"periodontal disease"[MeSH Terms] AND "gingivitis"[MeSH Terms]

mkdir -p /home/daytona/workspace/periodontal-pdf && ls /home/daytona/workspace/

~/periodontal-pdf/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, ListFlowable, ListItem, PageBreak
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import Image as RLImage
import urllib.request
import os
import io

# ── Download images ─────────────────────────────────────────────────────────
IMG_DIR = "/home/daytona/workspace/periodontal-pdf/imgs"
os.makedirs(IMG_DIR, exist_ok=True)

image_urls = {
    "chronic_perio.png":  "https://cdn.orris.care/cdss_images/33356f5f496fb283cc24558359756a3b881076f3538147250b5e8f6bcc49d971.png",
    "normal_gingiva.png": "https://cdn.orris.care/cdss_images/2e0ecc7ac02e9f8b4258175ade4bf4bdede06a0097b16e2ac4914a6abb11abd6.png",
    "advanced_perio.png": "https://cdn.orris.care/cdss_images/6476ed713e2de55cb2834230b1e1c2383ebd66d0a2c4f89105cb99c4b80d9286.png",
    "anug.png":           "https://cdn.orris.care/cdss_images/e4049e57bdbde5c93587687f30fad16d0b5fee605d7cb4671f8a7adc7532bb5e.png",
}

for fname, url in image_urls.items():
    dest = os.path.join(IMG_DIR, fname)
    if not os.path.exists(dest):
        try:
            urllib.request.urlretrieve(url, dest)
            print(f"  Downloaded {fname}")
        except Exception as e:
            print(f"  WARN: could not download {fname}: {e}")

# ── Colour palette ───────────────────────────────────────────────────────────
NAVY      = colors.HexColor("#1A3557")
TEAL      = colors.HexColor("#0D7377")
LIGHT_BG  = colors.HexColor("#EAF4F4")
ACCENT    = colors.HexColor("#F0A500")
WHITE     = colors.white
LIGHT_GREY= colors.HexColor("#F5F7FA")
MID_GREY  = colors.HexColor("#B0BAC9")
DARK_GREY = colors.HexColor("#444444")

# ── Styles ───────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def make_style(name, parent="Normal", **kwargs):
    return ParagraphStyle(name, parent=base[parent], **kwargs)

sTitle   = make_style("sTitle",   "Title",
                       fontSize=26, textColor=WHITE, alignment=TA_CENTER,
                       spaceAfter=4, leading=32)
sSubT    = make_style("sSubT",    "Normal",
                       fontSize=13, textColor=colors.HexColor("#CCE8EA"),
                       alignment=TA_CENTER, spaceAfter=2)
sH1      = make_style("sH1",      "Heading1",
                       fontSize=14, textColor=WHITE,
                       spaceAfter=4, spaceBefore=14, leading=18)
sH2      = make_style("sH2",      "Heading2",
                       fontSize=11, textColor=NAVY,
                       spaceAfter=3, spaceBefore=10, leading=14)
sBody    = make_style("sBody",    "Normal",
                       fontSize=9.5, textColor=DARK_GREY, leading=14,
                       spaceAfter=5, alignment=TA_JUSTIFY)
sBullet  = make_style("sBullet",  "Normal",
                       fontSize=9.5, textColor=DARK_GREY, leading=14,
                       leftIndent=12, spaceAfter=2)
sCaption = make_style("sCaption", "Normal",
                       fontSize=8, textColor=colors.HexColor("#666666"),
                       alignment=TA_CENTER, spaceAfter=6, leading=11)
sFooter  = make_style("sFooter",  "Normal",
                       fontSize=7.5, textColor=MID_GREY, alignment=TA_CENTER)
sBox     = make_style("sBox",     "Normal",
                       fontSize=9.5, textColor=NAVY, leading=14,
                       leftIndent=8, rightIndent=8, spaceAfter=3)
sTH      = make_style("sTH",      "Normal",
                       fontSize=9, textColor=WHITE,
                       alignment=TA_CENTER, leading=12, fontName="Helvetica-Bold")
sTD      = make_style("sTD",      "Normal",
                       fontSize=8.5, textColor=DARK_GREY,
                       alignment=TA_CENTER, leading=12)

