ANSWER
Irreversible pulpitis 

OTHER OPTIONS
• Reversible pulpitis – pain disappearing on removal of stimulus.
• Periapical abscess – No changes are seen in the periapical area so not an abscess.
• Cracked Tooth Syndrome – Pain relief on biting or pain aggravating upon bite release would be mentioned.

SYNOPSIS
• Spontaneous pain
• Lingering response to cold
• Night pain
• Radiograph – deep caries approaching pulp, PDL widening may be present due to early apical involvement
• These are classic features of symptomatic irreversible pulpitis.
• A clinical diagnosis characterized by lingering pain to thermal stimulus, spontaneous pain, or referred pain, indicating that the pulp is vital but inflamed beyond repair.

REFERENCE
Ingle’s Endodontics (7th Edition)

ANSWER
Asymptomatic Irreversible pulpits

OTHER OPTIONS
● Reversible pulpitis – Reversible pulpitis does not present with spontaneous or lingering pain.
● Symptomatic irreversible pulpitis – A clinical diagnosis characterized by lingering pain to thermal stimulus, spontaneous pain, or referred pain, indicating that the pulp is vital but inflamed beyond repair.
● Necrotic pulp – Pulp necrosis usually gives no response to vitality tests.

SYNOPSIS
● No spontaneous pain
● Lingering cold response
● Deep caries near pulp
● No periapical pathology
● These features points to asymptomatic irreversible pulpitis.

REFERENCE
Ingle’s Endodontics (7th Edition)

ANSWER
Root Canal treatment

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Even though the patient does not complain of pain, the pulp is irreversibly inflamed, and conservative pulp therapy (indirect or direct pulp capping) is contraindicated.
● For Asymptomatic Irreversible Pulpitis
– Complete removal of pulp tissue (Pulpectomy)
– Cleaning and shaping
– Obturation
– Final coronal restoration
● So if the tooth is restorable, Root Canal Treatment is the treatment of choice

REFERENCE
Ingle’s Endodontics (7th Edition)

ANSWER
Sodium hypochlorite

OTHER OPTIONS
● Normal saline – Only flushing action, no antimicrobial or tissue dissolving property
● Chlorhexidine – Good antimicrobial action but does NOT dissolve organic tissue.
● Hydrogen peroxide – Limited antibacterial effect and no tissue dissolving ability; not recommended as primary irrigant.

SYNOPSIS
● Sodium hypochlorite (NaOCl) is the gold standard irrigant in endodontics because
– It has excellent antimicrobial activity
– It dissolves necrotic and vital pulp tissue (organic tissue dissolution)
– It disrupts biofilm
– Effective even in difficult-to-instrument areas
● Concentrations commonly used: 0.5 – 5.25%

REFERENCE
Cohen’s Pathways of the Pulp (12th Edition)

ANSWER
Reversible pulpitis

OTHER OPTIONS
● Pulp necrosis – Pulp test will be negative
● Symptomatic irreversible pulpitis – Pain will be spontaneous and will linger even after removal of stimulis
● Chronic apical periodontitis – Radiographic changes will be seen

SYNOPSIS
● Pain is stimulus-dependent
● Pain does not linger
● No spontaneous pain
● No percussion tenderness
● No periapical changes
● These features are classical for reversible pulpitis.

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
Localized mild inflammatory response

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Reversible pulpitis shows
– Mild vascular dilation
– Limited inflammatory cell infiltration
– No widespread pulpal destruction
● The pulp retains healing potential if irritant is removed.

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
Removal of caries and placement of definitive restoration

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Since pulp inflammation is reversible
– Remove etiologic factor (caries)
– Place protective liner or base if required
– Restore tooth
● RCT is not indicated unless symptoms progress.

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
Short sharp response that subsides immediately

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Diagnostic criteria for reversible pulpitis
– Exaggerated response to cold
– Pain lasts only few seconds after removal of stimulus
– No spontaneous pain
– No percussion tenderness
– No radiohraphic changes

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
There is no need for treatment

OTHER OPTIONS
• Not applicable

SYNOPSIS
• This is a normal stage of dental development, usually between the ages of 9 and 12 years, preceding the eruption of the permanent canines(Ugly Duckling stage).
• It is caused when the upper central and lateral incisors are tipped laterally due to the crowding created by the unerupted canines.

REFERENCE
Gurkeerat-Singh-Textbook-Of-Orthodontics-2nd-Edition-Chapter 5-Page 46.

ANSWER
During eruption of maxillary central incisors

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Anterior dental crossbite should be corrected as early as possible, preferably during eruption of maxillary central incisors in the early mixed dentition.
● Early correction
– Prevents traumatic occlusion
– Avoids gingival recession
– Prevents skeletal Class III development
– Improves incisor guidance
● Delaying correction may result in functional shift and skeletal adaptation.

REFERENCE
Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics, 6th ed.

ANSWER
Excessive bleeding due to hepatic dysfunction

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● In Hepatitis B patients liver dysfunction may impair synthesis of clotting factors (II, VII, IX, X).
● This increases bleeding tendency. PT-INR must be assessed before extraction.
● Transmission risk is controlled with universal precautions, but bleeding due to coagulopathy is the primary clinical complication during extraction.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office

ANSWER
Stabilize the segment and postpone extraction

OTHER OPTIONS
● Not applicable

SYNOPSIS
● If a large tuberosity fracture occurs and the fragment is attached to the tooth
– Do NOT remove it immediately (risk of sinus perforation and loss of bone support).
– Reposition and stabilize (splinting).
– Postpone extraction for 4–6 weeks to allow healing.
● Removing large tuberosity compromises denture stability and sinus integrity.

REFERENCE
Peterson LJ. Contemporary Oral and Maxillofacial Surgery, 6th ed

ANSWER
Periodontal abscess

OTHER OPTIONS
● Not applicable

SYNOPSIS
– Non-carious tooth
– Vital pulp
– Isolated deep pocket
– Localized swelling
– Vertical bone loss
● These features indicate a periodontal origin, specifically a lateral periodontal abscess.
● Apical abscess would present with non-vital pulp.

REFERENCE
Carranza FA. Clinical Periodontology, 13th ed.

ANSWER
Replant immediately and splint for 2 weeks

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Extraoral dry time less than 60 minutes
● Stored in milk (physiologic medium) so PDL cells are likely viable
● Immediate replantation is indicated with flexible splint for 2 weeks
● Follow-up
– RCT within 7–10 days (for closed apex)
– Monitor for inflammatory resorption

REFERENCE
IADT Guidelines (2020)

ANSWER
1 hour before the procedure

OTHER OPTIONS
● Not applicable

SYNOPSIS
● For prevention of infective endocarditis in high-risk patients, amoxicillin 2 g orally (adult dose) is given 30–60 minutes before the procedure to ensure adequate serum concentration at the time of bacteremia.
● Post-procedure administration alone is not effective.

REFERENCE
Peterson LJ et al. Peterson’s Principles of Oral and Maxillofacial Surgery, 7th ed.

ANSWER
Diabetes

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● In diabetic ketoacidosis, patients exhibit a characteristic fruity or acetone odor due to ketone body accumulation.
● While rhinitis and tonsillitis may contribute to halitosis, the classic systemic fetor is seen in uncontrolled diabetes.

REFERENCE
Burket’s Oral Medicine, 13th ed.

ANSWER
Disc displacement with reduction

OTHER OPTIONS
● Disc displacement without reduction – Disc displacement without reduction presents with limited opening (closed lock).
● Rheumatoid arthritis – Rheumatoid arthritis shows pain, stiffness, and radiographic changes.
● Condylar fracture – Condylar fracture presents with trauma history and occlusal changes.

SYNOPSIS
● A clicking sound with normal mouth opening is characteristic of disc displacement with reduction, where the displaced disc returns to normal position during opening.

REFERENCE
Peterson LJ et al. Contemporary Oral and Maxillofacial Surgery, 7th ed.

ANSWER
Immediate extraction of mesiodens and ortho treatment

OTHER OPTIONS
• Frenectomy and then extraction of mesiodens – If Frenectomy is performed before the orthodontic procedure, the scar tissue might impede the closure of diastema.

