Gulfie Dentists Students
Evergreen Performance Test
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- Answered
- Review
- Question 1 of 150
1. Question
A child patient came to your clinic for restoration of few teeth. On examination he seemed to be lethargic . You requested to conduct a blood test and a Vitamin B12 deficiency was found. What is the condition of the child ?
CorrectANSWER
Megaloblastic anaemiaOTHER OPTIONS
• Microcytic anaemia – Vitamin C deficiency
• Sickle cell anaemia – Sickle shaped RBC s
• Iron deficiency anaemia – Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cellsSYNOPSIS
• Megaloblastic anemia is a form of macrocytic anemia.
• Macrocytic anemia is a blood disorder that causes your bone marrow to make abnormally large red blood cells.
• It’s also a type of vitamin deficiency anemia.
• This condition happens when you don’t get enough vitamin B12 and or vitamin B9 (folate).
• Healthcare providers treat megaloblastic anemia with vitamin B12 and vitamin B9 supplementsREFERENCE
Anaemia – American Society of HAematologyIncorrectANSWER
Megaloblastic anaemiaOTHER OPTIONS
• Microcytic anaemia – Vitamin C deficiency
• Sickle cell anaemia – Sickle shaped RBC s
• Iron deficiency anaemia – Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cellsSYNOPSIS
• Megaloblastic anemia is a form of macrocytic anemia.
• Macrocytic anemia is a blood disorder that causes your bone marrow to make abnormally large red blood cells.
• It’s also a type of vitamin deficiency anemia.
• This condition happens when you don’t get enough vitamin B12 and or vitamin B9 (folate).
• Healthcare providers treat megaloblastic anemia with vitamin B12 and vitamin B9 supplementsREFERENCE
Anaemia – American Society of HAematology - Question 2 of 150
2. Question
A routine radiographic examination of a 50 year old patient showed thickening of the root, of molars and diagnosed to be hypercementosis. Which is the synonym you can use for hypercementosis?
CorrectANSWER
Cemental hyperplasiaOTHER OPTIONS
• Cemental dysplasia – Cemento-osseous dysplasia (COD) is a benign condition of the jaws that may arise from the fibroblasts of the periodontal ligaments.
• Cementoma – Cementomas are benign jaw tumors that originate from periodontal ligament elements.SYNOPSIS
• Hypercementosis (cemental hyperplasia) is a nonneoplastic deposition of excessive cementum that is continuous with the normal radicular cementum.
• It may affect a single tooth or multiple teeth.
• The condition is asymptomatic and is detected on radiographic examination.REFERENCE
Shafer’s Textbook of PathologyIncorrectANSWER
Cemental hyperplasiaOTHER OPTIONS
• Cemental dysplasia – Cemento-osseous dysplasia (COD) is a benign condition of the jaws that may arise from the fibroblasts of the periodontal ligaments.
• Cementoma – Cementomas are benign jaw tumors that originate from periodontal ligament elements.SYNOPSIS
• Hypercementosis (cemental hyperplasia) is a nonneoplastic deposition of excessive cementum that is continuous with the normal radicular cementum.
• It may affect a single tooth or multiple teeth.
• The condition is asymptomatic and is detected on radiographic examination.REFERENCE
Shafer’s Textbook of Pathology - Question 3 of 150
3. Question
A patient returned after endodontic treatment followed by post and core management complaints of spontaneous dull pain on mastication shows mild mobility of tooth . You suspects a vertical root fracture. Which is the best radiographic technique to confirm a vertical root fracture?
CorrectANSWER
CBCTOTHER OPTIONS
• Bitewing – For interproximal lesions
• Occlusal – Diagnosis of cysts and canine impactionsSYNOPSIS
• Periapical radiographs (PRs) are the most used imaging modalities.
• However, the X-ray beam needs to be set at the same angle of the root fracture line in order to become visible.
• On the other hand, cone beam CT (CBCT) images are tridimensional exams, presenting the entire volume for that patient, without superimposing anatomic structures over the teeth.
• This exam gives a perception of dimension and allows the maxillofacial radiologist (MFR) to perform a complete diagnosis of pathologies, facial fractures, surgical planning and root fracturesREFERENCE
Radiographic diagnosis of root fractures- a systematic review, meta-analyses and sources of heterogeneity – British Institute of Radiology – Dentomaxillofacial RadiologyIncorrectANSWER
CBCTOTHER OPTIONS
• Bitewing – For interproximal lesions
• Occlusal – Diagnosis of cysts and canine impactionsSYNOPSIS
• Periapical radiographs (PRs) are the most used imaging modalities.
• However, the X-ray beam needs to be set at the same angle of the root fracture line in order to become visible.
• On the other hand, cone beam CT (CBCT) images are tridimensional exams, presenting the entire volume for that patient, without superimposing anatomic structures over the teeth.
• This exam gives a perception of dimension and allows the maxillofacial radiologist (MFR) to perform a complete diagnosis of pathologies, facial fractures, surgical planning and root fracturesREFERENCE
Radiographic diagnosis of root fractures- a systematic review, meta-analyses and sources of heterogeneity – British Institute of Radiology – Dentomaxillofacial Radiology - Question 4 of 150
4. Question
A patient underwent orthodontic fixed applaince therapy one year back shows large radiolucent area at the midroot region of tooth 11. What will be the treatment plan?
CorrectANSWER
RCTOTHER OPTIONS
• Root hemisection is sectioning of multi-rooted teeth with its crown portion, with the loss of periodontal attachment and is performed to retain the original tooth structure and attain the fixed prosthodontic prosthesis.
•Apexification- Its a procedure of inducing root end closure of an incompletely formed non vital permanent tooth by removing the coronal and non vital radicular tissue just short of the root end and placing a biocompatible agent such as CaOH in the canals for 2 weeks to 1month to disinfect the canal space and root end closure is accomplished with an apical barrier such as MTASYNOPSIS
• Midroot radiolucency during Orthodontic treatment may be due to Internal Root Resorption
• Internal resorption originates in a vital pulp, and the pulp must remain vital for the resorption to be progressive. Teeth with internal resorption usually are asymptomatic and often identified radiographically. Clinically, internal resorption teeth sometimes can be identified when resorption is in the coronal area and the tooth takes on a pink hue. Radiographically, internal resorption usually is round or oval-shaped and centered on the root canal, and the canal is not visible through the resorption area. Also, the defect for internal resorption is a widening of the canal.
• Treatment Perspectives
– In general, there are three treatment options for internal resorption
1. No treatment with eventual extraction if and when the tooth becomes symptomatic.
2. Immediate extraction.
3. Saving it by doing internal treatment that include conventional root canal treatment.
• Treatment must be based on prognosis of the tooth.
– If the resorption is contained within the root with no perforation, good prognosis for treatment with conventional endodontic treatment can be achieved.
– If the resorption perforates the root the prognosis is reduced.
– If the resorption is in the cervical area of the tooth, long term predictability of the tooth needs to be considered from a structural point, especially for anterior teeth. If the tooth is restorable and has a reasonable prognosis, root canal treatment is the choice.REFERENCE
Management of Internal Root Resorption in Orthodontics- Turkish Journal of Orthodontics- November 2016IncorrectANSWER
RCTOTHER OPTIONS
• Root hemisection is sectioning of multi-rooted teeth with its crown portion, with the loss of periodontal attachment and is performed to retain the original tooth structure and attain the fixed prosthodontic prosthesis.
•Apexification- Its a procedure of inducing root end closure of an incompletely formed non vital permanent tooth by removing the coronal and non vital radicular tissue just short of the root end and placing a biocompatible agent such as CaOH in the canals for 2 weeks to 1month to disinfect the canal space and root end closure is accomplished with an apical barrier such as MTASYNOPSIS
• Midroot radiolucency during Orthodontic treatment may be due to Internal Root Resorption
• Internal resorption originates in a vital pulp, and the pulp must remain vital for the resorption to be progressive. Teeth with internal resorption usually are asymptomatic and often identified radiographically. Clinically, internal resorption teeth sometimes can be identified when resorption is in the coronal area and the tooth takes on a pink hue. Radiographically, internal resorption usually is round or oval-shaped and centered on the root canal, and the canal is not visible through the resorption area. Also, the defect for internal resorption is a widening of the canal.
• Treatment Perspectives
– In general, there are three treatment options for internal resorption
1. No treatment with eventual extraction if and when the tooth becomes symptomatic.
2. Immediate extraction.
3. Saving it by doing internal treatment that include conventional root canal treatment.
• Treatment must be based on prognosis of the tooth.
– If the resorption is contained within the root with no perforation, good prognosis for treatment with conventional endodontic treatment can be achieved.
– If the resorption perforates the root the prognosis is reduced.
– If the resorption is in the cervical area of the tooth, long term predictability of the tooth needs to be considered from a structural point, especially for anterior teeth. If the tooth is restorable and has a reasonable prognosis, root canal treatment is the choice.REFERENCE
Management of Internal Root Resorption in Orthodontics- Turkish Journal of Orthodontics- November 2016 - Question 5 of 150
5. Question
What is the possible reason for the rubber dam sheets showing wrinkles?
CorrectANSWER
Punch holes placed too farOTHER OPTIONS
• Punch holes placed too near – The holes are stretched open around the teeth, permitting leakageSYNOPSIS
• Rubber dam also known as a dental dam is a thin square sheet used to isolate the operative site from the rest of the mouth.
• Dental rubber dams contain a hole in the middle that allows the dentist to isolate the treatment area using a dental clamp around the tooth.
• When punching holes in the rubber dam, the distance between holes are equal to the distance from the center of one tooth to the center of the adjacent tooth measured at the level of the gingival tissue.
• If the punch holes are placed too far the dam wrinkles around the teeth and may interfere with the access .REFERENCE
Rubber Dam Isolation – Journal of Pediatric and Preventive Dentistry.IncorrectANSWER
Punch holes placed too farOTHER OPTIONS
• Punch holes placed too near – The holes are stretched open around the teeth, permitting leakageSYNOPSIS
• Rubber dam also known as a dental dam is a thin square sheet used to isolate the operative site from the rest of the mouth.
• Dental rubber dams contain a hole in the middle that allows the dentist to isolate the treatment area using a dental clamp around the tooth.
• When punching holes in the rubber dam, the distance between holes are equal to the distance from the center of one tooth to the center of the adjacent tooth measured at the level of the gingival tissue.
• If the punch holes are placed too far the dam wrinkles around the teeth and may interfere with the access .REFERENCE
Rubber Dam Isolation – Journal of Pediatric and Preventive Dentistry. - Question 6 of 150
6. Question
GIC restoration done for a patient can be polished by?
CorrectANSWER
All are correctOTHER OPTIONS
• NilSYNOPSIS
• Finishing and polishing of GIC is done by the following methods
1. Best surface finish obtained if cement is allowed to set under matrix.
2. Carving the cement external to the cavity margins with sharp knives or scalers.
3. Finest abrasive should be used to minimize tearing.
4. Finishing with rotary instruments should be done at a subsequent visit.REFERENCE
Phillips Science of Dental MaterialsIncorrectANSWER
All are correctOTHER OPTIONS
• NilSYNOPSIS
• Finishing and polishing of GIC is done by the following methods
1. Best surface finish obtained if cement is allowed to set under matrix.
2. Carving the cement external to the cavity margins with sharp knives or scalers.
3. Finest abrasive should be used to minimize tearing.
4. Finishing with rotary instruments should be done at a subsequent visit.REFERENCE
Phillips Science of Dental Materials - Question 7 of 150
7. Question
What is the longest time to present to a dentist with an avulsed tooth to save it?
CorrectANSWER
60 minutesOTHER OPTIONS
• NilSYNOPSIS
• 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 case-extra oral time of less than 20 minutes-replant immediately after gentle washing and extra oral time of more than 20 minutes – endo treatment should be performed before replantation.
• In open apex case –
– An extra-oral time less than 20 min-soak in 1mg Doxycycline in 20mg saline for 5min before replantation.
– An extra-oral time of 20-60 minutes-soak in HBSS for 30 minutes and replant.
– An extra-oral time of more than 60minutes-According to the International Association of Dental Traumatology 2007 replantation of the avulsed tooth with an open apex with an extra-oral time of more than 60 minutes is not indicated.
– If the tooth remained dry for more than 60 minutes no consideration should be given to preserving PDL and an apexification procedure can be initiated in an open apex case.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 DentistryIncorrectANSWER
60 minutesOTHER OPTIONS
• NilSYNOPSIS
• 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 case-extra oral time of less than 20 minutes-replant immediately after gentle washing and extra oral time of more than 20 minutes – endo treatment should be performed before replantation.
• In open apex case –
– An extra-oral time less than 20 min-soak in 1mg Doxycycline in 20mg saline for 5min before replantation.
– An extra-oral time of 20-60 minutes-soak in HBSS for 30 minutes and replant.
– An extra-oral time of more than 60minutes-According to the International Association of Dental Traumatology 2007 replantation of the avulsed tooth with an open apex with an extra-oral time of more than 60 minutes is not indicated.
– If the tooth remained dry for more than 60 minutes no consideration should be given to preserving PDL and an apexification procedure can be initiated in an open apex case.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 - Question 8 of 150
8. Question
Which of the following impression material is hydrophilic?
CorrectANSWER
Poly etherOTHER OPTIONS
• All the other given options are HydrophobicSYNOPSIS
• Polyethers are elastomeric materials commonly used for making precision impressions.
• They are hydrophilic, which facilitates the contact of the unset material with the intraoral tissue and the wetting of the impression by cast materials.
• Polyethers may absorb water, significantly compromising die accuracy upon storage at high humidity.REFERENCE
Philips Science of Dental MaterialsIncorrectANSWER
Poly etherOTHER OPTIONS
• All the other given options are HydrophobicSYNOPSIS
• Polyethers are elastomeric materials commonly used for making precision impressions.
• They are hydrophilic, which facilitates the contact of the unset material with the intraoral tissue and the wetting of the impression by cast materials.
• Polyethers may absorb water, significantly compromising die accuracy upon storage at high humidity.REFERENCE
Philips Science of Dental Materials - Question 9 of 150
9. Question
What is the best way to produce a ferrule effect to return the tooth to occlusion for a fractured incisor tooth at the alveolar crest?
CorrectANSWER
Orthodontic extrusionOTHER OPTIONS
• Crown lengthening – for non-esthetic areaSYNOPSIS
• The ferrule has been defined as a 360-degree metal collar of the crown surrounding the parallel walls of the dentine extending coronally to the shoulder of the preparation
• A minimal height of 1.5 mm to 2 mm of intact tooth structure above the crown margin for 360 degrees around the circumference of the tooth preparation appears to be a rational guideline for this ferrule effect
• In the esthetic zone, forced orthodontic eruption of the tooth would be ideal than crown lengthening to maintain the ferrule, when the fracture is at the level of the alveolar crest
• Forced eruption of the tooth helps to maintain a healthy root-crown ratio to prevent root fractures due to stress build-up, followed by post and core
• Extrusion is widely performed with fixed orthodontic appliances using arch wires or elastics attached to the tooth.REFERENCE
Ferrule Effect – A literature reviewIncorrectANSWER
Orthodontic extrusionOTHER OPTIONS
• Crown lengthening – for non-esthetic areaSYNOPSIS
• The ferrule has been defined as a 360-degree metal collar of the crown surrounding the parallel walls of the dentine extending coronally to the shoulder of the preparation
• A minimal height of 1.5 mm to 2 mm of intact tooth structure above the crown margin for 360 degrees around the circumference of the tooth preparation appears to be a rational guideline for this ferrule effect
• In the esthetic zone, forced orthodontic eruption of the tooth would be ideal than crown lengthening to maintain the ferrule, when the fracture is at the level of the alveolar crest
• Forced eruption of the tooth helps to maintain a healthy root-crown ratio to prevent root fractures due to stress build-up, followed by post and core
• Extrusion is widely performed with fixed orthodontic appliances using arch wires or elastics attached to the tooth.REFERENCE
Ferrule Effect – A literature review - Question 10 of 150
10. Question
A 5 years old child with trauma to anterior teeth reports within half an hour to the clinic. You have found pinpoint
exposure, sensitivity, slight pain on percussion, slight bleeding on examination. But there is no radiographic changes
.What is the best treatment to do?CorrectANSWER
PulpotomyOTHER OPTIONS
• DPC is contra-indicated in primary teeth
• Apexification and apexogenesis are done in young permanent toothSYNOPSIS
• Pulpotomy is performed in a primary tooth when caries removal results in a pulp exposure in a tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure and there is no radiographic sign of infection or pathologic resorption for pulp exposure in primary tooth
• The coronal pulp is amputated and the remaining vital radicular pulp tissue surface is treated with a long-term clinically successful medicament such as Buckley’s solution of formocresol or ferric sulfate.
• MTA is the most recent material used for pulpotomies with a high rate of successREFERENCE
Guideline for Pulp Therapy for Primary and Immature Permanent teeth- AAPDIncorrectANSWER
PulpotomyOTHER OPTIONS
• DPC is contra-indicated in primary teeth
• Apexification and apexogenesis are done in young permanent toothSYNOPSIS
• Pulpotomy is performed in a primary tooth when caries removal results in a pulp exposure in a tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure and there is no radiographic sign of infection or pathologic resorption for pulp exposure in primary tooth
• The coronal pulp is amputated and the remaining vital radicular pulp tissue surface is treated with a long-term clinically successful medicament such as Buckley’s solution of formocresol or ferric sulfate.
• MTA is the most recent material used for pulpotomies with a high rate of successREFERENCE
Guideline for Pulp Therapy for Primary and Immature Permanent teeth- AAPD - Question 11 of 150
11. Question
A patient presented with a small swelling in the interdental papilla area between mandibular first and second premolars. It shows a tear shaped radiolucency on the same area on radiographic examination. Identify the diagnosis?
CorrectANSWER
Lateral periodontal cystOTHER OPTIONS
• Dentigerous cyst – Dentigerous cyst always includes a tooth which cannot complete the eruption process and occurs around the crown by the fluid accumulation between the layers of enamel organ
• Ameloblastoma – Ameloblastoma is a rare, noncancerous (benign) tumor that develops most often in the jaw near the molars. Ameloblastoma begins in the cells that form the protective enamel lining on your teeth.
• Traumatic Bone Cyst – The traumatic bone cyst (TBC) is an uncommon nonepithelial lined cavity of the jawsSYNOPSIS
• Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst.
• LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region.
