ANSWER
Benign migratory glossitis

OTHER OPTIONS
• Lichen planus – Lichen planus is seen usually as greyish white striae on skin and oral cavity.
• Fissured tongue – Fissured tongue shows small furrows or fissures across the surface, causing the tongue to have a wrinkled appearance.
• Median rhomboid glossitis – Median rhomboid glossitis presents in posterior midline of dorsum of tongue, just anterior to the V-shaped grouping of circumvallate papillae.

SYNOPSIS
• Benign migratory glossitis or geographic tongue is a psoriasiform mucositis of dorsum of tongue.
• Characteristic pattern is constantly changing pattern of serpiginous white lines surrounding areas of smooth, depapillated mucosa.
• Etiology is unknown and usually patient does not have any symptoms.
• May be seen associated with psoriatic skin.
• No treatment is necessary.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 31.

ANSWER
Heavy smoking habit

OTHER OPTIONS
Not applicable

SYNOPSIS
• Smoking results in increased periodontal destruction.
• It alters neutrophil chemotaxis, phagocytosis and oxidative burst.
• It increases TNF alpha and prostaglandin E2 in GCF.
• Immunoglobulin G2 level is reduced suggesting reduced protection against periodontal infection.
• Nicotine suppresses osteoblast production and stimulates alkaline phosphatase activity.
• Smoking in turn can also result in poorer oral hygiene.

REFERENCE
Essentials of Clinical Periodontology and Periodontics – 5th Edition Page No 151.

ANSWER
Ciprofloxacin

OTHER OPTIONS
• Erythromycin – Many strains show resistance.
• Amoxicillin – Effective against some oral pathogens but not reliably against A. actinomycetemcomitans alone.

SYNOPSIS
• Aggregatibacter actinomycetemcomitans is a key pathogen in aggressive periodontitis.
• Ciprofloxacin is unique because all strains of A. actinomycetemcomitans are susceptible to it.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Apexification

OTHER OPTIONS
• RCT – Later required following apexification once the root end is closed.
• DPC – done in cases with minute pulp exposure within short period of time.
• IPC – done in cases with deep dentinal caries that doesn’t reach pulp.

SYNOPSIS
• Apexification is the treatment of choice for non vital teeth with open apex and pulp exposure.
• Apexification is a method of treatment for immature permanent teeth in which root growth and development cease due to pulp necrosis.
• Its purpose is to induce root end closure with no canal wall thickening or continuous root lengthening.
• It can be achieved in two ways
1) As a long-term procedure use calcium hydroxide dressing to allow the formation of a biological hard tissue barrier.
2) As a short-term, more recent procedure, creating an artificial apical plug of MTA or other bioceramic material.
• Apexification is most often performed in incisors that lost vitality because of traumatic injury, after carious exposures, and in teeth with anatomic variations such as dens invaginatus with an immature root.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 489

ANSWER
Distal shoe

OTHER OPTIONS
• Lingual arch – It is indicated in case of bilateral loss of primary molars when no permanent anteriors are erupted.
• Band and loop – Can be used to replace E only after eruption of permanent first molar.
• Nance palatal arch – For missing bilateral maxillary molars.

SYNOPSIS
• The distal shoe appliance is used to maintain the space of a primary second molar that has been lost before the eruption of the permanent first molar.
• An unerupted permanent first molar drifts mesial within the alveolar bone if the primary second molar is lost prematurely.
• The distal shoe appliance is used to maintain the space of a primary second molar that has been lost prematurely before the eruption of the permanent first molar.
• A stainless steel extension is soldered to the distal end of the band and loop, this extension is positioned 1 mm below the mesial marginal ridge of the unerupted permanent first molar.
• The extension serves to guide the eruption of the permanent first molar.
• The distal shoe can have modifications.
• It can also be fabricated with the crown and distal shoe modification in design.
• Although feasible, like the crown and loop, it is difficult to modify and repair.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 381

ANSWER
Removal of occlusal prematurities

OTHER OPTIONS
• Full orthodontic treatment with braces – It might be necessary if additional alignment or correction is needed after removing the occlusal prematurities, but it is not the first-line treatment.
• Using a chin cup to restrict mandibular growth – It is inappropriate for pseudo-Class III malocclusion since the issue is dental rather than skeletal.
• Orthognathic surgery – It is typically reserved for true skeletal Class III malocclusions and is unnecessary for a dental-based problem like pseudo-Class III.

SYNOPSIS
• Pseudo-Class III malocclusion is often due to occlusal prematurities (interferences) that cause the mandible to shift forward during closure, creating an anterior crossbite. In such cases, the primary issue is dental, not skeletal.
• The most appropriate initial treatment is the removal of occlusal prematurities to eliminate the forward mandibular posture and correct the anterior crossbite. This conservative approach can often resolve malocclusion without the need for more invasive interventions.

REFERENCE
Pseudo Class III malocclusion – Saudi Medical Journal 2016 Apr – 37(4), 450-456

ANSWER
Clindamycin 600mg

OTHER OPTIONS
• Amoxicillin 2g – It is the standard dosage for patients who are not allergic to penicillin, so it is not appropriate for this patient.
• Clindamycin 300mg – It is below the recommended dosage for prophylaxis; 600mg is the correct dose.
• Azithromycin 250mg – It can be used as an alternative in penicillin-allergic patients, but the standard dosage for prophylaxis is 500mg, not 250mg.

SYNOPSIS
• For patients who are allergic to penicillin and require antibiotic prophylaxis before a dental procedure, the recommended alternative is Clindamycin 600mg taken orally 30 to 60 minutes before the procedure.
• This dosage is effective in preventing bacterial endocarditis and other infections in patients who are at risk.

REFERENCE
Preoperative Antibiotic Prophylaxis – Stat pearls

ANSWER
Epstein-Barr virus

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The Paul-Bunnell test, also known as the heterophile antibody test, is used to diagnose infectious mononucleosis, which is commonly caused by the Epstein-Barr virus (EBV).
• A positive result on this test typically indicates the presence of heterophile antibodies, which are associated with EBV infection.

REFERENCE
Journal of Clinical Pathology – Paul-Bunnell test in infectious mononucleosis and other diseases

ANSWER
Less than 5mm

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• To minimize the risk of black triangles between teeth, the distance from the contact point to the alveolar bone should be 5 mm or less. 
• The iconic study by Tarnow et al. who produced the 5 mm rule, states that when the distance from the contact point to the interproximal osseous crest is 5 mm or less, there is complete fill of the gingival embrasures with an interdental papilla.
• For every 1 mm above 5 mm, the chance of complete fill is progressively reduced by 50 percent.
• For square-shaped teeth with wide contact points, the chances of black triangles is minimal compared with triangular teeth having narrow, more incisally positioned contact points.

REFERENCE
Black triangle dilemma and its management in esthetic dentistry – Dental Research Journal 2013 June

ANSWER
Repositioned into socket with gentle pressure and splint

OTHER OPTIONS
Not applicable

SYNOPSIS
• Extrusion is partial displacement of tooth from its alveolar socket.
• Extruded teeth should be forced back into socket as soon as possible by means of gentle pressure, after accident and preferably done after anesthetizing the region.
• When extruded teeth are repositioned they are quite likely to be retained for a lifetime.
• Then the tooth should be splinted with a flexible splint for a period of 2 weeks.
• Tooth should be tested for vitality once a month and if non vital, perform RCT.

REFERENCE
Grossman’s Endodontic Practise – 13th Edition Page No 434.

ANSWER
Vertical Root Fracture

OTHER OPTIONS
• Nil

SYNOPSIS
• According to the American Association of Endodontists, A vertical root fracture is a longitudinally oriented fracture of the root that originates from the apex and propagates to the coronal part
• Possible symptoms include
– General discomfort or a sharp twinge of pain when biting or chewing,
– A visible crack during a dental examination,
– Swelling, and
– Abscess, or boil near the tooth indicating an infection,
– An isolated pocket in the gum next to the tooth in question.
• The prognosis of the root with VRF is poor therefore tooth extraction and root amputation are usually the only treatment options.

REFERENCE
Treatment of a vertical root fracture using dual-curing resin cement- a case report-Iranian Dental Journal

ANSWER
Change the brushing technique

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Changing the brushing technique can improve the condition of this patient
• Bass Method or Sulcular cleaning method is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin
• Indications
– Open interproximal areas
– Cervical areas beneath the height of the contour of enamel
– Exposed root surface
– Recommended for patients with or without periodontal involvement
• Technique
– The bristles are held at a 45-degree angle toward the gum line.
– Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the gum line.
– Only small groups of teeth can be done at a time.
– Once an area is complete, move on to the next set of teeth.

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Erosion

OTHER OPTIONS
• Attrition – Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. 
• Abrasion – Abrasion is the wearing away of tooth surface caused by friction or a mechanical process
• Abfraction – Abfraction is the loss of tooth structure from flexural forces.

SYNOPSIS
• Erosion is the wearing away of the tooth surface by an acid, which dissolves the enamel and the dentine.
• The causes may include dietary, acid regurgitation, environmental, etc
• The erosion is seen as a light yellow patch on the tooth. This indicates that the enamel has been dissolved and the sensitive dentine under the enamel has been exposed.
• This exposure of the dentine will result in pain from sweet, hot, and cold food and drinks. If the erosion penetrates deeper and reaches the nerves and blood vessels, the pain can become severe.
• Treatment includes
– Treating the underlying medical disorder or disease.
– Changing the patient’s lifestyle to avoid the food or beverage.
– Applying fluoride gels or varnishes to the teeth.
– Drinking milk or using other dairy products.
– Using a neutralizing agent such as antacid tablets.
– Applying dentine bonding agents to areas of exposed dentin.

REFERENCE
Shafer’s textbook of Oral Pathology

ANSWER
Streptococcus viridans

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Viridans streptococci (especially Streptococcus sanguis, S. mitis, S. mutans) are the most common cause of subacute bacterial endocarditis, often following dental procedures in susceptible patients.
• Staphylococcus aureus – causes acute bacterial endocarditis, particularly in IV drug users. It is the reason for acute infective endocarditis.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Minor salivary gland biopsy

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Sjögren syndrome diagnosis is confirmed with a positive salivary gland biopsy showing focal lymphocytic sialadenitis.
• Positive anti-SSA and anti-SSB antibodies further support the diagnosis.