SYNOPSIS
• First extraction is required to allow the diastema to close.
• Generally abnormal frenal attachment may require removal either before orthodontic treatment or at the end of active treatment.
• The advantage of excision before orthodontic treatment is the ease of surgical access. But, if the surgery is performed before the orthodontic procedure, the scar tissue might impede the closure of diastema.
• But the noted advantage of excision after orthodontic tooth movement is the scar tissue formation which helps maintain closure of diastema.

REFERENCE
Spontaneous closure of midline diastema following frenectomy- Kiran Koora
April 2007 Journal of Indian Society of Pedodontics and Preventive Dentistry.

ANSWER
Right condylar fracture

OTHER OPTIONS
● Not applicable

SYNOPSIS
● In unilateral condylar fracture, the mandible deviates toward the affected side due to loss of translatory movement of that condyle and unopposed action of the contralateral lateral pterygoid muscle.

REFERENCE
Peterson LJ et al. Contemporary Oral and Maxillofacial Surgery, 7th ed.

ANSWER
Vital bleaching

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Tetracycline stains are intrinsic stains incorporated into dentin during tooth development.
● Scaling or polishing will not remove intrinsic stains.
● Vital bleaching is the conservative first-line treatment.
● Severe cases may require veneers or crowns.

REFERENCE
Heymann HO, Swift EJ. Sturdevant’s Art and Science of Operative Dentistry, 7th ed.

ANSWER
Direct pulp capping

OTHER OPTIONS
• Pulpotomy is carried out when there is a large pulp exposure
• Apexification – Apexification is a method of treatment for immature permanent teeth in which root growth and development cease due to pulp necrosis.

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.
• In a young permanent tooth with recent traumatic pulp exposure and open apex, preserving pulp vitality is critical for continued root development (apexogenesis).

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 499

ANSWER
Internal resorption

OTHER OPTIONS
● Not applicable

SYNOPSIS
● In internal resorption, the canal space appears ballooned radiographically, and clinically the canal may appear enlarged or encountered earlier during access due to internal dentinal destruction.
● External resorption shows irregular root outline and canal remains intact radiographically.

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
Incision and drainage with antibiotics

OTHER OPTIONS
● Not applicable

SYNOPSIS
● This is an acute odontogenic infection with systemic involvement (fever).
● Management includes
– Establish drainage (I and D or through root canal)
– Empirical broad-spectrum antibiotics
– Eliminate source of infection
● Antibiotics alone are insufficient without drainage.

REFERENCE
Peterson LJ et al. Contemporary Oral and Maxillofacial Surgery, 7th ed.

ANSWER
Chronic hyperplastic pulpitis

OTHER OPTIONS
● Periapical granuloma – A periapical granuloma is a common, often asymptomatic, inflammatory lesion that develops at the root tip of a dead (necrotic) tooth, usually following untreated dental decay, trauma, or pulpal infection.
● Pyogenic granuloma – Pyogenic granuloma is a reactive, non-neoplastic inflammatory hyperplasia of connective tissue characterized by an exuberant proliferation of granulation tissue in response to local irritation, trauma, or hormonal influences.
● Peripheral giant cell granuloma – Peripheral giant cell granuloma is a reactive, non-neoplastic proliferative lesion of the gingiva or edentulous alveolar ridge

SYNOPSIS
● In young patients with open carious exposure and good vascularity, chronic irritation leads to hyperplastic pulp tissue overgrowth (pulp polyp).
● It appears as a red, painless, fleshy mass.

REFERENCE
Grossman’s Endodontic Practice, 13th ed

ANSWER
Chronically inflamed but vital pulp

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Hyperplastic pulpitis (pulp polyp) is a form of chronic, irreversible pulpitis characterized by excessive proliferation of granulation tissue, typically in young, high-resistance teeth with large, open carious exposures.
● The pulp is actively inflamed, vascular, and often asymptomatic, appearing as a fleshy, reddish tissue mass protruding from the chamber. The pulp tissue is not necrotic in this stage but in an irreversibly inflamed condition.
● Due to the chronic nature, the lesion is often asymptomatic or only causes discomfort (pain, bleeding) when chewed upon.

REFERENCE
Grossman’s Endodontic Practice, 13th edition

ANSWER
Pulpectomy

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Chronic hyperplastic pulpitis (pulp polyp) is a form of chronic irreversible pulpitis.
● Although the pulp is vital, it is irreversibly inflamed, so conservative pulp therapy like direct or indirect pulp capping is contraindicated.
● Management depends on restorability of the tooth. In this case, it’s restorable so pulpectomy is the choice of treatment.
● In non-restorable cases, extraction is the best choice.

REFERENCE
Grossman’s Endodontic Practice, 13th edition

ANSWER
5% or less

OTHER OPTIONS
● Not applicable

SYNOPSIS
● During mandibular third molar surgery, injury to the inferior alveolar nerve and or lingual nerve is a known but uncommon complication.
● Overall incidence of nerve injury – less than 5%
● Permanent nerve damage – usually less than 1%
● Most injuries are temporary (neuropraxia) and resolve within weeks to months

REFERENCE
Handbook of Local Anesthesia – Stanley F Malamed – 6th Edition

ANSWER
Above the gingival margin

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The loop portion made from 36-mil wire is carefully contoured to the abutment tooth without restricting lateral movement of the primary canine.
• The loop is also contoured to within 1.5 mm of the alveolar ridge. The solder joints should fill the angle between the band and wire to avoid food and debris accumulation.
• If placed at the gingival margin or below the gingival margin causes poor oral hygiene maintainance, high caries rate, and children with irregular attendance, as the gingival tissues may grow over the space maintainer.

REFERENCE
• Contemporary Orthodontics-William R.Proffit,Henry W. Fields,Brent larson,David M.Sarver-Chapter 11 -Page 389.

ANSWER
Chlorhexidine gluconate

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent with substantivity.
● A 0.12–0.2% rinse for 30–60 seconds significantly reduces salivary microbial load and aerosol contamination during dental procedures.
● Saline and distilled water lack antimicrobial action, hydrogen peroxide has limited short-term effect.

REFERENCE
Carranza’s Clinical Periodontology, 13th ed

ANSWER
Wash hands before and after glove use

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Hand hygiene must be performed before donning gloves and after removing gloves, even if gloves appear intact.
● Microperforations and contamination during removal can transmit microorganisms.

REFERENCE
CDC Guidelines for Infection Control in Dental Health-Care Settings

ANSWER
Apical cementum apposition

OTHER OPTIONS
● Not applicable

SYNOPSIS
● With age and attrition, secondary cementum deposition occurs at the apex, shifting the apical constriction coronally.
● Radiographic apex does not correspond to apical constriction, causing discrepancy in apex locator readings.

REFERENCE
Cohen’s Pathways of the Pulp, 11th edition

ANSWER
Recurrent aphthous stomatitis

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Recurrent aphthous stomatitis (minor type) presents as small, painful ulcers on non-keratinized mucosa, healing in 7–10 days without scarring.
● Herpetic lesions typically affect keratinized mucosa and begin as vesicles.

REFERENCE
Shafer’s Textbook of Oral Pathology, 9th edition

ANSWER
Pocket depth 4–5 mm

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Score 0 (Healthy) – No treatment needed. Plaque control, good brushing, and flossing recommended.
● Score 1 (Gingivitis) – Bleeding on probing, no pockets. Improve oral hygiene, and interdental cleaning (e.g., floss).
● Score 2 (Calculus or Plaque) – Plaque-retentive factors (calculus, overhanging fillings) present. Treatment – Professional cleaning (scaling) and removal of plaque traps.
● Score 3 (Moderate Pocketing) – Pockets 3.5–5.5 mm. Treatment – Initial periodontal therapy, including deep scaling or root planing and improved oral hygiene.
● Score 4 (Deep Pocketing) – Pockets. Treatment – Comprehensive periodontal treatment, including deeper scaling, and potential specialist (periodontist) referral.
● * (Furcation) – Used with codes 3 or 4 to indicate pocketing involves the area between the roots of multi-rooted teeth.