# ── Page template with header/footer ────────────────────────────────────────
PAGE_W, PAGE_H = A4
MARGIN = 2.2 * cm

def on_page(canvas, doc):
    canvas.saveState()
    # Header bar
    canvas.setFillColor(NAVY)
    canvas.rect(0, PAGE_H - 1.1*cm, PAGE_W, 1.1*cm, fill=1, stroke=0)
    canvas.setFillColor(WHITE)
    canvas.setFont("Helvetica-Bold", 8)
    canvas.drawString(MARGIN, PAGE_H - 0.72*cm, "Gingivitis & Periodontal Disease")
    canvas.setFont("Helvetica", 8)
    canvas.drawRightString(PAGE_W - MARGIN, PAGE_H - 0.72*cm,
                           "Medical Reference | Orris")
    # Footer
    canvas.setFillColor(NAVY)
    canvas.rect(0, 0, PAGE_W, 0.9*cm, fill=1, stroke=0)
    canvas.setFillColor(WHITE)
    canvas.setFont("Helvetica", 7.5)
    canvas.drawCentredString(PAGE_W/2, 0.32*cm,
        f"Page {doc.page}  •  Sources: Sherris & Ryan's Medical Microbiology | "
        "Tintinalli's Emergency Medicine | Scott-Brown's Otorhinolaryngology | "
        "Cummings Otolaryngology")
    canvas.restoreState()

def on_first_page(canvas, doc):
    canvas.saveState()
    # Hero gradient strip
    canvas.setFillColor(NAVY)
    canvas.rect(0, PAGE_H - 6.5*cm, PAGE_W, 6.5*cm, fill=1, stroke=0)
    canvas.setFillColor(TEAL)
    canvas.rect(0, PAGE_H - 6.5*cm, PAGE_W, 0.4*cm, fill=1, stroke=0)
    # Footer
    canvas.setFillColor(NAVY)
    canvas.rect(0, 0, PAGE_W, 0.9*cm, fill=1, stroke=0)
    canvas.setFillColor(WHITE)
    canvas.setFont("Helvetica", 7.5)
    canvas.drawCentredString(PAGE_W/2, 0.32*cm,
        "Sources: Sherris & Ryan's Medical Microbiology | Tintinalli's Emergency Medicine | "
        "Scott-Brown's Otorhinolaryngology | Cummings Otolaryngology")
    canvas.restoreState()

# ── Helper builders ──────────────────────────────────────────────────────────
def section_header(text):
    """Coloured section header band."""
    data = [[Paragraph(text, sH1)]]
    t = Table(data, colWidths=[PAGE_W - 2*MARGIN])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), TEAL),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def info_box(paragraphs):
    """Light-blue callout box."""
    data = [[p] for p in paragraphs]
    t = Table(data, colWidths=[PAGE_W - 2*MARGIN - 1.6*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), LIGHT_BG),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 14),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("LINEAFTER",  (0,0), (0,-1), 4, TEAL),
    ]))
    return t

def two_col_images(path1, cap1, path2, cap2, w=7.2*cm):
    img_cells = []
    for path, cap in [(path1,cap1),(path2,cap2)]:
        cell = []
        if path and os.path.exists(path):
            cell.append(RLImage(path, width=w, height=5*cm))
        cell.append(Paragraph(cap, sCaption))
        img_cells.append(cell)
    t = Table([img_cells], colWidths=[(PAGE_W-2*MARGIN)/2]*2)
    t.setStyle(TableStyle([
        ("ALIGN", (0,0), (-1,-1), "CENTER"),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("TOPPADDING", (0,0), (-1,-1), 4),
    ]))
    return t

