const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Dental & Oral Health – Clinical Overview";
pres.author = "Orris Medical";

// === COLOUR PALETTE ===
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// Text dark: 1A2B35  |  Highlight amber: F2A900  |  White: FFFFFF

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  white:     "FFFFFF",
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  softGray:  "D4EEF7",
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function addSlideHeader(slide, title, subtitle) {
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  // Bottom thin bar
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  slide.addText("Dental & Oral Health | Clinical Reference", {
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  slide.addText("June 2026", {
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}

// ─────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────
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  s.addText("DENTAL & ORAL HEALTH", {
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    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 3, margin: 0
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  s.addText("A Clinical Overview for Healthcare Professionals", {
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  s.addText([
    { text: "Topics Covered: ", options: { bold: true, color: C.amber } },
    { text: "Anatomy  •  Common Conditions  •  Periodontitis  •  Dental Caries  •  Oral Cancer  •  Systemic Links  •  Prevention  •  Clinical Procedures", options: { color: C.white } }
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  s.addText("Prepared by: Clinical Education Department  |  June 2026", {
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}

// ─────────────────────────────────────────
// SLIDE 2 – ANATOMY OF THE ORAL CAVITY
// ─────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.light };
  addSlideHeader(s, "Anatomy of the Oral Cavity", "Slide 2 of 10");

  // Left column – structures list
  const structures = [
    ["Lips & Cheeks", "Labial mucosa / buccal mucosa; key in speech and food manipulation"],
    ["Hard Palate", "Bony roof; formed by palatine processes of maxilla & palatine bones"],
    ["Soft Palate", "Muscular; uvula at posterior; involved in swallowing/phonation"],
    ["Tongue", "Intrinsic/extrinsic muscles; taste buds; lingual nerve (V3), CN VII (taste)"],
    ["Floor of Mouth", "Mylohyoid muscle; sublingual/submandibular salivary glands"],
    ["Teeth", "32 permanent (incisors, canines, premolars, molars); PDL anchors to alveolar bone"],
    ["Periodontium", "Gingiva, cementum, periodontal ligament, alveolar bone"],
    ["Salivary Glands", "Parotid (CN IX), submandibular, sublingual; 1-1.5 L saliva/day"],
  ];

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  const facts = [
    "Oral cavity boundary: lips anteriorly to palatoglossal arches posteriorly",
    "Primary teeth: 20 total; erupt 6 mo–3 yrs",
    "pH <5.5 demineralises enamel (critical caries threshold)",
    "Gingival sulcus depth: 1–3 mm (normal); >3 mm = periodontal pocket",
    "Blood supply: facial artery; lingual artery (branch of ECA)",
    "Lymph drainage: submandibular, submental, deep cervical nodes",
    "Saliva contains: amylase, IgA, lysozyme, mucins — antimicrobial function",
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}

// ─────────────────────────────────────────
// SLIDE 3 – DENTAL CARIES
// ─────────────────────────────────────────
{
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  s.background = { color: C.white };
  addSlideHeader(s, "Dental Caries", "Slide 3 of 10");

  // Title subtitle
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    { label: "MICROBE", sub: "Strep mutans\nLactobacillus\nBiofilm (plaque)", col: C.midBg },
    { label: "SUBSTRATE", sub: "Fermentable\ncarbohydrates\n(sucrose chief)", col: C.amber },
    { label: "TIME", sub: "Duration of\nacid exposure\n> repair capacity", col: "2E7D32" },
  ];
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  });

  const stages = [
    ["Stage 0", "Sound tooth – no clinical evidence"],
    ["Stage 1", "First visual change – white/brown spot (enamel), reversible"],
    ["Stage 2", "Distinct visual change – enamel lesion, no cavitation"],
    ["Stage 3", "Cavitation into enamel only"],
    ["Stage 4", "Shadow of dentine (enamel intact)"],
    ["Stage 5", "Cavitation into dentine"],
    ["Stage 6", "Extensive cavitation – pulp involvement likely"],
  ];
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}