REFERENCE
Carranza’s Clinical Periodontology, 13th ed.

ANSWER
Packable composite

OTHER OPTIONS
● Flowable composite – Used as a liner or base in small cavities, cervical lesions, and for sealing pits and fissures due to its low viscosity and good adaptability.
● Microfilled composite – Used mainly for anterior restorations where superior polishability and esthetics are required.
● Compomer – Used commonly in pediatric and non–stress-bearing restorations because it releases fluoride with better esthetics than GIC

SYNOPSIS
● Packable composites have higher filler content, improved strength, and better resistance to occlusal forces, making them suitable for stress-bearing posterior restorations.

REFERENCE
Anusavice. Phillips’ Science of Dental Materials, 12th ed

ANSWER
Oval

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Mandibular incisors have narrow mesiodistal but broader labiolingual dimension
● Therefore, access cavity is oval labiolingually to locate possible second canal.

REFERENCE
Ingle’s Endodontics, 7th ed.

ANSWER
Lingually

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Permanent successors develop lingual to primary teeth in early stages before erupting into proper alignment.

REFERENCE
Wheeler’s Dental Anatomy, Physiology and Occlusion, 11th edition

ANSWER
Radiograph

OTHER OPTIONS
● Lidocaine with epinephrine – Lidocaine (Category B) is considered safe.

SYNOPSIS
● Elective radiographs are not advisable because organogenesis occurs during weeks 2–8 (highest teratogenic risk).
● However, if absolutely necessary, dental radiographs can be taken with
– Lead apron
– Thyroid collar
– Digital or fast film
– Proper collimation
● Aspirin or acetylsalicylic acid is contraindicated in third trimester due to risk of premature closure of ductus arteriosus, prolonged labor, increased maternal and fetal bleeding

REFERENCE
Little and Falace. Dental Management of the Medically Compromised Patient, 9th ed.

ANSWER
Overbite

OTHER OPTIONS
• Open bite – Openbite is a dental condition where there is a lack of vertical overlap between the upper and lower teeth when the jaws are closed, resulting in a gap between the teeth, either anteriorly or posteriorly.
• Deep bite – Deep bite or deep overbite is defined as excessive vertical overlapping of the mandibular incisors by the maxillary incisors in centric occlusion.
• Overjet – Horizontal overlap of the maxillary central incisors over the mandibular central incisors.

SYNOPSIS
• Overbite is the vertical overlap of the maxillary central incisors over the mandibular central incisors.
• Normal overbite is 2-4mm

REFERENCE
Contemporary Orthodontics-William R.Proffit,Henry W. Fields,Brent larson,David M.Sarver-Chapter 8 -Page 249

ANSWER
Vibrating line

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● The posterior palatal seal is placed at or slightly posterior to the vibrating line (junction of movable and immovable soft palate) to ensure retention and compensate for polymerization shrinkage.
● Hamular notch forms lateral boundary but not the posterior limit alone.
● Retromolar pad is mandibular landmark.

REFERENCE
Boucher’s Prosthodontic Treatment for Edentulous Patients

ANSWER
It is the most successfully cured chronic dental disease

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Dentinal hypersensitivity is common and prevalent (8–30%) especially in young adults.
● It is explained by Brännström’s hydrodynamic theory.
● However, it is not easily or permanently cured and often requires long-term management.

REFERENCE
Addy M. Dentine hypersensitivity: new perspectives. J Clin Periodontol.

ANSWER
Incorrect posterior tooth arrangement

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Improper posterior tooth positioning (outside neutral zone or incorrect occlusal scheme) leads to instability and overlapping issues in complete dentures.

REFERENCE
Boucher’s Prosthodontic Treatment for Edentulous Patients

ANSWER
Maintaining occlusion

OTHER OPTIONS
● Not applicable

SYNOPSIS
● This situation predisposes to combination syndrome, where occlusal imbalance and excessive anterior forces cause bone resorption and instability.
● Occlusion control is the main challenge.

REFERENCE
Kelly E. “Changes caused by a mandibular removable partial denture opposing a maxillary complete denture – Journal of Prosthet Dentistry.

ANSWER
Weak bond between zirconia and resin cement

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Zirconia is non-etchable by conventional hydrofluoric acid and does not bond well without surface treatment (air abrasion + MDP primer).
● Poor bonding protocol leads to debonding.

REFERENCE
Anusavice. Phillips’ Science of Dental Materials, 12th ed.

ANSWER
Immediately

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Impression should be made promptly (within 1 minute) after removal of retraction cord before gingival tissues rebound and sulcus collapses.

REFERENCE
Shillingburg. Fundamentals of Fixed Prosthodontics, 4th ed.

ANSWER
To reduce postoperative sensitivity by sealing dentinal tubules

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Cavity varnish forms a thin resin film that occludes dentinal tubules, thereby reducing microleakage and postoperative sensitivity in amalgam restorations.
● It does not chemically bond amalgam nor increase its strength. It also does not release fluoride.

REFERENCE
Sturdevant CM et al. Sturdevant’s Art and Science of Operative Dentistry, 7th ed.

ANSWER
To remove smear layer and create microporosities for micromechanical retention

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Acid etching removes the smear layer and demineralizes enamel or dentin, creating microporosities that allow resin infiltration and hybrid layer formation, improving micromechanical retention.

REFERENCE
Sturdevant CM et al. Art and Science of Operative Dentistry, 7th ed

ANSWER
Initiate RCT and apply Calcium hydroxide as intracanal medicament at the site of resorption

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Internal root resorption is a pathologic process that occurs because of external stimuli that affect the pulp and result in the loss of dentinal tissue. The occurrence of IRR is considered relatively rare, and the etiology is not fully understood, although trauma is believed to be the main etiologic agent.
• Besides trauma, stimulation by infection or pressure (orthodontic force) can induce Internal root resorption.
• Root resorption in orthodontics is referred to as induced inflammatory resorption, and it is a form of pathological root resorption, in which orthodontic forces are transferred to the teeth.
• In the crown of the asymptomatic tooth, internal resorption may be manifested as a reddish area or pink spot often called the pink tooth of Mummery.
• Extraction is not the treatment of choice.
• The tooth can be saved by doing RCT depending on the extent of the lesion.
• Single visit endo is not indicated as Calcium hydroxide repeated dressing is needed for the healing.
• Calcium hydroxide is spun into the canal to facilitate the removal of the tissue in the irregular defect at the next visit.

REFERENCE
1. Ingles endodontics pg 435
2. Grossman’s endodontic practice pg 65

ANSWER
Rotary retreatment files

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Rotary NiTi retreatment systems are commonly used for efficient removal of gutta-percha.
● Hand files may be used adjunctively, but rotary instruments are preferred for initial bulk removal

REFERENCE
Ingle’s Endodontics, 7th Edition

ANSWER
It shifts with change in angulation

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Internal resorption remains centered within the canal and does not shift with parallax technique.
● Shifting indicates external resorption. It presents as smooth, symmetrical ballooning of canal space.

REFERENCE
Ingle’s Endodontics, 7th edition

ANSWER
Ankylosis of primary molar

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Ankylosed primary molars show infra-occlusion and absence of PDL space radiographically.
● Bone directly fuses to root surface, preventing normal exfoliation.

REFERENCE
McDonald RE, Avery DR. Dentistry for the Child and Adolescent, 10th ed.

ANSWER
Depth of impaction

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Depth of impaction and angulation (Winter’s classification) are key determinants of surgical difficulty.
● Greater depth increases complexity.

REFERENCE
Peterson LJ. Peterson’s Principles of Oral and Maxillofacial Surgery – 7th Edition

ANSWER
Reactionary dentine

OTHER OPTIONS
• Primary dentin – The dentin which forms before root completion is called primary dentin.
• Secondary dentin – Formed after root completion physiologically (age-related).
• Sclerotic dentin – Forms in earlier stages of caries by tubular occlusion (defense mechanism) but is not the main dentin deposited adjacent to the pulp in deep caries.