def single_image(path, cap, w=10*cm, h=6*cm):
    cells = []
    if path and os.path.exists(path):
        cells.append(RLImage(path, width=w, height=h))
    cells.append(Paragraph(cap, sCaption))
    t = Table([[c] for c in cells], colWidths=[PAGE_W-2*MARGIN])
    t.setStyle(TableStyle([
        ("ALIGN", (0,0), (-1,-1), "CENTER"),
        ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
        ("TOPPADDING", (0,0), (-1,-1), 4),
    ]))
    return t

def make_table(headers, rows, col_widths=None):
    if col_widths is None:
        n = len(headers)
        col_widths = [(PAGE_W - 2*MARGIN) / n] * n
    th_row = [Paragraph(h, sTH) for h in headers]
    td_rows = [[Paragraph(str(c), sTD) for c in row] for row in rows]
    data = [th_row] + td_rows
    t = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",    (0,0), (-1,0),  NAVY),
        ("BACKGROUND",    (0,1), (-1,-1), LIGHT_GREY),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, LIGHT_GREY]),
        ("GRID",          (0,0), (-1,-1), 0.4, MID_GREY),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ]
    t.setStyle(TableStyle(style))
    return t

# ── Build story ──────────────────────────────────────────────────────────────
story = []

# ─── COVER (first page content) ─────────────────────────────────────────────
story.append(Spacer(1, 5.2*cm))   # space below hero bar
story.append(Paragraph("Gingivitis & Periodontal Disease", sTitle))
story.append(Paragraph("A Comprehensive Medical Reference", sSubT))
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph(
    "Sources: Sherris & Ryan's Medical Microbiology · Tintinalli's Emergency Medicine · "
    "Scott-Brown's Otorhinolaryngology · Cummings Otolaryngology · Junqueira's Basic Histology",
    sSubT))
story.append(Spacer(1, 1*cm))
story.append(HRFlowable(width="100%", thickness=1, color=TEAL, spaceAfter=12))

# Quick overview box
story.append(info_box([
    Paragraph("<b>Overview</b>", sBox),
    Paragraph(
        "Periodontal disease is a continuum that begins with <b>gingivitis</b> — reversible "
        "inflammation of the marginal gingiva — and may progress to <b>chronic periodontitis</b>, "
        "with irreversible destruction of the periodontal ligament, alveolar bone, and ultimately "
        "tooth loss. Both conditions are driven by polymicrobial anaerobic plaque bacteria, modified "
        "by host immune response, genetics, and systemic factors.",
        sBox),
]))
story.append(Spacer(1, 0.6*cm))

# Chronic periodontitis hero image
p = os.path.join(IMG_DIR, "chronic_perio.png")
story.append(single_image(p,
    "Figure 1. Chronic periodontitis — inflamed, swollen gingiva with heavy plaque accumulation "
    "and calculus deposits. (Scott-Brown's Otorhinolaryngology)",
    w=12*cm, h=7*cm))

story.append(PageBreak())

# ─── SECTION 1: Anatomy ──────────────────────────────────────────────────────
story.append(section_header("1. Normal Anatomy of the Periodontium"))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "The <b>periodontium</b> (attachment apparatus) anchors each tooth to the alveolar bone and "
    "maintains the integrity of the dentoalveolar unit. It comprises two functional components:",
    sBody))

story.append(make_table(
    ["Component", "Structures Included", "Primary Function"],
    [
        ["Gingival component",    "Junctional epithelium, gingival tissue, gingival fibres", "Seals the gingival sulcus; barrier against plaque"],
        ["Periodontal component", "Periodontal ligament, alveolar bone, cementum",           "Mechanical support and tooth anchoring"],
    ],
    col_widths=[4.5*cm, 8*cm, 5.5*cm]
))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "The <b>free gingiva</b> forms a 2–3 mm gingival sulcus in the healthy state. The "
    "<b>attached gingiva</b> adheres firmly to underlying alveolar bone. Disease states weaken and "
    "destroy the attachment apparatus, resulting in tooth mobility and eventual tooth loss.",
    sBody))

