)" },
    { drug: "Amlodipine", use: "(calcium channel blocker)" },
  ];
  drugs.forEach((d, i) => {
    s.addText([
      { text: d.drug, options: { bold: true, color: C.accent2 } },
      { text: " " + d.use }
    ], {
      x: 5.1, y: 3.7 + i * 0.35, w: 4.55, h: 0.32,
      fontSize: 11, color: C.text, fontFace: "Calibri", margin: 0
    });
  });
  s.addText("Management: Substitute drug if possible → Scale → Gingivectomy", {
    x: 5.1, y: 4.77, w: 4.55, h: 0.38,
    fontSize: 10, color: C.subtext, italic: true, fontFace: "Calibri", margin: 0
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 20 — PREVENTION
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  addSlideTitleLight(s, "Prevention of Periodontal Disease", "Primary, Secondary & Tertiary Prevention");
  addFooter(s);

  const preventions = [
    {
      level: "PRIMARY", color: "2D8A5E",
      points: [
        "Twice daily brushing — Bass technique",
        "Daily flossing (interdental cleaning)",
        "Fluoride toothpaste use",
        "Stop smoking (single most modifiable factor)",
        "Healthy diet (Vitamin C prevents scurvy-related gingival disease)",
        "Water fluoridation (public health)",
      ]
    },
    {
      level: "SECONDARY", color: C.mid,
      points: [
        "Regular dental check-ups every 6 months",
        "Professional scaling and polishing",
        "Early detection via periodontal probing",
        "Radiographic screening in high-risk groups",
        "Chlorhexidine rinses for at-risk patients",
        "Diabetic control (bidirectional benefit)",
      ]
    },
    {
      level: "TERTIARY", color: C.accent,
      points: [
        "Root planing to arrest disease progression",
        "Periodontal surgery for advanced pockets",
        "Bone grafting to restore lost support",
        "Prosthetic rehabilitation after tooth loss",
        "Maintenance therapy every 3-6 months",
        "Implants as tooth replacement option",
      ]
    },
  ];

  preventions.forEach((p, i) => {
    const x = 0.22 + i * 3.27;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 1.1, w: 3.05, h: 4.15,
      fill: { color: C.white }, line: { color: p.color, pt: 2 }, rectRadius: 0.1
    });
    s.addShape(pres.shapes.RECTANGLE, { x, y: 1.1, w: 3.05, h: 0.52, fill: { color: p.color }, line: { color: p.color } });
    s.addText(p.level, {
      x: x + 0.1, y: 1.12, w: 2.85, h: 0.46,
      fontSize: 14, bold: true, color: C.white, align: "center", fontFace: "Calibri", margin: 0
    });
    p.points.forEach((pt, pi) => {
      s.addText([
        { text: "✓ ", options: { color: p.color, bold: true } },
        { text: pt }
      ], {
        x: x + 0.12, y: 1.73 + pi * 0.55, w: 2.8, h: 0.5,
        fontSize: 10.5, color: C.text, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 21 — KEY TAKEAWAYS / SUMMARY
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.OVAL, { x: 7.5, y: -0.5, w: 3.5, h: 3.5, fill: { color: C.mid, transparency: 70 }, line: { color: C.mid, transparency: 70 } });
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  s.addText("KEY TAKEAWAYS", {
    x: 0.4, y: 0.22, w: 9.2, h: 0.6,
    fontSize: 24, bold: true, color: C.white, align: "center", charSpacing: 3, fontFace: "Calibri"
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 2.5, y: 0.85, w: 5, h: 0.04, fill: { color: C.accent }, line: { color: C.accent } });