SYNOPSIS
• In deep caries with a vital pulp, odontoblasts respond to mild to moderate irritation by depositing reactionary dentin (a type of tertiary dentin).
• Reactionary dentin – Formed by existing odontoblasts in response to slowly progressing caries.
• Reparative dentin – Formed by newly differentiated odontoblast-like cells when original odontoblasts are destroyed.
• Thus, in deep caries with vital pulp, reactionary dentin is most characteristic.

REFERENCE
Goldberg M et al. Reactionary and reparative dentin formation. J Dent Res. 2011.

ANSWER
Lower than nonsealed teeth

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• A sealant is a clear or opaque plastic material that is applied to the pits and fissures of teeth where decay occurs most often. The purpose of the sealant is to provide a physical barrier to occlude pits and fissures and to protect them from bacteria and food.
• Teeth that have been sealed and then have lost the sealant have had fewer lesions than control teeth.
• This is possible due to the presence of tags that are retained in the enamel after the bulk of the sealant has been sheared from the tooth surface.
• When the resin sealer flows over the prepared surface it penetrates the finger-like depressions created by etching solution and making the tooth less susceptible to caries.
• Thus etched tooth surfaces are more resistant to acid attack.

REFERENCE
Pit and fissure sealants – Oral Health Foundation – Article.

ANSWER
Dentinal sclerosis

OTHER OPTIONS
• Dentinogenesis – Formation of dentine

SYNOPSIS
• Dentinal sclerosis or transparent dentin sclerosis of primary dentin is a change in the structure of teeth characterized by calcification of dentinal tubules.
• It can occur as a result of injury to dentin by caries or abrasion, or as part of the normal aging process.
• This form of dentine can be easily distinguished on the surface of a tooth, and is much darker in appearance compared to primary dentine.
Sclerosis results from aging is physiological dentine sclerosis and that resulting from a mild irritation is reactive dentine sclerosis.

REFERENCE
Orban’s oral histology and embryology, 14th edition

ANSWER
Increase

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The ANB angle provides a general idea of the anteroposterior discrepancy of the maxilla to the mandibular apical bases.
• +2 is considered ideal or average and usually indicates a balanced skeletal profile (Class I).
• Higher positive values(more than+ 4) suggest increasing Class II tendencies.
• Negative values (less than 0)suggest a Class III pattern.

REFERENCE
Radiographic Cephalometry-Basics to Videoimaging-Alexander Jacobson-Chapter 6-Page 78.

ANSWER
Zinc containing alloy

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Zinc-containing amalgam restorations can cause delayed expansion, which would be a reason for pain after amalgam restoration.
• Delayed expansion of amalgam often causes intense pain.
• It is assumed that when an expansion of this magnitude occurs, the restoration may become wedged so tightly against the cavity walls that pressure toward the pulp chamber results.
• Such pain may be experienced 10 to 12 days after the insertion of the restoration.
• If it is not removed, a contaminated amalgam restoration continues to expand and can result in a protruding restoration.

REFERENCE
Phillips Science of Dental Materials, 11th edition, page number 532.

ANSWER
Amalgam

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The change in length per unit length of a material for a 1degree C change in temperature is called the linear coefficient of thermal expansion
• Materials such as acrylic resin and amalgam expand more than tooth tissue, whereas ceramic expands less.
• Amalgam has the highest coefficient of thermal expansion among the given materials, followed by gold, tooth, and glass ionomer.

REFERENCE
Sturdevants Art and Science of Operative Dentistry, 5th edition, page number 64.

ANSWER
Zinc free

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Amalgam without zinc tends to be less plastic and less workable.
• These alloys are used only for cases where it is difficult to control moisture, e.g. patients having excessive salivation, retrograde root canal filling, subgingival lesions, etc.

REFERENCE
Basic dental materials by John J Manappallil, 4th edition, page number 139.

ANSWER
2-4-1-3

OTHER OPTIONS
• Not applicable

SYNOPSIS
SYNOPSIS
• A variety of supplemental dental materials can be incorporated into a restorative procedure for the health and well-being of the tooth that is being restored.
• The order of placement of these materials in a restoration is liner, base, varnish, and restoration.
• In the case of amalgam, the order is Calcium hydroxide, Zinc Phosphate, varnish, and amalgam.

REFERENCE
Liners, Bases, and Cements in Clinical Dentistry A Review Article.

ANSWER
Decrease strength

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Tin decreases strength and expansion and lengthens the setting time.
• Copper increases strength, reduces tarnish and corrosion, and reduces creep and, therefore, marginal deterioration

REFERENCE
Tarnish of Metallic Biomaterials – A Review – Decisions in dentistry

ANSWER
Atraumatic extraction with primary closure and antibiotic coverage

OTHER OPTIONS
● Not applicable

SYNOPSIS
● To reduce MRONJ risk
– Atraumatic technique
– Smooth sharp bone edges
– Primary wound closure
– Chlorhexidine rinse
– Antibiotic prophylaxis when indicated

REFERENCE
Ruggiero SL et al. Medication-Related Osteonecrosis of the Jaw – 2022 AAOMS Position Paper. J Oral Maxillofac Surg. 2022.

ANSWER
Blood pressure

OTHER OPTIONS
● Not applicable

SYNOPSIS
● In dental practice, especially before invasive procedures, blood pressure is the most critical parameter to assess cardiovascular risk.
● A reading of 158-90 mmHg indicates Stage 2 hypertension (ACC/AHA classification) and requires stress reduction measures.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office, 8th ed.

ANSWER
Gingival fibromatosis

OTHER OPTIONS
• Pericoronitis – Pericoronitis is swelling of the gum tissue around the wisdom teeth.
• Periodontitis – Periodontitis is a gum infection that damages the soft tissue and bone that supports the tooth
• Pyogenic granuloma – Oral mucosal pyogenic granulomas typically develop on the lip and gums (gingiva) as pedunculated or sessile slow-growing painless red papules ranging in size from a few millimeters to several centimeters. The surface can be ulcerated with a yellow-fibrinous surface and easy bleeding.

SYNOPSIS
• Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome.
• Clinically, a pink gingiva with marked stippling can be seen to cover almost all the tooth, in many cases preventing eruption.
• It usually begins during the transition from primary to permanent teeth, giving rise to a condition that can have negative psychological effects at that age.
• As it does not resolve spontaneously, the treatment of choice is gingivectomy.

REFERENCE
Hereditary gingival fibromatosis – Characteristics and treatment approach Journal of Clinical and Experimental Dentistry

ANSWER
1 mm

OTHER OPTIONS
• 2mm – The amount of functional cusp reduction in amalgam is 2 mm and that of non-functional cusp is 1.5mm.

SYNOPSIS
• The amount of functional cusp reduction in onlay is 1.5mm and that of nonfunctional cusp is 1 mm.
• Buccal and palatal inclinations of the palatal cusps were reduced evenly by 1.5 mm using a 1.4 fissure bur.
• For the buccal cusps, a 1 mm reduction was performed following cuspal inclinations.

REFERENCE
Dental decks, Operative – Amalgam, card number 10.
Dental decks, Operative – Gold, card number 1.

ANSWER
Lignocaine

OTHER OPTIONS
• NIL

SYNOPSIS
• The second trimester is weeks 14 through 27 in terms of gestational age.
• The risk of the teratogenic effects of drugs is lower during this period than during the first trimester.
• Elective dental treatment has been reported to be relatively safe during this period.
• Moreover, as the extent of physiological changes that occur during the second trimester is not too considerable, anesthesia is safer to perform in pregnant women for non-obstetric surgery in the second trimester than in the first or third trimester.
• Lidocaine with adrenaline is considered safe in pregnancy.
• Vasoconstrictors, mostly epinephrine, are added to lidocaine to reduce the absorption of the local anesthetic, reduce toxicity, and increase the analgesic effects.
• Vasoconstriction induced by epinephrine delays the absorption of local anesthetics by the mother, allowing the absorption of lidocaine to gradually occur in the maternal systemic circulation, while also allowing blood levels of lidocaine to gradually increase.
• The local anesthetic is transferred to the fetus slowly, and its margin of safety is also increased.