# ─── SECTION 2: Disease spectrum ────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(section_header("2. Disease Spectrum — Gingivitis vs. Periodontitis"))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Plaque-induced periodontal disease encompasses two related entities. <b>Gingivitis</b> is "
    "considered a precursor lesion; <b>chronic periodontitis</b> represents irreversible progression "
    "once alveolar bone resorption begins. — <i>Sherris &amp; Ryan's Medical Microbiology</i>",
    sBody))

story.append(make_table(
    ["Feature", "Gingivitis", "Chronic Periodontitis"],
    [
        ["Tissue involved",   "Marginal gingiva only",          "Deep tissues + alveolar bone"],
        ["Bone resorption",   "Absent",                         "Present"],
        ["Pocket depth",      "Normal sulcus (2–3 mm)",         "Deepened periodontal pocket (>3 mm)"],
        ["Reversibility",     "✓ Fully reversible",             "✗ Bone loss is permanent"],
        ["Pain",              "Usually absent",                 "Usually absent (unless abscess)"],
        ["Onset from plaque", "Within 2 weeks",                 "Months to years"],
        ["Treatment goal",    "Plaque removal → full resolution","Arrest progression; surgery if needed"],
    ],
    col_widths=[4.5*cm, 7.5*cm, 6*cm]
))

# ─── SECTION 3: Gingivitis ───────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(section_header("3. Gingivitis"))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Gingivitis is <b>inflammation confined to the marginal gingiva with no bone loss</b>. It "
    "develops within <b>2 weeks</b> in subjects who fail effective tooth cleansing.",
    sBody))

story.append(Paragraph("<b>3.1 Histopathology</b>", sH2))
story.append(info_box([
    Paragraph(
        "Marked inflammatory infiltrate of <b>PMNs, lymphocytes, and plasma cells</b> in the "
        "connective tissue adjacent to the epithelium lining the gingival crevice. "
        "<b>Collagen loss</b> from inflamed connective tissue. No direct bacterial tissue invasion "
        "in early stages. — <i>Sherris &amp; Ryan's Medical Microbiology</i>",
        sBox),
]))
story.append(Spacer(1, 0.3*cm))

story.append(Paragraph("<b>3.2 Causes of Gingival Bleeding</b>", sH2))
story.append(make_table(
    ["Local Causes", "Systemic Causes"],
    [
        ["Chronic gingivitis",         "Pregnancy (hormonal exacerbation)"],
        ["Chronic periodontitis",      "Leukaemia"],
        ["Acute necrotizing gingivitis","HIV infection"],
        ["Angioma / telangiectasia",   "Clotting defects / anticoagulants"],
        ["",                           "Scurvy (Vitamin C deficiency)"],
    ],
    col_widths=[9*cm, 9*cm]
))

# ─── SECTION 4: Chronic Periodontitis ───────────────────────────────────────
story.append(PageBreak())
story.append(section_header("4. Chronic Periodontitis"))
story.append(Spacer(1, 0.3*cm))

# Normal vs diseased image comparison
p_norm = os.path.join(IMG_DIR, "normal_gingiva.png")
p_adv  = os.path.join(IMG_DIR, "advanced_perio.png")
story.append(two_col_images(
    p_norm, "Figure 2A. Normal gingiva — healthy pink, firm tissue with intact interdental papillae.",
    p_adv,  "Figure 2B. Advanced periodontal disease — severely inflamed, bleeding gingiva with marked recession and bone loss."
))
story.append(Paragraph(
    "<i>Figures 2A–B: Sherris &amp; Ryan's Medical Microbiology</i>", sCaption))
story.append(Spacer(1, 0.3*cm))