// ─────────────────────────────────────────
// SLIDE 4 – PERIODONTITIS
// ─────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.light };
  addSlideHeader(s, "Periodontitis", "Slide 4 of 10");

  s.addText("Classification (2017 World Workshop) & Clinical Features", {
    x: 0.3, y: 0.62, w: 9.4, h: 0.3, fontSize: 11, italic: true, color: C.midBg, fontFace: "Calibri", margin: 0
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  // Left: Staging & Grading
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  const stages = [
    ["Stage I", "CAL 1-2 mm, probing depth ≤4 mm, no bone loss beyond coronal third"],
    ["Stage II", "CAL 3-4 mm, probing depth ≤5 mm, <15% bone loss, no complexity factors"],
    ["Stage III", "CAL ≥5 mm, PD ≥6 mm, bone loss extending to middle/apical third, tooth loss <4"],
    ["Stage IV", "Stage III + masticatory dysfunction; ≥5 teeth lost due to perio"],
  ];
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  // Right: Grading
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  const grades = [
    ["Grade A", "Slow progression; no risk factors; non-smoker, normoglycaemic"],
    ["Grade B", "Moderate progression; <10% bone loss per year; smoker <10 cig/day"],
    ["Grade C", "Rapid progression; >2 mm bone loss in 5 yrs; DM HbA1c ≥7%; smoker ≥10/day"],
  ];
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  // Bottom: Treatment steps
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  const steps = ["Step 1: Patient Education & Risk Reduction", "Step 2: Supra/Subgingival Debridement (SRP)", "Step 3: Re-evaluation (8–12 wks)", "Step 4: Periodontal Surgery (if needed)", "Step 5: Supportive Perio Therapy"];
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  });
}

// ─────────────────────────────────────────
// SLIDE 5 – ORAL CANCER
// ─────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addSlideHeader(s, "Oral Cancer", "Slide 5 of 10");

  s.addText("Squamous Cell Carcinoma (SCC) accounts for >90% of oral malignancies", {
    x: 0.3, y: 0.62, w: 9.4, h: 0.3, fontSize: 11, italic: true, color: C.midBg, fontFace: "Calibri", margin: 0
  });

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  // Col1 – Epidemiology + Risk Factors
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  s.addText("EPIDEMIOLOGY & RISK FACTORS", { x: 0.3, y: 1.0, w: 4.5, h: 0.3, align: "center", fontSize: 9, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });

  const riskItems = [
    ["Tobacco use", "Single largest risk factor (×6 relative risk); includes chewing tobacco"],
    ["Alcohol", "Synergistic with tobacco (×15 risk when combined)"],
    ["HPV-16/18", "Oropharyngeal SCC strongly linked; increasing incidence in younger pts"],
    ["Chronic UV exposure", "Lower lip carcinoma (actinic cheilitis progression)"],
    ["Betel quid", "Major risk in South/Southeast Asia; causes oral submucous fibrosis"],
    ["Immunosuppression", "HIV, transplant recipients – higher risk for malignant transformation"],
    ["Prior oral SCC", "~20% risk of second primary within 5 years"],
  ];
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  // Col2 – TNM + Screening
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  s.addText("TNM STAGING (AJCC 8th ed.)", { x: 5.1, y: 1.0, w: 4.6, h: 0.3, align: "center", fontSize: 9, bold: true, color: C.white, fontFace: "Calibri", margin: 0 });

  const tnm = [
    ["T1", "≤2 cm, DOI ≤5 mm"],
    ["T2", "≤2 cm DOI >5 mm; or >2–4 cm, DOI ≤10 mm"],
    ["T3", ">4 cm OR any tumour DOI >10 mm"],
    ["T4a", "Invades adjacent structures (cortical bone, deep muscles of tongue, maxillary sinus, skin)"],
    ["T4b", "Masticator space, pterygoid plates, skull base, carotid artery"],
    ["N0", "No regional LN involvement"],
    ["N1", "Single ipsilateral node ≤3 cm, ENE(-)"],
    ["N2a", "Single ipsilateral 3-6 cm, ENE(-)"],
    ["M1", "Distant metastasis (lung, liver, bone most common)"],
  ];
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  });
}

// ─────────────────────────────────────────
// SLIDE 6 – ORAL HEALTH & SYSTEMIC DISEASE
// ─────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.light };
  addSlideHeader(s, "Oral-Systemic Connections", "Slide 6 of 10");