REFERENCE
Use of local anesthetics for dental treatment during pregnancy, safety for parturient – Journal of Dental Anesthesia and Pain Medicine

ANSWER
A and B

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Dental amalgam has an exceptionally fine record of clinical performance because of its tendency to minimize marginal leakage as the restoration ages.
• Amalgam is not overly technique sensitive.
• Amalgams may expand or contract, depending on its manipulation. Ideally, dimensional change should be small.

REFERENCE
Basic dental materials by John J Manappallil, 4th edition, page number 138, 154.

ANSWER
Deeper than natural teeth

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Probing depths of 1 mm to 3 mm are normal around natural teeth.
• Around dental implants desirable probing depths are 2.5 mm to 4 mm.
• Probing depths may be greater around implants than teeth, because there are no connective tissue fibres inserting into implants, and connective tissue adhesions adjacent to implants do not impede probe penetration as in natural teeth.

REFERENCE
Dental implantology Article by Nicholas D Shumaker.

ANSWER
Full immersion in disinfectants

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Immersion disinfectants are used for items that cannot be sterilized by heat or by other chemicals.
• Rinse out the bio burden and immerse completely in disinfectants.
• Then rinse out the disinfectants.
• Water based disinfectants are used better than alcohol based disinfectants.

REFERENCE
Indian Journal of Infection control and Prevention in Dentistry.

ANSWER
20 percent

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Gutta percha is the most commonly used obturating material in root canal treatment.
• Composition of gutta percha includes –
• Matrix – gutta percha 20 percent
• Filler – zinc oxide 66 percent
• Radioopacifiers – heavy metal sulfates 11 percent
• Plasticizers – waxes or resins 3 percent

REFERENCE
Grossman’s Endodontic Practise – 13th Edition Page No 346.

ANSWER
Sodium perborate

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Sodium perborate is a stable, white powder used for internal bleaching.
• Sodium perborate alone, rather than in combination with hydrogen peroxide should be used as the primary bleaching agent.
• Sodium perborate may bleach more slowly, it is safer for the tooth.
• Sodium perborate cause less chances for cervical resorption.

REFERENCE
Grossman’s Endodontic Practise – 13th Edition Page No 510.

ANSWER
Topical steroids

OTHER OPTIONS
• Scaling – Scaling and plaque control alone cannot control desquamative gingivitis.
• Gingivoplasty and Gingivectomy – Both these methods are commonly used to treat gingival enlargment, suprabony pockets or gingival abscess.

SYNOPSIS
• Desquamative gingivitis is characterized by intense erythema, desquamation and ulceration of the free and attached gingiva.
• Etiology of most cases is lichen planus, cicatricial pemphigoid and pemphigus vulgaris.
• Treatment is usually using topical steroids.
• In some cases dermatological or internal medicine assistance might be required depending on the severity of underlying condition.

REFERENCE
Newman and Carranza’s Clinical Periodontology – 13th Edition Page No. 288

ANSWER
Extent of caries

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Factors that affect the outline form and initial depth
– Extension of carious lesion
– Proximity of the lesion to the other deep structural surface defects
– Relationship with adjacent and opposing teeth
– Caries index of the patient
– Need for esthetics
– Restorative material to be used
– Removal of all weakened and friable tooth structure

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry – 5th edition

ANSWER
Delayed expansion

OTHER OPTIONS
• Pulpal involvement – Pain will be immediate after restoration if there is a pulpal involvement.
• Occlusal trauma – The signs and symptoms experienced by patients with occlusal trauma are mobility of teeth, temperomandibular joint pain, pain on mastication and periodontal disease.
• Secondary caries – It is most often located on the gingival margins of Class II through V restorations (rarely have they been diagnosed on Class I restorations), and you might see a visually graying look, a translucent area on the radiograph or find a hypersensitive area.

SYNOPSIS
• The gradual expansion of a zinc-containing amalgam over a period o weeks to months is called delayed expansion.
• This expansion is associated with the development of hydrogen gas, which is caused by incorporating moisture in the plastic mass during its manipulation in cavity preparation.
• Possible remedies are using zinc-free alloys and careful attention given to rubber dam isolation of the prepared tooth.

REFERENCE
CRAIGs Restorative dental materials, 13th edition, page number 201.

ANSWER
Approximation without tension

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Proper suturing
– Approximate edges
– No excessive tension
– Knot placed away from incision line
– Avoid tissue blanching

REFERENCE
Peterson LJ. Contemporary Oral and Maxillofacial Surgery, 7th ed.

ANSWER
Needle prick

OTHER OPTIONS
• Nil

SYNOPSIS
• Percutaneous injuries (PI) pose the greatest risk for occupational exposure to bloodborne pathogens.
• The most serious exposures include hepatitis B, hepatitis C, and HIV.
• Percutaneous injuries can result from contact with contaminated needles, burs, scalpels, instruments, or other sharps that can penetrate, abrade, or cut skin.

REFERENCE
Percutaneous injury prevention – Charles John Palenik

ANSWER
Cold compress intermittently

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Within first 24 hours
– Cold compress reduces edema via vasoconstriction
– Heat is indicated after 24–48 hours

REFERENCE
Peterson’s Contemporary Oral and Maxillofacial Surgery, 7th ed.

ANSWER
To confirm cervical root resorption

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● A periodontal probe is used in endodontics to detect isolated deep periodontal pockets, which may indicate external cervical resorption or vertical root fracture.
● According to Ingle’s Endodontics, circumferential probing is essential in suspected cases of cervical resorption to detect localized defects.
● It does not assess pulp vitality or working length.

REFERENCE
Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics, 7th edition

ANSWER
Increased anxiety and anticipation of pain

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Stress and anxiety increase endogenous catecholamine release, elevating heart rate and blood pressure, potentially precipitating angina.
● Supine positioning may also increase venous return, but anxiety is the most common trigger.
● Malamed emphasizes stress reduction protocol as essential in cardiac patients.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office, 8th ed.

ANSWER
Mandibular deficiency

OTHER OPTIONS
• Maxillary advancement and mandibular deficiency – since the SNA is normal it is not considered as maxillary advancement.
• Horizontal growth of mandible and Vertical growth of mandible cannot be predicted by just SNA,SNB, and ANB values.

SYNOPSIS
• The ANB angle provides a general idea of the anteroposterior discrepancy of the maxilla to the mandibular apical bases.
• +2 is considered ideal or average and usually indicates a balanced skeletal profile (Class I).
• Higher positive values(more than+ 4) suggest increasing Class II tendencies.
• Negative values (less than 0)suggest a Class III pattern.

REFERENCE
Radiographic Cephalometry-Basics to Videoimaging-Alexander Jacobson-Chapter 6-Page 78.

ANSWER
Bruxism

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Contraindications for veneer placement include
– Insufficient tooth substrate (enamel for bonding)
– Labial version
– Excessive interdental spacing
– Poor oral hygiene or caries
– Parafunctional habits (clenching, bruxism)
– Moderate to severe malposition or crowding

REFERENCE
Advances in dental veneers- materials, applications, and techniques – Journal of Applied Sciences

ANSWER
All of the above

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Strip crowns consist of a clear plastic-like shell that is filled with tooth-colored composite material and then fitted over the damaged tooth.
• The indications for strip crowns include
– Extensive decay of the primary anterior teeth
– Fractured or malformed teeth
– Teeth that exhibit discoloration.
– As coverage for teeth that have received pulp therapy.

REFERENCE
Strip Crowns Technique for Restoration of Primary Anterior Teeth Case Report – Journal of Scientific Research in Dentistry

ANSWER
Laminate Veneer

OTHER OPTIONS
• Amalgam – Non-esthetic restoration
• GIC – Mainly used as a luting agent and as a restorative material.
• Crown – More destructive procedure. Requires more amount of tooth reduction.