• Observable clinical signs of a LPC include a small, soft-tissue swelling found just below or within the interdental papilla.
• However, as it is usually asymptomatic in nature, LPCs are usually detected through radiography.
• On radiographs, the LPC appears with a well-defined round, oval or sometimes tear-drop shape.
• Lateral periodontal cysts should be removed surgically by conservative enucleation or excision, and the patient should be followed radiographically for several years thereafter to monitor for recurrence.
• The bone will likely regenerate in the bony defect over 6 months to 1 year.REFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
Lateral periodontal cystOTHER OPTIONS
• Dentigerous cyst – Dentigerous cyst always includes a tooth which cannot complete the eruption process and occurs around the crown by the fluid accumulation between the layers of enamel organ
• Ameloblastoma – Ameloblastoma is a rare, noncancerous (benign) tumor that develops most often in the jaw near the molars. Ameloblastoma begins in the cells that form the protective enamel lining on your teeth.
• Traumatic Bone Cyst – The traumatic bone cyst (TBC) is an uncommon nonepithelial lined cavity of the jawsSYNOPSIS
• Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst.
• LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region.
• Observable clinical signs of a LPC include a small, soft-tissue swelling found just below or within the interdental papilla.
• However, as it is usually asymptomatic in nature, LPCs are usually detected through radiography.
• On radiographs, the LPC appears with a well-defined round, oval or sometimes tear-drop shape.
• Lateral periodontal cysts should be removed surgically by conservative enucleation or excision, and the patient should be followed radiographically for several years thereafter to monitor for recurrence.
• The bone will likely regenerate in the bony defect over 6 months to 1 year.REFERENCE
Shafer’s Textbook of Oral Pathology - Question 12 of 150
12. Question
A patient presented with a complaint of a tooth that has pain with sweet and cold that relieves after removal of stimulus . There is no sensitivity to heat and no pain on percussion . Identify the diagnosis?
CorrectANSWER
Reversible pulpitisOTHER OPTIONS
• Irreversible pulpitis – Sensitive to heat and percussion
• Acute periodontal disease – Percussion test will be positive
• Dentinal hypersensitivity – Short intense pain while having hot or cold food stuffsSYNOPSIS
• Pulpitis is an inflammation of the pulp.
• It usually happens when there’s an irritation inside a tooth due to things such as grinding or a cavity
• There are two types of pulpitis.
– Reversible pulpitis – In this early stage, pulpitis is reversible if treated
– Irreversible pulpitis – In this stage, the inflammation is more advanced and the tooth can’t recover. The pulp tissue will eventually die. This is pulp necrosis.
• Symptoms of reversible pulpitis include
– No pain when your dentist taps the tooth.
– No sensitivity to heat.
– Sensitivity to cold or sweets that goes away quickly.
• For reversible pulpitis, removal of the the cause can reverse the condition.
• Often, this involves the removal of the decay and sealing the tooth with a normal filling.REFERENCE
Grossman’s Endodontic PracticeIncorrectANSWER
Reversible pulpitisOTHER OPTIONS
• Irreversible pulpitis – Sensitive to heat and percussion
• Acute periodontal disease – Percussion test will be positive
• Dentinal hypersensitivity – Short intense pain while having hot or cold food stuffsSYNOPSIS
• Pulpitis is an inflammation of the pulp.
• It usually happens when there’s an irritation inside a tooth due to things such as grinding or a cavity
• There are two types of pulpitis.
– Reversible pulpitis – In this early stage, pulpitis is reversible if treated
– Irreversible pulpitis – In this stage, the inflammation is more advanced and the tooth can’t recover. The pulp tissue will eventually die. This is pulp necrosis.
• Symptoms of reversible pulpitis include
– No pain when your dentist taps the tooth.
– No sensitivity to heat.
– Sensitivity to cold or sweets that goes away quickly.
• For reversible pulpitis, removal of the the cause can reverse the condition.
• Often, this involves the removal of the decay and sealing the tooth with a normal filling.REFERENCE
Grossman’s Endodontic Practice - Question 13 of 150
13. Question
A patient reported to dentist with complaint of severe pain. On examination its found a tooth with severe periradicular pain and necrotic pulp. On radiographic examination the findings are broken lamina dura and a circumscribed radiolucency of long duration. The periradicular diagnosis is?
CorrectANSWER
Acute exacerbation of chronic apical periodontitisOTHER OPTIONS
• NilSYNOPSIS
• An acute exacerbation of a chronic periapical lesion is called phoenix abscess.
• It is a dental abscess that can occur immediately following root canal treatment.
• Another cause is due to untreated necrotic pulp (chronic apical periodontitis).
• It is also the result of inadequate debridement during the endodontic procedure.
• Risk of occurrence of a phoenix abscess is minimized by correct identification and instrumentation of the entire root canal ensuring no missed anatomy.
• Clinical Features
– Pain Loss of Vitality
– Tender to Touch
– Mobility.
• Radiographically there will be a periapical lesion associated with the tooth.
• This lesion is normally existent prior to this episode.
• Widened periodontal ligament (PDL) space is visible.
• For most situations urgent treatment is required to eliminate the pain and swelling.REFERENCE
Grossman’s Endodontic practiceIncorrectANSWER
Acute exacerbation of chronic apical periodontitisOTHER OPTIONS
• NilSYNOPSIS
• An acute exacerbation of a chronic periapical lesion is called phoenix abscess.
• It is a dental abscess that can occur immediately following root canal treatment.
• Another cause is due to untreated necrotic pulp (chronic apical periodontitis).
• It is also the result of inadequate debridement during the endodontic procedure.
• Risk of occurrence of a phoenix abscess is minimized by correct identification and instrumentation of the entire root canal ensuring no missed anatomy.
• Clinical Features
– Pain Loss of Vitality
– Tender to Touch
– Mobility.
• Radiographically there will be a periapical lesion associated with the tooth.
• This lesion is normally existent prior to this episode.
• Widened periodontal ligament (PDL) space is visible.
• For most situations urgent treatment is required to eliminate the pain and swelling.REFERENCE
Grossman’s Endodontic practice - Question 14 of 150
14. Question
A 59 years old patient visited your dental clinic with a grossly decayed lower first molar. On examination BP shows 159 -100. What will you do?
CorrectANSWER
Extraction when BP becomes 120 – 80OTHER OPTIONS
• Not applicableSYNOPSIS
• Dental treatment can be stressful and can trigger anxiety in patients
• The body releases a surge of hormones when under stress.
• These hormones cause the heart to beat faster and the blood vessels to narrow.
• These actions increase blood pressure for a time.
• In such situations, the dentist or his assistant should talk to the patient and reassure them and help them to calm down
• Recheck the BP after the patient is relaxed and if it turns out to be normal, proceed with the treatmentREFERENCE
Medical Emergencies – Dentistry TodayIncorrectANSWER
Extraction when BP becomes 120 – 80OTHER OPTIONS
• Not applicableSYNOPSIS
• Dental treatment can be stressful and can trigger anxiety in patients
• The body releases a surge of hormones when under stress.
• These hormones cause the heart to beat faster and the blood vessels to narrow.
• These actions increase blood pressure for a time.
• In such situations, the dentist or his assistant should talk to the patient and reassure them and help them to calm down
• Recheck the BP after the patient is relaxed and if it turns out to be normal, proceed with the treatmentREFERENCE
Medical Emergencies – Dentistry Today - Question 15 of 150
15. Question
What does score 3 means in Periodontal Health Score measurements?
CorrectANSWER
Peridontal pocket 5.5OTHER OPTIONS
• Explained belowSYNOPSIS
• Periodontal Health Scores
• The scores from 0-4 are used to record gum health.
• Score 0 – Good Health
– Gum Pockets measure 1-3mm (healthy range)
– No bleeding
– Teeth are clean and gums healthy
• Score1 – Gingivitis (reversible inflammation)
– Gum Pockets measure 1-3mm (healthy range)
– Some bleeding
– Teeth not perfectly clean
– Gingivitis can progress to periodontal disease if left
• Score 2 – Gingivitis (reversible inflammation) with tartar
– Gum Pockets measure 1-3mm (healthy range)
– Some tartar (hard scale) present
– Teeth not perfectly clean
– Gingivitis can progress to periodontal disease if left untreated
• Score 3 – Periodontal disease (irreversible damage)
– Gum Pockets measure 3.5 – 5.5mm (deeper than normal)
– Teeth have lost some support from gum
– Irreversible but can be stabilised with dental hygiene treatment and good dental hygiene at home
– Likely to be stable if no bleeding or plaque
• Score 4 – Advanced periodontal disease
– Gum Pockets measure 6mm or more (risk of tooth loss)
– Teeth have lost significant support from gum and jawbone
– Irreversible
– Risk of tooth loosening and loss
– Regular dental hygiene treatment and excellent dental hygiene at home will help to maintain teeth as long as possibleREFERENCE
Pocket DentistryIncorrectANSWER
Peridontal pocket 5.5OTHER OPTIONS
• Explained belowSYNOPSIS
• Periodontal Health Scores
• The scores from 0-4 are used to record gum health.
• Score 0 – Good Health
– Gum Pockets measure 1-3mm (healthy range)
– No bleeding
– Teeth are clean and gums healthy
• Score1 – Gingivitis (reversible inflammation)
– Gum Pockets measure 1-3mm (healthy range)
– Some bleeding
– Teeth not perfectly clean
– Gingivitis can progress to periodontal disease if left
• Score 2 – Gingivitis (reversible inflammation) with tartar
– Gum Pockets measure 1-3mm (healthy range)
– Some tartar (hard scale) present
– Teeth not perfectly clean
– Gingivitis can progress to periodontal disease if left untreated
• Score 3 – Periodontal disease (irreversible damage)
– Gum Pockets measure 3.5 – 5.5mm (deeper than normal)
– Teeth have lost some support from gum
– Irreversible but can be stabilised with dental hygiene treatment and good dental hygiene at home
– Likely to be stable if no bleeding or plaque
• Score 4 – Advanced periodontal disease
– Gum Pockets measure 6mm or more (risk of tooth loss)
– Teeth have lost significant support from gum and jawbone
– Irreversible
– Risk of tooth loosening and loss
– Regular dental hygiene treatment and excellent dental hygiene at home will help to maintain teeth as long as possibleREFERENCE
Pocket Dentistry - Question 16 of 150
16. Question
Which of the following may show gingival fibromatosis?
CorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Gingival fibromatosis and its related syndromes are mainly inherited in an autosomal-dominant manner, but autosomal-recessive inheritance has also been reported.
• Clinical syndromic presentation includes
– Zimmermann-Laband syndrome,
– Ramon syndrome,
– Rutherford syndrome,
– Cowden syndrome,
– Cross syndrome,
– Gohlich-Ratmann syndrome,
– Avani syndrome, and
– I-cell disease.
• However, a phenotypic overlap has been suggested, as many combinations of their systemic manifestations have been reported.
• Treatment of choice is usually gingivectomy with gingivoplasty.
• Before any therapy, clinical practitioners must take into consideration the clinical course of a particular syndrome and every possible functional and esthetic disorder.REFERENCE
Current concepts on gingival fibromatosis-related syndromesIncorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Gingival fibromatosis and its related syndromes are mainly inherited in an autosomal-dominant manner, but autosomal-recessive inheritance has also been reported.
• Clinical syndromic presentation includes
– Zimmermann-Laband syndrome,
– Ramon syndrome,
– Rutherford syndrome,
– Cowden syndrome,
– Cross syndrome,
– Gohlich-Ratmann syndrome,
– Avani syndrome, and
– I-cell disease.
• However, a phenotypic overlap has been suggested, as many combinations of their systemic manifestations have been reported.
• Treatment of choice is usually gingivectomy with gingivoplasty.
• Before any therapy, clinical practitioners must take into consideration the clinical course of a particular syndrome and every possible functional and esthetic disorder.REFERENCE
Current concepts on gingival fibromatosis-related syndromes - Question 17 of 150
17. Question
Which of the following conditions is characterized by enamel fracture and yellowish- brown discoloration of tooth?
CorrectANSWER
Enamel hypoplasiaOTHER OPTIONS
• Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans.
• Amelogenesis imperfecta -Amelogenesis imperfecta is a tooth development disorder. It causes the tooth enamel to be thin and abnormally formed. Enamel is the outer layer of the coronal, or crown portion of the teeth
• Dental dysplasia – Dentin dysplasia is a rare disturbance of dentin formation characterized by normal enamel but atypical dentin formation with abnormal pupal morphology. The teeth appear clinically normal in morphologic appearance and color.SYNOPSIS
• Enamel hypoplasia -An incomplete or defective formation of the organic enamel matrix of teeth. Local and systemic factors that interfere with normal matrix formation can cause enamel surface defects and irregularities.
• Clinical features of enamel hypoplasia are
– pits, tiny groves, depressions, and fissures
– White spots
– Yellowish-brown stains (where the underlying layer of dentin is exposed)
– Sensitivity to heat and cold
– Lack of tooth contact, the irregular wearing of teeth
– Susceptibility to acids in food and drink
– Retention of harmful bacteria
– Increased vulnerability to tooth decay and cavitiesREFERENCE
Shafers Textbook of Oral pathologyIncorrectANSWER
Enamel hypoplasiaOTHER OPTIONS
• Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans.
• Amelogenesis imperfecta -Amelogenesis imperfecta is a tooth development disorder. It causes the tooth enamel to be thin and abnormally formed. Enamel is the outer layer of the coronal, or crown portion of the teeth
• Dental dysplasia – Dentin dysplasia is a rare disturbance of dentin formation characterized by normal enamel but atypical dentin formation with abnormal pupal morphology. The teeth appear clinically normal in morphologic appearance and color.SYNOPSIS
• Enamel hypoplasia -An incomplete or defective formation of the organic enamel matrix of teeth. Local and systemic factors that interfere with normal matrix formation can cause enamel surface defects and irregularities.
• Clinical features of enamel hypoplasia are
– pits, tiny groves, depressions, and fissures
– White spots
– Yellowish-brown stains (where the underlying layer of dentin is exposed)
– Sensitivity to heat and cold
– Lack of tooth contact, the irregular wearing of teeth
– Susceptibility to acids in food and drink
– Retention of harmful bacteria
– Increased vulnerability to tooth decay and cavitiesREFERENCE
Shafers Textbook of Oral pathology - Question 18 of 150
18. Question
What are the main goals to be considered in periodontal therapy?
CorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• The goals of periodontal therapy are to
– Eliminate the local etiologic factors
– Preserve the natural dentition, periodontium and peri-implant tissues
– To maintain and improve periodontal and peri-implant health, comfort, esthetics, and function.
• Currently accepted clinical signs of a healthy periodontium include
– The absence of inflammatory signs of disease such as redness, swelling, suppuration, and bleeding on probing
– Maintenance of a functional periodontal attachment level
– Minimal or no recession in the absence of interproximal bone loss and functional dental implants.REFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• The goals of periodontal therapy are to
– Eliminate the local etiologic factors
– Preserve the natural dentition, periodontium and peri-implant tissues
– To maintain and improve periodontal and peri-implant health, comfort, esthetics, and function.
• Currently accepted clinical signs of a healthy periodontium include
– The absence of inflammatory signs of disease such as redness, swelling, suppuration, and bleeding on probing
– Maintenance of a functional periodontal attachment level
– Minimal or no recession in the absence of interproximal bone loss and functional dental implants.REFERENCE
Carranza’s Clinical Periodontology - Question 19 of 150
19. Question
Which type of bone graft is used for a two-walled defect?
CorrectANSWER
Cortical decalcified freeze dried bone graftOTHER OPTIONS
• Explained belowSYNOPSIS
• If the defect is lined by only two walls of bone, the defect is a two-wall defect.
• Cortical decalcified freeze-dried bone allograft is used for 2 walled osseous defects
• Cortical bone contains pure cortex-dense bone, hence it is used for weight or force-bearing areas
• Freeze drying decreases antigenicity and facilitates long-term storage
• Decalcifying improves osteostimulatory properties
• Cancellous bone provides more open spaces for faster revascularisation, but it lacks mechanical strength, particularly when used for non-weight or non-force-bearing areasREFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
Cortical decalcified freeze dried bone graftOTHER OPTIONS
• Explained belowSYNOPSIS
• If the defect is lined by only two walls of bone, the defect is a two-wall defect.
• Cortical decalcified freeze-dried bone allograft is used for 2 walled osseous defects
• Cortical bone contains pure cortex-dense bone, hence it is used for weight or force-bearing areas
• Freeze drying decreases antigenicity and facilitates long-term storage
• Decalcifying improves osteostimulatory properties
• Cancellous bone provides more open spaces for faster revascularisation, but it lacks mechanical strength, particularly when used for non-weight or non-force-bearing areasREFERENCE
Carranza’s Clinical Periodontology - Question 20 of 150
20. Question
The patient presented with pulpitis of the lower tooth which had class II composite done 5 days ago. What could be the cause?
CorrectANSWER
Any of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Most common reasons for immediate pain after composite restorations are
– Polymerization on shrinkage of the resin
– Microleakage around the margins of the restoration
– The build-up of residual stress in the tooth after placement of the direct composite restoration.
• Polymerization using low light-cure intensities may help to reduce polymerization shrinkage and possibly postoperative sensitivity.REFERENCE
Immediate Post-operative Sensitivity after Composite Resin Restoration – A Review of Treatment Protocol Monu Survashe, M. Parekh.IncorrectANSWER
Any of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Most common reasons for immediate pain after composite restorations are
– Polymerization on shrinkage of the resin
– Microleakage around the margins of the restoration
– The build-up of residual stress in the tooth after placement of the direct composite restoration.
• Polymerization using low light-cure intensities may help to reduce polymerization shrinkage and possibly postoperative sensitivity.REFERENCE
Immediate Post-operative Sensitivity after Composite Resin Restoration – A Review of Treatment Protocol Monu Survashe, M. Parekh. - Question 21 of 150
21. Question
Cast post and core have the advantages of all, except?
CorrectANSWER
Cast post and core doesn’t always require auxiliary retentionOTHER OPTIONS
• NilSYNOPSIS
• In cases where the post space is not a good match for a prefabricated post, a cast post and core can be custom fabricated for the tooth.
• A resin pattern is produced by placing a preformed plastic ‘burnout’ post into the post space and a resin material, such as Duralay resin, is used to build up the tooth to the proper dimensions.
