ANSWER
Congenital cleft palate

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Congenital cleft palate results from failure of fusion of the palatal shelves during embryonic development.
● The defect may involve the soft palate alone or extend through the hard palate and alveolus, producing a fissure that runs anteroposteriorly.
● Patients with cleft palate commonly experience feeding difficulties, speech abnormalities, and recurrent middle ear infections, necessitating multidisciplinary management.

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

ANSWER
Microcytic anemia

OTHER OPTIONS
● Macrocytic anemia – Characterized by enlarged red blood cells and is commonly associated with vitamin B₁₂ or folate deficiency.
● Normocytic anemia – Characterized by normal-sized red blood cells and is commonly seen in acute blood loss, anemia of chronic disease, or aplastic anemia.

SYNOPSIS
● Iron deficiency anemia is the most common nutritional anemia and is characterized by microcytic, hypochromic red blood cells.
● Oral manifestations include atrophic glossitis, angular cheilitis, mucosal pallor, and burning mouth symptoms.
● Diagnosis is based on complete blood count, reduced MCV and MCH, and iron studies demonstrating low serum ferritin and serum iron.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
All of the above

OTHER OPTIONS
● Nil

SYNOPSIS
● Lignocaine is primarily metabolized in the liver; therefore, conditions affecting hepatic function or hepatic blood flow reduce its clearance.
● Liver cirrhosis directly impairs hepatic metabolism, while hypotension and congestive heart failure decrease hepatic perfusion, resulting in slower drug metabolism.
● Patients with these conditions are at an increased risk of local anesthetic toxicity, and dose reduction with careful monitoring is recommended.

REFERENCE
Malamed SF. Handbook of Local Anesthesia – 7th Edition

ANSWER
Hypertension

OTHER OPTIONS
● Asthma – Epinephrine-impregnated retraction cords are not specifically contraindicated in asthma, although caution may be required in patients with sulfite sensitivity.
● Crohn disease – There is no direct contraindication to the use of epinephrine-containing gingival retraction cords in patients with Crohn disease.
● Infective endocarditis – The use of epinephrine retraction cords does not increase the risk of infective endocarditis; management focuses on appropriate antibiotic prophylaxis when indicated.

SYNOPSIS
● Epinephrine-impregnated gingival retraction cords can result in systemic absorption of epinephrine, leading to increased heart rate and blood pressure.
● Their use should be avoided or used with extreme caution in patients with uncontrolled hypertension and significant cardiovascular disease.
● Alternative retraction agents, such as aluminum chloride or ferric sulfate, are preferred in medically compromised patients at risk of adverse cardiovascular effects.

REFERENCE
Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Prosthodontics – 6th Edition

ANSWER
Prothrombin time

OTHER OPTIONS
● D-dimer – Used primarily to evaluate thromboembolic disorders such as deep vein thrombosis or disseminated intravascular coagulation and is not routinely indicated before dental extraction in patients with liver disease.
● Serum calcium level – Assesses calcium metabolism but does not evaluate the patient’s bleeding tendency.
● Blood urea nitrogen (BUN) – Reflects renal function and is not used to assess coagulation status in patients with liver disease.

SYNOPSIS
● The liver synthesizes most coagulation factors; therefore, liver disease may result in impaired coagulation and an increased risk of bleeding.
● Prothrombin time (PT) and International Normalized Ratio (INR) are the primary investigations used to assess coagulation status before invasive dental procedures in patients with liver disease.
● Additional investigations such as a complete blood count, including platelet count, and liver function tests may also be indicated depending on the severity of hepatic impairment.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Short-acting bronchodilator

OTHER OPTIONS
● Oxygen and IV corticosteroids – Oxygen is supportive, and corticosteroids have a delayed onset of action; they do not provide immediate bronchodilation.
● Oxygen – Corrects hypoxemia but does not relieve bronchospasm.
● Epinephrine injection – Reserved for severe, life-threatening asthma unresponsive to inhaled bronchodilators or when anaphylaxis is suspected; it is not the first-line treatment for a typical acute asthma attack.

SYNOPSIS
● In an acute asthma attack, an inhaled short-acting β₂-agonist (SABA) such as salbutamol is the first-line treatment because of its rapid bronchodilatory effect.
● Supplemental oxygen should be administered if hypoxemia is present, while systemic corticosteroids are used to reduce airway inflammation but have a delayed onset of action.
● Intramuscular epinephrine is reserved for severe refractory bronchospasm or asthma associated with anaphylaxis.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office – 8th Edition

ANSWER
90 days

OTHER OPTIONS
● Not applicable

SYNOPSIS
● The average incubation period for hepatitis B virus (HBV) infection is 90 days (about 3 months), with a total range of 30 to 180 days from exposure to the onset of symptoms.
● During the incubation period, infected individuals may be asymptomatic but can still transmit the virus.
● Knowledge of the incubation period is important when evaluating occupational exposures and planning post-exposure prophylaxis.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Systemic drugs

OTHER OPTIONS
● IV diazepam – Diazepam has no role in the management of oral lesions associated with inflammatory bowel disease.
● Adrenaline – Adrenaline is indicated for anaphylaxis and certain medical emergencies, not for inflammatory oral lesions.

SYNOPSIS
● Snail-track lesions of the oral mucosa are characteristic of pyostomatitis vegetans, an oral manifestation strongly associated with inflammatory bowel disease, particularly ulcerative colitis.
● Management primarily involves treating the underlying inflammatory bowel disease with systemic medications such as corticosteroids or immunosuppressive agents.
● Improvement of the systemic disease usually results in resolution of the oral lesions, while topical corticosteroids may be used as adjunctive therapy for symptomatic relief.

REFERENCE
Burket’s Oral Medicine – 13th Edition

ANSWER
Proceed with treatment using prophylactic antibiotics

OTHER OPTIONS
● Postpone the dental procedure – An ANC of 1,700 cells/mm³ is above the threshold at which routine dental treatment must be deferred, provided the patient is otherwise medically stable.
● Administer a platelet transfusion before treatment – Platelet transfusion is based on the platelet count, not the neutrophil count, and is unnecessary when platelet levels are adequate.
● Proceed with treatment without special precautions – Patients with leukemia and an ANC between 1,000 and 2,000 cells/mm³ are at increased risk of infection; prophylactic antibiotics should be considered in consultation with the treating physician.

SYNOPSIS
● The absolute neutrophil count (ANC) is an important indicator of infection risk before invasive dental procedures in patients with leukemia.
● Patients with an ANC >2,000 cells/mm³ generally do not require antibiotic prophylaxis, whereas those with an ANC between 1,000 and 2,000 cells/mm³ may require prophylactic antibiotics depending on the procedure and physician recommendations.
● Elective invasive dental procedures are generally deferred when the ANC is below 1,000 cells/mm³ because of the significantly increased risk of infection.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Hemophilia A

OTHER OPTIONS
● Thrombocytopenia – Inferior alveolar nerve block is contraindicated only in patients with severe thrombocytopenia or uncontrolled bleeding risk; the decision depends on the platelet count rather than the diagnosis alone.
● Hypoprothrombinemia – Patients require correction of the coagulation defect before invasive procedures. It is not an absolute contraindication in all cases.
● Von Willebrand disease – Inferior alveolar nerve block may be performed after appropriate medical management (e.g., desmopressin or factor replacement), depending on the severity of the disease.

SYNOPSIS
● Inferior alveolar nerve block carries a risk of deep tissue hemorrhage that may lead to airway compromise in patients with severe coagulation disorders.
● In untreated severe hemophilia, an inferior alveolar nerve block should not be administered unless adequate clotting factor replacement has been provided in consultation with the patient’s hematologist.
● Alternative techniques, such as infiltration, intraligamentary, or intraosseous anesthesia, may be preferred when appropriate.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Myocardial infarction

OTHER OPTIONS
● Stable angina pectoris – Stable angina is usually precipitated by exertion or stress, lasts less than 10–15 minutes, and is relieved by rest or sublingual nitroglycerin.
● Unstable angina pectoris – Unstable angina may occur at rest and is more severe than stable angina, but the pain often responds at least partially to nitroglycerin and does not cause myocardial necrosis. Persistent pain unrelieved by nitroglycerin is more suggestive of myocardial infarction.
● Congestive heart failure – Congestive heart failure typically presents with dyspnea, orthopnea, fatigue, and peripheral edema rather than prolonged crushing chest pain.

SYNOPSIS
● Myocardial infarction (MI) is characterized by prolonged, severe chest pain lasting more than 15–20 minutes, often radiating to the shoulder, arm, neck, or jaw, and not relieved by rest or nitroglycerin.
● Major risk factors include hypertension, dyslipidemia, obesity, diabetes mellitus, and smoking.
● During a dental procedure, suspected MI requires immediate termination of treatment, activation of emergency medical services, administration of aspirin (if not contraindicated), oxygen when indicated, and continuous monitoring until advanced medical care arrives.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office – 8th Edition

ANSWER
Diagnostic wax-up and fabrication of a surgical guide (surgical template)

OTHER OPTIONS
● Complete blood count – Routine hematologic investigations are not indicated in a medically healthy patient unless suggested by the medical history or clinical findings.
● Magnetic resonance imaging (MRI) – MRI is not routinely used for dental implant planning because CBCT provides superior evaluation of the osseous structures.
● Use of a fully adjustable articulator – A semi-adjustable articulator is generally adequate for implant treatment planning; a fully adjustable articulator is not routinely required.

SYNOPSIS
● A diagnostic wax-up helps determine the ideal prosthetic position, emergence profile, occlusion, and esthetic outcome of the implant-supported restoration.
● A surgical guide (template) transfers the prosthetically driven implant position from the diagnostic wax-up to the patient’s mouth, improving the accuracy of implant placement.
● Successful implant therapy is prosthetically driven, integrating clinical examination, CBCT evaluation, diagnostic casts, wax-up, and guided implant placement.

REFERENCE
Misch CE. Contemporary Implant Dentistry – 4th Edition

ANSWER
Maxillary sinusitis

OTHER OPTIONS
● Acute apical periodontitis – Usually results from pulpal inflammation or necrosis and is commonly associated with deep caries, extensive restorations, or radiographic evidence of periapical changes, although early lesions may not be radiographically visible.
● Canine space infection – Typically presents with facial swelling involving the canine fossa and upper lip rather than referred pain to the eye and ear.
● Dentoalveolar abscess – Characterized by severe localized pain, swelling, and evidence of pulpal infection or necrosis.

SYNOPSIS
● Maxillary sinusitis commonly produces referred pain to the maxillary premolars and molars because the roots of these teeth lie close to the floor of the maxillary sinus.
● Patients often report pain radiating to the eye, temple, or ear, tenderness of multiple maxillary posterior teeth, nasal congestion, and pain that worsens on bending forward.
● Vitality testing and radiographic examination help distinguish sinusitis from odontogenic causes of pain.

REFERENCE
Burket’s Oral Medicine – 13th Edition

ANSWER
Clinical and radiographic examination

OTHER OPTIONS
● Oral hygiene record – Oral hygiene assessment is useful for evaluating disease risk and treatment planning but is not sufficient to establish a definitive diagnosis.
● Chief complaint alone – The chief complaint identifies the patient’s primary concern but must be correlated with clinical and radiographic findings to establish a diagnosis.
● Past medical history alone – Medical history provides important information regarding systemic health and treatment modifications but cannot independently establish a dental diagnosis.