SYNOPSIS
• Several treatment modalities have been reported to improve dental esthetics.
• Laminate veneer, is a thin layer that covers only the surface of the tooth and is generally used for aesthetic purposes.
• Direct or indirect composite resin veneers may be used to mask the discoloration and improve the crown morphology and contact with adjacent teeth.
• Also, full-coverage adhesive composite resin or polycarbonate crowns have also been advocated

REFERENCE
Short clinical crowns (SCC) – treatment considerations and techniques – Journal of Applied Sciences

ANSWER
No mechanical preparation is necessary

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The special characteristics of these lesions are the presence of dentin or cementum in the gingival margins,
• Along with the lack of mechanical retention and difficulty in controlling moisture contamination in doing these restorations, longevity and marginal sealing are challenged.
• GICs are very durable in cervical restorations and compete with the composites, particularly where bonding to cervical dentin is required.
• Class V caries occur on the buccal and lingual aspects and may extend subgingivally, limiting the therapist’s ability to remove them completely and place a proper restoration.
• GICs have very low shrinkage and are thermally compatible with tooth structure.
• They can even bond to dentin surfaces without the removal of the smear layer and their biological compatibility is well proved.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Galvanic current

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The sense of tightness and pain is due to galvanism.
• The presence of metallic restorations in the mouth may cause a phenomenon called galvanic action or galvanism.
• This results from a difference in potential between dissimilar fillings in opposing or adjacent teeth.
• These fillings in conjunction with saliva as electrolyte make up an electric cell.

REFERENCE
Basic dental materials by John J Manappallil, 4th edition, page number 65.

ANSWER
Resilion

OTHER OPTIONS
• Gutta percha – GP is composed of zinc oxide.
• Carrier based – Alpha phase gutta percha is used in this method which contains zinc oxide.
• Activ gutta percha – It is a type of GP cone coated with GIC.

SYNOPSIS
• Resilion is polycaprolactone core material with methacrylate resin, bioactive glass, bismuth, barium sulphate and pigments.
• It is biocompatible.
• It is a good alternative for patients allergic to zinc oxide or latex.

REFERENCE
Grossman’s Endodontic Practise – 13th Edition Page No 346.

ANSWER
Cold lateral condensation would be very difficult

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Cold lateral condensation would be very difficult if a GP cone with a different taper than the taper of prepared canal is used.
• With the introduction of standardized endodontic instruments, standardized master cones were also made available, with various ISO sizes and a 2 percent taper.
• The standardized sizes are designed to match the size and taper of the corresponding stainless steel or nickel-titanium instruments employed for shaping the canals.
– ISO 2 percent from size Nos. 15 to 140
– Greater taper gutta-percha cones such as 4 or 6 percent taper
– Variable taper gutta-percha points suiting the taper of variable taper shaping instruments such as the ProTaper F1, F2, and F3.

REFERENCE
Grossman’s endodontics pg 317.

ANSWER
Digoxin toxicity

OTHER OPTIONS
• Stroke – In stroke, patient shows vision loss, facial drooping, speech difficulties, weakness, confusion, dizziness etc.
• Benzodiapene toxicity – In excess benzodiazepene intake, patient complaints of slurred speech, ataxia, confusion, dizziness.
• Heart failure – Heart failure symptoms include chest pain, shortness of breath, sweeling 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 pottasium can generally cause digoxin toxicity.

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

ANSWER
Hand, foot and mouth disease

OTHER OPTIONS
• Herpes zoster – Herpes zoster infection exhibits fever, malaise, linear vesicular lesions skin or mucosa supplied by affected nerve.
• Herpes simplex type 1 – HSV 1 affects face, lips, oral cavity and upper body.
• Herpangina – Herpangina exhibits sore throat, low grade fever, headache, with crops of ulcers on hard and soft palate, pharngeal wall, buccal mucosa, tongue and anterior faucial pillars.

SYNOPSIS
• Hand, foot and mouth disease is caused by a type of coxsackie virus.
• Disease affects mostly young children between 6 months to 5 years.
• Clinically manifested as low grade fever, lymphadenopathy, nausea, diarrhea, vomiting, pharyngitis and vesicular lesions on hand, feet and mouth.
• No specific treatment is required as the disease is self-limiting.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 321.

ANSWER
Full Metal crown

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• A full veneer crown is described as a restoration that covers all the coronal tooth surfaces (Mesial, Distal, Facial, Lingual and Occlusal).
• Laminate veneer, on the other hand, is a thin layer that covers only the surface of the tooth and is generally used for aesthetic purposes.
• Veneers are strong but brittle, and sharp or repeated impacts can dislodge or crack them.
• A crown encases the entire tooth. It can be made of metal, porcelain or a combination of both. It is usually around double the thickness of a veneer, making it more durable and resistant to cracking than a veneer.
• Among porcelain and metal, metal crowns are most retentive.
• Because they can be manufactured in a very thin layer without losing their solid and robust properties, metal crowns require the least tooth structure to be removed compared to other types of crowns, which preserve the core of the tooth for maximum strength and retention.

REFERENCE
Dental Crowns – Everything you need to know – Cosmetic Dental

ANSWER
8-10 minutes

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Clotting time (CT) measures the intrinsic and common pathways of coagulation.
• Normal values depend on the method used
– Lee–White method – 8–10 minutes (commonly quoted in dental exams)
– Capillary tube method – ~3–6 minutes
• In dentistry, 8–10 minutes is the standard exam answer.

REFERENCE
Guyton & Hall. Textbook of Medical Physiology

ANSWER
Gingival

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The gingival bevel is considered the most important bevel in an inlay preparation because
• It lies at the gingival seat, which is the critical margin of the restoration
• Provides a thin, well-adapted metal margin
• Improves marginal seal and reduces microleakage
• Enhances retention and resistance of the inlay
• Proper gingival beveling ensures accurate casting adaptation and longevity of the restoration.

REFERENCE
Shillingburg HT et al. Fundamentals of Fixed Prosthodontics, 4th ed.

ANSWER
Soak in citric acid and 2 percent stannous fluoride

OTHER OPTIONS
• Nil

SYNOPSIS
• Treatment in the office – Emergency visit – Place the tooth in HBSS while the exam is conducted and history is taken. Prepare the socket for gentle repositioning of the tooth. Prepare the root.
• Extraoral dry time less than 20 minutes-
– Closed apex — replant immediately after gentle washing.
– Open apex — soak in 1 mg doxycycline in 20 mg saline for 5 minutes.
• Extraoral dry time 20 to 60 minutes – Soak in HBSS for 30 minutes and replant.
• Extraoral dry time greater than 60 minutes – Soak in citric acid, 2percent stannous fluoride, and doxycycline and replant. RCT can be done extra orally

REFERENCE
Clinical management of the avulsed tooth – A Review

ANSWER
Maxilla 6 Mandibular 4

OTHER OPTIONS
• Nil

SYNOPSIS
• The number of implants required to support an overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity, and patient satisfaction still remains a controversial issue.
• The most frequent tendency is to place at least four implants in maxilla and 2 in mandible, splinted or unsplinted.
• The survival rate of implants appears to be higher when at least four implants are placed to support the overdenture, compared to less than four implants.
• The overwhelming majority of articles dealing with standard surgical procedures to rehabilitate edentulous jaws use 4 in mandible and 6 implants in maxilla.

REFERENCE
The optimal number of oral implants for fixed reconstructions – A review of the literature – European Journal of Implantology

ANSWER
Circumferential fiberotomy

OTHER OPTIONS
• Frenectomy – This technique is indicated when there is hypertrophy of the frenum with a low insertion, which is associated with an inter-incisor diastema, and when the lateral incisors have appeared without causing the diastema to disappear and also in cases of a short vestibule.

SYNOPSIS
• During the orthodontic correction, the teeth shift and sometimes, rotate, causing the elastic supracrestal gingival fibers to stretch and twist during the rotational tooth movement.
• After orthodontic treatment, this flexible tissue will try to morph back into its former position and may cause the teeth to relapse.
• Circumferential fiberotomy reduces the rotational relapse of orthodontically aligned teeth through the release of the connective supracrestal fibers that attach the tooth to the bone.

REFERENCE
Rotational relapse of anterior teeth following orthodontic treatment and circumferential supracrestal fiberotomy-RehamAl-JasseraMaiAl-SubaiebNasserAl-JassercAbdulazizAl-Rasheeda-The Saudi Dental Journal-2020.