story.append(Paragraph(
    "Chronic periodontitis is <b>responsible for most tooth loss in people over 35–40 years</b>. "
    "It progresses as a series of acute episodes separated by quiescent periods. Once alveolar "
    "bone is resorbed, the condition is termed periodontitis — the bone loss does not regenerate "
    "even if further inflammation is arrested. — <i>Sherris &amp; Ryan's Medical Microbiology</i>",
    sBody))

story.append(Paragraph("<b>4.1 Pathogenesis</b>", sH2))
story.append(Paragraph("As plaque-induced gingivitis progresses:", sBody))
for step in [
    "Apical migration of the gingival attachment down the tooth root surface",
    "Loss of connective tissue attachment (collagen destruction)",
    "Alveolar bone resorption → gingival sulcus deepens into a periodontal pocket",
    "If a pocket neck becomes constricted, an acute periodontal abscess may form",
    "Unchecked progression → tooth loosening → eventual tooth exfoliation",
]:
    story.append(Paragraph(f"• {step}", sBullet))
story.append(Spacer(1, 0.3*cm))

story.append(Paragraph("<b>4.2 Causative Organisms (Polymicrobial Anaerobic)</b>", sH2))
story.append(Paragraph(
    "All forms of periodontitis are polymicrobial infections involving predominantly "
    "<b>Gram-negative anaerobic bacteria</b> of the subgingival plaque. "
    "— <i>Sherris &amp; Ryan's Medical Microbiology</i>",
    sBody))
story.append(make_table(
    ["Organism", "Gram Stain", "Significance"],
    [
        ["Porphyromonas gingivalis",     "Gram −ve anaerobe", "Primary pathogen; drives progression"],
        ["Aggregatibacter (Actinobacillus) actinomycetemcomitans", "Gram −ve capnophile", "Produces leukotoxin; key in aggressive/juvenile periodontitis"],
        ["Treponema denticola",          "Spirochaete",       "Synergises with P. gingivalis"],
        ["Prevotella intermedia",        "Gram −ve anaerobe", "Found in high numbers in necrotizing disease"],
        ["Fusobacterium spp.",           "Gram −ve anaerobe", "Bridge organism in plaque biofilm"],
    ],
    col_widths=[6*cm, 4*cm, 8*cm]
))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("<b>4.3 Aggressive Periodontitis</b>", sH2))
story.append(make_table(
    ["Type", "Age Group", "Key Organism", "Feature"],
    [
        ["Localized aggressive periodontitis",   "Adolescents",  "A. actinomycetemcomitans", "Leukotoxin production; rapid bone loss"],
        ["Generalized aggressive periodontitis", "Young adults", "Mixed anaerobes",           "Widespread rapid attachment loss"],
    ],
    col_widths=[5*cm, 3.5*cm, 5.5*cm, 4*cm]
))

story.append(Paragraph("<b>4.4 Clinical Assessment</b>", sH2))
for pt in [
    "<b>Periodontal probing:</b> Probe placed in gingival sulcus; pocket depth >3 mm indicates attachment loss",
    "<b>Bleeding on probing:</b> Reflects active gingival inflammation",
    "<b>Radiography:</b> Demonstrates alveolar bone loss (horizontal or vertical patterns)",
    "<b>Tooth mobility:</b> Late sign indicating severe bone and ligament destruction",
]:
    story.append(Paragraph(f"• {pt}", sBullet))