REFERENCE

ANSWER
Calcification of pulp

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The more the tooth moves out of the alveolar socket, the higher the chances of disruption of the blood supply and development of pulp necrosis.
• Two main mechanisms can explain how the pulp of injured primary teeth becomes necrotic.
1) Infection of the pulp in cases of untreated crown fracture with pulp exposure and
2) Interrupted blood supply to the pulp through the apex in cases of luxation injury leading to ischemia.
• Crown discoloration is the external expression of changes in the pulp-dentin complex that become visible through the almost transparent enamel.
• Crown discoloration of primary incisors is a common posttraumatic finding and is often the only evidence of trauma to the tooth.
• Pulp canal obliteration (PCO) presents itself as a frequent pulp complication in traumatized primary teeth, characterized as a progressive deposition of hard tissue in the root canal.
• Yellow discoloration of primary incisors can be seen when the dentin is thick and the pulp chamber narrower than usual.
• This condition is termed pulp canal obliteration- PCO.
• Although PCO is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment except follow-up.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 238

ANSWER
Careful monitoring

OTHER OPTIONS
• No need for any particular treatment until symptomatic.

SYNOPSIS
• Occurrence of obliteration in permanent teeth increased over time, with most cases diagnosed more than 3 years following the trauma.
• Although pulp canal obliteration is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment in primary or permanent teeth except follow-up.
• In teeth with an open apex, there is a greater possibility of maintaining pulp vitality or revascularization of the neurovascular supply compared to mature teeth, due to the intense cell activity capable of promoting the defense and regeneration of affected tissues.

REFERENCE
Pulp canal obliteration to primary and permanent teeth following trauma-Bianca Santos

ANSWER
DPC

OTHER OPTIONS
• Pulpotomy – is carried out when there is a large pulp exposure.
• Indirect pulp capping – is done with deep dentinal caries that don’t reach the pulp.
• Apexification – Done in immature nonvital tooth with pulp exposure.

SYNOPSIS
• The direct pulp cap is only indicated in small exposures that can be treated within a few hours of the injury.
• The chances for pulp healing decrease if the tissue is inflamed, has formed a clot, or is contaminated with foreign materials.
• The objective, then, is to preserve vital pulp tissue that is free of inflammation and physiologically walled off by a calcific barrier.
• MTA, is the currently recommended capping agent.
• MTA is less toxic and produces less pulpal inflammation compared to Calcium Hydroxide. MTA is superior in dentinogenic processes and more predictable in hard tissue barrier formation.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 499

ANSWER
Streptococcus

OTHER OPTIONS
• Actinomyces – Present in oral biofilm and gingival crevices, but not the most prevalent in saliva.
• Staphylococcus – can be found, especially S. aureus and S. epidermidis, but in much lower proportions.

SYNOPSIS
• Saliva harbors a wide range of microorganisms, but the predominant bacteria are Streptococcus species (especially Streptococcus salivarius, Streptococcus mitis, Streptococcus mutans).

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Maxillary advancement and mandible setback

OTHER OPTIONS
Not applicable

SYNOPSIS
• Severe class III after growth completion is treated by surgical corrective procedures.
• Class III due to maxillary deficiency is treated by maxillary advancement procedures like LeFort I osteotomy.
• Class III due to mandibular excess is treated by mandibular setback procedures.
• A combination of both is also indicated.

REFERENCE
Orthodontics The Art and Science – 6th Edition Page No 518.

ANSWER
Extract the deciduous tooth

OTHER OPTIONS
• Observe over time – If a tooth is asymptomatic and does not pose any threat to permanent tooth bud.
• Pulpotomy – Done in cases where the coronal pulp is exposed.

SYNOPSIS
• Due to the close relationship between the apex of primary teeth and the bud of permanent teeth, any lesion to the primary dentition may influence the eruption of the permanent teeth.
• The severity of sequelae depends on the patient’s age, the degree of root reabsorption, the type and extent of the trauma, and the degree of development of the permanent successor at the time of trauma.
• Intrusion and avulsion of primary teeth are considered the types of traumas that produce the greatest number of alterations in the development of permanent teeth, according to various studies.
• Here the permanent tooth follicle shows dilation, so its better to extract the deciduous tooth.
• The main consequences of primary tooth trauma in the development of permanent teeth are enamel discoloration, enamel hypoplasia, coronal dilaceration, root dilaceration, odontoma-like malformations, and alterations in eruption.
• In cases of asymptomatic tooth, constant follow-up, with complementary tests, such as radiographs, and appropriate clinical interventions, can minimize or even prevent damage to the successor tooth.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 238

ANSWER
Permanent molar 

OTHER OPTIONS
• Direct pulp capping is contraindicated in primary teeth because of the risk of developing internal root resorption.

SYNOPSIS
• Direct Pulp Capping is the placement of a medicament or non-medicated material on an exposed pulp that is occurred in course of excavating the last portions of deep dentinal caries or because of trauma.
• Indications of Direct Pulp Capping
Pulp-capping procedures should be limited to asymptomatic (absence of pain)permanent teeth, vital young permanent teeth, with the possible exception of discomfort caused by the intake of food, the teeth should have
– True pinpoint exposure (small mechanical exposure less than 1 mm) surrounded by sound dentin produced accidentally by trauma during cavity preparation.
– Mechanical or carious exposures less than 1 mm, in an asymptomatic vital young permanent tooth.
– The exposure site should have bright red hemorrhage easily controlled by dry cotton pellet with minimal pressure.
– Lack of bleeding at the exposure site (the amount of bleeding considered normal in the absence of a hyperemic or an inflamed pulp.
• Contraindications
1) Curiously exposed deciduous teeth
2) Spontaneous pain or severe toothache at night
3) Swelling
4) Fistula
5) Tenderness to percussion
6) Pathologic mobility
7) Root resorption-external or internal
8) Periapical or interradicular radiolucency
9) Pulp calcifications
10) Profuse hemorrhage from the exposure site
11) Pus or exudate from exposure site.
• Presently, the materials most commonly used are calcium hydroxide, emdogain, and mineral trioxide aggregate – MTA.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 337, 338

ANSWER
Formocresol pulpotomy

OTHER OPTIONS
• DPC – not indicated in carious exposures of primary teeth.
• CaOH pulpotomy – induces internal root resorption.

SYNOPSIS
• When the carious process has reached the pulp or in incidences of direct pulpal exposure during excavation of a carious lesion, the pulpotomy procedure is indicated and is the treatment of choice.
• Pulpotomy techniques using formocresol on primary teeth have been a standard in pediatric dentistry for decades.
• The indication was primarily the presence of a carious exposure and a desire to retain the primary tooth until exfoliation.
• Contraindications for the formocresol pulpotomy are
(1) teeth with history of spontaneous pain
(2) pain percussion due to periapical involvement,
(3) suppuration in the canals,
(4) the presence of a parulis or sinus tract,
(5) hemorrhage which cannot be controlled in five minutes after extirpation of the coronal pulp,
(6) evidence of periapical or furcal pathology, and
(7) presence of necrotic pulp in the chamber.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 340

ANSWER
Furcation area

OTHER OPTIONS
• Lateral to root – periodontal infections are seen as radiolucent areas lateral to root

SYNOPSIS
• Infected primary molar teeth display radiographic bony changes that are different from those of permanent molars.
• Periapical radiographs are generally used to detect the effects that necrotic infected pulpal tissue have on the lamina dura and bone surrounding the root apices of permanent teeth and on the furcal area between the roots of primary molar teeth.
• The posterior bitewing radiographs’ greatest use is in the detection of furcal radiolucencies caused by pulpally infected primary molar teeth.
• It is particularly useful in viewing the root areas of maxillary primary molars where developing premolars obscure the furcation in the periapical radiograph.

REFERENCE
Radiographic Interpretation of Infected Primary Molar Teeth-Keith

ANSWER
Ciprofloxacin

OTHER OPTIONS
• High dose penicillin – Not reliably effective due to β-lactamase producing strains.
• Tetracycline – Useful in periodontal therapy but not effective against all strains.
• Macrolides – E.g., erythromycin, azithromycin) → resistance is common among A. actinomycetemcomitans.

SYNOPSIS
• Aggregatibacter actinomycetemcomitans is an important pathogen in aggressive periodontitis.
• Studies have shown that all strains of A. actinomycetemcomitans are susceptible to ciprofloxacin, making it unique among antibiotics used in periodontal therapy.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Grade III mobility

OTHER OPTIONS
Not applicable

SYNOPSIS
• Among the various periodontal prognosis systems, the one most widely used was proposed by McGuire and Nunn in 1996.
• It consists of five categories that include good, fair, poor, questionable and hopeless.
• In poor prognosis, it includes 50 percent attachment loss and grade II furcation.
• In questionable prognosis, more than 50 percent attachment loss and grade III furcation, poor crown root ratio, class II or more mobility.
• Hopeless includes severe attachment loss.
• Extraction may be preferred in this case.

REFERENCE
Strategies for Periodontal Risk Assessment and Prognosis by Decisions in Dentistry.

ANSWER
Gram-negative anaerobic rods

OTHER OPTIONS
• Gram-positive facultative cocci – (e.g., streptococci, enterococci) are common in early caries or pulpal infections, but not predominant in endo-perio.
• Spirochetes – Spirochetes are seen in necrotizing periodontal diseases, not the main flora in endo-perio lesions.
• Viridans streptococci – Viridans streptococci are mainly early colonizers in dental plaque, not responsible for advanced endo-perio pathology.

SYNOPSIS
• Endo-perio lesions involve infection spreading between the pulpal and periodontal tissues.
• The microbiota is typically mixed, but Gram-negative anaerobic rods predominate (e.g., Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum).
• These organisms produce endotoxins and enzymes that contribute to tissue destruction.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
8-10 mm

OTHER OPTIONS
• Not applicable

SYNOPSIS
• In the posterior mandible, a minimum bone height of 8-10 mm is typically required for successful dental implant placement. This ensures that the implant has sufficient bone support for stability.

REFERENCE
Contemporary Implant Dentistry – Carl E Misch

ANSWER
Iodophor

OTHER OPTIONS
• Glutaraldehyde – Preferred for elastomeric impression materials.
• Alcohol-based disinfectants – They are not recommended, as they cause rapid surface drying and poor disinfection.