ANSWER
Primary occlusal trauma

OTHER OPTIONS
• Secondary occlusal trauma – Secondary occlusal trauma is injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support. It occurs in the presence of attachment loss, bone loss, and normal or excessive occlusal force(s).
• Insufficient ferrule – leads to poor fracture resistance
• Periodontitis – Periodontitis is a severe gum infection that can lead to tooth loss and other serious health complications.

SYNOPSIS
• Occlusal trauma is a term used to describe an injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone, and cementum, as a result of occlusal force(s).
• Occlusal trauma may occur in an intact periodontium or in a reduced periodontium caused by periodontal disease.
• Primary occlusal trauma is an injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support.
• It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal force(s)
• The signs and symptoms experienced by patients with occlusal trauma are 
– Mobility of teeth,
– Temperomandibular joint pain,
– Pain on mastication
• Early diagnosis, proper treatment plan and correction of malocclusion can lead to a successful outcome.

REFERENCE
Carranzas Clinical Periodontology

ANSWER
Selected periapical and posterior bite wings

OTHER OPTIONS
• Not applicable

SYNOPSIS
• For first time visit a 7-year-old is recommended to take posterior bitewings and panoramic exam OR posterior bitewings and selected periapical
• For first visit , children of 1-5 year age group – posterior bitewings and periapical x-ray of anteriors. Bitewing x rays every 6-12 months for child with high caries risk and every 12-24 months for low caries risk children
• For 6-12 years old – posterior bitewings, selected periapical of anteriors or a Panoramic x ray and posterior bite wings .Bitewings are recommended every 6-18 months in high risk patients and every 12-36 months in low caries risk patients
• For those above 12 years of age with permanent teeth but no wisdom teeth,the Dentist might take bitewing x rays of posteriors, selected periapical x rays or a panoramic x ray, or a full mouth survey of x rays if there is evidence of widespread disease. Bitewings are recommended every 6- 18 months for high risk cases and every 12-36 months for low risk cases.

REFERENCE
AAPD Guidelines for use of Radiographs in Children

ANSWER
Adrenal crisis

OTHER OPTIONS
● Hyperglycemia – Symptoms are polyuria, polydipsia not sudden hypotension.
● Adrenal insufficiency – Chronic form, acute emergency is adrenal crisis.
● Hyperthyroidism – It causes tachycardia, anxiety, and hypertension not hypotension.

SYNOPSIS
● If the patient is on long-term steroid therapy for arthritis (e.g., prednisolone), their adrenal gland may be suppressed.
● Stress from dental treatment can lead to acute adrenal crisis.,
● Hypotension is the earliest and most important sign.
– BP 100-75 mmHg is low for a stressed state.
– Warm or weak feeling and discomfort further support a circulatory collapse picture.
● Patients on long-term steroids need stress dose steroid supplementation before major dental procedures to prevent adrenal crisis.

REFERENCE
Medical Emergencies in the Dental Office – Stanley F Malamed 7th Edition

ANSWER
IgE antibodies

OTHER OPTIONS
• IgG or IgM antibodies – Type II is caused by cytotoxic reaction mediated by IgG or IgM antibodies.
• Immune complex mediated – Type III is reaction mediated by immune complexes.
• Cell mediated – Type IV is delayed reaction mediated by cellular response.

SYNOPSIS
• Hypersensitivity is immune and inflammatory responses that are harmful to the host.
• Type 1 hypersensitivity is IgE mediated.
• Antigen induces cross linking of IgE bound to mast cells and basophils with release of vasoactive mediators.
• It occurs immediately after contact with allergens or antigens.
• Response to the antigen occurs in two stages – the sensitization and the effect stage.
• In the sensitization stage, the host experiences an asymptomatic contact with the antigen.
• Subsequently, in the effect period, the pre-sensitized host is reintroduced to the antigen, which then leads to a type I anaphylactic or atopic immune response.
• Typical manifestations include systemic anaphylaxis, localized anaphylaxis such as hay fever, asthma, hives, food allergies and eczema.

REFERENCE
Type I Hypersensitivity Reaction by National Library of Medicine.

ANSWER
One-fourth intercuspal distance

OTHER OPTIONS
• One-third intercuspal distance – ideal for molars

SYNOPSIS
• The ideal width for an amalgam cavity in premolar is one-fourth of the intercuspal distance.
• Minimum amount of marginal tooth structure to be preserved is 2mm in molars and 1.6mm in premolars
• Depth of amalgam restoration – 1.5 – 2mm
• Cavosurface angle for amalgam – 90 degree

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Vertical Root Fracture of 47

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.
• However, bonding of the fracture line with adhesive resin cement during the intentional replantation procedure was recently suggested as an alternative to tooth extraction.

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
Behcet’s disease

OTHER OPTIONS
• Major aphthous ulcer – It is more intense and the ulcers are deeper, larger (1 cm), long lasting (weeks to months) than minor aphthae. They appear on the lips, soft palate, and throat.
• Minor aphthous ulcer – Canker sores, also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums.
• Herpetic gingivostomatitis – Herpetic gingivostomatitis is a manifestation of herpes simplex virus type 1 (HSV-1) and is characterized by high-grade fever and painful oral lesions.

SYNOPSIS
• Behcet’s disease also called Behcet’s syndrome, is a rare disorder that causes blood vessel inflammation throughout the body.
• The disease can lead to numerous signs and symptoms that can seem unrelated at first.
• They can include mouth sores, eye inflammation, skin rashes and lesions, and genital sores.

REFERENCE
Ravikaran Ongole – Text book of Oral Medicine

ANSWER
Triamcinolone paste

OTHER OPTIONS
• Betadine – It is used to treat minor wounds (such as cuts, scrapes, burns) and to help prevent or treat mild skin infections.
• Gentian violet – Gentian violet belongs to the group of medicines called antifungals. Topical gentian violet is used to treat some types of fungal infections inside the mouth (thrush) and of the skin.
• Local therapy with amphotericin B – Indicated for empiric therapy for presumed fungal infection in febrile, neutropenic patients

SYNOPSIS
• Triamcinolone is a medium-strength corticosteroid that treats and relieves discomfort caused by mouth sores.
• It works by decreasing inflammation in the mouth.
• It belongs to a group of medications called topical steroids.
• This drug comes in a dental paste that allows it to stick to the inside of the mouth or cheeks or gums.
• It works by reducing the swelling, itching, and pain that can occur with mouth sores.

REFERENCE
Medical Pharmacology by Padmaja Udaykumar

ANSWERS
Acute apical periodontitis

OTHER OPTIONS
• Chronic apical periodontitis is generally a non-painful condition in which the apical portion (i.e. the part around the tip) of a tooth root is chronically inflamed.
• Apical abscess- is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally but in some cases the apical abscess may spread and result in severe complications or even mortality.

SYNOPSIS
• Acute apical periodontitis is a condition in which the apical portion of a tooth root becomes inflamed following trauma or infection.
• The presence of inflammation makes it tender when tapping or chewing on it.
• There are various causes for this apical inflammation and one of the reasons is a newly placed restoration or crown.
• Improper occlusion from the newly placed crown can result in abnormal occlusal forces that can contribute to apical periodontitis.
• In such cases there will be a periapical inflammatory response which may not be evident radiographically as there has been no bone or root resorption to create a widening of the periodontal ligament space or a radiolucency.

REFERENCE
Classification diagnosis and clinical manifestations of apical periodontitis- PAUL V. ABBOTT

ANSWER
Fluoride

OTHER OPTIONS
• Sealant – Sealants protect the chewing surfaces from cavities by covering them with a protective shield that blocks out germs and food in newly erupted molars.
• A Preventive Resin Restoration (PRR) –  A resin restoration is placed in the prepared tooth surface. A PRR is more of a definitive restoration, unlike a sealant which may need to be replaced from time to time.

SYNOPSIS
• Fluoride varnish is an effective way to control caries development in adult patients.
• Fluoride treatments can help to strengthen and protect teeth, preventing the need for invasive and expensive procedures in the future.
• Benefits
– It slows down the development of decay by stopping demineralisation.
– It makes the enamel more resistant to acid attack (from plaque bacteria), and speeds up remineralisation (remineralising the tooth with fluoride ions, making the tooth surface stronger and less soluble).