# ─── SECTION 5: ANUG ────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("5. Acute Necrotizing Ulcerative Gingivitis (ANUG)"))
story.append(Spacer(1, 0.3*cm))

p_anug = os.path.join(IMG_DIR, "anug.png")
story.append(single_image(p_anug,
    "Figure 3. Acute Necrotizing Ulcerative Gingivitis (ANUG) — severely inflamed, "
    "bleeding gingiva with tissue necrosis and punched-out interdental papillae. "
    "(Tintinalli's Emergency Medicine)",
    w=11*cm, h=6.5*cm))

story.append(Paragraph(
    "Also called <b>Vincent's disease</b> or <b>trench mouth</b>. ANUG is a "
    "<b>distinctly different disease</b> from gingivitis–chronic periodontitis. It is an "
    "acute, painful, aggressively destructive infection. — <i>Tintinalli's Emergency Medicine</i>",
    sBody))

story.append(Paragraph("<b>5.1 Diagnostic Triad</b>", sH2))
story.append(info_box([
    Paragraph("1. <b>Pain</b> (unlike chronic periodontitis)", sBox),
    Paragraph('2. Ulcerated / "punched-out" <b>interdental papillae</b>', sBox),
    Paragraph("3. <b>Gingival bleeding</b>", sBox),
]))
story.append(Spacer(1, 0.3*cm))

story.append(Paragraph("<b>5.2 Secondary Signs</b>", sH2))
for s in ["Fetid breath (halitosis)", "Pseudomembrane formation",
          "Foul metallic taste", "Tooth mobility",
          "Lymphadenopathy", "Fever and malaise"]:
    story.append(Paragraph(f"• {s}", sBullet))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("<b>5.3 Spectrum of Disease</b>", sH2))
story.append(make_table(
    ["Stage", "Description"],
    [
        ["ANUG (localized)",           "Destruction limited to soft gingival tissue; painful ulceration of interdental papillae"],
        ["Necrotizing ulcerative periodontitis", "Extension to alveolar bone and periodontal ligament"],
        ["Noma (cancrum oris)",        "Fatal necrosis spreading to cheeks, lips, and underlying facial bones"],
    ],
    col_widths=[5.5*cm, 12.5*cm]
))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("<b>5.4 Causative Organisms (Fusospirochetal)</b>", sH2))
story.append(Paragraph(
    "<i>Treponema</i> spp., <i>Fusobacterium</i>, <i>Selenomonas</i>, <i>Prevotella intermedia</i>. "
    "These organisms actually <b>invade</b> tissue, unlike organisms in chronic periodontitis. "
    "Spirochetes are demonstrable in tissue on morphologic studies. "
    "— <i>Sherris &amp; Ryan's Medical Microbiology</i>",
    sBody))

story.append(Paragraph("<b>5.5 Predisposing Factors</b>", sH2))
story.append(make_table(
    ["Factor", "Relevance"],
    [
        ["HIV infection (CD4 <200 cells/µL)", "Most important; ANUG should prompt HIV testing if status unknown"],
        ["Previous ANUG episode",             "Strongest independent risk factor for recurrence"],
        ["Poor oral hygiene",                 "Allows anaerobic plaque accumulation"],
        ["Emotional stress",                  "Impairs immune function"],
        ["Malnutrition / poor diet",          "Reduces mucosal integrity"],
        ["Tobacco and alcohol use",           "Impair mucosal defences"],
        ["Young age (early 20s)",             "Peak demographic"],
        ["Recent illness / immunosuppression","General immune compromise"],
    ],
    col_widths=[6.5*cm, 11.5*cm]
))

# ─── SECTION 6: Abscesses ───────────────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("6. Gingival and Periodontal Abscesses"))
story.append(Spacer(1, 0.3*cm))
story.append(make_table(
    ["Type", "Origin", "Features", "Treatment"],
    [
        ["Gingival abscess",    "Foreign body entrapment (popcorn kernel, bristle, food)",
         "Acutely painful; enlarges over 24–48 h; purulent exudate expressible",
         "Remove foreign body; irrigate with normal saline; home irrigation"],
        ["Periodontal abscess", "Plaque/debris entrapped in periodontal pocket",
         "Severe pain; small or large depending on pocket size",
         "Small: saline rinses + antibiotics. Large: I&D. Chlorhexidine 0.12% BID. NSAIDs for analgesia."],
    ],
    col_widths=[3.5*cm, 4.5*cm, 5*cm, 5*cm]
))