SYNOPSIS
● A definitive dental diagnosis is established by integrating the patient’s history, clinical examination, and radiographic findings.
● Clinical examination identifies signs such as swelling, mobility, tenderness, and periodontal status, while radiographs reveal underlying hard tissue changes.
● Additional investigations, such as vitality testing, laboratory tests, or advanced imaging, may be required when clinical and radiographic findings are inconclusive.

REFERENCE
Burket’s Oral Medicine – 13th Edition

ANSWER
Allow a stable blood clot to form and provide routine postoperative sinus precautions

OTHER OPTIONS
● Advance a buccal flap to close the opening – A buccal advancement flap is indicated when there is a confirmed oroantral communication with perforation of the sinus membrane, not when the Schneiderian membrane remains intact.
● Place an antibiotic dressing in the socket – Routine placement of an antibiotic dressing is not indicated when the sinus membrane is intact and there is no evidence of infection.
● No further treatment is required – The patient should receive appropriate postoperative instructions, including sinus precautions and follow-up.

SYNOPSIS
● If the Schneiderian membrane remains intact, there is no true oroantral communication, and healing usually occurs with formation of a stable blood clot.
● Routine postoperative care includes sinus precautions, such as avoiding nose blowing, sneezing with the mouth closed, smoking, and forceful rinsing.
● Surgical closure using a buccal advancement flap or other flap technique is indicated only when a true oroantral communication is present, particularly if it is larger than approximately 2 mm or is unlikely to close spontaneously.

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

ANSWER
Head tilt upward

OTHER OPTIONS
● Head tilt downward  – This would worsen the positioning error, producing an exaggerated “smile” appearance and further obscuring the mandibular apices.
● Lip placed on bite block – The patient should close the lips around the bite block, but this prevents an air space over the maxillary teeth and does not correct loss of root apices.

SYNOPSIS
● Proper panoramic positioning requires the Frankfort plane to be parallel to the floor.
● When the chin is tipped too low, the panoramic image shows
– An exaggerated “smile” curve.
– Shortened mandibular incisors.
– Possible loss of the mandibular root apices.
– Superimposition of the hyoid bone.
● Raising the chin restores the correct occlusal plane and improves visualization of the tooth apices.

REFERENCE
White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation – 8th Edition

ANSWER
Both are true.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Endodontically treated teeth exhibit greater brittleness and are more prone to fracture than non-endodontically treated teeth.
• Usually a considerable amount of tooth structure has been lost because of caries, endodontic treatment, and the placement of previous restorations.
• The loss of tooth structure makes retention of subsequent restorations more problematic and increases the likelihood of fracture during functional loading.

REFERENCE
Rosenstiel, Contemporary Fixed Prosthodontics, pg 272

ANSWER
There is considerable resorption of the residual ridges

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Indications for FPD
1. Span length – for posterior should be 2 teeth replacements or fewer and for anteriors 4 teeth replacements or fewer.
2. Span configuration – should have distal abutment but can be used with short cantilever pontic
3. Abutment alignment – Less than 25-degree inclination can be accommodated by preparation modification.
4. Abutment condition – should be good if abutments need crowns. Nonvital teeth can be used if there is sufficient coronal tooth structure.
5. Occlusion should be favorable loading
6. Periodontal condition – Good alveolar bone support, Crown root ratio 1-1 or below, No mobility, favorable root morphology provides rigid stabilization
7. Ridge form – Moderate resorption acceptable. No gross soft tissue defect should be present in the edentulous ridge. If present augment the ridge with grafts to enable the construction of fixed prosthesis

REFERENCE
Shillingburg, Fundamentals of Fixed Prosthodontics, pg 88

ANSWER
Micromechanical bond from etching of enamel and porcelain

OTHER OPTIONS
• Porcelain laminate preparations do not include preparation of undercuts or secondary retentive features.

SYNOPSIS
• Ceramic veneers should be etched, silaned, and bonded to the underlying enamel with a selected shade of dual-polymerizing hybrid composite resin cement.
• Optimal adhesion to the tooth is ensured through proper treatment of both the veneer and the prepared tooth.
• Bonding is achieved by performing the following steps –
1. Etching the fitting surface of the ceramic with hydrofluoric acid
2. Applying a silane coupling agent to the ceramic
3. Etching the enamel with phosphoric acid
4. Applying a resin bonding agent to etched enamel and silane
5. Seating the restoration with a composite resin luting agent

REFERENCE
Rosenstiel, Contemporary Fixed Prosthodontics, pg 776

ANSWER
0.89

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Undercuts on master cast may be measured with an undercut guage, such as those provided with the Ney and Jelenko surveyors.
• Desirable undercuts are engaged by retentive clasp arms of clasps to provide retention for the RPD. They are located on the facial or lingual surfaces of abutment teeth.
The amount of undercuts is measured in hundredths of an inch, with the gauges allowing measurements up to 0.03 inches. Theoretically amount of undercut used may vary with clasp to be upto 0.03 inch.However, undercuts of 0.01 inch are often adequate for retention by cast retainers.Thus the undercut of the abutment of the removable denture should be 0.89 from an inch.
• The location of the potential retentive undercut is related to the survey line and influences the selection of the retentive clasp arm.
• Selection of clasp material according to the buccolingual width of the undercut (more flexible material is required to facilitate insertion of the RPD into deeper undercuts).
a. 0.010 inch (0.25 mm) undercut-cast chrome alloy
b. 0.015inch (0.38mm) undercut- gold and its alloys
c. 0.020 inches (0.50 mm) undercut-wrought wire
• If possible, undesirable undercuts are eliminated. Undesirable undercuts on teeth may frequently be reduced, and sometimes eliminated, by recontouring the tooth by removing tooth structure or placing a crown.

REFERENCE
Robert W. Loney, Removable Partial Denture Manual, pg 13

ANSWER
Cobalt-chromium

OTHER OPTIONS
• Wrought wire – Wrought wire owing to its flexibility is used as material for the retentive arm of the circumferential clasp to engage deep undercuts.
• Gold – Type III and Type IV gold alloys can be used as RPD framework.
• Stainless steel – Stainless steel is not used in the fabrication of the RPD framework.

SYNOPSIS
• To function effectively and minimize potentially damaging effects, all major connectors must
1. Be rigid
2. Provide vertical support and protect the soft tissues
3. Provide a means for obtaining indirect retention where indicated
4. Provide a means for placement of one or more denture bases
5. Promote patient comfort
• Since Co-Cr alloys are more rigid than gold alloys, it is the best material of choice

REFERENCE
Stewarts clinical RPD 3rd ed, pg 22

ANSWER
Wrought wire with round cross section

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
Direct Retainer Choices for Kennedy Cl I and II (Tooth and Tissue Borne)
1. For posterior abutments, or any tooth needing stress release-
• Clasp of choice RPI (mesial rest, distal proximal plate and I-bar)
• If can’t use an I-bar in the vestibule, because of the frenum, shallow vestibule, or deep soft tissue undercut then use an RPA retainer (mesial rest, distal proximal plate, and wrought wire clasp)
• If can’t use a mesial rest because of rotation, heavy centric contact on mesial, or large amalgam restoration on mesial, then use Combination Clasp (distal rest, buccal wrought wire retention, lingual bracing)
2. For abutments adjacent modification spaces – use tooth-borne retainers.(Akers clasp)

REFERENCE
Removable Partial Denture Manual- Robert W. Loney, pg 55

ANSWER
Resin bonded retainer

OTHER OPTIONS
• One of the disadvantages of a conventional fixed partial denture with either full veneer or partial veneer crown retainers is the destruction of the tooth structure required for the abutment preparations upon which the retainers will be placed. The retainers from least to most conservative can be arranged as follows
Telescopic retainer – three-quarter retainer – pin ledge retainer – resin bonded retainer

SYNOPSIS
• The development of acid etching of enamel to improve the retention of resin, first described by Buonocore, has proven to be a means of attaching fixed partial dentures to teeth by less destructive means.
• The primary goal of the resin-retained fixed partial denture is the replacement of missing teeth and maximum conservation of tooth structure. Development of resin-retained FPD
1. Bonded pontics
2. Cast-perforated resin-retained FPD (Rochette bridge)
3. Etched cast resin-retained FPD (Maryland bridge)
4. Macromechanical retention (Virginia bridge)
5. Chemically bonding resin-retained FPD s
6. Fibre-reinforced composite resin FPDs

REFERENCE
Shillingburg Fundamentals of fixed prosthodontics, pg 542

ANSWER
PKT3

OTHER OPTIONS
• Wax Knife – Used for cutting excessive wax.
• Spoon excavator – A spoon excavator is used to clean out and shape a carious cavity before filling it.
• Spatula – Wax Spatulas are used to mix dental wax.

SYNOPSIS
• Waxing instruments can be categorized by the intent of their design wax addition, carving, or burnishing.
• The popular PKTs designed by Dr. Peter K. Thomas specifically for the additive waxing technique are –
– No. 1 and no. 2 are wax addition instruments,
– No. 3 is a burnisher for refining occlusal anatomy. Used to perfect and enhance the supplemental and developmental groves.
– No. 4 and 5 are wax carvers.
– No 4 Used to perfect the external contours and remove excess wax at the cavosurface margins.
– No 5 Used to remove excess wax. Its contour maintains desired convexity at these ridges.

REFERENCE
Shillingburg, Fundamentals of fixed prosthodontics, pg 335

ANSWER
Smaller than missing tooth buccolingually

OTHER OPTIONS
• Wider buccolingually – Wider pontics are difficult to cleanse and decrease chewing efficiency.

SYNOPSIS
• Reducing the buccolingual width of the pontic by as much as 30 percent has been suggested as a way to lessen occlusal forces on, and thus the loading of, abutment teeth.
• Critical analysis reveals that forces are lessened only when chewing food of uniform consistency and that a mere 12 percent increase in chewing efficiency can be expected from a one-third reduction of pontic width.
• Decreasing the buccolingual width leads to a decrease in interferences in eccentric movements.
• Narrowing the occlusal table may actually impede or even preclude the development of a harmonious and stable occlusal relationship.
• Like a malposed tooth, it may cause difficulties in plaque control and may not provide proper cheek support. For these reasons, pontics with normal occlusal widths (at least on the occlusal third) are generally recommended.

REFERENCE
Rosenstiel, Contemporary Fixed Prosthodontics, pg 527

ANSWER
Lack of attention to tooth shape, position and contacts

OTHER OPTIONS
• Refer Synopsis.