  s.addText("Bidirectional relationships between oral disease and systemic health", {
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    {
      system: "Cardiovascular Disease",
      detail: "Periodontal pathogens (P. gingivalis, F. nucleatum) identified in atheromatous plaques. Meta-analyses show adjusted OR ~1.2-1.5 for CAD in periodontitis patients. Bacteraemia from dental procedures → infective endocarditis risk in high-risk valvular disease.",
      icon: "♥",
      col: "C62828"
    },
    {
      system: "Diabetes Mellitus",
      detail: "True bidirectional link: poor glycaemic control worsens periodontitis; periodontal infection increases insulin resistance. Treating periodontitis reduces HbA1c by ~0.4% (comparable to adding a second-line anti-diabetic). Screen all diabetics for periodontitis.",
      icon: "⚕",
      col: "1565C0"
    },
    {
      system: "Adverse Pregnancy Outcomes",
      detail: "Periodontal disease associated with preterm birth, low birth weight, and pre-eclampsia. Proposed mechanism: IL-6, TNF-α, PGE2 from periodontal tissues enter bloodstream → premature cervical ripening. SRP in pregnancy is safe and recommended.",
      icon: "♀",
      col: "6A1B9A"
    },
    {
      system: "Respiratory Disease",
      detail: "Aspiration of oral bacteria (Streptococcus, anaerobes) → aspiration pneumonia, especially in elderly/ICU/ventilated patients. Oral hygiene in ICU patients reduces VAP by ~40% (Cochrane review). COPD exacerbations linked to periodontitis.",
      icon: "⛽",
      col: "2E7D32"
    },
    {
      system: "Osteoporosis / Medications",
      detail: "Bisphosphonates (alendronate, zoledronate) → MRONJ (medication-related osteonecrosis of jaw). Risk increased with IV bisphosphonates (oncology doses), denosumab. Dental clearance before antiresorptive therapy is best practice.",
      icon: "🦴",
      col: "E65100"
    },
    {
      system: "Alzheimer's Disease",
      detail: "P. gingivalis and its toxins (gingipains) detected in brain tissue of AD patients. Gingipains promote Aβ plaque formation and tau hyperphosphorylation. Longitudinal studies show periodontitis → faster cognitive decline.",
      icon: "🧠",
      col: "00695C"
    },
  ];

  connections.forEach((c, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i % 3;
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  });
}

// ─────────────────────────────────────────
// SLIDE 7 – COMMON ORAL LESIONS
// ─────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  addSlideHeader(s, "Common Oral Mucosal Lesions", "Slide 7 of 10");

  s.addText("Differential diagnosis at a glance", {
    x: 0.3, y: 0.62, w: 9.4, h: 0.3, fontSize: 11, italic: true, color: C.midBg, fontFace: "Calibri", margin: 0
  });

  // Table header
  const cols = ["Lesion", "Appearance", "Location", "Aetiology", "Management"];
  const colWidths = [1.6, 1.9, 1.7, 2.3, 2.2];
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    cx += colWidths[i];
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  const rows = [
    ["Aphthous ulcer", "Round/oval, yellow-grey base, red halo", "Non-keratinised mucosa", "Idiopathic; stress, trauma, deficiency (B12/Fe/folate)", "Topical steroids, chlorhexidine; rarely systemic if RAS"],
    ["Oral candidiasis", "White plaques (removable), erythema, angular cheilitis", "Buccal, palate, tongue", "Candida albicans; immunosuppression, AB use, dry mouth", "Nystatin suspension / fluconazole systemic; treat predispose"],
    ["Leukoplakia", "White patch, cannot be wiped off", "Floor of mouth, lateral tongue, vermilion border", "Unknown; tobacco major risk; ~5% malignant transformation", "Biopsy; cessation of risk; excision if dysplasia"],
    ["Erythroplakia", "Bright red velvety patch", "Floor of mouth, soft palate, tongue", "High-grade dysplasia / carcinoma in situ in >90%", "URGENT biopsy + excision; close surveillance"],
    ["Lichen planus", "Reticular (Wickham striae), erosive, plaque forms", "Buccal mucosa bilaterally", "T-cell mediated autoimmune; drug-induced OLP possible", "Topical steroids; tacrolimus; monitor for SCC"],
    ["Herpes labialis", "Vesicles → painful ulcers → crusting", "Lip (vermilion)/perioral skin", "HSV-1 reactivation; UV, stress, immunosuppression", "Topical/oral aciclovir; reduce triggers"],
    ["OSMF", "Fibrous bands, trismus, blanching mucosa", "Buccal mucosa, palate, lips", "Betel quid/areca nut; 5–10% malignant transformation", "Cessation; intralesional steroids; surgery for advanced"],
  ];

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// ─────────────────────────────────────────
// SLIDE 8 – DENTAL EMERGENCIES
// ─────────────────────────────────────────
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  addSlideHeader(s, "Dental Emergencies", "Slide 8 of 10");