• When this is completed, the pattern resinperplastic post is removed from the tooth structure and attached to a sprue former, much in the same way as is done with the wax pattern of a crown, and a single-unit cast post and core can thus be fabricated out of gold, titanium or another metal using the lost-wax technique.
• Alternatively, an impression can be taken of the post space and dental arch using a plastic post and a polyvinyl siloxane impression material, and this used to construct a suitable post in the dental laboratory.REFERENCE
Post and Core- wikipediaIncorrectANSWER
Cast post and core doesn’t always require auxiliary retentionOTHER OPTIONS
• NilSYNOPSIS
• In cases where the post space is not a good match for a prefabricated post, a cast post and core can be custom fabricated for the tooth.
• A resin pattern is produced by placing a preformed plastic ‘burnout’ post into the post space and a resin material, such as Duralay resin, is used to build up the tooth to the proper dimensions.
• When this is completed, the pattern resinperplastic post is removed from the tooth structure and attached to a sprue former, much in the same way as is done with the wax pattern of a crown, and a single-unit cast post and core can thus be fabricated out of gold, titanium or another metal using the lost-wax technique.
• Alternatively, an impression can be taken of the post space and dental arch using a plastic post and a polyvinyl siloxane impression material, and this used to construct a suitable post in the dental laboratory.REFERENCE
Post and Core- wikipedia - Question 22 of 150
22. Question
A patient presented with a periodontal condition with clinical attachment loss of around 4mm and a probing depth of less than 5mm along with horizontal bone loss. Identify the diagnosis
CorrectANSWER
Stage 2 PeriodontitisOTHER OPTIONS
• Not applicableSYNOPSIS
• The second stage of the disease, known as slight periodontal disease, is not reversible. However, it can be managed.
• Slight periodontal disease involves more bleeding, redness, and swelling, but still no pain.
• The infection, however, spreads below the gum line and starts destroying the tooth-supporting bone. The main signs are
• Interdental CAL – 3-4 mm,
• Max. probing depth less than 5 mm,
• Mostly horizontal bone loss.REFERENCE
Staging and Grading Periodontitis American Academy of Periodontology (AAP) and the European Federation of PeriodontologyIncorrectANSWER
Stage 2 PeriodontitisOTHER OPTIONS
• Not applicableSYNOPSIS
• The second stage of the disease, known as slight periodontal disease, is not reversible. However, it can be managed.
• Slight periodontal disease involves more bleeding, redness, and swelling, but still no pain.
• The infection, however, spreads below the gum line and starts destroying the tooth-supporting bone. The main signs are
• Interdental CAL – 3-4 mm,
• Max. probing depth less than 5 mm,
• Mostly horizontal bone loss.REFERENCE
Staging and Grading Periodontitis American Academy of Periodontology (AAP) and the European Federation of Periodontology - Question 23 of 150
23. Question
A 25 years old female patient brought to your clinic by her husband after fallen from a height shows intruded upper centrals and a deep cut injury on her lip? What will be your diagnosis?
CorrectANSWER
Intrusive Luxation and lacerationOTHER OPTIONS
• Subluxation – Injury to periodontal tissues but the tooth has not undergone any displacement from original position
• Extrusive luxation – It is a type of traumatic injury mainly caused by forces with oblique direction, characterized by the partial or total separation of periodontal attachments. Following injury, the loosening and axial displacement of the tooth are expected. This elongated tooth, also called partial avulsion, is threatened by loss of vascular supply and pulp vitality.SYNOPSIS
• Intrusive luxation has been defined as the dislocation of a tooth in an axial direction into the alveolar bone
• Tooth luxation occurs when trauma, such as a fall, disrupts the tissues, ligaments, and bone that hold a tooth in place.
• Tooth luxation can also affect the tooth’s nerves and blood supply. A luxated tooth is sometimes loose, angled or moved out of the socket.
• Lip lacerations are that even if they are small, they are easily visible and tend to form scars.
• These wounds may need suturing to keep the borders even and reduce the development of scars.
• Cuts inside the lips usually do not require stitches as they heal at normal speed.REFERENCE
Assessment and management of lip lacerations. Judd E HollanderIncorrectANSWER
Intrusive Luxation and lacerationOTHER OPTIONS
• Subluxation – Injury to periodontal tissues but the tooth has not undergone any displacement from original position
• Extrusive luxation – It is a type of traumatic injury mainly caused by forces with oblique direction, characterized by the partial or total separation of periodontal attachments. Following injury, the loosening and axial displacement of the tooth are expected. This elongated tooth, also called partial avulsion, is threatened by loss of vascular supply and pulp vitality.SYNOPSIS
• Intrusive luxation has been defined as the dislocation of a tooth in an axial direction into the alveolar bone
• Tooth luxation occurs when trauma, such as a fall, disrupts the tissues, ligaments, and bone that hold a tooth in place.
• Tooth luxation can also affect the tooth’s nerves and blood supply. A luxated tooth is sometimes loose, angled or moved out of the socket.
• Lip lacerations are that even if they are small, they are easily visible and tend to form scars.
• These wounds may need suturing to keep the borders even and reduce the development of scars.
• Cuts inside the lips usually do not require stitches as they heal at normal speed.REFERENCE
Assessment and management of lip lacerations. Judd E Hollander - Question 24 of 150
24. Question
19-year-old male patient presented with a swelling on the right side of the face. On clinical examination, 48 were unerupted and on radiographic examination, a pericoronal radiolucency was noticed. Histopathological examination showed that the epithelial lining was of variable thickness with certain few features resembling Gorlin and Vicker’s criteria. The probable diagnosis is?
CorrectANSWER
AmeloblastomaOTHER OPTIONS
• Dentigerous cyst – Non Keratinized Epithelium of 2-3 cell layers thick, Lining Epithelium similar to Reduced Enamel Epithelium,Cyst Attached to Neck of the Tooth, Odontogenic Epithelial Islands in Capsule, Presence of Rushton Bodies, radiographically Dentigerous cyst encloses only the coronal portion of the impacted tooth
• Adenomatoid Odontogenic cyst – AOT shows radiolucency usually surrounding both the coronal and radicular aspects of the involved toothSYNOPSIS
• The radiographic appearances of ameloblastoma are variable. unilocular lesions associated with an impacted tooth can often be mistaken for a dentigerious cyst radiographically.
• It may present as a multilocular cystic lesion with well-defined corticated margins. Scalloping of margins is common.
• Vickers and Gorlin criteria were originally described to help diagnose early ameloblastomas in cysts, they are useful when examining other lesions that are suspected of being ameloblastomas
• Vickers and Gorlin criteria state that nuclear hyperchromatism, nuclear palisading with reverse polarization, and cytoplasmic vacuolization with intercellular spacing, when observed together, constitute histopathologic evidence of neoplasia
• The Vickers and Gorlin criteria are indeed helpful for differential diagnosis, but not enough to establish the diagnosis of ameloblastomas in very incipient lesions.REFERENCE
The Onset of a Peripheral Ameloblastoma – Case reports on Oncological MedicineIncorrectANSWER
AmeloblastomaOTHER OPTIONS
• Dentigerous cyst – Non Keratinized Epithelium of 2-3 cell layers thick, Lining Epithelium similar to Reduced Enamel Epithelium,Cyst Attached to Neck of the Tooth, Odontogenic Epithelial Islands in Capsule, Presence of Rushton Bodies, radiographically Dentigerous cyst encloses only the coronal portion of the impacted tooth
• Adenomatoid Odontogenic cyst – AOT shows radiolucency usually surrounding both the coronal and radicular aspects of the involved toothSYNOPSIS
• The radiographic appearances of ameloblastoma are variable. unilocular lesions associated with an impacted tooth can often be mistaken for a dentigerious cyst radiographically.
• It may present as a multilocular cystic lesion with well-defined corticated margins. Scalloping of margins is common.
• Vickers and Gorlin criteria were originally described to help diagnose early ameloblastomas in cysts, they are useful when examining other lesions that are suspected of being ameloblastomas
• Vickers and Gorlin criteria state that nuclear hyperchromatism, nuclear palisading with reverse polarization, and cytoplasmic vacuolization with intercellular spacing, when observed together, constitute histopathologic evidence of neoplasia
• The Vickers and Gorlin criteria are indeed helpful for differential diagnosis, but not enough to establish the diagnosis of ameloblastomas in very incipient lesions.REFERENCE
The Onset of a Peripheral Ameloblastoma – Case reports on Oncological Medicine - Question 25 of 150
25. Question
The most common complication after a molar extraction is dry socket. How will you manage the condition?
CorrectANSWER
Any of the aboveOTHER OPTIONS
• NilSYNOPSIS
• One of the most commoncomplications after extraction is dry socket.
• The clinical term for dry socket is alveolar osteitis.
• Dry socket typically lasts 7 days.
• Pain can be noticeable as early as day 3 after extraction.
• After tooth extraction, a blood clot usually forms at the site to heal and protect it. Dislodgement of this clot can lead to dry socket formation.
• Placement of medicated dry socket packing immediately after molar extraction decreases the alveolar osteitis rate.
• Dry socket is treated by your dentist by flushing it thoroughly with saline, and then packing it with medicated paste or dressing.
• Depending on your pain severity, nonsteroidal anti-inflammatory drugs (NSAIDs) or an analgesic drug may be prescribed.REFERENCE
Complications following surgical removal of impacted teeth and their management- Textbook of Advanced Oral and Maxillofacial SurgeryIncorrectANSWER
Any of the aboveOTHER OPTIONS
• NilSYNOPSIS
• One of the most commoncomplications after extraction is dry socket.
• The clinical term for dry socket is alveolar osteitis.
• Dry socket typically lasts 7 days.
• Pain can be noticeable as early as day 3 after extraction.
• After tooth extraction, a blood clot usually forms at the site to heal and protect it. Dislodgement of this clot can lead to dry socket formation.
• Placement of medicated dry socket packing immediately after molar extraction decreases the alveolar osteitis rate.
• Dry socket is treated by your dentist by flushing it thoroughly with saline, and then packing it with medicated paste or dressing.
• Depending on your pain severity, nonsteroidal anti-inflammatory drugs (NSAIDs) or an analgesic drug may be prescribed.REFERENCE
Complications following surgical removal of impacted teeth and their management- Textbook of Advanced Oral and Maxillofacial Surgery - Question 26 of 150
26. Question
A child patient was brought to the clinic with late erupted primary dentition and has calculus and gingival recession related to upper molar. What would be your diagnosis?
CorrectANSWER
Local aggressive periodontitisOTHER OPTIONS
• NilSYNOPSIS
• Localized Aggressive Periodontitis (LAP) is a rare form of the inflammatory periodontal disease characterized by a rapid rate of progression, dramatic attachment and bone loss, on very specific teeth (first molars and incisors), and an early age of onset
• Clinical characteristics of localized aggressive periodontitis in the two dentitions are very similar
– Abundant calculus is infrequent
– Tissues do not look very inflamed upon clinical observation and
– Bone loss patterns are vertical or U shaped.
• However, it seems like the disease in primary dentition tends to be more localized to molars whereas the disease in permanent dentition can be detected solely at first molars or solely at incisors, or both 1st molars and incisors.
• Proper treatment of primary dentition requires early and accurate disease diagnosis.REFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
Local aggressive periodontitisOTHER OPTIONS
• NilSYNOPSIS
• Localized Aggressive Periodontitis (LAP) is a rare form of the inflammatory periodontal disease characterized by a rapid rate of progression, dramatic attachment and bone loss, on very specific teeth (first molars and incisors), and an early age of onset
• Clinical characteristics of localized aggressive periodontitis in the two dentitions are very similar
– Abundant calculus is infrequent
– Tissues do not look very inflamed upon clinical observation and
– Bone loss patterns are vertical or U shaped.
• However, it seems like the disease in primary dentition tends to be more localized to molars whereas the disease in permanent dentition can be detected solely at first molars or solely at incisors, or both 1st molars and incisors.
• Proper treatment of primary dentition requires early and accurate disease diagnosis.REFERENCE
Carranza’s Clinical Periodontology - Question 27 of 150
27. Question
You were presented with a case of root canal treated tooth 46 for crown placement. On IOPA, an underfilled canal is seen but is asymptomatic. How would you manage the case?
CorrectANSWER
No treatmentOTHER OPTIONS
• Non-surgical or conventional root canal therapy is the most common type of root canal done to protect natural teeth.
• Surgical RCT – An apicoectomy is needed when a standard root canal doesn’t solve the issue.SYNOPSIS
• The underfilled root canal is defined as one which fails to fill the circumference of the apical foramen in one or more dimensions, leaving voids for the stagnation of fluids, recontamination, and persistence of infection
• This error may be produced by
– Inadequate working length determination,
– Inadequate filling technique,
– Use of inflexible files,
– Variations in canal morphology such as excessive curvature and narrow canals (particularly in molars),
– Inadequate irrigation between each filing, and so forth.
• No treatment is required if the tooth is asymptomatic.
• If symptomatic consider RetreatmentREFERENCE
Ingles EndodonticsIncorrectANSWER
No treatmentOTHER OPTIONS
• Non-surgical or conventional root canal therapy is the most common type of root canal done to protect natural teeth.
• Surgical RCT – An apicoectomy is needed when a standard root canal doesn’t solve the issue.SYNOPSIS
• The underfilled root canal is defined as one which fails to fill the circumference of the apical foramen in one or more dimensions, leaving voids for the stagnation of fluids, recontamination, and persistence of infection
• This error may be produced by
– Inadequate working length determination,
– Inadequate filling technique,
– Use of inflexible files,
– Variations in canal morphology such as excessive curvature and narrow canals (particularly in molars),
– Inadequate irrigation between each filing, and so forth.
• No treatment is required if the tooth is asymptomatic.
• If symptomatic consider RetreatmentREFERENCE
Ingles Endodontics - Question 28 of 150
28. Question
You were presented with a case of erythematous and hyperkeratotic deep hemorrhagic bullae. On examination, other mucosal surfaces including ocular, nasal, pharyngeal, laryngeal, and upper respiratory were included. Identify the diagnosis?
CorrectANSWER
Erythema multiformeOTHER OPTIONS
• Herpes simplex virus (HSV) infection- The herpes simplex virus, also known as HSV, is a viral infection that causes genital and oral herpes.
• Mycoplasma pneumoniae infection- Mycoplasma pneumoniae are bacteria that can cause illness by damaging the lining of the respiratory system (throat, lungs, windpipe).
• Urticaria- a rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling, caused by an allergic reaction.SYNOPSIS
• Erythema multiforme (EM) is an acute, reactive, self-limiting and recurring mucocutaneous disorder that causes blistering and ulceration of the skin and mucous membranes.
• The face, oral mucosa, dorsal surface of the hands, feet, elbows and knees are the sites that are commonly affected.
• EM are triggered by HSV 1 and 2 infections.
• The typical dermal lesions of EM are target, iris or bull’s eye lesion. These are asymptomatic, discrete, erythematous macules or papules set in a concentric ring pattern usually comprising a central bulla.REFERENCE
Textbook of Oral medicine, Oral diagnosis and Oral radiology- Ravikaran OngoleIncorrectANSWER
Erythema multiformeOTHER OPTIONS
• Herpes simplex virus (HSV) infection- The herpes simplex virus, also known as HSV, is a viral infection that causes genital and oral herpes.
• Mycoplasma pneumoniae infection- Mycoplasma pneumoniae are bacteria that can cause illness by damaging the lining of the respiratory system (throat, lungs, windpipe).
• Urticaria- a rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling, caused by an allergic reaction.SYNOPSIS
• Erythema multiforme (EM) is an acute, reactive, self-limiting and recurring mucocutaneous disorder that causes blistering and ulceration of the skin and mucous membranes.
• The face, oral mucosa, dorsal surface of the hands, feet, elbows and knees are the sites that are commonly affected.
• EM are triggered by HSV 1 and 2 infections.
• The typical dermal lesions of EM are target, iris or bull’s eye lesion. These are asymptomatic, discrete, erythematous macules or papules set in a concentric ring pattern usually comprising a central bulla.REFERENCE
Textbook of Oral medicine, Oral diagnosis and Oral radiology- Ravikaran Ongole - Question 29 of 150
29. Question
The cephalometric Steiners analysis values of a patient were as follows. Angle S.N.A = 86, Angle S.N.B = 80. What was the orthodontist’s interpretation of the patient’s skeletal pattern?
CorrectANSWER
Skeletal class IIOTHER OPTIONS
• NilSYNOPSIS
• Steiners analysis
• SNA Angle -Mean is 82 degree -Greater angle indicates relative forward positioning of maxilla and lesser angle indicates recessive location of maxilla
• SNB angle -Mean is 80 degree -Angle less than 80 indicates recessive mandible while greater angle suggests Prognathic mandible.
• In the given scenario SNA angle is 86 degrees which shows a greater angle whereas SNB is normal. So it shows skeletal class II.REFERENCE
The art and science of Orthodontics- S M BalajiIncorrectANSWER
Skeletal class IIOTHER OPTIONS
• NilSYNOPSIS
• Steiners analysis
• SNA Angle -Mean is 82 degree -Greater angle indicates relative forward positioning of maxilla and lesser angle indicates recessive location of maxilla
• SNB angle -Mean is 80 degree -Angle less than 80 indicates recessive mandible while greater angle suggests Prognathic mandible.
• In the given scenario SNA angle is 86 degrees which shows a greater angle whereas SNB is normal. So it shows skeletal class II.REFERENCE
The art and science of Orthodontics- S M Balaji - Question 30 of 150
30. Question
Which is the most common complication during sinus surgery?
CorrectANSWER
Sinus perforationOTHER OPTIONS
• NilSYNOPSIS
• The most frequent intraoperative complication with sinus elevation is perforation of the Schneiderian membrane.
• The repair of this perforation is necessary to contain particulate grafting material and complete the procedure.
• A bioabsorbable collagen membrane is stabilized outside the antrostomy and then folded inward to create either a new superior wall that can obliterate a large perforation or a pouch that can completely contain the particulate material.
• Solutions proposed to treat the problems associated with sinus membrane perforations include the following
1. Abort the procedure and attempt after the perforation has healed.
2. Use a stabilized block graft without attempting to repair the perforation.
3. Repair the perforation with collagen membranes or lamellar bone.REFERENCE
Repair of Large Sinus Membrane Perforations Using Stabilized CollagenBarrier Membranes – Surgical Techniques with Histologic and Radiographic evidence of success.IncorrectANSWER
Sinus perforationOTHER OPTIONS
• NilSYNOPSIS
• The most frequent intraoperative complication with sinus elevation is perforation of the Schneiderian membrane.