SYNOPSIS
• Practical points to be noted before the commencement of a crown or bridge
1. Check the maximum intercuspal position (MIP) before the commencement of cavity or tooth preparation.
2. Adjust occlusal interference before restorative work is commenced.
3. Avoid placement of the junction between the restorative materials and the tooth surface where the MIP occlusal contact will be.
4.. When a tooth is being prepared for a full-cast crown, the occlusal surface and all axial walls should be prepared to help provide better retention
5. In patients with para-functional habits, an occlusal splint is indicated for the protection of restorations and teeth.
• Reasons for retainer failure
1. Insufficient occlusal reduction
2. High points in opposing dentition
3. Premature contacts
4. Soft metal
5. Porosity
6. Parafunctional habits

REFERENCE
Classification system for conventional crown and fixed partial denture failures, Journal of Prosthetic Dentistry 2008,99293-298

ANSWER
Angulated abutment

OTHER OPTIONS
Not applicable

SYNOPSIS
• Key factors related to successful treatment with overdentures include the number, location, and distribution of implants and choice of abutment.
• While the use of parallel implants that are widely distributed is generally desirable for optimal treatment, patients often present with challenging anatomical features, insufficient bone volume in all dimensions, and or critical anatomy that precludes ideal placement of dental implants.
• Angulation challenges may be especially evident in overdenture cases in which more than two implants are used, as differences in angulation are more visible in such cases.
• Angulated abutments hinder the path of insertion of overdentures.

REFERENCE
Marina Andreiotelli, Prosthodontic Complications with Implant Overdentures- A Systematic Literature Review.

ANSWER
Lack of skill of the patient

OTHER OPTIONS
Not applicable

SYNOPSIS
• Potential physical, sensory, and cognitive impairments associated with aging may make home oral health care and patient education or communications challenging.
• As, age advances certain physical attributes decline, memory may decline.
• At the time of denture delivery it is important for the patient to be taught to remove and wear the prosthesis repeatedly. In case of neural dysfunction extra efforts are required to teach the patient.

REFERENCE
Textbook of Prosthodontics Nallaswamy, pg 285

ANSWER
Working side.

OTHER OPTIONS
• Non-working side – The side of the mandible that moves toward the medial line in a lateral excursion, the condyle on
that side is referred to as the non-working side condyle. It is also called the balancing side.
• Compensating curve – The anteroposterior curving (in the median plane) and the mediolateral curving (in the frontal plane) within the alignment of the occluding surfaces and incisal edges of artificial teeth that are used to develop
balanced occlusion. They compensate for the opening influences produced by the condylar and incisal guidances during lateral and protrusive mandibular eccentric movements.

SYNOPSIS
• The mandibular movement to one side will place it in a working, or laterotrusive, relationship on that side and a nonworking, or mediotrusive, relationship on the opposite side, eg, if the mandible is moved to the left, the left side is the working side, and the right side is the nonworking side.

REFERENCE
Shillingburg Fundamentals of fixed prosthodontics, 3rd ed, pg 14

ANSWER
Most accurate impression

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Polyether impression materials are very accurate and easy to pour with gypsum products. These properties and the ease of use make polyethers popular.
• PROPERTIES OF POLYETHER
– Hydrophilic (i.e. absorbs water)
– Good shelf life of up to 2 years
– Good elastic recovery
– Nontoxic
– Low setting contraction
– Poor tear strength
– Excellent surface detail
– Good dimensional stability
– The cost is similar to that of addition silicone materials
• ADVANTAGES
– Accuracy
– Good on undercuts
– Ease of use
• DISADVANTAGES
– May cause allergic reactions due to the sulphonic acid ester
– Poor tear strength
– Rapid setting time (ie short working time)
– Stiff set material (hard to remove from mouth)

REFERENCE
Clinical Aspects of Dental Materials – Marcia Gladwin Pg 327

ANSWER
Polyether

OTHER OPTIONS
• Epoxy resin cannot be used with agar and alginate impression materials.

SYNOPSIS
• Epoxy resin is used with rubber-based impression materials like polyether, silicones, and polysulfide.
• Polyether impression is the best choice of material.
• The hydrophobic characteristics of silicone impression materials make them suitable for pouring of epoxy resin to produce dies.
• However, polysulphides are dimensionally unstable, hence it is not preferred.

REFERENCE
Philips Science of Dental Materials, 12th Ed, Pg 161

ANSWER
Open flap surgery

OTHER OPTIONS
• Scaling and root planing – Incipient or early furcation defects (Class I) are amenable to conservative periodontal therapy. Because the pocket is supra bony and has not entered the furcation, oral hygiene, scaling, and root planing are effective.

SYNOPSIS
• Once a horizontal component to the furcation has developed (Class II), therapy becomes more complicated.
• Shallow horizontal involvement without significant vertical bone loss usually responds favorably to localized flap procedures with odontoplasty, osteoplasty, and osteotomy.
• Isolated deep Class II furcations may respond to flap procedures with osteoplasty and odontoplasty.
• This reduces the dome of the furcation and alters gingival contours to facilitate the patient’s plaque removal.
• Open flap surgery with possible bone grafting and guided tissue regeneration (GTR) is the preferred approach to improve access and regeneration in Class II furcations.

REFERENCE
Carranza 11th edition chapter 62

ANSWER
Class 2

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Class I – Marginal tissue recession does not extend to the mucogingival junction. There is no loss of bone or soft tissue in the interdental area.
• Class II – Marginal tissue recession extends to or beyond the mucogingival junction. There is no loss of bone or soft tissue in the interdental area.
• Class III – Marginal tissue recession extends to or beyond the mucogingival junction. There is bone and soft tissue loss interdentally or mispositioning of the tooth.
• Class IV – Marginal tissue recession extends to or beyond the mucogingival junction. There is severe bone and soft tissue loss interdentally or severe tooth malposition

REFERENCE
Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985,5(2)-8-13.

ANSWER
Connective tissue graft

OTHER OPTIONS
• Free gingival graft – Effective for increasing keratinized tissue but less esthetic and less predictable for complete root coverage.
• Coronally advanced flap – Can be used alone for certain cases but is more effective when combined with a connective tissue graft.
• Guided tissue regeneration – Not commonly used for root coverage, more effective for treating intrabony defects.

SYNOPSIS
• Connective tissue grafting (CTG) is the gold standard for treating isolated gingival recession due to its high success rate in achieving root coverage and good esthetic results.
• It provides excellent tissue thickness and color match.

REFERENCE
Carranza 11th edition chapter 64

ANSWER
Inflamed and Edematous Gingiva

OTHER OPTIONS
• Fibrotic Gingiva – Fibrotic tissue is dense, firm, and resistant to curettage. Surgical interventions like gingivectomy or flap surgery are preferred.
• Bleeding Gingiva – Bleeding alone is not an indication. It could indicate systemic conditions (e.g., leukemia, vitamin C deficiency, platelet disorders) where curettage is not the first-line treatment.

SYNOPSIS
• Gingival curettage is a procedure used to remove the diseased soft tissue lining of the periodontal pocket to promote healing. It is primarily indicated in inflamed and edematous gingiva because
• Inflamed tissue is softer and more responsive to mechanical debridement.
• Curettage helps eliminate inflamed granulation tissue, reducing pocket depth.
• It is an adjunct to scaling and root planing (SRP) in mild periodontitis cases.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Long junctional epithelium.

OTHER OPTIONS
• New Attachment – While the long junctional epithelium provides a barrier, true new attachment involves the formation of new connective tissue fibers that attach to the root surface. This is a more desirable, but less frequent, outcome of healing. 
• New bone and connective tissue formation – GTR is needed.
• New PDL fibers attachment – Without regenerative therapy, new functional PDL fibers are not reinserted into cementum.

SYNOPSIS
• After scaling and root planing, healing primarily occurs through the formation of a long junctional epithelium
• While new attachment, new bone, and connective tissue formation are desirable outcomes, they are not the typical immediate result of these procedures.
• The long junctional epithelium is a tissue adaptation where the epithelium (lining of the gums) elongates and attaches to the tooth surface.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
A and C

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The outcome of periodontal treatment depends on multiple factors, including:
1. Patient age
• While age alone does not directly determine healing capacity, it influences tissue response, disease progression rate, and regenerative potential.
• Younger patients tend to have better healing capacity, but motivation and compliance may vary by age.
2. Proper scaling and root planing
• Thorough removal of plaque, calculus, and necrotic cementum is essential for reducing inflammation and pocket depth.
• Improper debridement leads to persistent inflammation and poor healing.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
0 degree

OTHER OPTIONS
• 33-degree – 33-degree cuspal angle teeth are anatomic teeth. These are highly esthetic and most commonly used.
• 30-degree – 30-degree cuspal angle teeth are known as Pilkinton-turner teeth.
• 20-degree – 20-degree cuspal angle teeth are known as modified cusp or low cusp or semi-anatomic teeth. They are used in conditions with mild jaw discrepancies.

SYNOPSIS
• Non-anatomic teeth or 0-degree teeth are indicated for highly resorbed or flat ridges
• Advantages of 0-degree teeth
1. Easy to set up
2. Least lateral stress.
3. Least anteroposterior interferences after settling
4. Best for patients with poor neuromuscular control
5. Best for poor ridge relationships
6. Reduced buccolingual width, and sharp grooves compensate for cusps in obtaining equal chewing efficiency.

• Disadvantages of 0-degree teeth
1. Less chewing efficiency
2. Poor esthetics
3. Difficult to obtain balanced occlusion

REFERENCE
Textbook of Prosthodontics, Nallaswamy, pg 228

ANSWER
Instruct patient not to use denture for 2 weeks then follow up

OTHER OPTIONS
Not applicable

SYNOPSIS
• Epulis fissuratum occurs in those who wear prosthetic appliances.
• This is an inflammatory fibrous hyperplasia of oral mucosa caused by ill-fitting or over-extended denture borders.
• When this situation occurs, the patient should be instructed to rest the tissue as much as possible by not wearing the existing denture for at least 2weeks and follow up.
• Proper oral hygiene and tissue massage will also improve the condition.
• The existing denture should also be refitted with a tissue conditioning or temporary reline material and the occlusion is improved as much as possible.
• If marked improvement does not occur, surgical correction will be needed to create a favorable foundation for the new denture.

REFERENCE
A Guide to Common Oral Lesions.pdf

ANSWER
Reduce porosity

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Porcelain powder is built into shape using a liquid binder to hold the particles together.
• The process of packing the particles together and removing the liquid binder is known as condensation.
• It is a 2-part process – Agitation of the particles and Removal of excess moisture.
• It is repetitious and the two components are carried out alternatively until no further moisture comes to the surface.
• Aim of condensation – pack particles as close as possible to reduce the amount of porosity and shrinkage during firing.

REFERENCE
Philips Science of Dental Materials, 12th ed Pg. 433

ANSWER
At contra bevel

OTHER OPTIONS
• At gingival level – The definitive crown seats on the finish line are prepared at the gingival level.

SYNOPSIS
• The finish line of the core should be placed at the contra bevel prepared on the occlusal surface of the remaining tooth structure.
• The remaining coronal tissue is prepared perpendicular to the post because this will create a positive stop to prevent over seating and splitting of the tooth.
• If there is a supra gingival tooth structure a flame bur is used to place the contra bevel.
• It is the bevel placed around the occlusal external surface of the periphery of the preparation, this will provide a good collar around the occlusal surface periphery of the preparation which will help in holding the tooth structure together and preventing the fracture of the remaining tooth structure.