SYNOPSIS
• Alginate impressions are hydrophilic and dimensionally unstable, hence, the disinfectant must be effective yet gentle.
• Glutaraldehyde, while effective, can be too aggressive for certain impression materials and may cause deformation.
• For effective disinfection, alginate impressions should typically be immersed in an iodophor solution for around 10 minutes.
• This time frame is sufficient to kill most microorganisms without compromising the quality or accuracy of the impression.

REFERENCE
Evaluation of the Effectiveness of Disinfectants on Impression Materials Cureus

ANSWER
Immersion

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Immersion is considered the best method for disinfecting dental impressions, as it allows for complete contact with the disinfectant, ensuring thorough penetration and effective microbial reduction.
• Spraying may lead to incomplete coverage and may not be as effective while spraying twice still doesn’t guarantee the same level of disinfection as immersion.

REFERENCE
Disinfection of impressions. Methods and effects on accuracy – State Dental Journal

ANSWER
Category C anesthetics can be used if the potential benefits to the mother outweigh the risks to the fetus.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Category C anesthetics are those for which animal reproduction studies have shown an adverse effect on the fetus, but there are no adequate studies in humans.
• They may be used if the benefits to the mother justify the potential risks to the fetus.
• It is important to evaluate each situation individually, considering the necessity of the procedure and the specific anesthetic involved.
• Of the five categories (A, B, C, D, and X) lidocaine is considered in Category B, the safest of the local anesthetics. 
• Mepivacaine and bupivacaine are Category C and may be used with caution.

REFERENCE
Local Anesthesia and Pregnancy – Dental Care.com

ANSWER
Chin is protruded

OTHER OPTIONS
• Not applicable

SYNOPSIS
• In Class III malocclusion, characterized by a reverse overjet, the mandible is positioned forward relative to the maxilla.
• This positioning often results in a protruded appearance of the chin.
• The upper soft tissues may also appear retruded relative to the lower, contributing to the overall profile typical of Class III relationships.

REFERENCE
Evolution of Class III treatment in orthodontics – American Journal of Orthodontics and Dentofacial Orthopedics

ANSWER
Plasma cells

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• In gingivitis, plasma cells produce antibodies in response to the inflammation, contributing to changes in the mucosal color.
• T lymphocytes and B lymphocytes also play roles in the immune response, but plasma cells are specifically responsible for the production of antibodies that can affect tissue appearance.
• Neutrophils are involved in the initial inflammatory response but do not directly cause changes in mucosal color related to chronic inflammation like gingivitis.

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Neurofibromatosis Type 1

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Neurofibromatosis-1 (NF-1), or Von Recklinghausen disease, is one of the inheritable neurocutaneous disorders manifested by developmental changes in the nervous system, bones, and skin. It is an autosomal dominant disorder
• Patients with NF-1 may present with the following
– Cafe-au-lait macules
– Neurofibromas
– Freckling
– Lisch nodules
– Skeletal abnormalities
– Neurological abnormalities
– Other malignancies
• Café au lait spots are commonly associated with neurofibromatosis type 1 (NF1).
• The presence of multiple spots, especially when there are six or more, is a key diagnostic criterion for NF1.
• Other conditions, such as tuberous sclerosis and McCune-Albright syndrome, can also present with skin findings but have additional characteristic features that are not present in this case.
• Freckling syndrome is not typically associated with café au lait spots.

REFERENCE
Shafers Textbook of Oral Pathology

ANSWER
Maxillary sinusitis

OTHER OPTIONS
• Acute apical periodontitis – In acute apical periodontitis, patient will complaints of deep dental caries, periapical pathology and associated tenderness on percussion.
• Reversible pulpitis – In reversible pulpitis, patient will have pain or sensitivity that relieves after removal of stimulus.

SYNOPSIS
• Maxillary sinusitis is an inflammation of the paranasal sinuses caused by bacteria, viruses, fungi or allergic reactions.
• It is clinically presented as headache, maxillary dental pain, cough, halitosis, facial pressure, nasal obstruction, nasal blockage etc.
• Usually pain radiates to ear, eyes and forehead similar to that of dental pain.
• Pain can maxillary sinusitis can be confused with dental pain most of the time.

REFERENCE
Peterson’s Principles of Oral and Maxillofacial Surgery – 2nd Edition Pge No 295.

ANSWER
Purple complex

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• In a young healthy patient (like 18 years old) with no periodontal breakdown, the microflora is dominated by early colonizers.
• Socransky (1998) grouped subgingival plaque bacteria into microbial complexes based on their association with disease.
• Purple complex (early colonizers) – Streptococcus sanguinis, Actinomyces species) are the first colonizers on the tooth surface. They pave the way for later colonizers.
• Green complex (Capnocytophaga, Eikenella corrodens, Aggregatibacter actinomycetemcomitans) is also involved in early colonization.
• Orange complex (Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus) is associated with gingivitis and precedes the red complex.
• Red complex (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) is strongly associated with chronic periodontitis and deep pockets.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Malpositioned upper teeth

OTHER OPTIONS
Not applicable

SYNOPSIS
• The most reliable guides to aid the dentist in the final setting of the maxillary anterior teeth are the nasolabial sulcus, the philtrum, and the commissure (corner) of the mouth.
• When proper lip support has been developed, by the denture base and anterior teeth arrangement these anatomic landmarks will exhibit a distinct, normal appearance.
• Without proper support, there is a noticeable deepening of the nasolabial, loss of definition in the philtrum and a lowering or drooping of the corners of the mouth.
• If denture teeth are set too far facially, it produces a stretched look. The nasolabial and the philtrum become very shallow and appear somewhat smooth, while the corners of the mouth are stretched laterally.

REFERENCE
Winkler S, Essentials of complete denture Prosthodontics, pg 203

ANSWER
Remove lateral undercut surgically and leave anterior undercut

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The ideal treatment is to remove the lateral undercut surgically and leave the anterior undercut.
• The anterior residual ridge must be preserved whenever possible, since this area is crucial for support and stability of the denture and tends to be a region of rapid bone loss.
• Undercuts that interfere with the path of placement both in anterior and posterior regions are usually detrimental to accurate tissue adaptation and should be reduced.
• If anterior and posterior interferences both are present, reduction of the posterior areas is preferred over reduction of the anterior regions.
• With bilateral bony protuberances in the tuberosity area, one side can usually be left intact and the opposite side surgically corrected.

REFERENCE
Winkler S, Essentials of complete denture Prosthodontics, pg 71

ANSWER
Prosthesis connector fracture

OTHER OPTIONS
Not applicable

SYNOPSIS
• In all ceramic fixed partial dentures the connector area is a common fracture location.
• The occlusal forces applied to a fixed dental prosthesis are transmitted to the supporting structures through the pontics, connectors, and retainers
• The connector area is usually narrowly constricted for biological or esthetic reasons, which typically considers stresses relative to the average stress levels in other areas of the prosthesis
• Long-term unmanaged hyper occlusion in an FPD can lead to prosthesis connector fracture

REFERENCE
Goodacre et al Clinical complications in fixed prosthodontics. Journal 0f Prosthetic Dentistry 2003,90-31-41

ANSWER
Group function

OTHER OPTIONS
• Canine-protected occlusion is otherwise called mutually protected occlusion

SYNOPSIS
• Unilateral balanced occlusion or group function calls for all teeth on the working side to be in contact during a lateral excursion. On the other hand, teeth on the nonworking side are contoured to be free of any contact.
• The group function of the teeth on the working side distributes the occlusal load. The absence of contact on the working side prevents those teeth from being subjected to the destructive, obliquely directed forces found in non-working interferences.
• Group function exposes posterior teeth to more lateral occlusal forces.

REFERENCE
Shillingburg, Fundamentals of Fixed Prosthodontics,pg 19

ANSWER
Tanerella forsythia

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Periodontitis is a polymicrobial disease – no single pathogen is solely responsible.
– However, certain bacteria are considered key pathogens
• Red complex organisms (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) are strongly linked with chronic periodontitis.
• Aggregatibacter actinomycetemcomitans is associated with localized aggressive periodontitis.
• Listeria is not associated with periodontal disease, it is mainly a foodborne pathogen.
• Streptococcus are early colonizers in plaque but not primary causes of periodontitis.
• Thus, among the given options, Tannerella forsythia is the best answer.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
A and B

OTHER OPTIONS
• Less dimensional stability – Dimensional change is greater in magnitude for the polysulfide than for the addition silicone elastomers. This result is expected because polysulfide loses polymerization by-products, i.e.,water.

SYNOPSIS
• Polyvinyl siloxane impressions can be poured even after seven days or more than once.
• Research has shown that a cast produced from an addition silicone impression between 24 hours and 1 week was as accurate as a cast made in the first hour assuming that there was no effect associated with the formation of hydrogen bubbles.
• These materials exhibit the least amount of distortion from the loads imposed on the set material.
• Thus, multiple pouring of the impressions and removal of the casts will maintain the dimensional stability of the impression even though a substantial force is needed each time a cast is removed from the impression.

REFERENCE
Philips Science of Dental materials, 12th Ed, Pg 166

ANSWER
Autonomy

OTHER OPTIONS
• Justice – Justice is principle concerned with providing individuals or groups with what is owed, dued and deserved.
• Beneficence – Beneficence is principle that actions and practises are right in so far as they produce good consequences.
• Veracity – Veracity is principle of being honest and telling truth and is related to autonomy.

SYNOPSIS
• Autonomy is an ethical principle which includes self governance.
• It includes patient’s privacy and safeguarding the patient’s privacy.
• It includes involving patient in treatment decisions with due consideration being given to patient needs, desires and abilities.
• Informing the patient of disease or defective dental concerns is first step.
• A written consent should be signed from patient before any treatment.

REFERENCE
Article on Ethics in Dentistry – Principles and Values.

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• Management of gingival trauma due to faulty brushing involves
– Correction of faulty technique – Educate patient to adopt an atraumatic method (e.g., Modified Bass or Stillman).
– Reassurance – Gingival lesions usually heal if trauma is removed.
– Soft brush substitution – Replacing medium hard brush with soft bristles prevents recurrence.
• Therefore, a combined approach is best.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Herbst appliance

OTHER OPTIONS
• Reverse head gear and Chin cup – Reverse head gear and chin cup are used in correction of skeletal class III in growing patients.
• Fixed orthodontics – Fixed orthodontics is indicated in non growing patients or to correct dental malocclusions mainly.