• The repair of this perforation is necessary to contain particulate grafting material and complete the procedure.
• A bioabsorbable collagen membrane is stabilized outside the antrostomy and then folded inward to create either a new superior wall that can obliterate a large perforation or a pouch that can completely contain the particulate material.
• Solutions proposed to treat the problems associated with sinus membrane perforations include the following
1. Abort the procedure and attempt after the perforation has healed.
2. Use a stabilized block graft without attempting to repair the perforation.
3. Repair the perforation with collagen membranes or lamellar bone.REFERENCE
Repair of Large Sinus Membrane Perforations Using Stabilized CollagenBarrier Membranes – Surgical Techniques with Histologic and Radiographic evidence of success. - Question 31 of 150
31. Question
A child who had a pulpotomy comes the next day with his parent and complained painful ulcer over the lower lip which was absent on the day of treatment. What would be the diagnosis?
CorrectANSWER
Mastictory traumaOTHER OPTIONS
• Classic signs of allergic reactions include urticaria, swelling, rash and rhinorrhoea, and they often appear soon fter the treatment if is caused by agents of pulpotomy.
• Aphthous ulcer- is the most common ulcerative condition of the oral mucosa, and presents as a painful punched-out sore on oral or genital mucous membranes.
• Herpes sores usually look like blisters or cold sores.SYNOPSIS
• Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia
• Following a dental appointment requiring local anesthesia of the lower teeth (either unilaterally or bilaterally) to treat dental disease , a child may bite his or her lower lip out of curiosity associated with the unfamiliar sensation of being numb or inadvertently because no pain is felt.
• Accidental lip biting can also occur during post-operative eating or sleeping.
• Appropriate management of lower lip ulcers resulting from masticatory trauma is limited to palliative care.REFERENCE
Lip biting in pediatric dental patients following dental local anesthesia- a case report- Donald ChiIncorrectANSWER
Mastictory traumaOTHER OPTIONS
• Classic signs of allergic reactions include urticaria, swelling, rash and rhinorrhoea, and they often appear soon fter the treatment if is caused by agents of pulpotomy.
• Aphthous ulcer- is the most common ulcerative condition of the oral mucosa, and presents as a painful punched-out sore on oral or genital mucous membranes.
• Herpes sores usually look like blisters or cold sores.SYNOPSIS
• Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia
• Following a dental appointment requiring local anesthesia of the lower teeth (either unilaterally or bilaterally) to treat dental disease , a child may bite his or her lower lip out of curiosity associated with the unfamiliar sensation of being numb or inadvertently because no pain is felt.
• Accidental lip biting can also occur during post-operative eating or sleeping.
• Appropriate management of lower lip ulcers resulting from masticatory trauma is limited to palliative care.REFERENCE
Lip biting in pediatric dental patients following dental local anesthesia- a case report- Donald Chi - Question 32 of 150
32. Question
Your relative approached you for placing an implant. What would you do if you are not well versed in implants?
CorrectANSWER
Will refer to an implantologistOTHER OPTIONS
• NilSYNOPSIS
• In the case of any dental implant procedures, it is always smart to opt for an oral surgeon or implantologist.
• It is common for patients to need ridge augmentation, bone grafts, or sinus lifts before getting a tooth implant.
• An oral surgeon would perform all of these, not a general dentist.
• Because the implant would build on these procedures, it makes sense to have someone qualified to complete the implant.REFERENCE
Why Implants Should Be Placed By a Surgeon Over a General Dentist – American DentalIncorrectANSWER
Will refer to an implantologistOTHER OPTIONS
• NilSYNOPSIS
• In the case of any dental implant procedures, it is always smart to opt for an oral surgeon or implantologist.
• It is common for patients to need ridge augmentation, bone grafts, or sinus lifts before getting a tooth implant.
• An oral surgeon would perform all of these, not a general dentist.
• Because the implant would build on these procedures, it makes sense to have someone qualified to complete the implant.REFERENCE
Why Implants Should Be Placed By a Surgeon Over a General Dentist – American Dental - Question 33 of 150
33. Question
What is the no of carpules of 2 percent lignocaine to be given for a 20 kg child?
CorrectANSWER
2OTHER OPTIONS
• NilSYNOPSIS
• MRD without epinephrine is 4.4mg per kg, with epinephrine is 7.7mg per kg
• Number of carpules = MTD(Maximum Total Dose) divided by Amount in 1 cartridge(36mg)
• MTD = MRD(maximum recommended dose) x weight of the patient.
• Putting the values into the formula MTD = 4.4 x 20= 88mg, so no of carpules = 88 by 36 =2.4
-With epinephrine, the values change accordinglyREFERENCE
Malamed SF- Handbook of Local AnesthesiaIncorrectANSWER
2OTHER OPTIONS
• NilSYNOPSIS
• MRD without epinephrine is 4.4mg per kg, with epinephrine is 7.7mg per kg
• Number of carpules = MTD(Maximum Total Dose) divided by Amount in 1 cartridge(36mg)
• MTD = MRD(maximum recommended dose) x weight of the patient.
• Putting the values into the formula MTD = 4.4 x 20= 88mg, so no of carpules = 88 by 36 =2.4
-With epinephrine, the values change accordinglyREFERENCE
Malamed SF- Handbook of Local Anesthesia - Question 34 of 150
34. Question
Patient is been smoking 15 -20 cigarettes a day for 8 years and he comes with a complain of pain in gingiva, final diagnosis was chronic gingivitis. What is the intensity of gingival inflammation?
CorrectANSWER
Less intensity than non-smokerOTHER OPTIONS
• NilSYNOPSIS
• Smoking has a profound effect on the prevalence, extent, and severity of periodontitis.
• Clinical parameters including probing pocket depth, and clinical attachment loss were found to be increased in smokers compared to nonsmokers. However, it is interesting to note the decrease in bleeding on probing and reduced inflammatory response for plaque accumulation among smokers as compared to nonsmokers.
• These changes have been implicated, by various investigators, to altered microvasculature of the gingival connective tissue and increased thickness of epithelium among smokers, which mask the signs of inflammation.
• It is reported that smokers exhibit reduced vascular density and reduction in the lumen area of the gingival vessels.
• Studies have suggested that nicotine increases the rate of proliferation of the gingival epithelium, thus increasing epithelial thickness among smokers.REFERENCE
Carranzas Clinical PeriodontologyIncorrectANSWER
Less intensity than non-smokerOTHER OPTIONS
• NilSYNOPSIS
• Smoking has a profound effect on the prevalence, extent, and severity of periodontitis.
• Clinical parameters including probing pocket depth, and clinical attachment loss were found to be increased in smokers compared to nonsmokers. However, it is interesting to note the decrease in bleeding on probing and reduced inflammatory response for plaque accumulation among smokers as compared to nonsmokers.
• These changes have been implicated, by various investigators, to altered microvasculature of the gingival connective tissue and increased thickness of epithelium among smokers, which mask the signs of inflammation.
• It is reported that smokers exhibit reduced vascular density and reduction in the lumen area of the gingival vessels.
• Studies have suggested that nicotine increases the rate of proliferation of the gingival epithelium, thus increasing epithelial thickness among smokers.REFERENCE
Carranzas Clinical Periodontology - Question 35 of 150
35. Question
What are the dominant cells in established gingivitis?
CorrectANSWER
Plasma cellsOTHER OPTIONS
• NilSYNOPSIS
• There is increased collagenolytic activity in this stage along with a rise in the number of macrophages, plasma cells, T and B lymphocytes.
• However, the predominant cells are plasma cells and B lymphocytes.REFERENCE
Gingivitis Manu RatheeIncorrectANSWER
Plasma cellsOTHER OPTIONS
• NilSYNOPSIS
• There is increased collagenolytic activity in this stage along with a rise in the number of macrophages, plasma cells, T and B lymphocytes.
• However, the predominant cells are plasma cells and B lymphocytes.REFERENCE
Gingivitis Manu Rathee - Question 36 of 150
36. Question
You are presented with a case of a 9-year-old girl who complaints of a discolored upper central incisor which occured after a fall few months back. On radiographic examination, it shows an open apex. How will you manage the case?
CorrectANSWER
ApexificationOTHER OPTIONS
• Pulpectomy- Pulpectomy is a root canal procedure for pulp tissue that is irreversibly inflamed or necrotic due to caries or trauma. The root canals are debrided and shaped with hand or rotary files and then irrigated.
• Pulpotomy- A pulpotomy is performed in a primary tooth when caries removal results in a pulp exposure in a tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure and there is no radiographic sign of infection or pathologic resorption. The coronal pulp is amputated, pulpal hemorrhage controlled, and the remaining vital radicular pulp tissue surface is treated with a long-term clinically-successful medicament.
• Pulp capping- using agents to layer above the pulp before filling with retorative material.SYNOPSIS
• Apexification- An apexification is a procedure whereby the root canal of an open apex tooth is filled with calcium hydroxide to stimulate the formation of a hard tissue barrier at the apical portion of the root. It is a method of inducing root end closure of an incompletely formed non-vital permanent tooth by removing the coronal and non-vital radicular tissue just short of the root end and placing a biocompatible agent such as calcium hydroxide in the canals for two weeks to one month to disinfect the canal space.
• Root end closure is accomplished with an apical barrier such as MTA.
• In instances when complete closure cannot be accomplished by MTA, an absorbable collagen wound dressing can be placed at the root end to allow MTA to be packed within the confines of the canal space.
• Gutta percha is used to fill the remaining canal space. If the canal walls are thin, the canal space can be filled with MTA or composite resin instead of gutta percha to strengthen the tooth against fracture.
• Indications- This procedure is indicated for non-vital permanent teeth with incompletely formed roots.REFERENCE
Pulp Therapy for Primary and Immature Permanent Teeth- The Reference Manual of Pediatric Dentistry.IncorrectANSWER
ApexificationOTHER OPTIONS
• Pulpectomy- Pulpectomy is a root canal procedure for pulp tissue that is irreversibly inflamed or necrotic due to caries or trauma. The root canals are debrided and shaped with hand or rotary files and then irrigated.
• Pulpotomy- A pulpotomy is performed in a primary tooth when caries removal results in a pulp exposure in a tooth with a normal pulp or reversible pulpitis or after a traumatic pulp exposure and there is no radiographic sign of infection or pathologic resorption. The coronal pulp is amputated, pulpal hemorrhage controlled, and the remaining vital radicular pulp tissue surface is treated with a long-term clinically-successful medicament.
• Pulp capping- using agents to layer above the pulp before filling with retorative material.SYNOPSIS
• Apexification- An apexification is a procedure whereby the root canal of an open apex tooth is filled with calcium hydroxide to stimulate the formation of a hard tissue barrier at the apical portion of the root. It is a method of inducing root end closure of an incompletely formed non-vital permanent tooth by removing the coronal and non-vital radicular tissue just short of the root end and placing a biocompatible agent such as calcium hydroxide in the canals for two weeks to one month to disinfect the canal space.
• Root end closure is accomplished with an apical barrier such as MTA.
• In instances when complete closure cannot be accomplished by MTA, an absorbable collagen wound dressing can be placed at the root end to allow MTA to be packed within the confines of the canal space.
• Gutta percha is used to fill the remaining canal space. If the canal walls are thin, the canal space can be filled with MTA or composite resin instead of gutta percha to strengthen the tooth against fracture.
• Indications- This procedure is indicated for non-vital permanent teeth with incompletely formed roots.REFERENCE
Pulp Therapy for Primary and Immature Permanent Teeth- The Reference Manual of Pediatric Dentistry. - Question 37 of 150
37. Question
A mother brings her 14 years old son to your clinic for a routine dental check-up. On examination, it shows a class I caries on tooth 36. The mother wants to restore it with any tooth-colored material like composite. But you are compelling them to do amalgam restoration as it is easy for you. Which ethics is violated here?
CorrectANSWER
AutonomyOTHER OPTIONS
• Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life.
• The principle of veracity, or truth-telling, requires that healthcare providers be honest in their interactions with patients.
• Justice – Justice is a concept intended to promote fair and equitable treatment of individuals within populations.The principle is that all patients should be treated equallySYNOPSIS
• The third ethical principle, autonomy, means that individuals have a right to self-determination, that is, to make decisions about their lives without interference from others.REFERENCE
Medical Principles and Practice KargerIncorrectANSWER
AutonomyOTHER OPTIONS
• Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life.
• The principle of veracity, or truth-telling, requires that healthcare providers be honest in their interactions with patients.
• Justice – Justice is a concept intended to promote fair and equitable treatment of individuals within populations.The principle is that all patients should be treated equallySYNOPSIS
• The third ethical principle, autonomy, means that individuals have a right to self-determination, that is, to make decisions about their lives without interference from others.REFERENCE
Medical Principles and Practice Karger - Question 38 of 150
38. Question
What could be the treatment for large chipping of porcelein crown?
CorrectANSWER
Remake the crownOTHER OPTIONS
• Plabet breaker end crown – A wreath or band for the head, especially one given as a reward of victory, or a mark of honor.SYNOPSIS
• A dental crown is made of metals, porcelain-fused-to-metal, resin, ceramic or porcelain. Dental Crowns are not easy to chip in, but they can happen.
• Porcelain crowns can chip, and like normal teeth, if the chip is not too large, it can be repaired using resin that matches the color of the crown.
• The durability of dental crowns is five to fifteen years or more. However, porcelain crowns are more delicate and may need to be replaced.REFERENCE
WebMDIncorrectANSWER
Remake the crownOTHER OPTIONS
• Plabet breaker end crown – A wreath or band for the head, especially one given as a reward of victory, or a mark of honor.SYNOPSIS
• A dental crown is made of metals, porcelain-fused-to-metal, resin, ceramic or porcelain. Dental Crowns are not easy to chip in, but they can happen.
• Porcelain crowns can chip, and like normal teeth, if the chip is not too large, it can be repaired using resin that matches the color of the crown.
• The durability of dental crowns is five to fifteen years or more. However, porcelain crowns are more delicate and may need to be replaced.REFERENCE
WebMD - Question 39 of 150
39. Question
Which is the surgical correction for mandibular deficiency?
CorrectANSWER
BSSOOTHER OPTIONS
• NilSYNOPSIS
• The bilateral sagittal split ramus osteotomy is the most common surgical procedure for mandibular deficiency because of its versatility and its amenability to rigid fixation.REFERENCE
Correction of the mandibular deficiency by inverted-L osteotomy of ramus and iliac crest bone grafting Song-Song Zhu,IncorrectANSWER
BSSOOTHER OPTIONS
• NilSYNOPSIS
• The bilateral sagittal split ramus osteotomy is the most common surgical procedure for mandibular deficiency because of its versatility and its amenability to rigid fixation.REFERENCE
Correction of the mandibular deficiency by inverted-L osteotomy of ramus and iliac crest bone grafting Song-Song Zhu, - Question 40 of 150
40. Question
You were presented with a case of impacted maxillary permanent canine. You had suggested orthodontic extrusion. What could be the after-effects if the patient was not ready for the treatment?
CorrectANWER
All the aboveOTHER OPTIONS
• NilSYNOPSIS
• The lack of monitoring and the delay in the treatment of the impacted canine can cause different complications such as
– Displacement of adjacent teeth,
– Loss of vitality of neighboring teeth,
– Shortening of the dental arch,
– Follicular cysts,
– Canine ankylosis,
– Recurrent infections,
– Recurrent pain,
– Internal resorption of the canine and the adjacent teeth,
– External resorption of the canine and the adjacent teeth,
– Combination of these factors.REFERENCE
Impacted maxillary canines and root resorption of adjacent teeth A retrospective Rossana GuarnieriIncorrectANWER
All the aboveOTHER OPTIONS
• NilSYNOPSIS
• The lack of monitoring and the delay in the treatment of the impacted canine can cause different complications such as
– Displacement of adjacent teeth,
– Loss of vitality of neighboring teeth,
– Shortening of the dental arch,
– Follicular cysts,
– Canine ankylosis,
– Recurrent infections,
– Recurrent pain,
– Internal resorption of the canine and the adjacent teeth,
– External resorption of the canine and the adjacent teeth,
– Combination of these factors.REFERENCE
Impacted maxillary canines and root resorption of adjacent teeth A retrospective Rossana Guarnieri - Question 41 of 150
41. Question
How long we give appliance after cessation of thumb sucking habit?
CorrectANSWER
6monthsOTHER OPTIONS
• NilSYNOPSIS
• If the child stops the habit before the age of 5 years no treatment is needed and dental changes will be corrected spontaneously soon after giving up the habit.
• Once the child is mature enough to understand, the pediatric dentist should conduct a direct interview with the child and encourage the child to stop the habit.
• This can give the child more pride and self-confidence.
• The child should be rewarded for his successful attempts at stopping the habit and should be reminded by the parents again if he fails to discontinue the habit
• The final stage in treatment is the use of an orthodontic appliance whether fixed or removable, which can play the role of reminder and can reduce the urge of thumb sucking.
• For long-term habits or unwilling patients, the fixed intra-oral appliance is the most effective inhibitor.
• In the case of using fixed or removable appliances, we should alarm the parents about potential problems in speaking or eating during the first 24 to 48h, which are usual and self-correcting.
• After the active phase of treatment, the appliance should remain in place for more than 3 to 6 months to minimize the relapse potential.
• A thumb-sucking habit appliance will remain in place until the sucking habit has been broken. This can take up to 6 month or as long as a year for a really persistent habit.REFERENCE
Management of Thumb Sucking Habit in a 8-Year-Old Child – A Case Report- International Journal of Science and ResearchIncorrectANSWER
6monthsOTHER OPTIONS
• NilSYNOPSIS
• If the child stops the habit before the age of 5 years no treatment is needed and dental changes will be corrected spontaneously soon after giving up the habit.
• Once the child is mature enough to understand, the pediatric dentist should conduct a direct interview with the child and encourage the child to stop the habit.
• This can give the child more pride and self-confidence.
• The child should be rewarded for his successful attempts at stopping the habit and should be reminded by the parents again if he fails to discontinue the habit
• The final stage in treatment is the use of an orthodontic appliance whether fixed or removable, which can play the role of reminder and can reduce the urge of thumb sucking.
• For long-term habits or unwilling patients, the fixed intra-oral appliance is the most effective inhibitor.