REFERENCE
Prosthodontic management of endodontically treated teeth, Factors Determining Post Selection, Foundation Restorations and Review of Success and Failure Data

ANSWER
Reverse Town view

OTHER OPTIONS
● Occipitomental (Waters) view – Primarily used for evaluating midfacial fractures, including zygomaticomaxillary complex and orbital fractures, rather than condylar fractures.
● 30° Lateral oblique view – Useful for imaging the body, angle, and ramus of the mandible, but it is less effective for demonstrating condylar head and neck fractures.

SYNOPSIS
● The Reverse Towne view provides an excellent projection of the condylar head and neck, allowing assessment of fracture location, displacement, and mediolateral angulation.
● It is the preferred conventional radiographic view for suspected mandibular condylar fractures.
● Computed tomography (CT) is now considered the gold standard because it provides three-dimensional visualization of the fracture, degree of displacement, and associated facial injuries.

REFERENCE
Peterson LJ. Contemporary Oral and Maxillofacial Surgery – 7th Edition

ANSWER
4–5 mm

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Residual crestal bone height is an important determinant of the sinus augmentation technique and whether implants can be placed simultaneously.
● A minimum of approximately 4–5 mm of residual alveolar bone is generally recommended to obtain adequate primary implant stability during simultaneous sinus floor elevation and implant placement.
● When the residual bone height is less than 4 mm, a staged lateral window sinus augmentation is generally preferred, with implant placement after graft maturation.

REFERENCE
Misch CE. Contemporary Implant Dentistry – 4th Edition

ANSWER
Maxillary second molar

OTHER OPTIONS
● Maxillary first molar – The roots of the maxillary first molar are frequently close to or may protrude into the maxillary sinus, but CBCT studies have shown that the second molar most commonly exhibits the closest relationship.
● Maxillary premolar – The premolar roots are generally separated from the maxillary sinus by a greater amount of bone than the molars.
● Maxillary canine – The canine is located anterior to the maxillary sinus and is not closely related to the sinus floor.

SYNOPSIS
● The maxillary second molar most commonly demonstrates the closest anatomical relationship to the floor of the maxillary sinus, followed by the maxillary first molar.
● This close proximity increases the risk of oroantral communication, root displacement into the sinus, and sinus perforation during extraction or endodontic surgery.
● Preoperative imaging, particularly CBCT, is valuable for assessing the relationship between tooth roots and the maxillary sinus before surgical procedures.

REFERENCE
White and Pharoah. Oral Radiology: Principles and Interpretation – 8th Edition

ANSWER
Zygomatic fracture

OTHER OPTIONS
● Le Fort I fracture – Characterized by a horizontal maxillary fracture with mobility of the tooth-bearing maxilla, without isolated unilateral orbital findings.
● Le Fort II fracture – A pyramidal fracture involving the nasal bridge, infraorbital rims, and maxilla, typically producing bilateral facial edema and mobility of the midface.
● Le Fort III fracture – Craniofacial dysjunction characterized by separation of the entire midface from the cranial base, usually associated with bilateral periorbital ecchymosis and extensive facial trauma.

SYNOPSIS
● Zygomaticomaxillary complex (ZMC) fractures commonly result from a direct blow to the cheek and present with flattening of the malar prominence, unilateral periorbital ecchymosis, subconjunctival hemorrhage, infraorbital nerve paresthesia, and trismus due to impingement of the fractured zygomatic arch on the coronoid process.
● Ecchymosis in the maxillary buccal vestibule is a common intraoral finding in ZMC fractures.
● Diagnosis is confirmed with computed tomography (CT), which is the imaging modality of choice for evaluating zygomatic fractures and planning surgical management.

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

ANSWER
Bleeding time

OTHER OPTIONS
● Clotting time – Clotting time evaluates the coagulation cascade and is not affected by aspirin, which impairs platelet function.
● Complete blood count – A complete blood count provides platelet numbers but does not assess platelet function or the antiplatelet effect of aspirin.
● Absolute neutrophil count – The absolute neutrophil count assesses infection risk and has no role in evaluating the effect of aspirin before dental extraction.

SYNOPSIS
● Aspirin irreversibly inhibits platelet cyclooxygenase-1 (COX-1), reducing thromboxane A₂ production and impairing platelet aggregation.
● Bleeding time was historically used to evaluate platelet function in patients taking aspirin but is no longer recommended because of poor sensitivity, poor reproducibility, and limited predictive value for surgical bleeding.
● Current guidelines recommend continuing aspirin therapy for most routine dental extractions and using local hemostatic measures rather than discontinuing medication or performing routine laboratory testing.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Adrenal crisis

OTHER OPTIONS
● Hyperglycemia – Usually presents with polyuria, polydipsia, dehydration, and gradual onset of symptoms rather than acute hypotension immediately after a stressful event.
● Adrenal insufficiency – Refers to chronic deficiency of adrenal hormones; the patient’s acute hypotension and collapse during a stressful procedure are more consistent with an adrenal crisis.
● Hypoglycemia – Commonly presents with sweating, tremors, tachycardia, confusion, and hunger rather than hypotension caused by corticosteroid insufficiency.

SYNOPSIS
● Patients receiving long-term corticosteroid therapy may develop suppression of the hypothalamic-pituitary-adrenal axis, predisposing them to adrenal crisis during stressful procedures.
● Adrenal crisis is characterized by acute hypotension, weakness, dizziness, nausea, confusion, and possible circulatory collapse, requiring immediate recognition and treatment.
● Dental management includes identifying patients at risk, minimizing stress, considering supplemental corticosteroids when indicated, and initiating emergency treatment with oxygen, supportive care, and urgent medical assistance if adrenal crisis is suspected.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Epinephrine, subcutaneous 1:1,000

OTHER OPTIONS
● Epinephrine 1:10,000 – Primarily used for intravenous administration during advanced cardiac life support, not for subcutaneous injection in asthma.
● Epinephrine 1:100,000 – This concentration is commonly used as a vasoconstrictor in local anesthetic solutions and is not intended for emergency treatment of asthma.

SYNOPSIS
● The first-line treatment for an acute asthma attack is an inhaled short-acting β₂-agonist (salbutamol).
● If bronchospasm is severe and unresponsive to inhaled bronchodilators, or if associated with anaphylaxis, subcutaneous or intramuscular epinephrine (1:1,000) may be administered while activating emergency medical services.
● Supplemental oxygen and close monitoring should accompany emergency management until advanced medical care is available.

REFERENCE
Malamed SF. Medical Emergencies in the Dental Office – 8th Edition

ANSWER
Intermediate-level disinfectant

OTHER OPTIONS
● High-level disinfectant – Intended for heat-sensitive semicritical instruments and is not routinely used for environmental surface disinfection.
● Low-level disinfectant – Suitable for housekeeping surfaces with minimal contamination but not recommended for surfaces contaminated with body fluids such as vomitus.
● No disinfectant is required – Body fluid spills require cleaning followed by appropriate surface disinfection to prevent cross-contamination.

SYNOPSIS
● Vomitus is considered a potentially infectious body fluid and should be managed using standard precautions and appropriate PPE.
● The contaminated area should first be cleaned to remove visible organic material and then disinfected with an intermediate-level disinfectant (e.g., an EPA-registered hospital disinfectant with tuberculocidal activity or an appropriate sodium hypochlorite solution).
● Environmental surface disinfection is an essential component of infection prevention in the dental clinic.

REFERENCE
Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team – 7th Edition

ANSWER
Temporomandibular joint disorder

OTHER OPTIONS
● Migraine – A primary neurological headache disorder that is not typically relieved by restoration of missing posterior teeth.
● Trigeminal neuralgia – Characterized by recurrent episodes of sharp, electric shock-like facial pain and is unrelated to occlusal rehabilitation.
● Masticatory muscle spasm – Muscle tenderness and spasm are common features of TMD but do not represent the overall diagnosis in this clinical scenario.

SYNOPSIS
● Loss of posterior occlusal support may alter mandibular function and contribute to temporomandibular joint dysfunction.
● Headache is a common symptom of TMD and may improve after restoration of stable occlusion with a fixed prosthesis.
● Occlusal rehabilitation can reduce abnormal loading of the temporomandibular joint and associated musculature, leading to symptom resolution.

REFERENCE
Okeson JP. Management of Temporomandibular Disorders and Occlusion – 9th Edition

ANSWER
47°C for 1 minute

OTHER OPTIONS
● 42°C for 10 seconds – This temperature and duration are insufficient to produce irreversible bone damage.
● 42°C for 30 seconds – Mild hyperthermia at this level does not result in bone necrosis.
● 47°C for 30 seconds – Bone injury may begin, but sustained exposure for one minute is the accepted threshold for irreversible damage.

SYNOPSIS
● Excessive heat generated during bone cutting can cause thermal osteonecrosis and impair healing.
● Experimental studies have shown that exposure of bone to 47°C for 1 minute results in irreversible bone injury and loss of vitality.
● Adequate irrigation and intermittent pressure during drilling are essential to maintain bone temperature below this critical threshold and ensure successful healing and osseointegration.

REFERENCE
Peterson’s Principles of Oral and Maxillofacial Surgery – 4th Edition.

ANSWER
3–5 days

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Alveolar osteitis (dry socket) is characterized by premature loss or disintegration of the blood clot after extraction, resulting in exposed bone and severe pain.
● Clinical symptoms usually begin 1–3 days after extraction and are most commonly observed 3–5 days postoperatively.
● Dry socket is more common following traumatic extractions, particularly of mandibular third molars, and is associated with factors such as smoking, oral contraceptive use, and poor oral hygiene.

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

ANSWER
A gap exists between the wound edges that is filled with granulation tissue and heals with scar formation

OTHER OPTIONS
● Wound edges are closely approximated with minimal scar formation – This describes healing by primary intention, not secondary intention.

SYNOPSIS
● Healing by secondary intention occurs when there is extensive tissue loss and the wound edges cannot be brought together.
● The defect is filled with granulation tissue and fibrous connective tissue, resulting in greater wound contraction and scar formation.
● Compared with primary intention healing, secondary intention healing is slower and involves a more pronounced inflammatory response.

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

ANSWER
All of the above

OTHER OPTIONS
● Nil

SYNOPSIS
● Successful healing of surgical wounds, including closure of oroantral communications, requires tension-free primary closure.
● Wound disturbance and inadequate flap design increase the risk of dehiscence and delayed healing.
● Proper flap management, atraumatic surgery, and secure suturing are critical determinants of prognosis.

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

ANSWER
Formation of fibrous connective tissue after degeneration of the graft

OTHER OPTIONS
● Formation of viable dermis and fibrous connective tissue – The transplanted dermis does not remain entirely viable; it undergoes remodeling.
● The transplanted tissue remains completely viable – Autogenous dermal grafts undergo partial degeneration and replacement rather than remaining fully viable.
● The graft becomes one with the glenoid fossa – The purpose of the graft is to act as an interpositional material, not to fuse with the glenoid fossa.

SYNOPSIS
● Autogenous dermal grafts have been used as interpositional materials in TMJ surgery following disc perforation or discectomy.
● After transplantation, the graft undergoes degeneration and is gradually replaced by dense fibrous connective tissue.
● The resulting fibrous tissue serves as a functional cushion between the condyle and glenoid fossa, helping to prevent adhesions and maintain joint function.