SYNOPSIS
• Class II malocclusion by mandibular deficiency is treated during mixed dentition period by use of myofunctional appliances.
• This moves mandible forward and downward direction and therefore stimulates mandibular growth.
• They can also cause retrusion of maxillary anteriors and proclination of mandibular anteriors.
• Examples of myofunctional appliances are activator and functional regulator.
• In case of a patient at end of growing period, fixed functional appliances like herbst appliance or jasper jumper is indicated.

REFERENCE
Orthodontics The Art and Science – 6th Edition Page No 497.

ANSWER
Inadequate vertical dimension of occlusion

OTHER OPTIONS
• Inadequate denture adhesive – Inadequate denture adhesive is not the most likely reason in this case, as the patient’s dentures have been described as well-fitting with no apparent issues.
• Improper denture base material – Improper denture base material is not the most likely reason, as there are no indications of material-related problems in the scenario.
• Overextended denture borders – Overextended denture borders may cause discomfort or sore spots but are less likely to be the primary reason for posterior displacement during smiling.

SYNOPSIS
• The most likely reason for the posterior displacement of the dentures during smiling is an inadequate vertical dimension of occlusion.
• The vertical dimension of occlusion (VDO) refers to the space between the upper and lower jaws when the teeth are in contact.
• Proper VDO is crucial for maintaining the stability and function of dentures.
• If the VDO is too low, it can cause the dentures to displace backward during muscle activity like smiling.
• In this case, since the patient has no apparent issues with the denture fit or oral examination, the problem is likely related to the VDO.
To address this issue, the dentist should assess and adjust the VDO to ensure the patient’s dentures have proper stability and do not displace during function.

REFERENCE
Textbook of Prosthodontics – Deepak Nallaswamy

ANSWER
Marsupialisation

OTHER OPTIONS
• Explained below

SYNOPSIS
• Dentigerous cyst is managed by Enucleation, Marsupialisation, or a combination of both
• Enucleation – As a general surgical technique, enucleation refers to the surgical removal of a mass without cutting into or dissecting it.
• Marsupialization – Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. Sutured in this fashion, the site remains open and can drain freely.
• Large dentigerous cysts may also be treated by marsupialization followed by enucleation
• For small to moderate-sized cysts, enucleation with removal of associated tooth is the treatment of choice.
• For very large cysts (as in this case, extending into the ramus), enucleation risks fracture of mandible, damage to inferior alveolar nerve, and removal of large bone volume.
• In this case, Marsupialisation (decompression) is preferred initially as it reduces intracystic pressure, promotes bone fill, and decreases cyst size. Later, if required, a second-stage enucleation can be performed more safely.
m

REFERENCE
Shafer’s textbook of oral pathology

ANSWER
Active infection control

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Without proper infection control techniques, many of the things in a dental clinic, including people, instruments, and even computer components can be carriers for cross-contamination and contribute to the spreading of germs and disease.
• Active Infection control prevents or stops the spread of infections in healthcare settings.
•.Non-disposable items like dental tools are cleaned and sterilized between patients.
• Disposable dental tools and needles are never reused.
• Infection control precautions also require all dental staff involved in patient care to use appropriate protective equipment such as gloves, masks, gowns, and eyewear when needed.
• Failure to follow any of the above guidelines means failure of active infection control.

REFERENCE
Hepatitis B- Penina Haber, MPH and Sarah Schillie, MD, MPH, MBA

ANSWER
Avulsed tooth

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Class I – Simple crown fracture with little or no dentin affected.
• Class II – Extensive crown fracture with considerable loss of dentin, but with the pulp not affected.
• Class III – Extensive crown fracture with considerable loss of dentin and pulp exposure.
• Class IV – A tooth devitalized by trauma with or without loss of tooth structure.
• Class V – Teeth lost as a result of trauma.
• Class VI – Root fracture with or without the loss of crown structure.
• Class VII – Displacement of the tooth with neither root nor crown fracture
• Class VIII – Complete crown fracture and its replacement.
• Class IX – Traumatic injuries of primary teeth.

REFERENCE
An overview of the classification of dental trauma-Sasikala Pagadala

ANSWER
Lateral pterygoid

OTHER OPTIONS
• Masseter – The large muscle which raises the lower jaw, and assists in mastication.
• Temporalis – A broad muscle that fans out to cover much of the temporal bone on the side of the skull that elevates and retracts the jaw.
• Medial pterygoid – The medial pterygoid elevates and closes the jaw, contributes to protrusion of the mandible, and assists in mastication.

SYNOPSIS
• Lateral pterygoid is a muscle of mastication with two heads. It lies superiorly to the medial pterygoid.
• The lateral pterygoid is the only muscle of mastication that actively opens the jaw.
• Unilateral action of a lateral pterygoid produces lateral movement in the jaw, usually performed in concert with the medial pterygoids

REFERENCE
Muscles of mastication – Pocket Dentistry

ANSWER
OKC

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of the dental lamina.
• It can occur anywhere in the jaw but is commonly seen in the posterior part of the mandible.
• Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for a radicular or lateral periodontal cyst.
• The exact reason for the high recurrence rate of OKC has not been established, it is thought to be due to incomplete removal of the primary lesion with thin epithelial lining, the presence of satellite cysts, and epithelial remnants.

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
Arch length tooth size discrepancy

OTHER OPTIONS
Not applicable

SYNOPSIS
• Class I malocclusions is a situation where the anteroposterior occlusal
relationship is normal and there is a discrepancy either within the arches or in the transverse or vertical relationship between the arches.
• Dental factors are the main aetiological influences in Class I malocclusions.
• The most common are tooth or arch size discrepancies, leading to crowding or, less frequently, spacing.
• Local factors also include displaced or impacted teeth, and anomalies in the
size, number and form of the teeth, all of which can lead to a localized
malocclusion.
• Soft tissue and skeletal factors can cause this malocclusion.

REFERENCE
Arch Size and Tooth Size in Class I malocclusion by JDAT.

ANSWER
Apposition

OTHER OPTIONS
• Initiation – Anodontia, hypodontia etc
• Histodifferentiation – Cysts or neoplasm
• Morphodifferentiation – Anomalies in morphology of teeth

SYNOPSIS
• Systemic postnatal infection (e.g. measles, chicken pox, streptococcal infections, scarlet fever) can cause enamel hypoplasia.
• The band-like discoloration on the tooth is visualized where the enamel layer has a variable thickness and becomes extrinsically stained after tooth eruption.
• Enamel hypoplasia occurs when the special cells that produce dental enamel are disturbed during a particular stage of enamel formation – the matrix formation stage or apposition stage

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
Submandibular space

OTHER OPTIONS
• Pterygomandibular space -The pterygomandibular space is a fascial space of the head and neck. It is located between the lateral pterygoid muscle and the medial surface of the ramus of the mandible.
• Lateral pharyngeal space -The parapharyngeal space, is a potential space in the head and the neck. It has clinical importance in otolaryngology due to parapharyngeal space tumors and parapharyngeal abscesses developing in this area.
• Retropharyngeal space -The retropharyngeal space (RPS) is an anatomical region that spans from the base of the skull to the mediastinum. Its location is anterior to the prevertebral muscles and posterior to the pharynx and esophagus.

SYNOPSIS
• Usually, the impacted third molar tooth is indicated for extraction.
• Sometimes, it may displace into the lingual pouch or submandibular space during extraction particularly when the lingual cortex is extremely thin.
• It may further traverse into pharyngeal spaces if not managed by some expert.
• The intraoral approach under local anesthesia is the simplest and least invasive technique for the removal of displaced roots from the lingual pouch.

REFERENCE
Retrieval of mandibular third molar tooth accidentally displaced in submandibular space – Ravinder Solanki

ANSWER
Passivity

OTHER OPTIONS
• Explained below

SYNOPSIS
• Implant restorations can be screw-retained or cement retained.
• In screw-retained restorations, the fastening screw provides a solid joint between the restoration and the implant abutment, while in cement-retained prostheses the restorative screw is eliminated to enhance esthetics, occlusal stability, and passive fit of the restorations.
• The factors that influence the type of fixation of the prostheses to the implants are as follows.
1) Passivity of the framework.
2) Ease of fabrication and cost.
3) Occlusion.
4) Complications.
5) Esthetics.
6) Accessibility.
7) Retention.
8) Retrievability.
9) Cementation.
• Advantages of Screw-retained implant restorations
– Predictable retention,
– Retrievability and
– Lack of potentially retained sub-gingival cement.
• Disadvantages
–  Precise placement of the implant for the optimal and esthetic location of the screw access hole and
– Obtaining passive fit.

REFERENCE
Factors influencingthe success of cement versus screw-retained implant restorations A clinical review – Journal of Osseointegration

ANSWER
Vertical root fracture

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The radiographic halo appearance is a classic sign of a vertical root fracture (VRF).
• This fracture typically occurs in endodontically treated teeth due to excessive force during obturation or post-placement.
• Other signs include isolated deep periodontal pockets and persistent sinus tracts.

REFERENCE
Cohen S, Hargreaves KM. Pathways of the Pulp – 11th edition, Elsevier, 2015.

ANSWER
Subgingival fracture extension

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Subgingival fracture extension compromises the biological width and makes restorability difficult.
• It can lead to periodontal complications and poor aesthetics.
• Endodontic and restorative procedures may be challenging or impossible without crown lengthening or orthodontic extrusion

REFERENCE
Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th Edition, Wiley-Blackwell, 2007.

ANSWER
Poor oral hygiene

OTHER OPTIONS
Not applicable

SYNOPSIS
• Hairy tongue is condition of defective desquamation of filiform papillae.
• Can be caused by poor oral hygiene, smoking, excessive intake of tea or coffee etc.
• Filiform papillae in hairy tongue are more than 15mm in length.
• Patient complaints of tickling sensation in soft palate and oropharynx during swallowing.
• Tongue has a thick coating in the middle with a greater accentuation towards back.
• Treatment includes improved oral hygiene, surgical removal of papilla and controlling precipitating factors.

REFERNCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 32.

ANSWER
GTR (guided tissue regeneration)

OTHER OPTIONS
• Open Flap Debridement – Only cleans the defect, does not regenerate lost bone or attachment.
• Apically Repositioned Flap – Used for pocket elimination but worsens recession, making it unsuitable.

SYNOPSIS
• A deep infrabony pocket (defect within bone) suggests vertical bone loss, which requires regeneration rather than just resection.
• Recession indicates soft tissue loss, which may need coverage or preservation.
• GTR promotes new attachment of periodontal ligament and bone, preventing epithelial down-growth.
• Bone grafting enhances bone fill, improving long-term stability.

REFERENCE
Carranza’s Clinical Periodontology, 14th Edition

ANSWER
Give milk

OTHER OPTIONS
Not applicable

SYNOPSIS
• Accidental ingestion of excessive amounts of fluoride containing products can lead to acute or chronic toxicity.
• Acute toxicity can cause a sudden onset of nausea, abdominal pain, vomiting, diarrhea, cytotoxic effects, hyperkalemia, seizures and multiple organ failure.
• Treatment includes inducing vomiting, give 1 percent calcium chloride or tolerated levels of milk orally and inform emergency department.

REFERENCE
Pediatric Dentistry Infancy through Adolescence – 6th Edition Page No 292.

ANSWER
Cluster headache

OTHER OPTIONS
• Migraine – Migraine is characterized by deep, aching, throbbing pain that is usually unilateral with visual aura, anorexia and even vomiting.
• Trigeminal neuralgia – Trigeminal neuralgia is associated with trigger zones and usually arises from acts like eating, smiling or even exposure to strong breeze.

SYNOPSIS
• Sphenopalatine neuralgia or cluster headache is characterized by attacks of severe, strictly unilateral pain in orbital, supraorbital, temporal or in any combination.
• There is no trigger zone.
• Patients usually described their pain as toothache.
• Pain is also associated with swelling of mucosa, severe nasal discharge, watering of eyes, bloodshot eyes and epiphora.
• It can also wake up patient from sleep and is referred as alarm clock headache.
• Cocainization of ganglion or alcohol injection can reduce pain.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 573.

ANSWER
Digoxin toxicity

OTHER OPTIONS
• Stroke – In stroke, patient shows vision loss, facial drooping, speech difficulties, weakness, confusion, dizziness etc. Benzodiazepine toxicity – In excess benzodiazepine intake, patient complaints of slurred speech, ataxia, confusion, dizziness.
• Heart failure – Heart failure symptoms include chest pain, shortness of breath, swelling of legs, dizziness and sudden fatigue.

SYNOPSIS
• Digoxin is a drug used commonly for treatment of hypotension.
• Digoxin toxicity can cause symptoms like nausea, vomiting, excessive salivation, yellowish – green visual problems, syncope, palpitations, tachycardia, arrhythmias etc.
• Kidney dysfunction and low levels of potassium can generally cause digoxin toxicity.

REFERENCE
Digoxin Toxicity Article by Earl D Cummings and Henry D Swoboda.

ANSWER
Reamer

OTHER OPTIONS
Not applicable

SYNOPSIS
• Reamers and files are by far the most widely used root canal instruments.
• Traditionally, this group of instruments has been made from stainless steel
• Because of its fewer flutes and triangular cross section, the reamer is a much more flexible instrument than the K-file, H-file and broaches.

REFERENCE
Endodontic Instruments by Pocket Dentistry.

ANSWER
Osteoid osteoma

OTHER OPTIONS
• Cementoblastoma – Cementoblastoma is a relatively uncommon, benign odontogenic neoplasm of jaws where lesions are generally diagnosed on a routine radiograph with sometimes localized expansion of cortical plates is observed.
• Osteoblastoma – Osteoblastoma lacks the characteristic pain and halo sclerotic bone which is associated with osteoid osteoma.
• Fibrous dysplasia – Fibrous dysplasia is seen as pain, deformity and swelling of affected jaw and mostly seen in age between 3-15 years with orange peel appearance in radiograph.

SYNOPSIS
• Osteoid osteoma is a benign tumour of bone seen mainly in young persons below 30 years age.
• Condition is associated with sharp, severe pain which is worse at night and is relieved by taking NSAIDs like Aspirin.
• Localized swelling of soft tissue over involved area of bone may occur and may be tender.
• Radiographically, seen as a small ovoid or round radiolucent area surrounded by rim of sclerotic bone.
• Treatment includes surgical removal of lesion.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 208.

ANSWER
Modified ridge lap pontic

OTHER OPTIONS
• Ridge lap – The ridge lap design provides reasonably good esthetics. The large, concave tissue surface of the pontic makes the removal of adherent plaque often quite difficult usually associated with inflammation and ulceration of the soft tissues.
• An ovate pontic – Ovate pontics are used when the residual ridge is defective or incompletely healed.
• Hygiene pontic – The hygienic pontic is used in the nonappearance zone, particularly for replacing mandibular first molars.

SYNOPSIS
• The modified ridge lap design is the most common pontic form used in areas of the mouth that are visible during function (maxillary and mandibular anterior teeth and maxillary premolars and first molars).
• The modified ridge lap pontic combines the best features of the hygienic and saddle pontic designs, combining esthetics with easy cleaning.
• The modified ridge lap design overlaps the residual ridge on the facial (to achieve the appearance of a tooth emerging from the gingiva) but remains clear of the ridge on the lingual.
• To enable optimal plaque control, the gingival surface must have no depression or hollow. Rather, it should be as convex as possible from mesial to distal (the greater the convexity, the easier the oral hygiene).
• Tissue contact should resemble a letter T whose vertical arm ends at the crest of the ridge.

REFERENCE
Rosenstiel, Contemporary Fixed Prosthodontics, pg 521

ANSWER
Toothbrush used after meals. Miswak at prayer time and when out of station

OTHER OPTIONS
• Miswak and toothbrush must be used together – Not necessary, toothbrush alone is sufficient if available.
• Miswak use is not just socioeconomic, but also cultural or religious.
• Don’t use the miswak and use the toothbrush instead – WHO recognizes miswak as a useful traditional oral hygiene aid.

SYNOPSIS
• Toothbrush with fluoridated toothpaste remains the gold standard for mechanical plaque removal and caries prevention.
• Use the miswak only when they can not afford to buy the toothbrush and toothpaste – Miswak has cultural, religious, and antibacterial benefits. It can be used as an adjunct, especially at prayer times or when toothbrush or toothpaste are unavailable (e.g., while traveling).

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Papillary gingivitis

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• Gingivitis is classified depending on the distribution.
• Marginal gingivitis involves the gingival margin, and it can include a portion of the contiguous attached gingiva.
• Papillary gingivitis involves the interdental papillae and it often extends into the adjacent portion of the gingival margin.
• Diffuse gingivitis affects the gingival margin, the attached gingiva and the
interdental papillae.

REFERENCE
Gingivitis by Rehan Adhan Radhi.

ANSWER
Pleomorphic adenoma

OTHER OPTIONS
• Warthin’s tumour – Warthin’s tumour is the second most frequent benign neoplasm of the salivary glands after pleomorphic adenoma.
• Adenoid cystic carcinoma – Adenoid cystic carcinoma is a malignant neoplasm affecting salivary gland manifested as early local pain, facial nerve paralysis, swelling with marked tendency to spread through perineural spaces.
• Mucoepidermoid carcinoma – Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, accounting for 10-15 percent of all salivary gland tumors and one-third of all salivary gland malignancies.

SYNOPSIS
• Pleomorphic adenoma is the most common salivary gland tumor, is also known as benign mixed tumors.
• It is the commonest of all salivary gland tumors constituting up to two-thirds of all salivary gland tumors.
• Pleomorphic adenoma mostly presents as a solitary mobile slow growing, painless mass, which may be present for many years.
• In the parotid gland, signs of facial nerve weakness occur when the tumor is large.
• Histology will reveal proliferation of myoepithelial and epithelial cells of the ducts.
• Presently pleomorphic adenoma of the parotid gland is treated either with superficial or total parotidectomy or excision.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 266.

ANSWER
Class III malocclusion

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• If SNA is greater than 82, maxilla is considered protruded.
• If SNA is less than 82, maxilla is said to be retruded.
• If SNB is greater than 80, mandibular prognathism is noted.
• If SNB angle less than 80 means mandibular retrognathism.
• ANB angle indicates relative position of maxilla to mandible.
• ANB greater than 2 means a class 2 tendency.
• ANB less than 2 means a class 3 tendency.

REFERENCE
Contemporary Orthodontics 6th Edition Page No 175.

ANSWER
Dense cortical and coarse trabecular

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• Misch classified bone density into-
• D1 – dense cortical bone and seen in anterior mandible.
• D2 – thick dense to porous cortical bone crest and coarse trabecular bone within and seen in anterior and posterior mandible and anterior maxilla.
• Type 2 bone is the best bone for osseointegration of dental implants.
• It provides good cortical anchorage for primary stability, yet has better vascularity than Type 1 bone.
• D3 – thin porous cortical bone on crest and fine trabecular bone within and seen in posterior mandible and anterior and posterior maxilla.
• D4 – fine trabecular bone as seen in posterior maxilla.
• Thus, prosthesis movement will be more limited and the amount of bone density and volume is most favourable in anterior mandible between mental foramens.

REFERENCE
Textbook of Prosthodontics, V Rangarajan – Page No 768.

ANSWER
Clindamycin 600 mg

OTHER OPTIONS
Not applicable

SYNOPSIS
• Infective endocarditis develops if the patient has conditions like valvular heart disease, congenital heart disease, prosthetic valves, cardiomyopathy or congenital malformations.
• Dental extractions, oral prophylaxis, implant placement, biopsies, periodontal treatments, periapical endodontic treatments and any other oral procedures causing intraoral bleeding can lead to infective endocarditis in patients with cardiac issues as mentioned above.
• Amoxicillin 2g orally 1 hr before procedure is common antibiotic prophylaxis.
• If unable to take orally, ampicillin 2 g IV or IM 30 minutes before procedure is given.
• If allergic to pencillin, clindamycin 600 mg or azithromycin or clarithromycin 500 mg can be given orally.
• If unable to take orally and allergic to pencillin, clindamycin 600 mg IV or cefazolin 1 g IM or IV within 30 minutes is indicated.