  const takeaways = [
    { num: "1", text: "Periodontal disease = continuum from GINGIVITIS (reversible) → PERIODONTITIS (irreversible bone loss)", color: C.accent },
    { num: "2", text: "PRIMARY CAUSE: Dental plaque biofilm. Key pathogens = Red Complex (P. gingivalis, T. denticola, T. forsythia)", color: C.accent2 },
    { num: "3", text: "ANUG (Trench Mouth) = Pain + Punched-out papillae + Bleeding. Treat with Chlorhexidine + Metronidazole", color: "2D8A5E" },
    { num: "4", text: "SYSTEMIC LINKS: Diabetes (bidirectional), CVD, HIV, Preterm birth — the mouth reflects systemic health", color: C.mid },
    { num: "5", text: "TREATMENT: Non-surgical FIRST (Scaling + Root Planing) → Surgical only for refractory/advanced cases", color: C.accent },
    { num: "6", text: "PREVENTION: Brushing + Flossing + Stop Smoking + Control Diabetes + 6-monthly professional cleaning", color: C.accent2 },
  ];

  takeaways.forEach((t, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
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    const y = 1.05 + row * 1.35;
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      x, y, w: 4.65, h: 1.22,
      fill: { color: C.dark }, line: { color: t.color, pt: 1.5 }, rectRadius: 0.08
    });
    s.addShape(pres.shapes.OVAL, { x: x + 0.1, y: y + 0.08, w: 0.42, h: 0.42, fill: { color: t.color }, line: { color: t.color } });
    s.addText(t.num, {
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      fontSize: 10.5, color: C.white, fontFace: "Calibri", margin: 0, valign: "middle"
    });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 22 — THANK YOU
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.shapes.OVAL, { x: 6.5, y: -1, w: 5.5, h: 5.5, fill: { color: C.mid, transparency: 65 }, line: { color: C.mid, transparency: 65 } });
  s.addShape(pres.shapes.OVAL, { x: -1, y: 3.2, w: 3, h: 3, fill: { color: C.accent, transparency: 60 }, line: { color: C.accent, transparency: 60 } });

  s.addText("THANK YOU", {
    x: 0.5, y: 1.4, w: 9, h: 1.0,
    fontSize: 44, bold: true, color: C.white, align: "center", charSpacing: 8, fontFace: "Calibri"
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 2.5, y: 2.5, w: 5, h: 0.05, fill: { color: C.accent }, line: { color: C.accent } });
  s.addText("Periodontal Disease — Dental Posting Seminar", {
    x: 0.5, y: 2.65, w: 9, h: 0.5,
    fontSize: 14, color: C.accent2, align: "center", italic: true, fontFace: "Calibri"
  });
  s.addText("Questions & Discussion Welcome", {
    x: 0.5, y: 3.25, w: 9, h: 0.45,
    fontSize: 13, color: C.subtext, align: "center", fontFace: "Calibri"
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 3.82, w: 9, h: 0.04, fill: { color: C.mid }, line: { color: C.mid } });
  s.addText("Sources: Harrison's Principles of Internal Medicine 22E  •  Goldman-Cecil Medicine  •  Tintinalli's Emergency Medicine  •  Park's PSM", {
    x: 0.4, y: 3.95, w: 9.2, h: 0.45,
    fontSize: 9, color: C.subtext, align: "center", fontFace: "Calibri"
  });
  s.addText("Prepared by MBBS 3rd Year | Dental Posting", {
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    fontSize: 10, color: C.subtext, align: "center", italic: true, fontFace: "Calibri"
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SAVE
// ════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/periodontal-ppt/Periodontal_Disease_Presentation.pptx" })
  .then(() => console.log("SUCCESS: /home/daytona/workspace/periodontal-ppt/Periodontal_Disease_Presentation.pptx"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/periodontal-ppt && node create_pptx.js 2>&1

cd /home/daytona/workspace/periodontal-ppt && node -e " const { execSync } = req…

cd /home/daytona/workspace/periodontal-ppt && curl -sL "https://cdn.orris.care/i…

~/periodontal-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/periodontal-ppt/create_pptx.js'

~/periodontal-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/periodontal-ppt/create_pptx.js'

~/periodontal-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/periodontal-ppt/create_pptx.js'

~/periodontal-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/periodontal-ppt/create_pptx.js'

~/periodontal-ppt/create_pptx.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/periodontal-ppt/create_pptx.js'

cd /home/daytona/workspace/periodontal-ppt && node create_pptx.js 2>&1

ls -lh /home/daytona/workspace/periodontal-ppt/Periodontal_Disease_Presentation.…