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

ANSWER
2 – 4 – 1 – 3

OTHER OPTIONS
● Not applicable

SYNOPSIS
● The first priority in cleft palate management is to establish adequate nutrition through appropriate feeding techniques.
● Early orthopedic measures are aimed at preventing collapse of the maxillary segments and facilitating subsequent surgical repair.
● Speech rehabilitation and cosmetic correction are addressed later as part of a multidisciplinary approach involving surgeons, orthodontists, speech therapists, and pediatricians.

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

ANSWER
Provide definitive dental treatment under local anesthesia without delaying care

OTHER OPTIONS
● Blood transfusion – Routine blood transfusion is not indicated before routine dental treatment in a medically stable patient with sickle cell disease and is reserved for specific medical indications.
● Extract the tooth under local anesthesia without epinephrine – Extraction is indicated only if the tooth is non-restorable. For symptomatic irreversible pulpitis, a restorable tooth should receive endodontic treatment. In addition, epinephrine is not absolutely contraindicated in sickle cell disease when used judiciously.
● Prescribe antibiotics and analgesics – Antibiotics are not indicated unless there is evidence of odontogenic infection. Analgesics alone do not eliminate the source of pulpal pain.

SYNOPSIS
● Medically stable patients with sickle cell disease can undergo routine dental treatment with appropriate stress reduction, adequate oxygenation, hydration, and pain control.
● Definitive treatment of the source of dental pain should not be delayed, as untreated odontogenic disease may precipitate a vaso-occlusive crisis.
● Local anesthesia with a vasoconstrictor can be used cautiously in recommended doses unless other contraindications exist.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Oropharyngeal pseudomembranous candidiasis

OTHER OPTIONS
● Leukoplakia – Conventional leukoplakia is a potentially malignant disorder and is not specifically associated with AIDS. (Note: Oral hairy leukoplakia is associated with HIV infection, but it is different from conventional leukoplakia.)
● Oral melanosis – May occur due to physiologic pigmentation, medications, or systemic disorders but is not a characteristic manifestation of AIDS.
● Squamous cell carcinoma – Although HIV-positive patients may have an increased risk of malignancy, squamous cell carcinoma is not a characteristic oral manifestation of AIDS.

SYNOPSIS
● Oropharyngeal pseudomembranous candidiasis is one of the most common opportunistic oral infections in patients with advanced HIV infection and AIDS.
● It presents as removable white plaques that leave an erythematous or bleeding surface after wiping.
● The presence of oral candidiasis in an HIV-infected patient may indicate significant immunosuppression and disease progression.

REFERENCE
Burket’s Oral Medicine – 13th Edition

ANSWER
Graves disease

OTHER OPTIONS
● Cleidocranial dysostosis – Characterized by clavicular hypoplasia, delayed eruption of permanent teeth, and multiple supernumerary teeth; exophthalmos is not a typical feature.
● Peutz-Jeghers syndrome – Characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps rather than exophthalmos.
● Down syndrome – Common features include intellectual disability, hypotonia, and characteristic craniofacial features, but exophthalmos is not a characteristic finding.

SYNOPSIS
● Graves disease is an autoimmune disorder causing hyperthyroidism and is the most common cause of exophthalmos (thyroid eye disease).
● Clinical manifestations include exophthalmos, diffuse goiter, tachycardia, heat intolerance, weight loss, and tremors.
● Dental management should minimize stress, avoid excessive use of vasoconstrictors in uncontrolled hyperthyroidism, and postpone elective treatment in untreated or poorly controlled patients.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
Proceed with the planned restoration

OTHER OPTIONS
● Defer dental treatment until completion of chemotherapy – Elective restorative treatment may be performed when hematologic parameters are within acceptable limits and the patient is medically stable.
● Prescribe prophylactic antibiotics before treatment – Routine antibiotic prophylaxis is not indicated solely because a patient is receiving chemotherapy if the neutrophil count is normal and there is no other indication.
● Prescribe analgesics and refer the patient back to the oncologist – Referral without treatment is unnecessary when the patient is medically stable and laboratory values are within normal limits.

SYNOPSIS
● Routine restorative dental treatment can be safely performed in patients undergoing chemotherapy when the complete blood count, particularly the absolute neutrophil count and platelet count, is within acceptable limits.
● Consultation with the oncologist is recommended to determine the optimal timing of treatment and to confirm medical stability.
● Antibiotic prophylaxis is reserved for patients with significant neutropenia or other specific medical indications and is not routinely required.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
200

OTHER OPTIONS
Not applicable

SYNOPSIS
● The normal CD4+ T-lymphocyte count ranges from approximately 500 to 1,500 cells/mm³.
● A CD4+ count <200 cells/mm³ or the presence of an AIDS-defining illness is the accepted criterion for the diagnosis of AIDS.
● Patients with low CD4+ counts are at increased risk of opportunistic infections, and dental treatment should be planned after assessing immune status and overall medical condition.

REFERENCE
Little and Falace's Dental Management of the Medically Compromised Patient - 10th Edition

ANSWER
Dyspnea

OTHER OPTIONS
● Chronic cough – A common symptom of chronic obstructive pulmonary disease (COPD), but it is not synonymous with breathlessness.
● Cyanosis – Refers to bluish discoloration of the skin and mucous membranes due to inadequate oxygenation, not breathlessness.
● Dysphagia – Refers to difficulty in swallowing and is unrelated to emphysema-induced respiratory symptoms.

SYNOPSIS
● Emphysema is a form of chronic obstructive pulmonary disease (COPD) characterized by destruction of alveolar walls and enlargement of distal air spaces.
● Dyspnea (breathlessness) is the hallmark clinical feature of emphysema and typically worsens with exertion as lung function declines.
● Dental management should include short appointments, stress reduction, upright chair positioning, and avoidance of respiratory depressants in patients with severe emphysema.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient – 10th Edition

ANSWER
9th to 11th week

OTHER OPTIONS
● 6th week – This period is primarily associated with the development and fusion of the upper lip.
● 6th to 8th week – Failure of fusion during this period is more commonly associated with cleft lip rather than cleft palate.
● 10th week – Palatal fusion occurs over a range of weeks rather than at a single point in time.

SYNOPSIS
● The secondary palate is formed by fusion of the palatal shelves derived from the maxillary processes.
● Fusion of the palatal shelves normally occurs between the 9th and 11th weeks of intrauterine life.
● Failure of this fusion results in cleft palate, which may occur alone or in association with cleft lip.

REFERENCE
Langman’s Medical Embryology – 15th Edition.

ANSWER
Costochondral graft

OTHER OPTIONS
● Endochondral graft – Endochondral ossification refers to a mechanism of bone formation and is not a specific graft type used for condylar reconstruction.
● Periosteal graft – Periosteal grafts lack the structural support required for condylar reconstruction.

SYNOPSIS
● Costochondral grafts harvested from the rib are widely used for reconstruction of the mandibular condyle following trauma, ankylosis, tumor resection, or gunshot injuries.
● These grafts provide both bone and cartilage components, closely resembling the structure and function of the mandibular condyle.
● In growing patients, costochondral grafts possess growth potential and are considered the gold standard for autogenous condylar reconstruction.

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

ANSWER
7–14 days

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Wound healing proceeds through inflammatory, proliferative, and remodeling phases.
● During the proliferative phase, angiogenesis and granulation tissue formation result in re-establishment of vascularity.
● Functional vascularization of the wound is generally achieved within 7–14 days, which is critical for tissue repair and resistance to infection.

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

ANSWER
Pushing bone into contact with the root surface without fracturing the bone at its base

OTHER OPTIONS
● Pushing bone into contact with the root surface with fracturing the bone at its base – Bone swaging preserves the base of the bone and maintains its blood supply.
● Removal of bone from the root surface during periodontal surgery – This describes osseous resective procedures rather than bone swaging.
● A technique used for saucerization of bone – Saucerization involves reshaping bony architecture and is distinct from bone swaging.

SYNOPSIS
● Bone swaging is a regenerative osseous procedure in which a section of bone adjacent to an intrabony defect is repositioned against the root surface.
● The bone is displaced without fracturing its base, thereby preserving vascularity and promoting bone regeneration.
● Bone swaging is indicated when sufficient thickness of interproximal bone is present adjacent to a vertical defect.

REFERENCE
Carranza’s Clinical Periodontology – 14th Edition.

ANSWER
Extraction with hyperbaric oxygen therapy

OTHER OPTIONS
● Endodontic treatment and periodontal curettage – Conservative dental treatment is preferred to avoid extractions but does not specifically reduce the risk once extraction is required.
● Enucleation – This is a surgical procedure for cyst removal and has no role in preventing osteoradionecrosis.
● Marsupialization – This technique is used for decompression of cysts and is unrelated to the prevention of osteoradionecrosis.

SYNOPSIS
● Osteoradionecrosis is a serious complication of radiation therapy characterized by hypovascular, hypocellular, and hypoxic bone.
● When dental extraction is unavoidable in irradiated patients, the risk of osteoradionecrosis can be reduced by using hyperbaric oxygen therapy (HBOT) in conjunction with atraumatic extraction techniques.
● Hyperbaric oxygen therapy enhances angiogenesis and tissue oxygenation, thereby promoting wound healing and decreasing the incidence of osteoradionecrosis.

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

ANSWER
Maxillary artery

OTHER OPTIONS
● Infraorbital artery – More commonly involved in Le Fort II fractures due to infraorbital rim involvement.
● Mandibular artery – Not a recognized major artery associated with Le Fort I fractures.
● Facial artery – Supplies superficial facial structures and is not the principal source of bleeding in Le Fort I fractures.

SYNOPSIS
● Le Fort I fracture is a horizontal fracture of the maxilla extending through the lateral wall of the maxillary sinus and pterygomaxillary region.
● Significant hemorrhage in Le Fort I fractures commonly originates from branches of the maxillary artery, especially the descending palatine branch.
● Injury to these vessels can lead to severe palatal and nasal bleeding following maxillary fractures.

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

ANSWER
Prescribe analgesics and antibiotics

OTHER OPTIONS
• Prescribe analgesics – While analgesics will provide temporary pain relief, they do not address the infection or the elevated blood sugar levels, making this option insufficient.
• Postpone treatment – Immediate treatment of the infection is necessary as uncontrolled diabetes can worsen the condition. Delaying management without addressing the infection is not appropriate.
• Prescribe antibiotics – Antibiotics alone are insufficient for pain relief and managing symptoms, as they do not address the patient’s immediate discomfort.

SYNOPSIS
• Patients with diabetes and infections require cautious management.
• The elevated RBS indicates poor glycemic control, which can impair healing and exacerbate the infection.
• Immediate extraction is contraindicated until the infection is managed and blood sugar levels are better controlled.
• Prescribing a combination of antibiotics to manage the infection and analgesics for pain relief is appropriate.
• Extraction can be performed after the infection subsides, and glycemic levels are stabilized.
• Coordination with the patient’s physician for blood sugar control is crucial.