# ─── SECTION 7: HIV-Related ─────────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(section_header("7. HIV-Related Periodontal Disease"))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "HIV-associated periodontal disease is classified into three categories. With HAART, "
    "prevalence has dropped from &lt;10% to as low as &lt;1%. CD4 counts below "
    "<b>200 cells/µL</b> greatly increase the risk of necrotizing disease. "
    "— <i>Cummings Otolaryngology Head and Neck Surgery</i>",
    sBody))
story.append(make_table(
    ["Category", "Clinical Features", "Key Association"],
    [
        ["Linear gingival erythema",
         "Distinct linear erythema along gingival margin; does not respond to conventional therapy",
         "Closely associated with oral candidiasis (OC)"],
        ["Necrotizing periodontal disease (NUP)",
         "Ulceration of interdental papilla + bleeding + pain; may invade alveolar bone",
         "Strongly associated with OC; may extend to noma"],
        ["Enhanced chronic periodontitis",
         "Accelerated progression of pre-existing periodontal disease",
         "CD4 depletion reduces host defence"],
    ],
    col_widths=[4.5*cm, 7.5*cm, 6*cm]
))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("<b>Treatment of HIV-Related Disease:</b>", sH2))
for pt in [
    "Dental plaque removal + oral rinses with 10% povidone-iodine + 0.1–0.2% chlorhexidine gluconate",
    "Topical or systemic antifungal treatment (candidiasis is closely associated)",
    "Debridement of necrotic tissue; scaling",
    "If no response: parenteral clindamycin or metronidazole",
]:
    story.append(Paragraph(f"• {pt}", sBullet))

# ─── SECTION 8: Systemic Associations ───────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(section_header("8. Systemic Associations"))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Significant research links periodontal disease with systemic conditions. "
    "The relationship is often <b>bidirectional</b>. "
    "— <i>Scott-Brown's Otorhinolaryngology Head &amp; Neck Surgery</i>",
    sBody))
story.append(make_table(
    ["Systemic Condition", "Relationship to Periodontal Disease"],
    [
        ["Diabetes mellitus",         "Hyperglycaemia impairs host defences; periodontitis worsens glycaemic control (bidirectional)"],
        ["Atherosclerotic vascular disease", "Shared inflammatory mechanisms; bacteraemia from oral flora implicated"],
        ["Pregnancy",                 "Hormonal changes exacerbate gingivitis; associated with preterm birth risk"],
        ["HIV/AIDS",                  "Immunosuppression accelerates all forms; ANUG is an AIDS-defining illness in context"],
        ["Leukaemia",                 "Gingival infiltration and haematologic bleeding cause gingival enlargement and bleeding"],
    ],
    col_widths=[5.5*cm, 12.5*cm]
))