• In the case of using fixed or removable appliances, we should alarm the parents about potential problems in speaking or eating during the first 24 to 48h, which are usual and self-correcting.
• After the active phase of treatment, the appliance should remain in place for more than 3 to 6 months to minimize the relapse potential.
• A thumb-sucking habit appliance will remain in place until the sucking habit has been broken. This can take up to 6 month or as long as a year for a really persistent habit.REFERENCE
Management of Thumb Sucking Habit in a 8-Year-Old Child – A Case Report- International Journal of Science and Research - Question 42 of 150
42. Question
What birth defects are caused by smoking while pregnant?
CorrectANSWER
Cleft lip with a cleft palateOTHER OPTIONS
• NilSYNOPSIS
• Smoking doubles your risk of abnormal bleeding during pregnancy and delivery. This can put both Mother and baby in danger.
• Smoking raises babys risk for birth defects, including cleft lip, cleft palate, or both. A cleft is an opening in babys lip or in the roof of her mouth (palate).REFERENCE
Smoking, Pregnancy, and Babies EspañolIncorrectANSWER
Cleft lip with a cleft palateOTHER OPTIONS
• NilSYNOPSIS
• Smoking doubles your risk of abnormal bleeding during pregnancy and delivery. This can put both Mother and baby in danger.
• Smoking raises babys risk for birth defects, including cleft lip, cleft palate, or both. A cleft is an opening in babys lip or in the roof of her mouth (palate).REFERENCE
Smoking, Pregnancy, and Babies Español - Question 43 of 150
43. Question
Which is the indication for Cvek pulpotomy?
CorrectANSWER
Injured permanent incisor teeth with exposed vital pulp tissue and immature apicesOTHER OPTIONS
• NilSYNOPSIS
• Partial pulpotomy (Cvek pulpotomy) is the treatment of choice for injured permanent incisor teeth with exposed vital pulp tissue and immature apices.
• This treatment preserves pulpal function, thus allowing continued root development.REFERENCE
Pulp Therapy for Primary and Immature Permanent Teeth American Academy of Pediatric Dentistry.IncorrectANSWER
Injured permanent incisor teeth with exposed vital pulp tissue and immature apicesOTHER OPTIONS
• NilSYNOPSIS
• Partial pulpotomy (Cvek pulpotomy) is the treatment of choice for injured permanent incisor teeth with exposed vital pulp tissue and immature apices.
• This treatment preserves pulpal function, thus allowing continued root development.REFERENCE
Pulp Therapy for Primary and Immature Permanent Teeth American Academy of Pediatric Dentistry. - Question 44 of 150
44. Question
Identify the given image(Key point – infection in floor of the mouth )
CorrectANSWER
Ludwigs anginaOTHER OPTIONS
• Cellulitis typically presents as a poorly demarcated, warm, erythematous area with associated edema and tenderness to palpation. The infection is without an abscess or purulent discharge.
• Vincent angina This is trench mouth, a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums. Certain germs (including fusiform bacteria and spirochetes) are thought to be involved.SYNOPSIS
• Ludwigs angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the sub mylohyoid (also known as submaxillary) space.
• It rapidly progresses to the surrounding tissues, leading to various potentially lethal complications, such as airway obstruction, aspiration pneumonia, and carotid arterial rupture or sheath abscess.
•Therefore, early recognition and treatment, including airway protection, antibiotic therapy, and surgical drainage in well-established infections, are crucial.REFERENCE
Spitalnic SJ, Sucov A. Ludwigs angina case report and review. J Emerg MedIncorrectANSWER
Ludwigs anginaOTHER OPTIONS
• Cellulitis typically presents as a poorly demarcated, warm, erythematous area with associated edema and tenderness to palpation. The infection is without an abscess or purulent discharge.
• Vincent angina This is trench mouth, a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums. Certain germs (including fusiform bacteria and spirochetes) are thought to be involved.SYNOPSIS
• Ludwigs angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the sub mylohyoid (also known as submaxillary) space.
• It rapidly progresses to the surrounding tissues, leading to various potentially lethal complications, such as airway obstruction, aspiration pneumonia, and carotid arterial rupture or sheath abscess.
•Therefore, early recognition and treatment, including airway protection, antibiotic therapy, and surgical drainage in well-established infections, are crucial.REFERENCE
Spitalnic SJ, Sucov A. Ludwigs angina case report and review. J Emerg Med - Question 45 of 150
45. Question
A patient presented for tooth extraction shows normal PT, prolonged APTT and prolonged bleeding time in his lab test report. Which blood disorder he is suffering from?
CorrectANSWER
HemophiliaOTHER OPTIONS
• Leukemia- . A high percentage elevated PT.
• Thrombocytopenia – Prolonged Plasma thromboplastin time (PTT) and prothrombin time (PT).
• Prolonged BT and slightly prolonged PTTSYNOPSIS
• Hemophilia is a rare disorder in which the blood doesnt clot in the typical way because it doesnt have enough blood-clotting proteins (clotting factors).
• Hemophilia is almost always a genetic disorder.
• Patient presents with normal PT, prolonged APTT and prolonged bleeding time .
• Treatment includes regular replacement of the specific clotting factor that is reduced.
• Newer therapies that dont contain clotting factors also are being used.REFERENCE
Hemophilia. Ongole 2nd edition pg 787.IncorrectANSWER
HemophiliaOTHER OPTIONS
• Leukemia- . A high percentage elevated PT.
• Thrombocytopenia – Prolonged Plasma thromboplastin time (PTT) and prothrombin time (PT).
• Prolonged BT and slightly prolonged PTTSYNOPSIS
• Hemophilia is a rare disorder in which the blood doesnt clot in the typical way because it doesnt have enough blood-clotting proteins (clotting factors).
• Hemophilia is almost always a genetic disorder.
• Patient presents with normal PT, prolonged APTT and prolonged bleeding time .
• Treatment includes regular replacement of the specific clotting factor that is reduced.
• Newer therapies that dont contain clotting factors also are being used.REFERENCE
Hemophilia. Ongole 2nd edition pg 787. - Question 46 of 150
46. Question
Which of the following is not included in andrews six keys of occlusion?
CorrectANSWER
Rotation presentOTHER OPTIONS
• NilSYNOPSIS
Andrews six keys to occlusion
1. Molar relationship the distal surface of the distobuccal cusp of the upper first permanent molar occludes with the mesial surface of the mesiobuccal cusp of the lower second molar.
2. Crown angulation (mesio-distal tip) the gingival part of the long axis of the crown is distal to the incisal part of the axis. The extent of angulation varies according to tooth type.
3. Crown inclination (labio-lingual, bucco-lingual) the incisors are at a sufficient angulation to prevent overeruption.
• Upper posterior teeth the lingual tip is constant and similar from canine to second premolar and increased in the molars.
• Lower posterior teeth the lingual tip increases progressively from the canines to the molar.
4. Rotations are not present.
5. There are no interdental spaces.
6. There is a flat plane of occlusion.REFERENCE
Andrews six keys to occlusion. Medicine and health — DentistryIncorrectANSWER
Rotation presentOTHER OPTIONS
• NilSYNOPSIS
Andrews six keys to occlusion
1. Molar relationship the distal surface of the distobuccal cusp of the upper first permanent molar occludes with the mesial surface of the mesiobuccal cusp of the lower second molar.
2. Crown angulation (mesio-distal tip) the gingival part of the long axis of the crown is distal to the incisal part of the axis. The extent of angulation varies according to tooth type.
3. Crown inclination (labio-lingual, bucco-lingual) the incisors are at a sufficient angulation to prevent overeruption.
• Upper posterior teeth the lingual tip is constant and similar from canine to second premolar and increased in the molars.
• Lower posterior teeth the lingual tip increases progressively from the canines to the molar.
4. Rotations are not present.
5. There are no interdental spaces.
6. There is a flat plane of occlusion.REFERENCE
Andrews six keys to occlusion. Medicine and health — Dentistry - Question 47 of 150
47. Question
A 53 years old female complaints of difficulty while swallowing shows hardened and thickened shiny skin on hands and face. On examination small red spots seen on face. What is the diagnosis?
CorrectANSWER
SclerodermaOTHER OPTIONS
• Addisons disease, also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesnt produce enough of certain hormones. In Addisons disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone
• McCune-Albright syndrome is a disorder that affects the bones, skin, and several hormone-producing (endocrine) tissues. People with McCune-Albright syndrome develop areas of abnormal scar-like (fibrous) tissue in their bones, a condition called polyostotic fibrous dysplasia.
• Sjögren’s syndrome is a chronic (long-lasting) autoimmune disorder that happens when the immune system attacks the glands that make moisture in the eyes, mouth, and other parts of the body. The main symptoms are dry eyes and mouth, but other parts of the body may be affected as well, with many people reporting fatigue and joint and muscle pain.SYNOPSIS
Symptoms of scleroderma may include
– Thickening and swelling of the fingers.
– Pale fingers that may become numb and tingle when exposed to cold or stress, known as Raynauds phenomenon
• In some people, it only affects the skin, but in others, scleroderma goes much deeper, harming your joints, blood vessels, internal organs and the digestive tract, in addition to the skin.
• The particular symptoms might just be annoying or they could cause significant problems and pain.
• For some, the symptoms can be life-threatening.REFERENCE
Scleroderma Ravikiran ongole textbook of oral medicine pg 763.IncorrectANSWER
SclerodermaOTHER OPTIONS
• Addisons disease, also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesnt produce enough of certain hormones. In Addisons disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone
• McCune-Albright syndrome is a disorder that affects the bones, skin, and several hormone-producing (endocrine) tissues. People with McCune-Albright syndrome develop areas of abnormal scar-like (fibrous) tissue in their bones, a condition called polyostotic fibrous dysplasia.
• Sjögren’s syndrome is a chronic (long-lasting) autoimmune disorder that happens when the immune system attacks the glands that make moisture in the eyes, mouth, and other parts of the body. The main symptoms are dry eyes and mouth, but other parts of the body may be affected as well, with many people reporting fatigue and joint and muscle pain.SYNOPSIS
Symptoms of scleroderma may include
– Thickening and swelling of the fingers.
– Pale fingers that may become numb and tingle when exposed to cold or stress, known as Raynauds phenomenon
• In some people, it only affects the skin, but in others, scleroderma goes much deeper, harming your joints, blood vessels, internal organs and the digestive tract, in addition to the skin.
• The particular symptoms might just be annoying or they could cause significant problems and pain.
• For some, the symptoms can be life-threatening.REFERENCE
Scleroderma Ravikiran ongole textbook of oral medicine pg 763. - Question 48 of 150
48. Question
A patient presented with upper CD and lower RPD shows the only natural teeth present are lower premolars on examination. What should be the considerable amount of resorption to be reported if the tooth is under trauma from occlusion?
CorrectANSWER
30-40percentOTHER OPTIONS
• NilSYNOPSIS
• Case of Kennedys Class I modification I
• With RPD normally resorption will be there and the rate of resorption will increase when the remaining natural teeth is in traumatic occlusionREFERENCE
Trauma from Occlusion – Carranzas Clinical PeriodontologyIncorrectANSWER
30-40percentOTHER OPTIONS
• NilSYNOPSIS
• Case of Kennedys Class I modification I
• With RPD normally resorption will be there and the rate of resorption will increase when the remaining natural teeth is in traumatic occlusionREFERENCE
Trauma from Occlusion – Carranzas Clinical Periodontology - Question 49 of 150
49. Question
You were presented with a grossly decayed mandibular second molar which was planned for extraction after evaluation. You had given IANB two times but the patient had pain still. Which type of anesthesia would be your choice then?
CorrectANSWER
IntraligamentaryOTHER OPTIONS
• Long buccal – provides soft tissue anesthesia and is given along with IANB
• IANB – 2 blocks already given. Repeat injection has been described as the first option when the initial injection is unsuccessful and may be effective in some cases. On the contrary, a success rate of repeat IANB to be as low as 32 percent . Repeated injections in the same area can lead to post-injection pain and even trismusSYNOPSIS
• Intraligamentary injection is performed by spreading a local anesthetic solution to the cancellous medullary bone surrounding the teeth through the periodontal ligament using high injection pressure.
• It is the most commonly used method after IANB failure in the treatment of mandibular posterior teeth with irreversible pulpitisREFERENCE
Overcoming the failure of anesthesia in the mandibular teeth – Saudi Medical JournalIncorrectANSWER
IntraligamentaryOTHER OPTIONS
• Long buccal – provides soft tissue anesthesia and is given along with IANB
• IANB – 2 blocks already given. Repeat injection has been described as the first option when the initial injection is unsuccessful and may be effective in some cases. On the contrary, a success rate of repeat IANB to be as low as 32 percent . Repeated injections in the same area can lead to post-injection pain and even trismusSYNOPSIS
• Intraligamentary injection is performed by spreading a local anesthetic solution to the cancellous medullary bone surrounding the teeth through the periodontal ligament using high injection pressure.
• It is the most commonly used method after IANB failure in the treatment of mandibular posterior teeth with irreversible pulpitisREFERENCE
Overcoming the failure of anesthesia in the mandibular teeth – Saudi Medical Journal - Question 50 of 150
50. Question
A patient comes with pain in the upper left premolar region, which is radiating to ear and eye. On examination there is no caries or periapical pathology. But when you press the premolar area it feels severe pain. What is the cause?
CorrectANSWER
Maxillary SinusitisOTHER OPTIONS
• Chronic pulpitis – Pain is mild to moderate or absent. Reaction to thermal changes is reduced
• Asymptomatic reversible pulpitis – In reversible pulpitis, pain occurs when a stimulus (usually cold or sweet) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 seconds.SYNOPSIS
• Sinusitis is a common medical problem that can occasionally manifest as dental pain.
• If the patient is experiencing dental pain in the maxillary posterior teeth, then it is appropriate for the dentist to rule out sinusitis as a source of the problem before proceeding with definitive dental treatment.
• Often there is an obvious odontogenic source of the pain, and this should be resolved first, but in other situations, it is difficult to determine the cause of the symptoms.
• In some patients, the source of the pain is so equivocal that it may be necessary to treat the patient for sinusitis to eliminate this as the source of the dental pain.
• In this process, the dentist has one of 2 options- either refer the patient to a physician or treat the sinusitis. The option chosen regarding patient management is made by the dentist and depends on the particular clinical situation and the dentists training and experience.REFERENCE
Sinusitis as a source of Dental Pain – Dentistry todayIncorrectANSWER
Maxillary SinusitisOTHER OPTIONS
• Chronic pulpitis – Pain is mild to moderate or absent. Reaction to thermal changes is reduced
• Asymptomatic reversible pulpitis – In reversible pulpitis, pain occurs when a stimulus (usually cold or sweet) is applied to the tooth. When the stimulus is removed, the pain ceases within 1 to 2 seconds.SYNOPSIS
• Sinusitis is a common medical problem that can occasionally manifest as dental pain.
• If the patient is experiencing dental pain in the maxillary posterior teeth, then it is appropriate for the dentist to rule out sinusitis as a source of the problem before proceeding with definitive dental treatment.
• Often there is an obvious odontogenic source of the pain, and this should be resolved first, but in other situations, it is difficult to determine the cause of the symptoms.
• In some patients, the source of the pain is so equivocal that it may be necessary to treat the patient for sinusitis to eliminate this as the source of the dental pain.
• In this process, the dentist has one of 2 options- either refer the patient to a physician or treat the sinusitis. The option chosen regarding patient management is made by the dentist and depends on the particular clinical situation and the dentists training and experience.REFERENCE
Sinusitis as a source of Dental Pain – Dentistry today - Question 51 of 150
51. Question
A 75 years old male patient having prostrate cancer and metastasis. He is under zolendronate medication. He presents with a badly carious, non restorable tooth. Cold test shows no response. What is the best management for this case?
CorrectANSWER
Do RCT followed by crown amputationOTHER OPTIONS
• NILSYNOPSIS
• The most common complication in patients on bisphosphonate therapy is osteonecrosis of jaw which occurs after any surgical dental procedure.
• According to the information currently available, risk for developing bisphosphonate associated osteonecrosis of jaw is higher in patients on IV bisphosphonate therapy than the patients on oral bisphosphonates as orally they are poorly absorbed
• In IV administered bisphosphonates, Zolendronate is the most potent bisphosphonate because of its high mineral binding affinity and FPPS enzyme inhibition
• For patients who have already started with the therapy, any elective procedures should be avoided if possible to avoid the risk of bisphosphonate induced osteonecrosis of jaw.
• Root canal treatment should be done rather than dental extraction when possible.
• Patients in which dental extractions are unavoidable should be first consulted with the prescriber of bisphosphonate therapy for possible temporary interruption of drug if beneficial. Extraction should be done as atraumatically as possible and flap raising should be avoided. Sterile technique has to be followed. Patient should be kept on chlorhexidine mouthwash twice daily for two months and postoperatively 2 month follow up should be done.
• In some cases it has been recommended to do root canal of the teeth followed by coronal amputation and leave the roots.REFERENCE
Dental complications and management of patients on bisphosphonate therapy- A review article -Journal of Oral Biology and Craniofacial ResearchIncorrectANSWER
Do RCT followed by crown amputationOTHER OPTIONS
• NILSYNOPSIS
• The most common complication in patients on bisphosphonate therapy is osteonecrosis of jaw which occurs after any surgical dental procedure.
• According to the information currently available, risk for developing bisphosphonate associated osteonecrosis of jaw is higher in patients on IV bisphosphonate therapy than the patients on oral bisphosphonates as orally they are poorly absorbed
• In IV administered bisphosphonates, Zolendronate is the most potent bisphosphonate because of its high mineral binding affinity and FPPS enzyme inhibition
• For patients who have already started with the therapy, any elective procedures should be avoided if possible to avoid the risk of bisphosphonate induced osteonecrosis of jaw.
• Root canal treatment should be done rather than dental extraction when possible.
• Patients in which dental extractions are unavoidable should be first consulted with the prescriber of bisphosphonate therapy for possible temporary interruption of drug if beneficial. Extraction should be done as atraumatically as possible and flap raising should be avoided. Sterile technique has to be followed. Patient should be kept on chlorhexidine mouthwash twice daily for two months and postoperatively 2 month follow up should be done.
• In some cases it has been recommended to do root canal of the teeth followed by coronal amputation and leave the roots.REFERENCE
Dental complications and management of patients on bisphosphonate therapy- A review article -Journal of Oral Biology and Craniofacial Research - Question 52 of 150
52. Question
Which type of headgear do we used for maxillary retrusion?