REFERENCE
Malamed, S. F. (2019). Handbook of Local Anesthesia (7th ed.). Elsevier.
Greenberg, M. S., Glick, M., & Ship, J. A. (2019). Burket’s Oral Medicine (13th ed.). People’s Medical Publishing House.

ANSWER
2 weeks

OTHER OPTIONS
• 6 months – Leaving calcium hydroxide in the canal for this long may weaken dentin and increase the risk of fracture.

SYNOPSIS
• Apexification using Ca(OH)₂ as the main barrier-inducing material – Replaced every 3 months until barrier forms (6–24 months total)
• Short-term Ca(OH)₂ before MTA apical plug 1–2 weeks only

REFERENCE
Hargreaves, K. M., & Berman, L. H. (2016). Cohen’s Pathways of the Pulp (11th ed.). Elsevier.

ANSWER
Contemplation

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The stage of change model, or Transtheoretical Model, consists of several stages – precontemplation, contemplation, preparation, action, and maintenance.
• In the contemplation stage, the patient is aware of their problem (in this case, plaque accumulation and clinical attachment loss) and is thinking about making a change but has not yet taken significant action.
• The patient admits to inconsistent oral hygiene but is likely aware of the need to improve.
• This stage typically involves ambivalence-recognizing the need for change but not fully committing to it.
• Precontemplation occurs when the patient is not yet aware of or is in denial about their oral health issues.
• Relapse would apply if the patient had previously made significant progress in improving their oral hygiene but had fallen back into poor habits.
• Maintenance occurs after the patient has made changes and is working to sustain the new behaviors.

REFERENCE
Oral Health Promotion and Disease Prevention by David W. Jones.

ANSWER
No need to stop the anticoagulant.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• For most routine dental extractions, there is no need to stop anticoagulant medication in patients with atrial fibrillation.
• Studies have shown that the risk of significant bleeding is minimal when the extraction is performed under local measures, such as using hemostatic agents (e.g., collagen sponges, sutures) and applying pressure post-operatively.
• Stopping anticoagulants increases the risk of thromboembolic events, which can be life-threatening.
• The dentist should consult the patient’s physician if there is any uncertainty, but routine anticoagulant therapy should generally be continued.

REFERENCE
Guidelines on the Management of Anticoagulant Therapy in Dental Procedures by the American College of Cardiology.

ANSWER
Infectious mononucleosis

OTHER OPTIONS
• Oral candidiasis – This is caused by Candida albicans, a fungal infection, not EBV.
• Herpangina – This is caused by Coxsackievirus, not EBV.
• Kaposi sarcoma – This is associated with Human Herpesvirus 8 (HHV-8), not EBV.

SYNOPSIS
• The Epstein-Barr Virus (EBV) is a member of the herpesvirus family and is known to cause several diseases.
• The most common condition caused by EBV is infectious mononucleosis, which is characterized by fever, lymphadenopathy, pharyngitis, and fatigue.
• EBV also has a strong association with other conditions, including
– Burkitt’s lymphoma (a type of non-Hodgkin lymphoma).
– Nasopharyngeal carcinoma (common in certain populations).
– Hodgkin’s lymphoma (certain subtypes).
– Oral hairy leukoplakia (seen in immunocompromised patients, such as those with HIV).

REFERENCE
Jawetz, Melnick & Adelberg’s Medical Microbiology, 28th Edition.
Epstein-Barr Virus and Human Disease in The Lancet by Cohen, J. I. (2021).

ANSWER
Extraction of maxillary first premolars

OTHER OPTIONS
• Extraction of mandibular first premolars – This is less commonly done in Class II cases as it may worsen the skeletal imbalance and is more appropriate for Class I cases or severe crowding in the lower arch.
• Extraction of maxillary third molars – Third molar extractions are typically not performed to treat crowding or malocclusion unless there are specific concerns regarding impaction or pathology, and they do not directly address the occlusal issues seen in Class II malocclusion.
• No extraction necessary – In some cases of mild Class II malocclusion, no extraction may be needed, but in a patient with moderate crowding and deep overbite, extractions are often required to achieve ideal space and occlusion.

SYNOPSIS
• In Angle’s Class II malocclusion, especially with moderate crowding, the typical approach often involves extracting maxillary first premolars to create space for aligning the anterior teeth and improving the overbite.
• This helps in correcting the overjet, aligning the upper and lower teeth, and improving the occlusion.
• The upper arch typically benefits from the extraction of first premolars in Class II cases because this moves the upper teeth back to reduce the overjet and helps achieve better facial balance.

REFERENCE
Contemporary Orthodontics by William R. Proffit, Henry W. Fields Jr., and David M. Sarver.
Principles of Orthodontics – Extraction or Non-extraction Treatment? – Journal of Orthodontics and Dentofacial Orthopedics by Bishara, S. E.

ANSWER
Severe

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Traumatic dental injuries such as intrusion are classified based on the degree of intrusion
• Mild – Intrusion of less than 3 mm in primary or permanent teeth.
• Moderate – Intrusion of 3–6 mm in permanent teeth.
• Severe – Intrusion of greater than 6 mm in permanent teeth.
• Very Severe – Rarely used clinically, may describe complete displacement into the alveolar bone.
• Since the intrusion depth in this scenario is 7 mm, it falls into the severe category.

REFERENCE
Chapter 8 – Intrusive Luxation -Traumatic Dental Injuries – A Manual, 3rd Edition. Andreasen JO, Andreasen FM, Andersson L.

ANSWER
ASA III

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The ASA classification system is used to determine the physical status of a patient and assess their anesthetic risk. It ranges from ASA I (healthy patient) to ASA VI (brain-dead patient).
– ASA I – A healthy patient with no systemic disease.
– ASA II – A patient with mild systemic disease that does not limit daily activities (e.g., controlled hypertension, mild asthma).
– ASA III – A patient with severe systemic disease that limits daily activity but is not incapacitating (e.g., poorly controlled diabetes, sickle cell anemia with frequent crises).
– ASA IV – A patient with severe systemic disease that is a constant threat to life (e.g., unstable angina, recent myocardial infarction).
• The patient has sickle cell anemia, a severe systemic condition.
• Frequent vaso-occlusive crises indicate the condition significantly impacts daily life.
• However, the patient is stable at the time of the consultation and not in acute crisis, so they do not fall into the ASA IV category.
• Thus, the patient is classified as ASA III.

REFERENCE
Chapter 1 – Patient Assessment and Risk Management – Malamed SF. Handbook of Local Anesthesia, 7th Edition,

ANSWER
Recent pneumothorax

OTHER OPTIONS
• Chronic sinus infections – Nitrous oxide can accumulate in sinuses, causing mild discomfort, but it is not strictly contraindicated.
• Mild anxiety – Nitrous oxide is commonly used for managing anxiety during dental procedures.
• History of dental phobia – Nitrous oxide is effective in calming phobic patients.

SYNOPSIS
• Nitrous Oxide Contraindications:
• Nitrous oxide is generally safe for sedation but is contraindicated in conditions where gas expansion or pressure effects could be harmful due to its ability to diffuse into closed air spaces.
• Recent pneumothorax – Nitrous oxide diffuses into pleural spaces, significantly increasing pressure, which may exacerbate the condition or lead to recurrence. This makes pneumothorax a clear contraindication.
• In this case, the patient’s recent pneumothorax is the contraindication.

REFERENCE
Chapter 7 – Nitrous Oxide-Oxygen Sedation – Malamed SF. Sedation – A Guide to Patient Management, 6th Edition

ANSWER
Denture on flat ridge

OTHER OPTIONS
• Denture on Tori Cases – Tori (bony outgrowths) can complicate denture fabrication and fitting, but once relieved properly during denture fabrication, tissue conditioning is less frequently required.
• Denture on Ridge with Sharp Bone – Sharp bony ridges can cause tissue trauma, but pre-prosthetic surgery to smoothen the ridge is often recommended before denture fabrication.

SYNOPSIS
• A flat ridge results from extensive alveolar bone resorption, offering minimal support, retention, and stability for the denture.
• Due to poor ridge morphology, the denture tends to move, causing trauma to the soft tissues and necessitating frequent tissue conditioning to distribute pressure evenly and alleviate sore spots.

REFERENCE
Chapter 5 Management of the Atrophic Ridge – Zarb GA, Bolender CL, Eckert SE. Prosthodontic Treatment for Edentulous Patients, 13th Edition

ANSWER
Dry mouth, dry eyes, and lymphocytic infiltration of salivary glands

OTHER OPTIONS
• Polyuria and polydipsia – Diabetes Mellitus
• Butterfly-shaped facial rash – SLE
• Severe generalized gingival hyperplasia – This is commonly associated with drug-induced changes (e.g., phenytoin, cyclosporine) or leukemia, not Sjögren syndrome.

SYNOPSIS
• Sjögren syndrome is a chronic autoimmune disorder characterized by
– Xerostomia (Dry Mouth) -Caused by dysfunction or destruction of salivary glands due to lymphocytic infiltration.
– Keratoconjunctivitis Sicca (Dry Eyes) – Due to reduced tear secretion by the lacrimal glands.
– Systemic Features – Fatigue, joint pain, and other connective tissue diseases like rheumatoid arthritis or lupus.
– Histopathology – Lymphocytic infiltration of salivary glands is a hallmark feature.

REFERENCE
Scully C. Oral and Maxillofacial Medicine – The Basis of Diagnosis and Treatment, 3rd Edition.

ANSWER
Deep bite

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Serial extraction is an orthodontic treatment protocol typically used in patients with moderate to severe crowding. It involves the planned extraction of specific primary and permanent teeth to guide the eruption of remaining teeth and create space for proper alignment.
• However, serial extraction is contraindicated in certain occlusal conditions due to the potential for exacerbating the existing malocclusion.
• Deep bite refers to excessive vertical overlap between the upper and lower incisors, which can lead to potential functional and aesthetic issues.
• Serial extractions can aggravate a deep bite, as extracting teeth to create space in a patient with a deep bite can further reduce the vertical dimension and may lead to an even more severe deep bite. T
• The procedure may lead to undesirable tooth movement, worsening the vertical overlap, and affecting occlusal stability in the long term.

REFERENCE
Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics, 5th Edition, 2018.

ANSWER
Elastomer

OTHER OPTIONS
• Hardwax – While it is an older material used for bite registrations, it can distort easily, especially under pressure or temperature changes, making it less reliable.
• Plaster of Paris – Though it provides accurate models, it is brittle and difficult to use directly for bite restoration.
• Zinc oxide-eugenol paste – Often used for its flow properties, but it is brittle once set, making it less durable for accurate bite restoration.

SYNOPSIS
• Elastomeric materials, such as polyvinyl siloxane (PVS), are considered the best for bite registration due to their superior accuracy, dimensional stability, and ease of manipulation.
• These materials are soft enough to prevent distortion during occlusal contact but rigid enough to ensure precise recording of occlusal relationships.
• Elastomers set quickly, reducing the chance of patient movement affecting the accuracy.

REFERENCE
Craig, R. G., & Powers, J. M. (2012). Restorative Dental Materials (13th ed.). Mosby.