# ─── SECTION 9: Treatment Summary ───────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("9. Treatment Summary"))
story.append(Spacer(1, 0.3*cm))
story.append(make_table(
    ["Condition", "First-Line Treatment", "Adjuncts / Notes"],
    [
        ["Gingivitis",
         "Improved oral hygiene; professional plaque removal",
         "Fully reversible. Chlorhexidine rinses may supplement."],
        ["Chronic Periodontitis",
         "Scaling and root planing (SRP); oral hygiene instruction",
         "Bone loss is permanent; goal is to arrest progression. Periodontal surgery if SRP insufficient."],
        ["Aggressive Periodontitis",
         "SRP + systemic antibiotics (amoxicillin + metronidazole)",
         "Referral to periodontist essential; more rapid progression"],
        ["ANUG",
         "Chlorhexidine 0.12% rinses BID + professional debridement",
         "Metronidazole for immunocompromised or systemic signs. Address predisposing factors."],
        ["Periodontal Abscess",
         "I&D for large abscesses; saline rinses + antibiotics for small",
         "NSAIDs preferred over narcotics for analgesia"],
        ["HIV-Related Periodontal Disease",
         "Povidone-iodine/chlorhexidine rinses + debridement",
         "Add antifungals; clindamycin/metronidazole if refractory; ensure HAART optimisation"],
        ["Peri-Implantitis",
         "Remove plaque/debris around implant; irrigate with normal saline or 0.12% chlorhexidine",
         "Refer to dentist; treat similarly to periodontal abscess"],
    ],
    col_widths=[4*cm, 7*cm, 7*cm]
))
story.append(Spacer(1, 0.3*cm))
story.append(info_box([
    Paragraph(
        "<b>Referral Note:</b> All patients with periodontal disease require dentist referral for "
        "definitive treatment — extensive dental cleaning, oral hygiene instruction, and in some "
        "cases, periodontal surgery. Treatment is primarily directed at removing plaque and its "
        "by-products. — <i>Tintinalli's Emergency Medicine</i>",
        sBox),
]))

# ─── SECTION 10: Key Points ─────────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(section_header("10. High-Yield Key Points"))
story.append(Spacer(1, 0.3*cm))
key_points = [
    "Gingivitis develops within <b>2 weeks</b> of inadequate oral hygiene; it is <b>fully reversible</b>.",
    "Periodontitis = gingivitis + <b>alveolar bone loss</b>; bone does NOT regenerate once lost.",
    "Main organisms: <i>P. gingivalis</i>, <i>T. denticola</i>, <i>A. actinomycetemcomitans</i> (leukotoxin in aggressive disease).",
    "ANUG is <b>painful</b> (unlike chronic periodontitis) with punched-out interdental papillae.",
    "ANUG in a patient of unknown HIV status → prompt HIV serologic testing.",
    "HIV-related periodontal disease: linear gingival erythema, necrotizing ulcerative periodontitis, enhanced chronic periodontitis.",
    "Periodontal disease has bidirectional relationships with <b>diabetes</b> and <b>cardiovascular disease</b>.",
    "Bleeding on probing = active gingival inflammation; pocket depth >3 mm = attachment loss.",
    "Periodontal abscess treatment: NSAIDs preferred over narcotics for analgesia.",
    "With HAART, prevalence of HIV-related periodontal disease dropped from <10% to <1%.",
]
for i, kp in enumerate(key_points, 1):
    story.append(Paragraph(f"<b>{i}.</b>  {kp}", sBullet))

story.append(Spacer(1, 1*cm))
story.append(HRFlowable(width="100%", thickness=0.5, color=MID_GREY, spaceAfter=6))
story.append(Paragraph(
    "References: Sherris &amp; Ryan's Medical Microbiology (8th ed.) · Tintinalli's Emergency "
    "Medicine (pp. 1621–1625) · Scott-Brown's Otorhinolaryngology Head &amp; Neck Surgery · "
    "Cummings Otolaryngology Head and Neck Surgery · Junqueira's Basic Histology (17th ed.)",
    sFooter))

# ─── Build PDF ───────────────────────────────────────────────────────────────
OUT = "/home/daytona/workspace/periodontal-pdf/Gingivitis_Periodontal_Disease.pdf"

doc = SimpleDocTemplate(
    OUT,
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=MARGIN + 0.8*cm,   # leave room for header
    bottomMargin=MARGIN + 0.3*cm,
    title="Gingivitis & Periodontal Disease",
    author="Orris Medical Reference",
    subject="Dental/Oral Medicine",
)

doc.build(story,
          onFirstPage=on_first_page,
          onLaterPages=on_page)

print(f"PDF saved to: {OUT}")

cd /home/daytona/workspace/periodontal-pdf && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/periodontal-pdf/Gingivitis_Periodontal_Disease.pd…

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