REFERENCE
Fluoride Varnishes for Dental Health – A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines – Saudi Dental Journal

ANSWER
For space deficiency in mandibular anterior region

OTHER OPTIONS
• For space deficiency in the maxilla – Space can be gained by expansion.

SYNOPSIS
• Extraction in mandible is done to avoid lower anterior crowding.
• Serial extraction increases the amount of space available for the erupting permanent teeth and thereby enables them to assume a more normal position and occlusal and spatial relationship.
• Indications –
– Absence of physiologic spacing.
– Unilateral or bilateral premature loss of deciduous canines with midline shift
– Malpositioned or impacted lateral incisors that erupt palatally out of the arch
– Markedly irregular or crowded maxillary and mandibular anteriors
– Localized gingival recession in the mandibular anterior region
– Ectopic eruption of teeth
– Mesial migration of buccal segment
– Abnormal eruption pattern and sequence
– Mandibular anterior flaring
– Ankylosis of one or more teeth.

REFERENCE
Orthodontics-The art And Science-Fifth edition-Bhalaji-Page 297-300.

ANSWER
Refer the patient to an oral medicine specialist for further evaluation

OTHER OPTIONS
• Reassure the patient that the lesion is benign and no treatment is required – Reassurance without further evaluation is not ideal due to the systemic implications.
• Prescribe antifungal medication and review in two weeks – HIV is viral infection.

SYNOPSIS
• The lesion described is characteristic of oral hairy leukoplakia (OHL), which commonly appears on the lateral tongue and is strongly associated with Epstein-Barr Virus (EBV) in immunocompromised patients, especially those with HIV/AIDS.
• OHL is not premalignant, but its presence may indicate HIV disease progression or poor immune function
• It does not typically require biopsy if the clinical diagnosis is clear, but a referral to a specialist is appropriate for confirmation, monitoring, and coordination of HIV care.

REFERENCE
Wilkins’ Clinical Practice of the Dental Hygienist, 13th Edition (2020). Chapter on oral manifestations of systemic disease.

ANSWER
Traumatic bone cyst

OTHER OPTIONS
• Stafne bone cyst – Stafne bone cyst is developmental abnormality seen as asymptomatic radiolucency at angle of mandible below mandibular canal.
• Dentigerous cyst – Dentigerous cyst is odontogenic cyst seen as pericoronal radiolucency around unerupted tooth.

SYNOPSIS
• Traumatic bone cyst is a pseudocyst and non odongenic.
• May develop due to trauma.
• Found in young patients mean age of 18 years.
• Clinically, it is asymptomatic and discovered in routine radiographic examination.
• Radiographically, it is seen as radiolucent area with sclerotic border sometimes involving the roots of teeth in the region , especially in posterior mandible.
• All associated teeth will be vital and treatment involves surgical exploration of cavity with enucleation of lining and reestablish bleeding into cavity.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 95.

ANSWER
Ameloblastoma

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Ameloblastoma is a benign but locally aggressive odontogenic tumor that commonly occurs in the mandible.
• The classic radiographic appearance is a multilocular radiolucent lesion with a soap bubble or honeycomb appearance.
• Histopathologically, ameloblastomas show epithelial cells with reverse polarity and stellate reticulum-like areas, which are characteristic findings.
• Treatment typically involves surgical resection due to the tumor’s potential for local recurrence.

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
15 – 20 seconds

OTHER OPTIONS
Not applicable

SYNOPSIS
• Current recommendations are to flush water lines for atleast 15-20 seconds between every patients.
• Water lines should be atleast 3 minutes at he begining of day.
• This does not remove biofilm but lowers level of free-floating microorganisms like Legionella pneumonia and Pseudomonas aeroginosa in water.
Only chemical disinfection will remove or control biofilm.

REFERENCE
Dental Secrets, Stephen T Sonis – 4th Edition Page No 302.

ANSWER
Bennett angle

OTHER OPTIONS
• Incisal guidance angle – Incisal guidance angle is angle formed between incisal margin of maxillary and mandibular incisors.
• Cusp angle – Cusp angle is measured by angle formed by mesiobuccal cusp incline horizontal plane when long axis of tooth is vertical to plane.
• Rake angle – Rake angle is angle formed between rake face and radial line from center of bur.

SYNOPSIS
• Bennett angle is the angle formed between the non working condyle and sagittal plane.
• That is angle formed between sagittal plane and path of advancing condyle during lateral mandibular movement.
• It is also known as lateral condylar guidance angle.
• This angle is determined using lateral records or using Hanau’s formula
(L is equal to (H divided by 8) plus 12).
• It can range from 2 – 44 degree with an average of 16 degree.

REFERENCE
Textbook of Prosthodontics, V Rangarajan – Page No 104.

ANSWER
Cleidocranial dysplasia

OTHER OPTIONS
• Apert syndrome – Apert’s syndrome is seen as midface hypoplasia, craniosynostosis, scaphocephaly and bilateral syndactyly.
• Gardner’s syndrome – Gardener’s syndrome is characterized by osteomas, odontomas, intestinal polyps, supernumerary teeth and epidermoid cysts
• Achondroplasia – Achondroplasia is characterized by large head with frontal bossing, hypoplasia of midface and short limbs.

SYNOPSIS
• Cleidocranial dysplasia is a hereditary syndrome of autosomal dominant trait.
• It is characterized by missing clavicle, large fontanelles, brachycephaly, short stature etc.
• It shows oral features like supernumerary teeth, underdeveloped maxilla, high arch palate, prolonged retention of primary teeth and delayed eruption of permanent teeth.
• There is no specific treatment but oral rehabilitation is important.

REFERENCE
Shafer’s Textbook of Oral Pathology – 8th Edition Page No 482.

ANSWER
Plastic scaler

OTHER OPTIONS
Not applicable

SYNOPSIS
• All metal instruments and ultrasonic scalers increase the surface roughness of titanium.
• Use of plastic, teflon coated and carbon coated scalers and nonmetal ultrasonic tips are advocated for scaling titanium implant from contamination by other metals and reduce scratching the surface.

REFERENCE
Newman and Carranza’s Clinical Periodontology – 13th Edition Page No 864.

ANSWER
Apply braces wax to avoid any injury to the mucosa.

OTHER OPTIONS
• Cut the wire – This is done it the inflammation is distal to the end of the wire alone.
• Apply cotton – This might stick to the inflamed mucosa and increase pain.

SYNOPSIS
• Dental wax is the most popular choice for eliminating the discomfort caused by braces.
• It creates a barrier between the inside of your mouth and your braces, reducing friction and allowing any irritation or sores to heal.
• To apply orthodontic wax, follow these steps-
1. Wash your hands.
2. Brush your teeth to make sure the area to which you’re going to apply the wax is clean.
3. Take a small piece of wax (just enough to cover the offending wire or bracket) and roll it into a ball. This will make it more malleable and easier to apply.
4. Press the wax onto the bracket or wire that is causing discomfort.
5. Rub the wax into place. It should form a small bump overtop of the bracket or wire, preventing further friction.
• Recent-Lip Protectors-Lip protectors are flexible bumpers that cover your braces from end to end, shielding your lips and gums from your braces.

REFERENCE
Textbook of Craniofacial Growth-Sridhar Premkumar-Chapter 28-Page 339.

ANSWER
Attachment level or Attachment loss

OTHER OPTIONS
• NIL

SYNOPSIS
• The severity of the disease is based on the amount of clinical attachment loss (CAL).
• It is described as
– Mild when the CAL is 1 to 2 mm,
– Moderate the CAL is 3 to 4 mm, or
– Severe when the CAL is more than 5 mm

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Hypertension 

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Epinephrine-impregnated gingival retraction cords are used to control gingival bleeding during impression making.
● However, epinephrine can be systemically absorbed through the gingival sulcus.
● In patients with Hypertension epinephrine may cause
– Sudden rise in blood pressure
– Tachycardia
– Cardiac arrhythmias
– Hypertensive crisis (in severe cases)
● Systemic absorption from cords may equal several cartridges of local anesthetic containing epinephrine.

REFERENCE
Peterson’s Principles of Oral and Maxillofacial Surgery