ANSWER
Less than 90 degrees

OTHER OPTIONS
• More than 90 degrees – An angle greater than 90 degrees fails to transmit occlusal forces along the supporting vertical axis of the abutment tooth. This also permits slippage of the prosthesis away from the abutment, which can result in orthodontic-like forces being applied to an inclined plane on the abutment, with possible tooth movement.

SYNOPSIS
• The angle formed by the occlusal rest and the vertical minor connector from which it originates should be less than 90 degrees.
• Only in this way can the occlusal forces be directed along the long axis of the abutment tooth.

REFERENCE
Chapter 6 Rests and Rest Seats. Pocket dentistry.

ANSWER
Both A and C

OTHER OPTIONS
• Both the crown and root move in the same direction either labially or lingually the same amount of distance – Labiolingual direction is more of a tipping movement

SYNOPSIS
• Bodily tooth movement in orthodontics refers to a type of tooth movement in which the entire tooth, including both the crown and the root, moves together as a unit in a horizontal direction.
• This is one of the most controlled and desirable forms of tooth movement during orthodontic treatment because the tooth shifts its position without significant tipping or rotation.

REFERENCE
Biomechanics and esthetic strategies in clinical orthodontics-Nanda-Page 6.

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
Bilateral Sagittal Split Osteotomy (BSSO)

OTHER OPTIONS
• Le Fort I Osteotomy – Used for maxillary repositioning, not primary treatment for mandibular prognathism.
• Segmental Mandibular Osteotomy – Segmental Mandibular Osteotomy – Rarely used for major mandibular setbacks; mainly for localized mandibular adjustments.
• Genioplasty – Used for chin modifications (e.g., reducing chin projection), but does not correct the overall mandibular prognathism.

SYNOPSIS
• Bilateral Sagittal Split Osteotomy (BSSO) is the gold standard surgical procedure for mandibular prognathism.
• It allows the mandibular body to be moved posteriorly, improving occlusion and facial harmony while maintaining good bony contact for stability.

REFERENCE
Reyneke JP. Essentials of Orthognathic Surgery. Quintessence Publishing; 2010.

ANSWER
Iron

OTHER OPTIONS
• Vitamin B12 – Causes glossitis and burning tongue but is associated with megaloblastic anemia, neurological symptoms (paresthesia, ataxia), not dysphagia.
• Vitamin B6 – Can cause stomatitis and cheilitis but is not strongly linked to dysphagia.
• Vitamin D – Associated with bone-related symptoms (osteomalacia, muscle weakness), not mucosal changes like glossodynia and dysphagia.

SYNOPSIS
• Iron is essential for epithelial integrity, its deficiency leads to mucosal atrophy, increasing susceptibility to inflammation and discomfort.
• Iron deficiency is commonly associated with atrophic glossitis (smooth, burning tongue), dysphagia, and pallor, which are characteristic signs of Plummer-Vinson syndrome.
• Dysphagia occurs due to the formation of esophageal webs in severe cases.

REFERENCE
Proctor GB, Carpenter GH. Oral Nutritional Deficiencies and Their Effects on Oral Health. Adv Dent Res. 2011, 23(1)- 52-58.

ANSWER
Michigan O probe

OTHER OPTION
• William probe – In this probe the markings 4 and 6 are missing to decrease confusion in determining the depth of the Pocket. This missing numbers makes it easy for determining the depth of the pocket due to the small size of the markings.
• Nabers Probe – The Nabers Probe is a specialized periodontal instrument used mainly for assessing furcation involvement in multi-rooted teeth.
• UNC 15 Probe – The UNC-15 probe is a periodontal probe designed for precise measurement of pocket depths and clinical attachment levels in periodontal assessment. Clearly marked at 1 mm intervals up to 15 mm. Color-coded bands at 5 mm, 10 mm, and 15 mm for quick visualization.

SYNOPSIS
• A long, slender instrument for exploring wounds, body cavities, passages, or periodontal pockets. Dental probes are marked in millimeters to measure the depth of periodontal pockets
redirected from Michigan O probe)
• University of Michigan O probes have markings at 3 mm, 6 mm, and 8 mm.
• A modification of this probe with Williams’ markings also is available.

REFERENCE
Periodontal Probing Systems A Review of Available Equipment Srinivas Sulugodu Ramachandra

ANSWER
5 mg per kg

OTHER OPTION
• NIL

SYNOPSIS
Toxicity
• Safely tolerated dose (STD). Dose below which symptoms of toxicity
are unlikely – 1 mg per kg body weight.
• Potentially lethal dose (PLD). The lowest dose associated with a fatality.
The patient should be hospitalized when the dose is 5 mg per kg body weight.
• Certainly lethal dose (CLD). Survival unlikely which is 32-64 mg per kg body
weight.

REFERENCE
Oxford clinical dentistry 7th edition pg 28

ANSWER
Immediate

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The golden time for replantation is 20-30 minutes, if it is not possible, the tooth should be stored in an appropriate storage media for preserving the viability of PDL cells.
• In closed apex cases with extra-oral time less than 20 minutes, replant immediately after gentle washing. For cases with an extra-oral time of more than 20 minutes, endodontic treatment should be performed before replantation.
• In open apex cases,
– Extra oral time less than 20 min-soak in 1mg Doxycycline in 20mg saline for 5min before replantation
– Extra oral time 20-60 minutes-soak in HBSS for 30 minutes and replant
– Extra oral time more than 60minutes
– According to International Association of Dental Traumatology 2007 replantation of avulsed tooth with open apex with extra oral time more than 60 minutes is not indicated
– If tooth remained dry for more than 60 minutes no consideration should be given to preserve PDL and apexification procedure can be initiated.

REFERENCE
-Clinical Management of avulsed tooth ;Review- M Trope- NCBI
-Replantation of immature avulsed teeth with extra oral dry storage -International Journal of Clinical Pediatric .Dentistry

ANSWER
3rd molar, 2nd premolar, lateral incisor

OTHER OPTIONS
• NIL

SYNOPSIS
• Hypodontia refers to one or more missing teeth
• Hypodontia of the permanent teeth is usually symmetrical and affects, in order of occurrence, the third molars (more than 35 percent of cases), mandibular second premolars, maxillary lateral incisors, mandibular central incisors, and maxillary first premolars (In Asian Population).
• In hypodontia of the permanent teeth, overall dental development may be delayed by around 1.5 years (Uslenghi and Liversidge, 2006), a factor that needs to be considered when assigning a dental age.

REFERENCE
Dental Disease, Defects, and Variations in Dental Morphology Mary Lewis,

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
Denture stomatitis

OTHER OPTIONS
• Epulis fissuratum – Epulis fissuratum is a benign reactive hyperplasia of the fibrous connective tissue that occurs adjacent to the flanges of complete or partial ill-fitting dentures. The lesion consists of two or more folds of soft tissue separated by a central groove into which the appliance border fits.
• Hypertrophic frenum – can cause poor retention of denture. Frenectomy is indicated in this case.

SYNOPSIS
• Denture stomatitis or Denture sore mouth is related to the wearing of dentures.
• The mildest form of denture sore mouth appears as small, localized, and asymptomatic red spots on the posterior palatal mucosa and areas turn crimson red when severe.
• The cause is unknown but there is evidence that Candida albicans is at least contributory.
• Because the disease is limited to the area covered by the denture, it is often assumed that the patient is allergic to denture base material.
• Treatment includes fungicides such as nystatin, clotrimazole, ketoconazole, or fluconazole in the usual doses for oral candidiasis. Good oral and denture hygiene may help. The denture should fit well and not be worn at night.

REFERENCE
A Guide to Common Oral Lesions.pdf

ANSWER
Mandibular premolar

OTHER OPTION
• Mandibular molars – The mandibular canal, also known as the inferior alveolar canal (IAC), is located within the internal aspect of the mandible and contains the inferior alveolar nerve, artery and vein.

SYNOPSIS
• The mental foramen is an opening or a hole in the bone located on the external surface of the mandible in the region of the mandibular premolars.
• On a mandibular periapical radiograph, the mental foramen appears as a small, ovoid or round, radiolucent area located in the apical region of the mandibular premolars.
• On a mandibular periapical radiograph, the mental foramen appears as a small, ovoid or round, radiolucent area located in the apical region of the mandibular premolars.

REFERENCE
Assessment of the Effect of Dimensions of the Mandibular Ramus and Mental Foramen on Age and Gender Using Digital Panoramic Radiographs: A Retrospective Study. Tanvi Dosi

ANSWER
All the above

OTHER OPTIONS
• NIL

SYNOPSIS
• The retentive force of a complete denture depends on multiple factors, including
• Force of Adhesion
– Adhesion is the attraction between saliva and the denture base.
– Helps the denture stick to the tissues.
– Works best with a thin, even film of saliva.
• Gravity
– Especially important for mandibular dentures.
– The weight of the denture can help keep it in place, but only slightly. Not a major contributor, but still a factor.
• Control of Saliva Flow
– Adequate and well-controlled saliva improves cohesion and adhesion.
– Too much or too little saliva can reduce denture retention.
– Saliva should be of the right viscosity – neither too thick nor too watery.

REFERENCE
Zarb G, Hobkirk JA, Eckert SE, Jacob RF. Prosthodontic Treatment for Edentulous Patients: Complete Denture and Implant. Supported Prostheses. 13th ed. St. Louis Pg 145

ANSWER
Periodontal probe

OTHER OPTIONS
• Explorer – Typically used to detect caries or to check for roughness on restorations. Not ideal for measuring pocket depths.
• Sickle probe – Mainly used for scaling and detecting tartar or calculus, not for precise pocket measurement.

SYNOPSIS
• A periodontal probe is the standard instrument used to measure pocket depths around an implant (just as it’s used around natural teeth).
• Measuring Pocket Depth
– A periodontal probe has calibrated markings (usually in millimeters) that help measure the depth of the sulcus or pocket around the implant.
– The probe is designed to be gentle enough not to damage the implant or surrounding tissues, but still provide accurate readings
• Importance of Checking Pocket Depth
– Pocket depth around an implant can indicate the presence of peri-implantitis (infection) or implant failure if it’s too deep.
– A loose implant can often be associated with deeper pockets or bone loss.

REFERENCE
How to Manage a Loosened Dental Implant Associated with Pain? J Can Dent Assoc.

ANSWER
No resistance to probing

OTHER OPTIONS
• Root resorption – More commonly associated with trauma, pressure (e.g., ortho), or internal resorptive conditions not a result of epithelial healing
• Ankylosis – Involves fusion of bone to tooth root not related to epithelial healing and not a complication of scaling.
• Gingival recession – May occur after scaling, but it is not directly due to irregular epithelial attachment — it’s more related to removal of inflamed tissue or loss of collagen support.

SYNOPSIS
• After scaling, healing often occurs by formation of a long junctional epithelium, especially in non-surgical therapy.
• This epithelium
– Reattaches to the root surface
– Lacks firm connective tissue attachment
– Offers less resistance to probing
• As a result, false pocket readings or easy bleeding may be observed on probing even though the tissue looks clinically healthy.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Supragingival plaque removal

OTHER OPTION
• Subgingival air polishing can serve as an alternative or adjunctive method for biofilm management in periodontal maintenance therapy.