REFERENCE
Peterson’s Principles of Oral and Maxillofacial Surgery – 2nd Edition Page No 24.

ANSWER
Both B and C

OTHER OPTIONS
• Determine the presence of caries – Explorer is used to determine the presence of caries.

SYNOPSIS
• The periodontal probe is a narrow rounded or flat, blunt ended, graduated instrument.
• Because of its blunt end, it can be inserted into the gingival sulcus without causing trauma.
• Periodontal probe is used to primarily to measure periodontal probing depth.
• It is also used to determine the degree of gingival inflammation, to evaluate furcation lesions and also used to evaluate the extent of tooth mobility.

REFERENCE
Periodontal Probe by ScienceDirect.

ANSWER
Cold test

OTHER OPTIONS
Not applicable

SYNOPSIS
• Cold pulp testing has generally high diagnostic accuracy and can be considered the pulp testing method in clinical practice.
• Diagnostic accuracy in 86 percent.
• Cold pulp test is the simplest and most accurate pulpal sensibility test available to clinicians and hence should be the primary diagnostic tool to assess pulpal status.
• Materials used are endo ice, CO2 snow, pencil of ice, ice cold water under rubber dam isolation and ethyl chloride.

REFERENCE
Cold Pulp Testing is the Simplest and Most Accurate of all Dental Pulp Sensibility Tests by PMC.

ANSWER
RMGIC

OTHER OPTIONS
Not applicable

SYNOPSIS
• In a root caries procedure, lack of dentin and poor isolation may present restoration challenges.
• Resin modified glass ionomer cement (RMGIC) is a restorative material that can be used effectively in this situation.
• Clinical studies have demonstrated that RMGIC have very good retention over time due it’s chemical and mechanical adhesion.
• It shows low polymerization shrinkage and is less adversely affected by moisture.
• Release fluoride to the dental structure is an important feature of RMGIC that makes it more effective in root caries.

REFERENCE
What kind of restoration material is best recommended for root caries, especially where isolation is a problem by CDA Oasis.

ANSWER
Continue taking warfarin

OTHER OPTIONS
Not applicable

SYNOPSIS
• Dentist should consult with the patient’s physician to determine the level of anticoagulation being maintained with warfarin therapy.
• If invasive procedures or minor oral surgery are planned and the patient’s INR is between 2.0 and 3.5, no adjustment in warfarin dosage is indicated.
• If the INR is greater than 3.5, the dentist should request that the dosage be reduced to allow the INR to fall in the range of 2.0 to 3.5.
• If major oral surgery is planned and the patient’s INR is between 3.0 and 3.5, the dentist may request that the dosage be reduced to allow the INR to fall in the range of 2.0 to 3.0.
• If the dosage of warfarin is reduced by the patient’s physician it will take 3 to 5 days for the desired reduction to occur.
• The reduction should be confirmed by INR before the dental or surgical procedure.

REFERENCE
Little and Falace’s Dental Management of Medically Compromised Patients – 9th Edition Page No 450.

ANSWER
Iron deficiency anemia

OTHER OPTIONS
• Thalassemia – Thalassemia shows microcytic normochromic anemia with reduced MCV and MCH and normal MCHC.
• Vit B12 deficiency anemia and Folate deficiency anemia – Vit B12 deficiency and folate deficiency anemia are associated with macrocytic normochromic and increasef MCV and MCH and a normal MCHC.

SYNOPSIS
• Iron deficiency anemia is a manifestation of severe iron deficiency and is most common anemia in the world.
• Developed by nutritional deficiency, impaired absorption, chronic inflammation etc.
• Reduced MCV, MCH and MCHC with microcytic hypochromic RBCs are found in smear.
• Angular cheilitis, atrophic glossitis, oesophageal webs, dysphagia are seen orally.
• Patient may experience fatigue, leg cramps, craving for ice or cold vegetables, intolerance to cold, poor mental performance etc.
• Treated with iron supplements.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 501.

ANSWER
Increases

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• ANB angle indicates relative position of maxilla to mandible.
• ANB greater than 2 means a class 2 tendancy.
• ANB less than 2 means a class 3 tendancy.
• If SNA is greater than 82, maxilla is considered protruded.
• If SNA is less than 82, maxilla is said to be retruded.
• If SNB is greater than 80, mandibular prognathism is noted.
• If SNB angle less than 80 means mandibular retrognathism.

REFERENCE
Contemporary Orthodontics 6th Edition Page No 175.

ANSWER
37 percent phosphoric acid

OTHER OPTIONS
Not applicable

SYNOPSIS
• Acid etching is done using 37 percent phosphoric acid.
• It aids and enhances the formation of resin bond to teeth.
• On acid etching, enamel rods are dissolved to depths of 10-100 micrometers.
• This increases surface area, increases surface energy to enhance wetting and creates porous enamel rod ends for resin penetration.

REFERENCE
Phillip’s Science of Dental Materials – 12th Edition Page No 300.

ANSWER
Antimalarial

OTHER OPTIONS
Not applicable

SYNOPSIS
• Lichenoid reaction is similar to lichen planus but associated with an underlying cause.
• Drugs like antimalarials, NSAIDS, antihypertensives, antiretrovirals, dental restorative materials like amalgam, gold, chromium, cobalt, epoxy resins etc can trigger lichenoid reactions.
• Seen as greyish white streak or even ulcerations.
• Lesions are usually unilateral.
• Treatment is to identify and eliminate trigger factors.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 548.

ANSWER
Internal root resorption

OTHER OPTIONS
Not applicable

SYNOPSIS
• Calcium hydroxide is commonly used endodontics due to its antimicrobial effect and potential to stimulate mineralized repair of pulp and periapical tissues.
• But calcium hydroxide is less used in primary teeth because it can cause chronic pulpal inflammation and internal root resorption.
• Chronic inflammation influence macrophages to fuse to form odontoblasts which starts resorption.

REFERENCE
Article on Calcium Hydroxide Induced Resorption of Deciduous teeth – Possible Explanation.

ANSWER
50 gm

OTHER OPTIONS
Not applicable

SYNOPSIS
• Tipping is the simplest type of tooth movement where a single force is applied to the crown, which results in movement of crown in the direction of force and root in opposite direction.
• It is simplest among tooth movements.
• Controlled tipping occurs when tooth tips about a centre of rotation at its apex.
• Uncontrolled tipping is when tooth movement occurs about a centre of rotation apical and very close to centre of resistance.
• A 50 gm force directed lingually and perpendicular to the long axis of the tooth produced 0.17152 N per mm2 compressive stress at the cervical margin on the lingual side and tensile stresses 0.024357 N per mm2 at the cervical margin on the labial surface.

REFERENCE
Orthodontic Force Distribution – A Three dimensional Finite Element Analysis by Hemanth M and Siddharth D Lodaya.

ANSWER
2 weeks

OTHER OPTIONS
Not applicable

SYNOPSIS
• Extrusive luxation is a type of traumatic injury mainly caused by forces with oblique direction, characterized by the partial or total separation of periodontal attachments.
• Following injury, the loosening and axial displacement of the tooth are expected.
• Before the accident your tooth was held in place by fibers and cells called the periodontal ligament.
• These fibers were torn apart and many of the cells were damaged as the tooth was torn from its location in the bone.
• When extruded teeth are repositioned they are quite likely to be retained for a lifetime.
• The longer the tooth has been extruded without repositioning, the more difficult repositioning becomes because a blood clot forms that makes repositioning less successful.
• Reposition the extruded tooth and stabilize it with a flexible splint for up to 2 weeks.
• By 48 hours it is unlikely the tooth can be repositioned to its original location.
• Examination at 2 weeks, 3 months, 6 months, 12 months are done.
• Patient should be informed of the signs and symptoms of pulp necrosis and RCT should be initiated then.

REFERENCE
The Extruded Permanent Tooth – Information for dentists by The Toronto Dental Trauma Research Group.

ANSWER
Pustule

OTHER OPTIONS
• Papule – Papules are solid lesions raised above the skin surface that are smaller than 1 cm in diameter.
• Vesicle – Vesicle is an elevated blister containing clear fluid that are under 1 cm in diameter.
• Macules are well circumscribed flat lesions.

SYNOPSIS
• Pustule – Pustule is raised lesion containing purulent material.
• Size – usually less than5 mm.
• Color – yellowish or whitish (due to pus).
• Surrounding area – often erythematous.
• Course – pustules rupture easily, leaving behind an ulcer covered with a yellow crust.
• Common Sites in the Oral Cavity
– Buccal mucosa
– Gingiva
– Lips
– Tongue (less common)

REFERENCE
Oral and Maxillofacial Pathology, Neville – 4th Edition Page No 50.

ANSWER
Closer to the apex

OTHER OPTIONS
Not applicable

SYNOPSIS
• As bone support around tooth decreases, the centre of resistance of tooth also changes.
• With the change in positioning of the center of resistance, which becomes more apical as the alveolar bone height is reduced, there is a change in the moment to force ratio.
• When there is alveolar bone loss, the center of resistance is apically displaced proportionally to the amount of bone height present.
• Therefore, it is suggested to bond the orthodontic accessories as cervically as possible, provided it does not interfere with hygiene procedures.

REFERENCE
Orthodontic Treatment of Periodontal Patients – Challenges and Solutions, from Planning to Retention by PMC.

ANSWER
Herpes simplex infection

OTHER OPTIONS
• Herpes zoster – Herpes zoster infection exhibits fever, malaise, linear vesicular lesions skin or mucosa supplied by affected nerve.
• Herpangina – Herpangina exhibits sore throat, low grade fever, headache, vomiting and abdominal pain with crops of ulcers on hard and soft palate, pharyngeal wall, buccal mucosa, tongue and anterior faucial pillars.
• Hand, foot and mouth disease – Hand, foot and mouth disease is seen as low grade fever, lymphadenopathy, nausea, diarrhea, vomiting, pharyngitis and vesicular lesions on hand, feet and mouth.