CorrectANSWER
Reverse pullOTHER OPTIONS
• High pull – Its often used when a child also has an open bite, which means the upper and lower teeth do not touch when the mouth is closed.
• Cervical pull – worn to move upper teeth and jaw bones into the proper position. The headgear moves the front teeth and jaw backward and closer to the lower teeth.SYNOPSIS
• A reverse pull headgear, also known as a Delaire-type facemask, offers growth stimulation at the maxillary (upper jaw) sutures allowing the upper jaw to be moved forward in a growing child.
• It is used to intercept a developing skeletal Class III malocclusion with maxillary deficiency.
• Rapid maxillary expansion (RME) is recommended along with the reverse pull headgear because there is disruption of the circummaxillary and intermaxillary sutures.REFERENCE
Contemporary Orthodontics – William R ProfitIncorrectANSWER
Reverse pullOTHER OPTIONS
• High pull – Its often used when a child also has an open bite, which means the upper and lower teeth do not touch when the mouth is closed.
• Cervical pull – worn to move upper teeth and jaw bones into the proper position. The headgear moves the front teeth and jaw backward and closer to the lower teeth.SYNOPSIS
• A reverse pull headgear, also known as a Delaire-type facemask, offers growth stimulation at the maxillary (upper jaw) sutures allowing the upper jaw to be moved forward in a growing child.
• It is used to intercept a developing skeletal Class III malocclusion with maxillary deficiency.
• Rapid maxillary expansion (RME) is recommended along with the reverse pull headgear because there is disruption of the circummaxillary and intermaxillary sutures.REFERENCE
Contemporary Orthodontics – William R Profit - Question 53 of 150
53. Question
A 9 years old child patient with class III and maxillary hypoplasia needs which appliance?
CorrectANSWER
Face maskOTHER OPTIONS
• Reverse head gear – Reverse-pull headgear is an orthodontic appliance used in growing patients to correct an underbite and help the upper jaw developSYNOPSIS
• The characteristic features of Class III malocclusion are present at an early age, usually between 3 and 5 years of age.
• If left untreated, the Class III malocclusion or severe anterior crossbite may worsen, with the majority of these patients ultimately requiring orthognathic surgery as adults.
• The treatment in all developing Class III cases should be undertaken as soon as the abnormality is diagnosed to prevent it from becoming permanent and resulting in a full-blown Class III malocclusion.
• It provides more pleasing facial esthetics (lip posture and facial appearance), thus improving the psychosocial development of a child.
• Various treatment options available for the management of developing Class III malocclusion are as follows-
1. Functional appliances such as reverse twin block, Frankel appliance, and the removable mandibular retractor – can be used in this particular case as the child is only 5 years old.
2. Orthopedic appliances such as chin cap and face mask
3. Orthodontic appliances, namely removable maxillary expansion plate or fixed orthodontic appliance with the expanded upper archwire.
• A treatment plan may be chosen depending on the amount of maxillary growth restriction, mandibular plane angle, the soft-tissue profile, and the age of the patient.REFERENCE
Treatment Modalities for Early Management of Class III Skeletal Malocclusion- A Case Series – Contemporary Clinical DentistryIncorrectANSWER
Face maskOTHER OPTIONS
• Reverse head gear – Reverse-pull headgear is an orthodontic appliance used in growing patients to correct an underbite and help the upper jaw developSYNOPSIS
• The characteristic features of Class III malocclusion are present at an early age, usually between 3 and 5 years of age.
• If left untreated, the Class III malocclusion or severe anterior crossbite may worsen, with the majority of these patients ultimately requiring orthognathic surgery as adults.
• The treatment in all developing Class III cases should be undertaken as soon as the abnormality is diagnosed to prevent it from becoming permanent and resulting in a full-blown Class III malocclusion.
• It provides more pleasing facial esthetics (lip posture and facial appearance), thus improving the psychosocial development of a child.
• Various treatment options available for the management of developing Class III malocclusion are as follows-
1. Functional appliances such as reverse twin block, Frankel appliance, and the removable mandibular retractor – can be used in this particular case as the child is only 5 years old.
2. Orthopedic appliances such as chin cap and face mask
3. Orthodontic appliances, namely removable maxillary expansion plate or fixed orthodontic appliance with the expanded upper archwire.
• A treatment plan may be chosen depending on the amount of maxillary growth restriction, mandibular plane angle, the soft-tissue profile, and the age of the patient.REFERENCE
Treatment Modalities for Early Management of Class III Skeletal Malocclusion- A Case Series – Contemporary Clinical Dentistry - Question 54 of 150
54. Question
Type 4 bone is
CorrectANSWER
Fine trabecular boneOTHER OPTIONS
• Type 1- Dense cortical.
• Type 2- D2 bone Dense-to-thick porpus cortical and coarse trabeculae.
• Type 3- D3 bone Thinner porous cortical bone.SYNOPSIS
• D4 bone Least density – Fine trabecular bone
• Found in posterior molar region.
• Disadvantages of D4 bone
– Difficult to obtain rigid fixation
– Rotating drills not to be used apart from pilot drill
– Osteotomes may be used to compress osteotomy site
– Cortical bone in the opposite landmark to be engaged (if any)
– Increase number of implants to improve load distribution
– No cantilever advocatedREFERENCE
Misch classification of bone densityIncorrectANSWER
Fine trabecular boneOTHER OPTIONS
• Type 1- Dense cortical.
• Type 2- D2 bone Dense-to-thick porpus cortical and coarse trabeculae.
• Type 3- D3 bone Thinner porous cortical bone.SYNOPSIS
• D4 bone Least density – Fine trabecular bone
• Found in posterior molar region.
• Disadvantages of D4 bone
– Difficult to obtain rigid fixation
– Rotating drills not to be used apart from pilot drill
– Osteotomes may be used to compress osteotomy site
– Cortical bone in the opposite landmark to be engaged (if any)
– Increase number of implants to improve load distribution
– No cantilever advocatedREFERENCE
Misch classification of bone density - Question 55 of 150
55. Question
How is the anterior guidance for a patient who presented with class II division 2 malocclusion?
CorrectANSWER
SteepOTHER OPTIONS
• NilSYNOPSIS
• According to Dawson, anterior guidance is the dynamic relationship of the lower anterior teeth against the upper anterior teeth through all the ranges of function.
• It plays a very important role in protecting the posterior teeth from protrusive and lateral stresses by discluding effect.
• An unfavorable anterior guidance contributes to anterior alveolar bone loss and teeth mobility when there are susceptible periodontal tissues and excessive forces.
• As the overbite increases and overjet decreases the incisal guidance becomes steep leading to more off-axial forces on the teeth which are potentially dangerous.REFERENCE
Role of anterior guidance in esthetic and functional rehabilitation- Aradhana Nagarsekar, Meena ArasIncorrectANSWER
SteepOTHER OPTIONS
• NilSYNOPSIS
• According to Dawson, anterior guidance is the dynamic relationship of the lower anterior teeth against the upper anterior teeth through all the ranges of function.
• It plays a very important role in protecting the posterior teeth from protrusive and lateral stresses by discluding effect.
• An unfavorable anterior guidance contributes to anterior alveolar bone loss and teeth mobility when there are susceptible periodontal tissues and excessive forces.
• As the overbite increases and overjet decreases the incisal guidance becomes steep leading to more off-axial forces on the teeth which are potentially dangerous.REFERENCE
Role of anterior guidance in esthetic and functional rehabilitation- Aradhana Nagarsekar, Meena Aras - Question 56 of 150
56. Question
Identify the abnormality seen in the image?
CorrectANSWER
Stillmans cleftOTHER OPTIONS
• McCalls festoon- Semilunar-shaped enlargements of the marginal gingivae primarily on the labial surfaces of the anterior and premolar teeth, described by John Oppie McCall in 1922.
• Fenestration is the condition, in which the bony coverage of the root surface is lost, and the root surface is only covered by the periosteum and gingiva. In such lesions, marginal bone is intact.
• Cervical abrasions- the abrasions that are seen on the neck of the tooth near the gum lines.SYNOPSIS
• Stillman’s cleft is a mucogingival triangular-shaped defect predominantly seen on the buccal surface of a root, first described by Stillman as a recession related to occlusal trauma, either associated with marginal gingivitis or with mild periodontitis.
• It can be found as a depression or as a sharply defined fissure extending up to 5–6 mm of length.
• Other possible etiological factors are assumed to be periodontal inflammation , which leads to proliferation of the pocket epithelium into the gingival corium and its subsequent anastomosis with the outer epithelium. In addition, the traumatic tooth-brushing and the incorrect use of the interdental floss have been described among the possible causes.
• The prognosis of the clefts is variable they can heal uneventfully or remain as superficial lesions combined with deep periodontal pockets.REFERENCE
The gingival Stillman’s clefts histopathology and cellular characteristics- Maria Antonietta CassiniIncorrectANSWER
Stillmans cleftOTHER OPTIONS
• McCalls festoon- Semilunar-shaped enlargements of the marginal gingivae primarily on the labial surfaces of the anterior and premolar teeth, described by John Oppie McCall in 1922.
• Fenestration is the condition, in which the bony coverage of the root surface is lost, and the root surface is only covered by the periosteum and gingiva. In such lesions, marginal bone is intact.
• Cervical abrasions- the abrasions that are seen on the neck of the tooth near the gum lines.SYNOPSIS
• Stillman’s cleft is a mucogingival triangular-shaped defect predominantly seen on the buccal surface of a root, first described by Stillman as a recession related to occlusal trauma, either associated with marginal gingivitis or with mild periodontitis.
• It can be found as a depression or as a sharply defined fissure extending up to 5–6 mm of length.
• Other possible etiological factors are assumed to be periodontal inflammation , which leads to proliferation of the pocket epithelium into the gingival corium and its subsequent anastomosis with the outer epithelium. In addition, the traumatic tooth-brushing and the incorrect use of the interdental floss have been described among the possible causes.
• The prognosis of the clefts is variable they can heal uneventfully or remain as superficial lesions combined with deep periodontal pockets.REFERENCE
The gingival Stillman’s clefts histopathology and cellular characteristics- Maria Antonietta Cassini - Question 57 of 150
57. Question
Which cyst is most commonly associated with impacted tooth and is derived from residual dental lamina?
CorrectANSWER
OKCOTHER OPTIONS
• Dentigerous cyst – derived from Reduced Enamel Epithelium
• Radicular Cyst – Originates from Epithelial remnants of Periodontal ligament (cell rests of Malassez)as a result of inflammation associated with pulp necrosis
• Residual cyst – Growth from the remnants of a radicular cystSYNOPSIS
• Odontogenic keratocyst is an aggressive odontogenic cyst that is derived from the rests of the dental lamina, with distinctive histological features comprising of the following
• Corrugated parakeratin layer
• Lining epithelium of 6 to 10 cells in thickness
• Palisaded basal cell layerREFERENCE
Shafer’s textbook of oral pathologyIncorrectANSWER
OKCOTHER OPTIONS
• Dentigerous cyst – derived from Reduced Enamel Epithelium
• Radicular Cyst – Originates from Epithelial remnants of Periodontal ligament (cell rests of Malassez)as a result of inflammation associated with pulp necrosis
• Residual cyst – Growth from the remnants of a radicular cystSYNOPSIS
• Odontogenic keratocyst is an aggressive odontogenic cyst that is derived from the rests of the dental lamina, with distinctive histological features comprising of the following
• Corrugated parakeratin layer
• Lining epithelium of 6 to 10 cells in thickness
• Palisaded basal cell layerREFERENCE
Shafer’s textbook of oral pathology - Question 58 of 150
58. Question
Which impression material can be poured after 24 hours?
CorrectANSWER
PVSOTHER OPTIONS
• NilSYNOPSIS
• An accurate impression is the first and a crucial step in the process of fabricating indirect dental restoration.
• PVS impressions have shown better dimensional stability then PE.
• PVSE and PVS are highly stabile during the first 1 week period and can be pouring after 1 week.REFERENCE
Comparing Volumetric Dimensional Stability and Accuracy of Newly Formulated Polyvinyl Siloxanether, Polyvinyl Siloxane and Polyether Impression Materials Using Micro-Computed Tomography- Yilmaz Umut Aslan.IncorrectANSWER
PVSOTHER OPTIONS
• NilSYNOPSIS
• An accurate impression is the first and a crucial step in the process of fabricating indirect dental restoration.
• PVS impressions have shown better dimensional stability then PE.
• PVSE and PVS are highly stabile during the first 1 week period and can be pouring after 1 week.REFERENCE
Comparing Volumetric Dimensional Stability and Accuracy of Newly Formulated Polyvinyl Siloxanether, Polyvinyl Siloxane and Polyether Impression Materials Using Micro-Computed Tomography- Yilmaz Umut Aslan. - Question 59 of 150
59. Question
You were presented with a case of grossly decayed teeth 51,52,61 and 62 that need to be done pulpectomy. Which type of temporary crowns were indicated for the case?
CorrectANSWER
Polycarbonate crownsOTHER OPTIONS
• NilSYNOPSIS
• The main problem facing the clinician while performing esthetic restorations in children is
– Small size of teeth
– Proximity of the pulp to the tooth surface
– Relatively thin enamel
– Surface area for bonding a restoration
– Behavior of the child.
• There have been four types of full coverage restorations available to restore primary incisors.
– Stainless steel crowns
– Open-faced stainless steel crowns
– Polycarbonate crowns
– Strip crowns
• Primary tooth polycarbonate crowns
• Advantages
– Esthetically acceptable
– Less chair side time
– Improved retention
– Flexible
– Better adaptabilityREFERENCE
Polycarbonate crowns for primary teeth revisited- Restorative options, technique and case reports- Karthik VenkataraghavanIncorrectANSWER
Polycarbonate crownsOTHER OPTIONS
• NilSYNOPSIS
• The main problem facing the clinician while performing esthetic restorations in children is
– Small size of teeth
– Proximity of the pulp to the tooth surface
– Relatively thin enamel
– Surface area for bonding a restoration
– Behavior of the child.
• There have been four types of full coverage restorations available to restore primary incisors.
– Stainless steel crowns
– Open-faced stainless steel crowns
– Polycarbonate crowns
– Strip crowns
• Primary tooth polycarbonate crowns
• Advantages
– Esthetically acceptable
– Less chair side time
– Improved retention
– Flexible
– Better adaptabilityREFERENCE
Polycarbonate crowns for primary teeth revisited- Restorative options, technique and case reports- Karthik Venkataraghavan - Question 60 of 150
60. Question
A patient presented with missing tooth 46 needs to be replaced by FPD. On examination, tooth 47 is mesially tilted for 30 degrees. What could be the possible complication that occur when doing tooth prepartion for FPD on teeth 45,46 and 47?
CorrectANSWER
Pulp exposure on tooth 47OTHER OPTIONS
• NilSYNOPSIS
• Dental pulp is a soft tissue structure and like other connective tissues, it contains nerves, vascular structures, connective tissue fibers and cells plus specific cells called odontoblasts.
• Crown preparation can jeopardize the vitality of the dental pulp through overheating the pulp , microcirculation interruptions, thrombosis, haemostasis, internal bleeding and reduced blood flow. (Zach 1972).
• The size of the pulp chamber is another factor that should be measured especially if realignment of the tooth is to be considered.
• The risk of pulp exposure in severely tilted teeth should be predicted to prevent future embarrassments. Root canal treatment should be considered in the case of the pulp exposure during crown preparation. (Whitworth, Walls et al. 2002)REFERENCE
Incidence Of Dental Pulp Complications After Prosthodontic Treatments-Dr.Faranak ZaeimdarIncorrectANSWER
Pulp exposure on tooth 47OTHER OPTIONS
• NilSYNOPSIS
• Dental pulp is a soft tissue structure and like other connective tissues, it contains nerves, vascular structures, connective tissue fibers and cells plus specific cells called odontoblasts.
• Crown preparation can jeopardize the vitality of the dental pulp through overheating the pulp , microcirculation interruptions, thrombosis, haemostasis, internal bleeding and reduced blood flow. (Zach 1972).
• The size of the pulp chamber is another factor that should be measured especially if realignment of the tooth is to be considered.
• The risk of pulp exposure in severely tilted teeth should be predicted to prevent future embarrassments. Root canal treatment should be considered in the case of the pulp exposure during crown preparation. (Whitworth, Walls et al. 2002)REFERENCE
Incidence Of Dental Pulp Complications After Prosthodontic Treatments-Dr.Faranak Zaeimdar - Question 61 of 150
61. Question
Bottle feeding should stopped at which age?
CorrectANSWER
12 monthsOTHER OPTIONS
• NilSYNOPSIS
• The recommended age of bottle weaning varies.
• The American Academy of Pediatrics recommends weaning by 12 months
• The American Academy of Pediatric Dentistry recommends 12-15 months
• The US Department of Agriculture recommends 18 monthsREFERENCE
Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WICIncorrectANSWER
12 monthsOTHER OPTIONS
• NilSYNOPSIS
• The recommended age of bottle weaning varies.
• The American Academy of Pediatrics recommends weaning by 12 months
• The American Academy of Pediatric Dentistry recommends 12-15 months
• The US Department of Agriculture recommends 18 monthsREFERENCE
Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WIC - Question 62 of 150
62. Question
Radiographic evidence of a 20 yr old female patient revealed a radioopaque lesion with some expansion giving a orange peel appearance in the posterior aspect of maxilla. . Histologically, it shows a fibrous growth. Diagnosis?
CorrectANSWER
Fibrous dysplasiaOTHER OPTIONS
• Paget’s Disease – The cotton wool appearance is a plain film sign of Paget disease and results from thickened, disorganized trabeculae which lead to areas of sclerosis in a previously lucent area of bone, typically the skull. These sclerotic patches are poorly defined and fluffy
• Hyperparathyroidism – The common symptomatic osseous findings include subperiosteal and subchondral joint resorption, acroosteolysis, the salt-and-pepper skull, the brown tumors, and osteopenia.
• Osteosarcoma – The characteristic radiological features are sun-burst appearance, periosteal lifting with formation of Codman’s triangleSYNOPSIS
• Fibrous dysplasia is a non-neoplastic hamartomatous developmental lesion of the bone of unknown origin.
• It is characterized by the replacement of bone with fibro-osseous tissue,
• The maxilla is more frequently involved than the mandible.