SYNOPSIS
• Supragingival air polishing has been used to remove plaque and stain. Significant advancements in air polishing powders, device nozzles, and equipment have enabled the creation of subgingival air polishing procedures.
• Air polishing devices are commonly used to remove supragingival biofilm and, with advances in device design and powders, they are now able to remove biofilm subgingivally.
• Sodium carbonate (sometimes confused with sodium bicarbonate, which is more commonly used) is an abrasive agent used in air polishing systems, primarily for
– Removing supragingival plaque and stains from the enamel surface
– Being gentle on soft tissue and enamel when used correctly
• It is not intended for
– Subgingival use (can irritate tissues).
– Calculus removal (which typically requires scaling instruments).

REFERENCE
Subgingival air-polishing in the treatment of periodontal biofilm infections Gregor

ANSWER
Smooth and well polished

OTHER OPTIONS
• NIL

SYNOPSIS
• An implant analogue is a replica of the dental implant fixture used in laboratory models to simulate the implant’s position in the mouth during prosthetic fabrication.
• It should be smooth and well polished to ensure accurate fit and easy removal from the cast without damaging the stone.
• A rough surface is not necessary and can cause inaccuracies or damage.
• It should not be altered (e.g., by sandblasting) before use.

REFERENCE
Dental Implants. By Dongliang Zhang

ANSWER
It is circular in form and occupies the region of contact area

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The size and shape of the completed solder connector must satisfy the requirements of the prosthesis for strength, cosmetics, and hygiene.
• The larger the buccolingual and occlusogingival dimensions are, the stronger the joint will be.
• Biologically and mechanically acceptable solder joint of FPD is circular and occupies the region of contact area.
• In posterior regions – rounded triangular shape
• Provides adequate strength with gingival access for hygiene.
• In the anterior region – oval shaped – due to limited labiolingual dimensions of these teeth and their cosmetic prominence (but strength is minimal).
• Large connector or inappropriately shaped connector leads to display of metal
• Recommended occlusogingival height 3 – 4 mm
• For ease of plaque control, the connectors should occupy the normal anatomic interproximal contact areas because encroaching on the buccal, gingival, or lingual embrasure restricts access. However, to improve the appearance without significantly affecting plaque control, anterior connectors are normally placed toward the lingual.

REFERENCE
Contemporary Fixed Prosthodontics ROSENSTIEL,pg 709

ANSWER
I Bar clasp

OTHER OPTIONS
• NIL

SYNOPSIS
• It is a retentive clasp used in removable partial dentures.
• The I-bar approaches the undercut from a gingival direction.
• It looks like a straight or slightly curved bar that extends from the base or meshwork and contacts the tooth surface at a point near the gingival third of the crown.
• It resembles the capital letter ‘I’ when viewed from the side.

REFERENCE
Stewart’s Clinical Removable Partial Denture ,4th edition

ANSWER
Increased vertical dimension causes clicking, pain, and TMJ problems

OTHER OPTIONS
Refer Synopsis

SYNOPSIS
Effects of increased vertical dimension
• Increased trauma – discomfort
• Increased lower- facial height – loss of free-way space
• Cheek biting
• Difficulty in swallowing and speech
• Pain and clicking in the temporomandibular joint
• Stretching of facial muscles – appearance
• Residual ridge resorption
• Drooling of saliva
• Long-term use of complete dentures with increased vertical dimension can cause TMJ disorders.

REFERENCE
Post Insertion Problems And Their Management In Complete Denture Journal of Evolution of Medical and Dental Sciences.Vol 2(3) Jan 2013 pp 194-99

ANSWER
Makes the denture more stable without changing the denture teeth

OTHER OPTION
• Not applicable

SYNOPSIS
• Relining is done simply to improve the denture’s fitting.
• Rebasing is a more dramatic adjustment that entails retrofitting the dentures by replacing the entire acrylic base with new acrylic. The procedure makes the denture more stable without changing the denture teeth.

REFERENCE
Denture Repair How a Dentist Can Rebase Your Dentures. Randal S

ANSWER
Complete surgical excision with curettage of underlying bone

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The histology confirms multinucleated giant cells in a vascular stroma indicative of peripheral giant cell granuloma.
• PGCG requires complete surgical excision, including curettage of the underlying bone, to reduce recurrence risk.

REFERENCE
Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral and Maxillofacial Pathology.

ANSWER
Increase in gingival fluid and bacteria

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Pregnant women have increased gingival fluid and increased growth of bacteria.
• A rise in the ovarian hormones, estrogen and progesterone, increases the risk of inflammation of the gingiva leading to rise in GCF.
• Both pregnancy and use of oral contraceptives (OCs) increases the levels of these hormones. These levels stimulate bacterial growth in the mouth, resulting in a shift in bacteria flora.

REFERENCE
Carranza 11th edition chapter 27

ANSWER
Irrigate the wound with saline and close it with sutures

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Clean wounds can be irrigated with saline and closed primarily if tetanus vaccination is up to date.
• There is no need for immunoglobulin or delayed closure.

REFERENCE
Fitzpatrick, T. B., et al. (2017). Emergency Medicine – Clinical Essentials.

ANSWER
Monitor the lesion and manage underlying immunosuppression

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Oral hairy leukoplakia is caused by Epstein-Barr virus and is associated with immunosuppression.
• Management involves addressing the underlying immunosuppressive state rather than direct treatment of the lesion, as it is benign.

REFERENCE
Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral and Maxillofacial Pathology.

ANSWER
Administer topical corticosteroids and ensure IBD control

OTHER OPTIONS
• Not applicable

SYNOPSIS
Crohn’s disease can present oral lesions, such as aphthous ulcers, cobblestone mucosa, or diffuse swelling. These lesions are inflammatory, and topical corticosteroids (e.g., triamcinolone acetonide) are the first line of treatment
• Oral ulcers in inflammatory bowel disease (IBD) are treated with topical corticosteroids to alleviate symptoms.
• Optimal management of Crohn’s disease is crucial to reduce recurrence.

REFERENCE
Chapple, I. L., et al. (2019). Oral manifestations of systemic diseases. Periodontology 2000.

ANSWER
High pull headgear

OTHER OPTIONS
• Cervical pull headgear – Cervical pull headgear encourages vertical growth, making it unsuitable for hyperdivergent cases.
• Reverse pull headgear – Reverse pull headgear is used for Class III malocclusion.
• Straight pull headgear – Straight pull headgear applies force parallel to the occlusal plane, which is less effective for hyperdivergent cases.

SYNOPSIS
• High-pull headgear applies forces to control vertical growth and reduce lower anterior facial height, making it suitable for hyper divergent cases.

REFERENCE
Graber, T. M., Vanarsdall, R. L., & Vig, K. W. (2016). Orthodontics – Current Principles and Techniques.

ANSWER
Trigeminal Neuralgia

OTHER OPTIONS
• TMJ Disorder – can cause pain in your jaw joint and in the muscles that control jaw movement
• Postherpetic neuralgia – Postherpetic neuralgia is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.
• Cluster headache – strikes quickly, usually without warning, although you might first have migraine-like nausea and aura. Common signs and symptoms during a headache include: Excruciating pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head, and neck.

SYNOPSIS
• Trigeminal neuralgia, also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve.
• TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.)
• The typical or classic form of the disorder (called Type 1 or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. 
• The atypical form of the disorder (called Type 2 or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1.  Both forms of pain may occur in the same person, sometimes simultaneously. The intensity of pain can be physically and mentally incapacitating. 
• Pain varies, depending on the type of TN, and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping.
• Treatment includes :
– Anticonvulsant medicines-used to block nerve firing are generally effective in treating TN1 but often less effective in TN2. These drugs include carbamazepine, oxcarbazepine, topiramate, gabapentin, pregabalin, clonazepam, phenytoin, lamotrigine, and valproic acid.
– Tricyclic antidepressants such as amitriptyline or nortriptyline can be used to treat pain. Common analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN1, although some individuals with TN2 do respond to opioids.  Eventually, if medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, then surgical treatment may be indicated. Since TN is a progressive disorder that often becomes resistant to medication over time, individuals often seek surgical treatment.

REFERENCE
Trigeminal Neuralgia Fact Sheet – National Institute of Neurological Disorders and Stroke

ANSWER
Both A and B

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Cleoid Discoid carvers are dental instruments used as part of restorative procedures.
• This instrument is used for trimming excess filling materials.
• The Cleoid Discoid instrument is made of high-grade stainless steel and is used to carve amalgam or wax following natural anatomical form.
• It is an essential carving instrument to develop grooves and triangular ridges.

REFERENCE
Basic Guide to Dental Instruments – Carmen Scheller- Sheridan

ANSWER
Stratified squamous epithelium

OTHER OPTIONS
• Ciliated columnar epithelium – Ciliated columnar epithelial cells are seen in respiratory epithelial lining.
• Non keratinized squamous epithelium – Junctional epithelium is non keratinised squamous epithelium.
• Stratified ciliated columnar epithelium – Stratified ciliated columnar epithelium lines parts of the respiratory passages, the vas deferens, and the epididymis.

SYNOPSIS
• The oral cavity is lined by a mucous membrane (the oral mucosa) consisting of a stratified squamous epithelium, which may or may not be keratinized, and an underlying connective tissue layer, the lamina propria. The surface is kept moist with mucus produced by the major and numerous minor salivary glands.

REFERENCE
Tencate oral histology

ANSWER
Observe over time

OTHER OPTIONS
• Extraction – Only done if there is no means of saving the tooth.
• Endodontic management – Done in closed apex cases with necrotic pulp changes.
• Pulpotomy – A pulpotomy is a dental procedure in which the pulp in the crown of a tooth is removed in order to save the tooth from infection or decay. 

SYNOPSIS
• Electric pulp testing is based on stimulation of sensory nerves and requires and relies on subjective assessments and comments from the patient. These can lead to false-positive and false-negative results.
• Younger or anxious patients can have false-positive results due to psychological factors.
• Likewise, false-negative results are possible in teeth with incomplete apical development, trauma, root canal calcification, periodontal disease, or in patients undergoing orthodontic treatment.
• So it’s always better to wait and observe for some time and evaluate the pulp status of the tooth.

REFERENCE
Grossman’s endodontic practice pg 378.

ANSWER
Provides a sterile field

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• When excavating a deep carious lesion and risking pulpal exposure, use of the rubber dam is strongly recommended to prevent pulpal contamination from oral fluids.i.e it provides a sterile field.
• Other advantages are –
a. Increased access and visibility.
b. Isolates area.
c. Keeps area dry.
d. Protects patient and operator.
e. Retracts soft tissue
f. Preserves and protects materials.

REFERENCE
Mosbys review NBDE part 2 pg 55.

ANSWER
All the above

OTHER OPTIONS
• Nil

SYNOPSIS
• The color of the attached and marginal gingiva is generally described as coral pink, it is produced by the vascular supply, the thickness and degree of keratinization of the epithelium, and the presence of pigment containing cells.
• The color also varies among different persons and appears correlated with cutaneous pigmentation. It is lighter in blond individuals with fair complexions than in swarthy, dark-haired individuals.

REFERENCE
Carranza 11th edition chapter 2