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  const emergencies = [
    {
      title: "Irreversible Pulpitis / Acute Apical Abscess",
      sx: "Spontaneous, severe, lingering pain; localised swelling; tooth tender to percussion",
      mx: "Incision & drainage if fluctuant; pulpectomy (root canal) or extraction; oral antibiotics only if systemic signs (fever, trismus, cellulitis)",
      color: C.darkBg
    },
    {
      title: "Dental Trauma – Avulsion",
      sx: "Complete tooth displacement from socket. Time-critical: replant within 30–60 min for best prognosis",
      mx: "Handle by crown, NOT root. Store in Hanks BSS / milk / saline / saliva. Replant immediately, splint 2 wks. Refer for RCT within 2 wks.",
      color: C.midBg
    },
    {
      title: "Ludwig's Angina",
      sx: "Bilateral submandibular/sublingual/submental space infection; 'woody' floor of mouth; risk of airway compromise",
      mx: "EMERGENCY: Secure airway (may need surgical airway). IV benzylpenicillin + metronidazole. Surgical decompression. ICU admission often required.",
      color: "C62828"
    },
    {
      title: "Dry Socket (Alveolar Osteitis)",
      sx: "Dull aching pain 3–4 days post-extraction; visible empty socket; halitosis; no abscess",
      mx: "Gentle irrigation with chlorhexidine. Alvogyl dressing (eugenol-based). Analgesia. Resolves in 7–10 days.",
      color: "5D4037"
    },
    {
      title: "Periocoronitis",
      sx: "Pain, swelling, trismus around partially erupted lower wisdom tooth; pericoronal flap (operculum); systemic fever if severe",
      mx: "Irrigation under operculum; oral hygiene instruction; chlorhexidine rinse. Antibiotics (amoxicillin or metronidazole) if spreading cellulitis. Extraction of tooth when acute episode resolves.",
      color: "1565C0"
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// ─────────────────────────────────────────
// SLIDE 9 – PREVENTION & ORAL HYGIENE
// ─────────────────────────────────────────
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  addSlideHeader(s, "Prevention & Oral Hygiene", "Slide 9 of 10");

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        "Brush 2×/day, 2 minutes, with fluoride toothpaste (1000–1500 ppm F)",
        "Interdental cleaning daily: floss or interdental brushes (superior for IPD disease)",
        "Fluoride mouthrinse (0.05% NaF daily or 0.2% NaF weekly) for high-caries-risk patients",
        "Tongue cleaning reduces halitosis-causing volatile sulfur compounds",
        "Limit sugar frequency: max 4 sugar exposures/day",
        "Do NOT rinse after brushing — allows fluoride to remain on enamel",
      ]
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      title: "PROFESSIONAL CARE",
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      items: [
        "Recall interval: 3–12 months based on caries/perio risk assessment",
        "Scaling and polishing: remove supra-gingival calculus and plaque",
        "Topical fluoride varnish (22,600 ppm NaF): 2–4 × per year in high-risk",
        "Fissure sealants: first permanent molars in children 6–7 yrs",
        "Radiographic monitoring: bitewings 12–24 monthly (moderate-risk adults)",
        "Oral cancer screening: visual examination + palpation of neck nodes at every recall",
      ]
    },
    {
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      color: "2E7D32",
      items: [
        "Water fluoridation: 0.7 mg/L (USA) / 1 mg/L (UK): safe, effective, reduces caries 25%",
        "Tobacco cessation counselling: 5As model at each dental visit",
        "Dietary advice: COMA/SACN guidance on free sugars <5% total energy",
        "Fluoride supplements: children in non-fluoridated areas (0.25–1 mg/day by age)",
        "Xylitol: gum/lozenges reduce Strep mutans colonisation; 5 g/day in divided doses",
        "Salivacoat substitutes/pilocarpine for xerostomia patients (increase caries risk ×10)",
      ]
    }
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}

// ─────────────────────────────────────────
// SLIDE 10 – KEY CLINICAL GUIDELINES & SUMMARY
// ─────────────────────────────────────────
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  s.addText("DENTAL & ORAL HEALTH  |  CLINICAL REFERENCE", {
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    { org: "ADA / AAP", point: "Periodontal disease classification: use the 2017 EFP/AAP staging & grading system in all clinical documentation." },
    { org: "NICE (UK)", point: "Recall intervals should be risk-stratified: not a universal 6-month recall. Use BPE scoring at every visit." },
    { org: "SIGN 138", point: "Dental anxiety management: offer cognitive behavioural therapy (CBT), sedation (oral/IV), or general anaesthesia in a hospital setting for severe cases." },
    { org: "WHO IARC", point: "HPV vaccination (Gardasil-9) prevents HPV-16/18 — key drivers of oropharyngeal SCC. Recommend in adolescents." },
    { org: "BSSRO / ADA", point: "Pre-dental treatment for antiresorptive therapy: optimise oral health before IV bisphosphonate or denosumab initiation." },
    { org: "PHE / USPHS", point: "Pit & fissure sealants + topical fluoride varnish are first-line caries prevention in children. Cost-effective." },
  ];

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  // Footer
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// ─────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/dental-ppt/Dental_Oral_Health_Clinical.pptx" })
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