SYNOPSIS
• Herpes simplex is an acute infectious disease of viral origin.
• Common in children and young adults.
• Clinically characterized by fever, irritability, headache, pain upon swallowing and regional lymphadenopathy.
• Mouth becomes painful with gingival erythema, edema and inflammation.
• Lips, tongue, buccal mucosa, palate, pharynx and tonsils may show yellowish fluid filled vesicles which may eventually rupture to form shallow, ragged painful ulcers covered by grey membrane surrounded by erythematous halo.
• They heal within 7-14 days and leave no scar.
• Antiviral drugs can be used for treatment.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 325.

ANSWER
Charter technique

OTHER OPTIONS
• Bass technique – Sulcular penetration so contraindicated in immediate post-surgical phase (risk of trauma)
• Modified Stillman – More suited for patients with gingival recession, not for surgical sites.

SYNOPSIS
• In Charter technique bristles placed at a 45° angle directed coronally (toward occlusal surface), with gentle vibratory strokes.
• This avoids bristle penetration into the gingival sulcus or surgical wound, while keeping plaque away from the gingival margin.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Angle

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• Mandibular fractures occurs mainly due to trauma.
• The most common sites for the mandible to fracture are the condyle, the angle and the symphysis.
• Condylar fracture is the most common site of fracture which accounts for around 29.1 percent.
• Angle fracture is seen in around 24.5 percent people followed by symphysis fracture seen in around 22 percent individuals.
• Body fracture is seen in 16 percent, alveolar fracture in 3.1 percent and coronoid fracture is seen in 1.3 percent individuals.
• 1.7 percent people might show ramus fracture.

REFERENCE
Contemporary Oral and Maxillofacial Surgery St. Louis, Mosby, 2013 – 6th Edition.

ANSWER
Exploratory surgery

OTHER OPTIONS
Not applicable

SYNOPSIS
• When clinical and radiographic evaluations are equivocal, exploratory surgery may be indicated.
• Vertical root fractures are a significant cause of failure and may be difficult to diagnose in the early stages.
• The identification of a VRF may be challenging, as patients are often reluctant to undergo the surgical exploration that is required to permit direct visualization of the root surface, as the fracture may be masked by extra‐coronal restorations or located subgingivally.
• An early stage VRF may share similar pathological signs to post‐treatment endodontic disease leading to greater uncertainty in reaching an accurate diagnosis.
• CBCT can be also preferred.

REFERENCE
Present Status and Future Directions – Vertical Root Fractures in Root Filled Teeth by PMC.

ANSWER
Mucous membrane distal to second maxillary molar just below mesiopalatal cusp

OTHER OPTIONS
• Mucous membrane taking pterygomandibular raphae and coronoid notch as landmarks – Inferior alveolar nerve block is given in mucous membrane taking pterygomandibular raphae and coronoid notch as landmarks.
• Adjacent to maxillary tuberosity at the height of mucogingival junction next to maxillary third molar – Vazirani akinosi is administered adjacent to maxillary tuberosity at the height of mucogingival junction next to maxillary third molar.
• Mucobuccal fold above maxillary second molar – Posterior superior alveolar nerve block is administered in mucobuccal fold above maxillary second molar.

SYNOPSIS
• Mandibular nerve block or Gow Gates technique provides sensory anesthesia to virtually the entire distribution of mandibular nerve.
• It anesthetizes inferior alveolar, mental, incisive, lingual, mylohyoid, auriculotemporal and buccal nerves.
• Area of insertion is mucous membrane on mesial of mandibular ramus, mucosa distal to maxillary second molar by placement of needle tip just below the mesiopalatal cusp of maxillary second molar.
• Landmarks includes center of external auditory meatus and corner of mouth extraorally and intraorally mesiopalatal cusp of upper 2nd molar and soft tissues distal to 2nd molar.

REFERENCE
Handbook of Local Anesthesia, Stanley F Malamed – 7th Edition Page No 237.

ANSWER
Internal resorption

OTHER OPTIONS
• Dens invaginatus – Dens invaginatus is a developmental variation which arises as an invagination in surface of tooth crown before calcification has occurred.
• Pulp stones – Pulp stones are foci of calcification in the pulp of tooth that are seen as radiopaque structures in pulp.
• Replacement resorption – Replacement resorption is a continuous process whereby the tooth is gradually replaced by bone.

SYNOPSIS
• Internal resorption may develop from trauma, pulpotomy or crown preparation.
• Inflammed pulp is tissue involved in resorbing root structure.
• Usually asymptomatic, but can be manifested as pink tooth.
• Radiographically seen as a well defined, sharp and smooth radiolucency involving root canal.
• Immediate removal of inflamed tissue and completion of endodontic treatment can stop internal resorption.

REFERENCE
Grossman’s Endodontic Practise – 13th Edition Page No 139.

ANSWER
Multiple myeloma

OTHER OPTIONS
• Multiple sclerosis – Multiple sclerosis is autoimmune demylinating disease of central nervous system.
• Osteosarcoma – Osteosarcoma is malignancy of bone that shows sunburst appearance radiographically.
• Paget’s disease – Paget’s disease shows cotton wool appearance radiographically.

SYNOPSIS
• Multiple myeloma is malignancy of plasma cells.
• It results from mutation of plasma cells.
• Findings include bone pain, anemia, hypercalcemia and infections.
• Orally manifested as pain, swelling, expansion of jaw, numbness and mobility of teeth.
• Radiographically it shows numerous punched-out radiolucencies in affected bones likd ribs, skull, jaw and end of long bones.
• Diffuse destructive lesions of bone may also occur.
• Bence jones protein in urine is an important feature.
• Treatment includes chemotherapy, bisphosphonate therapy etc.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 241.

ANSWER
Symptomatic irreversible pulpitis and symptomatic apical periodontitis

OTHER OPTIONS
Not applicable

SYNOPSIS
• Symptomatic irreversible pulpitis is a pulpal inflammation irreversible in nature, which is usually caused by deep caries or restorations.
• It is clinically manifested primarly as spontaneous pain.
• Pain will be sharp, severe, exaggerated, continous, lingering and nocturnal type.
• Radiographs show no periradicular changes.
• In acute or symptomatic apical periodontitis, tenderness on percussion will be present.
• RCT or extraction are the treatment of choice.

REFERENCE
Grossman’s Endodontic Practice – 13th Edition Page No 101.

ANSWER
Extraction

OTHER OPTIONS
Not applicable

SYNOPSIS
• Among the various periodontal prognosis systems, the one most widely used was proposed by McGuire and Nunn in 1996.
• It consists of five categories that include good, fair, poor, questionable and hopeless.
• In poor prognosis, it includes 50 percent attachment loss and grade II furcation.
• In questionable prognosis, more than 50 percent attachment loss and grade III furcation, poor crown root ratio, class II or more mobility.
• Hopeless includes severe attachment loss.
• Extraction may be preferred in this case.

REFERENCE
Strategies for Periodontal Risk Assessment and Prognosis by Decisions in Dentistry.

ANSWER
Admix

OTHER OPTIONS
Not applicable

SYNOPSIS
• The ‘admix impression’ is a definitive secondary impression technique used in the management of severely resorbed mandibular ridges covered with atrophic mucosa.
• In cases exhibiting high degree of resorption, more the denture covers the basal seat area, the better the stability of the prosthesis.
• To gain as much coverage of the basal seat as possible, an admixed technique is advocated.
• It involves making of a primary impression by mixing impression compound and green stick compound in the ratio of 3 by 7.
• This technique is quite useful in poor ridge cases.

REFERENCE
Impression techniques for the Resorbed Mandibular arch – A Guide to Increased Guide by ResearchGate.

ANSWER
ASA

OTHER OPTIONS
Not applicable

SYNOPSIS
• The anterior superior alveolar, or infraorbital, nerve block, is a useful technique for achieving anesthesia of the maxillary central and lateral incisors and canine as well as the surrounding soft tissue on the buccal aspect.
• In case of RCT, pulpal anesthesia is required and achieved by ASA nerve block alone.
• Nasopalatine nerve block is indicated when palatal soft tissue anesthesia is also needed as in cases like minor surgical procedures.

REFERENCE
Handbook of Local Anesthesia, Stanley F Malamed – 7th Edition Page No 197.

ANSWER
Generalized stage III, grade C

OTHER OPTIONS
Not applicable

SYNOPSIS
• Localized means less than 30 percent teeth are involved.
• Generalized means more than 30 percent teeth are involved.
• Stage 1 Periodontitis – In stage 1 periodontitis, clinical attachment loss will be 1-2mm and probing depth tends to be less than or equal to 4mm with horizontal bone loss.
• Stage 2 Periodontitis – Stage 2 periodontitis is characterized by a CAL of 3-4 mm, probing depth less than or equal to 5mm and mostly horizontal bone loss.
• Stage 3 Periodontitis – In stage 3 periodontitis, clinical attachment loss will be greater than or equal to 5mm and probing depth tends to be greater than or equal to 6 mm with vertical bone loss.
• Stage 4 Periodontitis – In stage 4 periodontitis, clinical attachment loss will be greater than or equal to 5mm with severe mobility, teeth loss and masticatory dysfunction.
• Grade A is if ratio of percentage of bone loss to age is less than 0.25.
• Grade B is if ratio of percentage of bone loss to age is between 0.25-1.
• Grade C is if ratio of percentage of bone loss to age is more than 1.

REFERENCE
Staging and Grading Periodontitis by AAP.

ANSWER
Bad breath originating from the gastrointestinal tract is quite common

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Bad breath appears to be largely bacterial in origin – The primary cause of halitosis is volatile sulfur compounds (VSCs) produced by anaerobic bacteria in the oral cavity (mainly the tongue dorsum, periodontal pockets, and throat).
• Gastrointestinal causes are uncommon and account for less than 1 percent of halitosis cases.
• Self-perceptions of bad breath appear to be unreliable. Studies show many patients who believe they have halitosis actually don’t (pseudo-halitosis), while some with halitosis are unaware.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
William probe

OTHER OPTIONS
• Marquis color coded probe – Marquis probe has calibrations at 3,6,9,12 mm sections.
• UNC 15 probe – UNC 15 probe is 15mm long with millimeter markings and color coding at 5,10 and 15mm.
• WHO probe – WHO probe has 0.5mm ball at tip and millimeter markings at 3.5, 8.5 and 11.5 mm and color coding from 3.5-5.5 mm.