• The most common radiographic pattern observed was the ground-glass appearance, followed by orange peel, cotton wool, sunray and thumbprint appearance, which leads to a perplex differential diagnosis.REFERENCE
The radiological versatility of fibrous dysplasia An 8-year retrospective radiographic analysis in a north Indian population – Indian Journal of DentistryIncorrectANSWER
Fibrous dysplasiaOTHER OPTIONS
• Paget’s Disease – The cotton wool appearance is a plain film sign of Paget disease and results from thickened, disorganized trabeculae which lead to areas of sclerosis in a previously lucent area of bone, typically the skull. These sclerotic patches are poorly defined and fluffy
• Hyperparathyroidism – The common symptomatic osseous findings include subperiosteal and subchondral joint resorption, acroosteolysis, the salt-and-pepper skull, the brown tumors, and osteopenia.
• Osteosarcoma – The characteristic radiological features are sun-burst appearance, periosteal lifting with formation of Codman’s triangleSYNOPSIS
• Fibrous dysplasia is a non-neoplastic hamartomatous developmental lesion of the bone of unknown origin.
• It is characterized by the replacement of bone with fibro-osseous tissue,
• The maxilla is more frequently involved than the mandible.
• The most common radiographic pattern observed was the ground-glass appearance, followed by orange peel, cotton wool, sunray and thumbprint appearance, which leads to a perplex differential diagnosis.REFERENCE
The radiological versatility of fibrous dysplasia An 8-year retrospective radiographic analysis in a north Indian population – Indian Journal of Dentistry - Question 63 of 150
63. Question
What is the minimum time taken for surface epithelialization after gingivectomy for a patient on phenytoin medication?
CorrectANSWER
7-14 daysOTHER OPTIONS
• Other options do not applySYNOPSIS
• Healing after Surgical Gingivectomy
• Initial response
1. Blood clot formation.
2. Underlying tissue is acutely inflamed and necrotic and soon replaced by the granulation tissue –24 hours later- increased CT cells ( mainly angioblasts).
3. Epithelial cells at the margins of the wound start migrating over the granulation tissue. Epithelial activity reaches a peak in 24 to 36 hours. 3 days later – Young fibroblasts are seen.
4. Highly vascular granulation tissue grows coronally creating a free gingival margin and sulcus
– After 2 weeks – Capillaries from vessels of periodontal ligament migrate into connective tissue and connect with gingival margins
– After 5 to 14 days, surface epithelialization is generally complete.
– Complete repair takes about 1 month.
– Connective tissue repair in 7 weeks and the pigmentation is diminished.REFERENCE
GINGIVECTOMY – R Sumukh BharadwajIncorrectANSWER
7-14 daysOTHER OPTIONS
• Other options do not applySYNOPSIS
• Healing after Surgical Gingivectomy
• Initial response
1. Blood clot formation.
2. Underlying tissue is acutely inflamed and necrotic and soon replaced by the granulation tissue –24 hours later- increased CT cells ( mainly angioblasts).
3. Epithelial cells at the margins of the wound start migrating over the granulation tissue. Epithelial activity reaches a peak in 24 to 36 hours. 3 days later – Young fibroblasts are seen.
4. Highly vascular granulation tissue grows coronally creating a free gingival margin and sulcus
– After 2 weeks – Capillaries from vessels of periodontal ligament migrate into connective tissue and connect with gingival margins
– After 5 to 14 days, surface epithelialization is generally complete.
– Complete repair takes about 1 month.
– Connective tissue repair in 7 weeks and the pigmentation is diminished.REFERENCE
GINGIVECTOMY – R Sumukh Bharadwaj - Question 64 of 150
64. Question
Which instrument is used to check suppuration in pockets?
CorrectANSWER
Perio probeOTHER OPTIONS
• Ball burnisher- They are used to smoothen and polish the restoration and to remove scratches present on the amalgam surface after its carving.
• Mouth mirror- is used as supplement to improve access to instrumentation.
• Explorer- used as a diagnostic aid in evaluating condition of teeth especially pits and fissures.SYNOPSIS
• The periodontal probe is a narrow rounded or flat blunt-ended graduated instrument.
• Because of its blunt end it can be inserted into the gingival sulcus without causing trauma.
• The periodontal probe is used to
– Measure periodontal probing depth and check gingival bleeding.
– Determine the degree of gingival inflammation.
– Evaluate furcation lesions.
– Evaluate the extent of tooth mobility.REFERENCE
Textbook of Operative Dentistry- Nisha GargIncorrectANSWER
Perio probeOTHER OPTIONS
• Ball burnisher- They are used to smoothen and polish the restoration and to remove scratches present on the amalgam surface after its carving.
• Mouth mirror- is used as supplement to improve access to instrumentation.
• Explorer- used as a diagnostic aid in evaluating condition of teeth especially pits and fissures.SYNOPSIS
• The periodontal probe is a narrow rounded or flat blunt-ended graduated instrument.
• Because of its blunt end it can be inserted into the gingival sulcus without causing trauma.
• The periodontal probe is used to
– Measure periodontal probing depth and check gingival bleeding.
– Determine the degree of gingival inflammation.
– Evaluate furcation lesions.
– Evaluate the extent of tooth mobility.REFERENCE
Textbook of Operative Dentistry- Nisha Garg - Question 65 of 150
65. Question
A patient presented to the clinic seeking for replacement of missing teeth 24, 25, 14 and 15 with RPD. Examination revealed high smile line. The patient was concerned about the esthetic appearance of the future provided treatment. Which of the following options is the most likely to meet the patients concern?
CorrectANSWER
I bar claspOTHER OPTIONS
• Twin flex clasp- This consists of a wire clasp soldered into a channel that is cast in the major connector. This clasp is flexible it does not generate as much as torque when the distal extension is depressed. The ability to adjust this clasp and its conventional path of insertion provides an excellent design option for retention to an adjacent edentulous segment.
• Casted Akers clasp- These clasps embrace more than half of the abutment tooth. They may show a continuous or a limited three-point contact with the tooth.
• Wrought wire clasp- They are more flexible and kinder to the abutment tooth.SYNOPSIS
• It is a modified I type roach clasp introduced by Kratochvil.
• It has a mesial rest arising from a major connector an I-bar retentive arm and a long proximal plate.
• It is designed to reduce tooth contact.
• Krol in 1973 modified kratochvils I-bar system and introduced the RPI and RPA systems.
• The rest is on the proximal side away from the edentulous space.I-bar retainer is used instead of a occlusally approaching retainer for direct retention.REFERENCE
Textbook of Prosthodontics-Deepak NallaswamyIncorrectANSWER
I bar claspOTHER OPTIONS
• Twin flex clasp- This consists of a wire clasp soldered into a channel that is cast in the major connector. This clasp is flexible it does not generate as much as torque when the distal extension is depressed. The ability to adjust this clasp and its conventional path of insertion provides an excellent design option for retention to an adjacent edentulous segment.
• Casted Akers clasp- These clasps embrace more than half of the abutment tooth. They may show a continuous or a limited three-point contact with the tooth.
• Wrought wire clasp- They are more flexible and kinder to the abutment tooth.SYNOPSIS
• It is a modified I type roach clasp introduced by Kratochvil.
• It has a mesial rest arising from a major connector an I-bar retentive arm and a long proximal plate.
• It is designed to reduce tooth contact.
• Krol in 1973 modified kratochvils I-bar system and introduced the RPI and RPA systems.
• The rest is on the proximal side away from the edentulous space.I-bar retainer is used instead of a occlusally approaching retainer for direct retention.REFERENCE
Textbook of Prosthodontics-Deepak Nallaswamy - Question 66 of 150
66. Question
What will be the complications if a hyperthyroidism patient has given local anesthesia with adrenaline?
CorrectANSWER
ThyrotoxicosisOTHER OPTIONS
• NilSYNOPSIS
• Hyperthyroidism results from abnormally high production of thyroid hormones.
• Hyperthyroid patients are often anxious with warm and sweaty hands and an occasional tremor. They also may have increased blood pressure and heart rate.
• Thyroid diseases have a high probability of inducing cardiovascular disease owing to the direct action of thyroid hormones on the myocardium .
• Angina can be worsened by thyrotoxicosis.
• Epinephrine and other vasoconstrictors in local anesthetic drugs cause cardiovascular stimulation and hyperthyroid patients can develop dysrhythmias tachycardia and thyrotoxic crisis when administered these drugs.
• Therefore if local anesthesia is required minimal doses of epinephrine should be administered with aspiration prior to injectionREFERENCE
Management of hyperthyroid patients in dental emergencies a case report- Kyung-Jin LeeIncorrectANSWER
ThyrotoxicosisOTHER OPTIONS
• NilSYNOPSIS
• Hyperthyroidism results from abnormally high production of thyroid hormones.
• Hyperthyroid patients are often anxious with warm and sweaty hands and an occasional tremor. They also may have increased blood pressure and heart rate.
• Thyroid diseases have a high probability of inducing cardiovascular disease owing to the direct action of thyroid hormones on the myocardium .
• Angina can be worsened by thyrotoxicosis.
• Epinephrine and other vasoconstrictors in local anesthetic drugs cause cardiovascular stimulation and hyperthyroid patients can develop dysrhythmias tachycardia and thyrotoxic crisis when administered these drugs.
• Therefore if local anesthesia is required minimal doses of epinephrine should be administered with aspiration prior to injectionREFERENCE
Management of hyperthyroid patients in dental emergencies a case report- Kyung-Jin Lee - Question 67 of 150
67. Question
A 20 years old boy presented with increased overjet with crowding. How to camouflage?
CorrectANSWER
Extraction of upper and lower first premolarsOTHER OPTIONS
• NilSYNOPSIS
• The classical features of class II, div 1 malocclusion include a mild to severe class II skeletal base with an Angles class II molar relation and class II canine and incisor relations, proclined maxillary incisors and an increased overjet and it generally has convex profile with incompetent lips.
• Its management frequently involves the use of a myofunctional appliance in growing patients, but in the nongrowing, adult patients, it usually includes an orthognathic surgery or selective removal of the permanent teeth, with a subsequent dental camouflage to mask the skeletal discrepancy.
• For the correction of the class II malocclusions in non-growing patients, the extractions can involve 2 maxillary premolars or 2 maxillary and 2 mandibular premolars
• The extraction of only 2 maxillary premolars is generally indicated when there is no crowding or cephalometric discrepancy in the mandibular arch.
• The extraction of 4 premolars is indicated primarily for crowding in the mandibular arch, a cephalometric discrepancy, or a combination of both, in growing patients.
• Recent studies have shown that patient satisfaction with a camouflage treatment is similar to that which is achieved with a surgical mandibular advancement and that the treatment with two maxillary premolar extractions gives a better occlusal result than the treatment with four premolar extractionsREFERENCE
Orthodontic Camouflage Treatment in an Adult Patient with a Class II, Division 1 Malocclusion – A Case Report -Journal of Clinical and Diagnostic ResearchIncorrectANSWER
Extraction of upper and lower first premolarsOTHER OPTIONS
• NilSYNOPSIS
• The classical features of class II, div 1 malocclusion include a mild to severe class II skeletal base with an Angles class II molar relation and class II canine and incisor relations, proclined maxillary incisors and an increased overjet and it generally has convex profile with incompetent lips.
• Its management frequently involves the use of a myofunctional appliance in growing patients, but in the nongrowing, adult patients, it usually includes an orthognathic surgery or selective removal of the permanent teeth, with a subsequent dental camouflage to mask the skeletal discrepancy.
• For the correction of the class II malocclusions in non-growing patients, the extractions can involve 2 maxillary premolars or 2 maxillary and 2 mandibular premolars
• The extraction of only 2 maxillary premolars is generally indicated when there is no crowding or cephalometric discrepancy in the mandibular arch.
• The extraction of 4 premolars is indicated primarily for crowding in the mandibular arch, a cephalometric discrepancy, or a combination of both, in growing patients.
• Recent studies have shown that patient satisfaction with a camouflage treatment is similar to that which is achieved with a surgical mandibular advancement and that the treatment with two maxillary premolar extractions gives a better occlusal result than the treatment with four premolar extractionsREFERENCE
Orthodontic Camouflage Treatment in an Adult Patient with a Class II, Division 1 Malocclusion – A Case Report -Journal of Clinical and Diagnostic Research - Question 68 of 150
68. Question
Laboratory remounting of denture is for?
CorrectANSWER
Correcting processing errorsOTHER OPTIONS
• NilSYNOPSIS
• Errors in occlusion can be corrected by clinical remounting and laboratory remounting.
• Processing errors can be eliminated by laboratory remounting.
• It is a procedure by which the processed dentures are mounted on the articulator to correct occlusal errors resulting from denture processing.REFERENCE
Textbook of Prosthodontics NallaswamyIncorrectANSWER
Correcting processing errorsOTHER OPTIONS
• NilSYNOPSIS
• Errors in occlusion can be corrected by clinical remounting and laboratory remounting.
• Processing errors can be eliminated by laboratory remounting.
• It is a procedure by which the processed dentures are mounted on the articulator to correct occlusal errors resulting from denture processing.REFERENCE
Textbook of Prosthodontics Nallaswamy - Question 69 of 150
69. Question
A patient presents with limited mouth opening and deviation to the right side when the mouth opens. On examination, there is no clicking, crepitus, or any other abnormalities. Identify the diagnosis?
CorrectANSWER
Disc displacement without reductionOTHER OPTIONS
• Anterior and Posterior Disc derangement – Temperomandibular joint displacement, also known as internal disc derangement, is an abnormal relationship between the articular disc, the mandibular condyle, and the mandibular fossa The most frequent displacement of the disc is anterior to the mandibular condyle, however, in rare cases, it can be posteriorly. The prognosis for these conditions is good and normally recover with minimal intervention or conservative management
• Disc displacement with reduction – The articular disc displaces anteriorly to the condylar head, when the mouth is opened the disc relocates on the condylar head.
– Hearing and palpating joint noises during opening and closing
– Protrusive opening and closings stops the reciprocal click
– There is unlikely to be any restriction in ROM due to the disc relocating when the mouth opensSYNOPSIS
• Disc displacement without reduction (DDwoR) with a limited opening – the articular disc displaces but does not reduce.
– TMJ pain
– Limited jaw range of movement
– No clicking or popping sound
• Interventions can range from conservative management to surgical intervention. Although primary management for disc displacement should always be conservative.
• Conservative management (primarily physiotherapy)
– Education and self-management8
– Splinting
– Therapeutic exercise
– Joint mobilisation of the TMJ
– Active jaw exercises and strengthening
– Cognitive behavioral therapy
– NSAIDs and analgesia
• Surgical intervention
– Arthrocentesis
– Arthroscopy
– Open joint interventionREFERENCE
TMJ Disc Displacements – Journal of Oral and Maxillofacial SurgeryIncorrectANSWER
Disc displacement without reductionOTHER OPTIONS
• Anterior and Posterior Disc derangement – Temperomandibular joint displacement, also known as internal disc derangement, is an abnormal relationship between the articular disc, the mandibular condyle, and the mandibular fossa The most frequent displacement of the disc is anterior to the mandibular condyle, however, in rare cases, it can be posteriorly. The prognosis for these conditions is good and normally recover with minimal intervention or conservative management
• Disc displacement with reduction – The articular disc displaces anteriorly to the condylar head, when the mouth is opened the disc relocates on the condylar head.
– Hearing and palpating joint noises during opening and closing
– Protrusive opening and closings stops the reciprocal click
– There is unlikely to be any restriction in ROM due to the disc relocating when the mouth opensSYNOPSIS
• Disc displacement without reduction (DDwoR) with a limited opening – the articular disc displaces but does not reduce.
– TMJ pain
– Limited jaw range of movement
– No clicking or popping sound
• Interventions can range from conservative management to surgical intervention. Although primary management for disc displacement should always be conservative.
• Conservative management (primarily physiotherapy)
– Education and self-management8
– Splinting
– Therapeutic exercise
– Joint mobilisation of the TMJ
– Active jaw exercises and strengthening
– Cognitive behavioral therapy
– NSAIDs and analgesia
• Surgical intervention
– Arthrocentesis
– Arthroscopy
– Open joint interventionREFERENCE
TMJ Disc Displacements – Journal of Oral and Maxillofacial Surgery - Question 70 of 150
70. Question
What is the use of chin cup?
CorrectANSWER
Reduces the ramus heightOTHER OPTIONS
• NilSYNOPSIS
• Chin cup is an extra oral appliance (outside of the mouth) that is used to help reduce or correct mandibular prognathism in adolescents.
• A chin cup is attached to elastic bands that usually fit over the crown of the head and put a moderate force on the lower jaw to help restrict its growth.
• The use of a chin cup significantly improved the mandibular and maxillary relationship, but with only minor skeletal effects.
•The use of a chin cup significantly reduced the ramus height and increased the anterior facial height, mandibular plane angle, and retroclination of the mandibular incisors.REFERENCE
Orthodontics- The Art and Science by Dr. S.I. BhalajhiIncorrectANSWER
Reduces the ramus heightOTHER OPTIONS
• NilSYNOPSIS
• Chin cup is an extra oral appliance (outside of the mouth) that is used to help reduce or correct mandibular prognathism in adolescents.
• A chin cup is attached to elastic bands that usually fit over the crown of the head and put a moderate force on the lower jaw to help restrict its growth.
• The use of a chin cup significantly improved the mandibular and maxillary relationship, but with only minor skeletal effects.
•The use of a chin cup significantly reduced the ramus height and increased the anterior facial height, mandibular plane angle, and retroclination of the mandibular incisors.REFERENCE
Orthodontics- The Art and Science by Dr. S.I. Bhalajhi - Question 71 of 150
71. Question
You were presented with a case of periodontitis in relation to tooth 47. On radiographic examination, it shows a distal infrabony pocket in relation to the same tooth. Which incision is given for the treatment?
CorrectANSWER
Intra sulcularOTHER OPTIONS
• Vestibular- incision is made at least 3-5 mm above the mucogingival junction.
• Semilunar- made parallel to the free gingival margin of the facial tissue, and coronally positioning this tissue over the denuded root.
• Submarginal- A horizontal incision is made in the attached gingival tissue about 3–4 mm above the gingival margin, with two vertical releasing incisions on either side of the flap located one or two teeth distal to where the lesion is located.SYNOPSIS
• The most common intrasulcular flap involves a triangular incision with a single vertical releasing incision located distal and one or two teeth distal to the lesion.