SYNOPSIS
• William Probe was introduced by Charles H M Williams.
• It is stainless steel probe with 1mm diameter and 13 mm length with a blunt tip end.
• All marking from 1 to 10 mm except 4 and 6 are missing, which minimizes confusion during reading markings.
• It is intended to measure depth of periodontal pockets.

REFERENCE
Article on Complete Guide – Periodontal instruments and their Uses.

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• Before performing a laterally repositioned flap (laterally positioned flap, LRP) for root coverage or gingival augmentation, the following factors must be evaluated
• Presence of bone on the facial surface of the donor tooth – Adequate bone support is crucial to ensure flap survival and prevent recession.
• Thickness of the gingiva at the donor site – Thicker gingiva enhances vascular supply and flap stability, leading to better healing.
• Width of attached gingiva at the donor site – A wider band of attached gingiva ensures sufficient donor tissue for successful flap mobilization.

REFERENCE
Lindhe 6th edition chapter 39
Carranza 11th edition chapter 63

ANSWER
Stainless steel crown

OTHER OPTIONS
Not applicable

SYNOPSIS
• Stainless steel crowns are indicated after pulpotomy or pulpectomy specially for primary first molar.
• Used when three or more surfaces need restoration.
• Used as an abutment for fixed appliances.
• SCCs are also used in high caries index patient.
• Strong consideration should be given to the use of stainless steel crowns in children who require general anesthesia.

REFERENCE
The Use of Stainless Steel Crowns by AAPD.

ANSWER
Pulpotomy

OTHER OPTIONS
Not applicable

SYNOPSIS
• When the carious process has reached the pulp or in incidences of direct pulpal exposure during excavation of a carious lesion, the pulpotomy procedure is indicated and is the treatment of choice.
• Pulpotomy procedure is based on the rationale that the radicular pulp tissue is healthy or is capable of healing after surgical amputation of the affected or infected coronal pulp.
• The presence of any signs or symptoms of inflammation extending beyond the coronal pulp is a contraindication for a pulpotomy.
• Thus, a pulpotomy is contraindicated when there is any swelling (of pulpal origin), fistula, pathologic mobility, pathologic external root resorption, internal root resorption, periapical or interradicular radiolucency, pulp calcifications, or excessive bleeding from the amputated radicular stumps.

REFERENCE
Pediatric Dentistry Infancy through Adolescence – 6th Edition Page No 340.

ANSWER
Implant is doing well

OTHER OPTIONS
Not applicable

SYNOPSIS
• The rate of crestal bone loss in the region can be used to determine the long term success of dental implant.
• A crucial success factor was suggested as crestal bone loss of less than 1.5 mm in the first year following loading.
• Less than 0.2 mm annually after that is also considered normal.

REFERENCE
Article on Comparative Evaluation of Crestal Bone Level around Pre and Post-Loaded Endosseous Implants.

ANSWER
Less tactile sensitivity

OTHER OPTIONS
Refer synopsis.

SYNOPSIS
• Automated probes like florida probe and interprobe measures probing depth electronically and transferred automatically to computer.
• These probes have more reproducibility, less variability and does not require any assistance to record data.
• But these probes underestimate probing depth due to their less tactile sensitivity.

REFERENCE
Newman and Carranza’s Clinical Periodontology – 13th Edition Page No 388.

ANSWER
Less bleeding on probing

OTHER OPTIONS
• Increased attachment level – Would suggest improvement, but requires long-term monitoring. Not as immediate or sensitive as BOP for short-term evaluation.
• Decreased plaque score – Reflects improved oral hygiene. Helpful, but not as directly correlated with tissue health as BOP.

SYNOPSIS
• BOP is an early and sensitive sign of inflammation.
• Its absence is a strong predictor of periodontal stability.
• According to Lang & Tonetti (2003) and Carranza’s Clinical Periodontology, absence of BOP is a key indicator of periodontal health after therapy.
• Highly reproducible and easily measurable in clinical practice.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
9 ml

OTHER OPTIONS
Not applicable

SYNOPSIS
• Acetaminophen in children is given to a dose of 10-15 mg per kg per dose.
• In a child of 20 kg, maximum dose of acetaminophen that can be given is 20 multiplied with 15 and that is 300 mg per dose.
• In a commercially available syrup 160 mg of acetaminophen is present in 5 ml.
• So, at least 9 ml can be consumed per dose to maximum by a child of 20kg.

REFERENCE
Pediatric Acetaminophen Dosage By Medscape.

ANSWER
Consent

OTHER OPTIONS
• Justice – Justice is principle concerned with providing individuals or groups with what is owed, dued and deserved.
• Paternalism – Paternalism means the health care professional acts as a parent and makes decisions for the patient on the basis of what the professional believes is in the best interest of the patient.

SYNOPSIS
• Informed consent is the basis for every treatment you propose to and perform on patients.
• Dentists must obtain informed consent from each patient or from the patient’s legal guardian or decision-maker.
• State laws impact whether consent can be verbal or written.
• For common simple procedures such as an evaluation or prophylaxis for a healthy individual, the act of sitting in the dental chair may be interpreted as implied or waived consent.

REFERENCE
Informed Consent or Refusal by ADA.

ANSWER
High pull headgear

OTHER OPTIONS
• Reverse pull headgear or Face mask – Reverse pull headgear or Face mask is used in class III cases with maxillary hypoplasia.
• Cervical headgear – Cervical headgear is used in correcting class II especially in distalizing maxilla and maxillary molars.

SYNOPSIS
• High pull headgear derive anchorage from parietal region of cranium.
• They produce vertically directed force on maxilla and maxillary dentition.
• These can be used to produce intrusive forces on anterior region of maxilla thereby producing counter clockwise moment of the maxilla.
• This is beneficial in correction of vertical maxillary excess and gummy smile.
• Intrusive forces on posterior aspect of maxilla can be of benefit in anterior open bite patients as it intrudes the maxillary molars and therefore produces a clockwise moment of the maxilla.

REFERENCE
Orthodontics The Art and Science – 6th Edition Page No 456.

ANSWER
Combined mesiodistal width of permanent canines and premolars is less than that of primary canines and molars

OTHER OPTIONS
Not applicable

SYNOPSIS
• Second transitional period during mixed dentition stage is characterized by replacement of deciduos molar and canines by premolars and permanent cuspids respectively.
• Combined mesiodistal width of permanent canines and premolars is less than that of the deciduous molars and canines and this surplus is called leeway space of Nance.
• Amount of leeway space is greater in mandibular arch than maxillary arch.
• It is about 1.7 mm on each side or arch (3.4 mm total) in mandible.
• It is about 0.9 mm on each side or arch (1.8 mm total) in maxilla.

REFERENCE
Orthodontics The Art and Science – 6th Edition Page No 58.

ANSWER
Disrupts membrane integrity

OTHER OPTIONS
Not applicable

SYNOPSIS
• Chlorhexidine is a broad spectrum biocide effective against gram positive bacteria, gram-negative bacteria and fungi.
• Chlorhexidine inactivates microorganisms with a broader spectrum than other antimicrobials (e.g. antibiotics) and has a quicker kill rate than other antimicrobials (e.g. povidone-iodine).
• It has both bacteriostatic (inhibits bacterial growth) and bactericidal (kills bacteria) mechanisms of action, depending on its concentration.
• Chlorhexidine kills by disrupting the cell membrane.
• Upon application in vitro, chlorhexidine can kill nearly 100 percent of gram positive and gram negative bacteria within 30 seconds.
• Chlorhexidine is a positively charged molecule that binds to the negatively charged sites on the cell wall, it destabilizes the cell wall and interferes with osmosis.

REFERENCE
Chlorhexidine in Dentistry – Pharmacology, Uses and Adverse effects by PMC.

ANSWER
Turner’s hypoplasia

OTHER OPTIONS
• Dens in dente – A condition resulting from invagination of the inner enamel epithelium producing the appearance of a tooth within a tooth.
• Dens evagenatus – Describes an outfolding of the enamel organ that results in an extra cusp, usually in the central groove or ridge of posterior teeth and in the cingulum area of the anterior teeth, sometimes called a talon cusp.
• Ankylosis – Fusion of tooth to bone

SYNOPSIS
• Trauma to the primary teeth may progress to cellulitis, and may result in aborted development or enamel hypoplasia of the succedaneous tooth.
• Enamel hypoplasia or hypomineralization can be generalized throughout the dentition or it can be localized.
• Enamel development, or amelogenesis, is an exquisitely regulated process at the molecular level but can be disrupted by many environmental factors, such as fever, infection, trauma, changes in oxygen saturation, antibiotics, and many other factors.
• Trauma leads to hypomineralization to marked enamel hypoplasia, which manifests as blue-gray to yellow-brown color.
• The altered tooth is called Turner’s tooth.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page

ANSWER
Extract supernumerary and wait for central incisors to erupt

OTHER OPTIONS
Not applicable

SYNOPSIS
• Unerupted maxillary incisors may result secondary to supernumerary teeth.
• Early surgical extraction of a mesiodens or mesiodens, ideally before 7 years of age.
• In order to promote eruption and proper alignment of adjacent teeth, it is recommended to extract mesiodens in the early mixed dentition, which may reduce the need for orthodontic treatment.
• It might take six months to three years for an unerupted tooth to erupt after removal of the mesiodens.
• If treatment is postponed after this age, more complex surgical and orthodontic treatment may be necessary.
• The type and position of the unerupted tooth, the space available in the dental arch, in addition to the stage of root development may influence how long it takes for an impacted tooth to erupt after surgical removal of the mesiodens.

REFERENCE
Diagnosis and Management of Supernumerary (Mesiodens) – A Review of the Literature by PMC.

ANSWER
Talon cusp

OTHER OPTIONS
• Fusion – Fusion is union of two normally separate tooth germs.
• Dens in dente – Dens in dente or dens invaginatus is a developmental variation which is thought to arise as a result of invagination in surface of tooth crown.
• Enamel pearls – Ectopic formation of enamel in form of globule on root surface.

SYNOPSIS
• Talon cusp or eagle’s talon projects lingually from cingulum areas of maxillary or mandibular permanent incisors.
• It can poses problems such as esthetics, caries control and occlusal accommodation.
• It there is occlusal interference, it should be removed but exposure of the pulp horn, necessitating endodontic therapy.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 41.