• This flap is characterized by increased tension, the traction forces increasing especially at the fixed extremity.
• This flap may help to access the infrabony pockets.REFERENCE
Flap design. New perspectives in periapical surgery- Penarrocha DiagoIncorrectANSWER
Intra sulcularOTHER OPTIONS
• Vestibular- incision is made at least 3-5 mm above the mucogingival junction.
• Semilunar- made parallel to the free gingival margin of the facial tissue, and coronally positioning this tissue over the denuded root.
• Submarginal- A horizontal incision is made in the attached gingival tissue about 3–4 mm above the gingival margin, with two vertical releasing incisions on either side of the flap located one or two teeth distal to where the lesion is located.SYNOPSIS
• The most common intrasulcular flap involves a triangular incision with a single vertical releasing incision located distal and one or two teeth distal to the lesion.
• This flap is characterized by increased tension, the traction forces increasing especially at the fixed extremity.
• This flap may help to access the infrabony pockets.REFERENCE
Flap design. New perspectives in periapical surgery- Penarrocha Diago - Question 72 of 150
72. Question
Which of the following tests is used to determine the germicidal value of a given disinfectant?
CorrectANSWER
Rideal walker testOTHER OPTIONS
• NilSYNOPSIS
• Phenol compounds at a concentration of 2-5percent are generally considered bactericidal, tuberculocidal, fungicidal and virucidal against lipophilic viruses.Phenol Coefficient is determined by two methods-
1. Rideal Walker test
2. Chick-Martin Test
• Rideal Walker test
– Organism- Salmonella typhi suspension, Temp- 20°C,
– Subcultures are performed from both the test and phenol at intervals of 2.5, 5, 7.5 and 10 minutes.
– The plates are incubated for 48-72 hours at 37°C and observed Growth or no growth.
– R.W phenol coefficient– That dilution of disinfectant which disinfects the suspension in a given time is divided by that dilution of phenol which disinfects the suspension in same time.
• Disadvantages of the Rideal-Walker test-
1- No organic matter is included ( to test efficacy in the presence of organic matter, Chick Martin test is done)
2- Microorganism Salmonella typhi may not be appropriate.
3- The time allowed for disinfection is short.
4- Used to evaluate phenolic type disinfectants only.REFERENCE
Rideal Walker Test and Chick-Martin Test- Phenol Coefficient Test – pharmacopediaIncorrectANSWER
Rideal walker testOTHER OPTIONS
• NilSYNOPSIS
• Phenol compounds at a concentration of 2-5percent are generally considered bactericidal, tuberculocidal, fungicidal and virucidal against lipophilic viruses.Phenol Coefficient is determined by two methods-
1. Rideal Walker test
2. Chick-Martin Test
• Rideal Walker test
– Organism- Salmonella typhi suspension, Temp- 20°C,
– Subcultures are performed from both the test and phenol at intervals of 2.5, 5, 7.5 and 10 minutes.
– The plates are incubated for 48-72 hours at 37°C and observed Growth or no growth.
– R.W phenol coefficient– That dilution of disinfectant which disinfects the suspension in a given time is divided by that dilution of phenol which disinfects the suspension in same time.
• Disadvantages of the Rideal-Walker test-
1- No organic matter is included ( to test efficacy in the presence of organic matter, Chick Martin test is done)
2- Microorganism Salmonella typhi may not be appropriate.
3- The time allowed for disinfection is short.
4- Used to evaluate phenolic type disinfectants only.REFERENCE
Rideal Walker Test and Chick-Martin Test- Phenol Coefficient Test – pharmacopedia - Question 73 of 150
73. Question
Which cement is less irritating to the pulp?
CorrectANSWER
Zinc polycarboxylateOTHER OPTIONS
• Zinc phosphate- Zinc phosphate cement can cause severe pulpal damage
because of its acidic nature.
• Resin – If the resin cement are appropriately applied, they are expected to be well tolerated by the human pulp..SYNOPSIS
• In dental applications, both GIC and Zinc Polycarboxylate cement provide direct adhesion to the tooth and can provide fluoride release, but the latter is more radioopaque and biocompatible than GIC
• Polycarboxylate cement has less strength, different flow properties and a shorter working time, but excellent biocompatibility.
• Polycarboxylate cement is an alternative where pulp reactions are expected to occur and the load on the restoration during mastication is limited.REFERENCE
Luting Cements Review and comparisons – International Dental JournalIncorrectANSWER
Zinc polycarboxylateOTHER OPTIONS
• Zinc phosphate- Zinc phosphate cement can cause severe pulpal damage
because of its acidic nature.
• Resin – If the resin cement are appropriately applied, they are expected to be well tolerated by the human pulp..SYNOPSIS
• In dental applications, both GIC and Zinc Polycarboxylate cement provide direct adhesion to the tooth and can provide fluoride release, but the latter is more radioopaque and biocompatible than GIC
• Polycarboxylate cement has less strength, different flow properties and a shorter working time, but excellent biocompatibility.
• Polycarboxylate cement is an alternative where pulp reactions are expected to occur and the load on the restoration during mastication is limited.REFERENCE
Luting Cements Review and comparisons – International Dental Journal - Question 74 of 150
74. Question
What is the best base used under composite restoration?
CorrectANSWER
Glass Ionomer cementOTHER OPTIONS
• Ca(OH)2 – Studies have shown that Ca(OH)2 softens under resin-based composite restorations
• Zinc Phosphate – Irritant to pulp
• Zinc oxide Eugenol – Eugenol inhibits the polymerization of the resinSYNOPSIS
• GIC is found to be the best base that can be used under a composite restoration
• The use of GIC in association with composite materials has been called sandwich restoration
• Glass-ionomer cement can react with dentin and enamel tooth surface reducing the marginal gap along the restorations.
• Thus it has been proposed to improve the marginal seal and marginal adaptation of composite resin and bonding agents.REFERENCE
Glass-Ionomer Cements as Base for Composite Restorations – Bioceramics and the Human bodyIncorrectANSWER
Glass Ionomer cementOTHER OPTIONS
• Ca(OH)2 – Studies have shown that Ca(OH)2 softens under resin-based composite restorations
• Zinc Phosphate – Irritant to pulp
• Zinc oxide Eugenol – Eugenol inhibits the polymerization of the resinSYNOPSIS
• GIC is found to be the best base that can be used under a composite restoration
• The use of GIC in association with composite materials has been called sandwich restoration
• Glass-ionomer cement can react with dentin and enamel tooth surface reducing the marginal gap along the restorations.
• Thus it has been proposed to improve the marginal seal and marginal adaptation of composite resin and bonding agents.REFERENCE
Glass-Ionomer Cements as Base for Composite Restorations – Bioceramics and the Human body - Question 75 of 150
75. Question
Which of the following is a tissue bonded maxillary expander?
CorrectANSWER
HassOTHER OPTIONS
• Hyrax (hygienic appliance) – does not cause irritation of tissues due to the absence of palatal acrylic
• Issacson expander – It is a tooth borne appliance without any palatal covering.
• Quad helix – attached to the molars by 2 bands and has two or four active helix springsSYNOPSIS
• Tissue supported expanders allow the forces to be applied directly to the tissues of palatal mucosa instead of teeth.
• The most common type is known as the Haas Appliance
• It has palatal acrylic that is in contact with palatal mucosa.
• Inside the acrylic there is a jackscrew embedded, to expand the device.
• Support wires also extend from the premolars and molars to add additional rigidity to the appliance.
• One of the disadvantages of this type of appliance is it leading to irritation of palatal mucosa.REFERENCE
Timms, Donald J. (1986-07-01). Rapid Maxillary Expansion. Chicago- Quintessence Publishing Co., Inc. IIncorrectANSWER
HassOTHER OPTIONS
• Hyrax (hygienic appliance) – does not cause irritation of tissues due to the absence of palatal acrylic
• Issacson expander – It is a tooth borne appliance without any palatal covering.
• Quad helix – attached to the molars by 2 bands and has two or four active helix springsSYNOPSIS
• Tissue supported expanders allow the forces to be applied directly to the tissues of palatal mucosa instead of teeth.
• The most common type is known as the Haas Appliance
• It has palatal acrylic that is in contact with palatal mucosa.
• Inside the acrylic there is a jackscrew embedded, to expand the device.
• Support wires also extend from the premolars and molars to add additional rigidity to the appliance.
• One of the disadvantages of this type of appliance is it leading to irritation of palatal mucosa.REFERENCE
Timms, Donald J. (1986-07-01). Rapid Maxillary Expansion. Chicago- Quintessence Publishing Co., Inc. I - Question 76 of 150
76. Question
Which is the drug of choice for multiple sclerosis?
CorrectANSWER
PrednisoloneOTHER OPTIONS
• Other options do not applySYNOPSIS
• Multiple Sclerosis is characterized by relapses separated by periods of relative quiescence.
• High dose intravenous corticosteroid pulses for 3 – 5 days is the current standard for the treatment of acute relapses.
• High dose (1,250 mg) oral prednisone is an acceptable therapy to MS patients for the treatment of acute relapses with a high rate of compliance.REFERENCE
MS patients report excellent compliance with oral prednisone for acute relapses
Sarah A Morrow, Lynn McEwan, Katayoun Alikhani, Christopher HysonIncorrectANSWER
PrednisoloneOTHER OPTIONS
• Other options do not applySYNOPSIS
• Multiple Sclerosis is characterized by relapses separated by periods of relative quiescence.
• High dose intravenous corticosteroid pulses for 3 – 5 days is the current standard for the treatment of acute relapses.
• High dose (1,250 mg) oral prednisone is an acceptable therapy to MS patients for the treatment of acute relapses with a high rate of compliance.REFERENCE
MS patients report excellent compliance with oral prednisone for acute relapses
Sarah A Morrow, Lynn McEwan, Katayoun Alikhani, Christopher Hyson - Question 77 of 150
77. Question
While extracting a primary tooth clinician accidentally removes permanent tooth bud. What is the management?
CorrectANSWER
Place it back gentlyOTHER OPTIONS
• Explained belowSYNOPSIS
• Step one of replacing a tooth bud or immature tooth is the separation of it from the primary tooth.
• Do this gently and try to avoid touching the tooth bud and immature tooth as much as possible, especially avoid touching the apical portion.
• Once you have only the tooth bud remaining place it back into the socket.
• The position is not critical as it will likely develop and erupt just as one does in an auto-transplantation case or surgical extrusion technique case.
• However, there is definitely a right position for the tooth bud.
• You should try to put it back exactly where it came from. The piece should fit together like a piece of a puzzle.REFERENCE
Accidental tooth bud extraction. What to do for an accidental tooth bud extraction during primary tooth removal? By Bryan BauerIncorrectANSWER
Place it back gentlyOTHER OPTIONS
• Explained belowSYNOPSIS
• Step one of replacing a tooth bud or immature tooth is the separation of it from the primary tooth.
• Do this gently and try to avoid touching the tooth bud and immature tooth as much as possible, especially avoid touching the apical portion.
• Once you have only the tooth bud remaining place it back into the socket.
• The position is not critical as it will likely develop and erupt just as one does in an auto-transplantation case or surgical extrusion technique case.
• However, there is definitely a right position for the tooth bud.
• You should try to put it back exactly where it came from. The piece should fit together like a piece of a puzzle.REFERENCE
Accidental tooth bud extraction. What to do for an accidental tooth bud extraction during primary tooth removal? By Bryan Bauer - Question 78 of 150
78. Question
Which is the best material for making an impression on patients who had radiotherapy in recent days?
CorrectANSWER
AlginateOTHER OPTIONS
• Mentioned belowSYNOPSIS
• The key of success in the construction of a dental prosthesis in irradiated patients is to ensure that there is minimal trauma to the mucosa and this can be obtained with the right impression technique and a balanced occlusion and articulation in the completed denture.
• Devlin and Barker advocated the application of 1percenthydrocortisone preparation and soluble paracetamol analgesia over the inflamed mucosal tissue before impression making.
• A two-stage impression technique with the use of special tray was recommended to ensure accuracy and maximum extension of the denture base.
• Zinc oxide and plaster impression material should be avoided as they may irritate or traumatise the atrophic mucosa.
• Zincoxide-eugenol compounds may cause a burning sensation and aggravate ulceration in the already inflamed mucosa.
• Light-body rubber base or reversible hydrocolloid (alginate) can be diluted to 1.5 times its normal impression consistency, as they are usually better-tolerated than materials with greater viscosityREFERENCE
Managing Complications of Radiation Therapy in Head and Neck Cancer Patients- Part III. Provision of Dentures – Faculty of Dentistry, Universiti Kebangsaan MalaysiaIncorrectANSWER
AlginateOTHER OPTIONS
• Mentioned belowSYNOPSIS
• The key of success in the construction of a dental prosthesis in irradiated patients is to ensure that there is minimal trauma to the mucosa and this can be obtained with the right impression technique and a balanced occlusion and articulation in the completed denture.
• Devlin and Barker advocated the application of 1percenthydrocortisone preparation and soluble paracetamol analgesia over the inflamed mucosal tissue before impression making.
• A two-stage impression technique with the use of special tray was recommended to ensure accuracy and maximum extension of the denture base.
• Zinc oxide and plaster impression material should be avoided as they may irritate or traumatise the atrophic mucosa.
• Zincoxide-eugenol compounds may cause a burning sensation and aggravate ulceration in the already inflamed mucosa.
• Light-body rubber base or reversible hydrocolloid (alginate) can be diluted to 1.5 times its normal impression consistency, as they are usually better-tolerated than materials with greater viscosityREFERENCE
Managing Complications of Radiation Therapy in Head and Neck Cancer Patients- Part III. Provision of Dentures – Faculty of Dentistry, Universiti Kebangsaan Malaysia - Question 79 of 150
79. Question
In a cerebrovascular accident, all of the following should be done except?
CorrectANSWER
Continue with the procedureOTHER OPTIONS
• Mentioned belowSYNOPSIS
• In a cerebrovascular accident, all of the following should be done except continue with the procedure.
– Monitor vital signs
– Basic life support should be administered
– Arrange a medical referral
• If the patient is conscious, he or she should be placed in an upright position and reassured.REFERENCE
Medical Emergencies – MalamedIncorrectANSWER
Continue with the procedureOTHER OPTIONS
• Mentioned belowSYNOPSIS
• In a cerebrovascular accident, all of the following should be done except continue with the procedure.
– Monitor vital signs
– Basic life support should be administered
– Arrange a medical referral
• If the patient is conscious, he or she should be placed in an upright position and reassured.REFERENCE
Medical Emergencies – Malamed - Question 80 of 150
80. Question
What precaution would be taken for a patient who has an infectious medical condition?
CorrectANSWER
StandardOTHER OPTIONS
• Not applicableSYNOPSIS
• The standard precaution is also the universal precaution.
• It is the precaution that treats all patients like they are infectious.
• This should be used with all patients.REFERENCE
Infection Control – CDCIncorrectANSWER
StandardOTHER OPTIONS
• Not applicableSYNOPSIS
• The standard precaution is also the universal precaution.
• It is the precaution that treats all patients like they are infectious.
• This should be used with all patients.REFERENCE
Infection Control – CDC - Question 81 of 150
81. Question
When a patient becomes agitated and starts overbreathing, he or she is experiencing?
CorrectANSWER
HyperventilationOTHER OPTIONS
• Not applicableSYNOPSIS
• When a patient becomes agitated and starts over-breathing, he or she is experiencing hyperventilation.
• Anxiety is a common symptom of hyperventilation.
• It is important to reassure the patient and help her return to normal breathing.
• Advise patient to try to control breathing or to belly-breathe first.
• If these techniques don’t work and the patient doesn’t have other health problems, you might advise breathing in and out of a paper bag.
• Take 6 to 12 easy, natural breaths, with a small paper bag held over the mouth and nose. Then remove the bag from the nose and mouth, and take easy, natural breaths.
• Next, try belly breathing.
• Switch between these techniques until hyperventilation stops.REFERENCE
Medical Emergencies – MalamedIncorrectANSWER
HyperventilationOTHER OPTIONS
• Not applicableSYNOPSIS
• When a patient becomes agitated and starts over-breathing, he or she is experiencing hyperventilation.
• Anxiety is a common symptom of hyperventilation.
• It is important to reassure the patient and help her return to normal breathing.
• Advise patient to try to control breathing or to belly-breathe first.
• If these techniques don’t work and the patient doesn’t have other health problems, you might advise breathing in and out of a paper bag.
• Take 6 to 12 easy, natural breaths, with a small paper bag held over the mouth and nose. Then remove the bag from the nose and mouth, and take easy, natural breaths.
• Next, try belly breathing.
• Switch between these techniques until hyperventilation stops.REFERENCE
Medical Emergencies – Malamed - Question 82 of 150
82. Question
A sign of vasodilation is?
CorrectANSWER
Red skinOTHER OPTIONS
• Not applicableSYNOPSIS
• A sign of vasodilation is red skin.
• As the blood vessels open, they allow more flow to an area.
• This effect causes the skin to become red. .
• An example of vasodilation is blushingREFERENCE
Assisting in a Medical Emergency – WilkinsIncorrectANSWER
Red skinOTHER OPTIONS
• Not applicableSYNOPSIS
• A sign of vasodilation is red skin.
• As the blood vessels open, they allow more flow to an area.
• This effect causes the skin to become red. .
• An example of vasodilation is blushingREFERENCE
Assisting in a Medical Emergency – Wilkins - Question 83 of 150
83. Question
During a scheduled appointment for an extraction, a diabetic patient appears weak and begins to tremble and perspire Which diagnostic test will NOT be performed?
CorrectANSWER
Bleeding IndexOTHER OPTIONS
• Mentioned belowSYNOPSIS
• Vital signs are critical indicators of patient status, both at rest and during exercise or activity.
• Vital signs are monitored at the beginning of treatment and needed to be recorded if patient shows signs of collapse in between the procedure
• Early warning signs (these changes need to be reported immediately)
– Temperature higher than 100.4 F or lower than 96.8 F
– Heart rate greater than 90 beats per minute
– Respirations greater than 20 breaths per minute
– Significant blood pressure changes
• Bleeding index is not a vial signREFERENCE
Vital Signs Medical Emergencies – MalamedIncorrectANSWER
Bleeding IndexOTHER OPTIONS
• Mentioned belowSYNOPSIS
• Vital signs are critical indicators of patient status, both at rest and during exercise or activity.
• Vital signs are monitored at the beginning of treatment and needed to be recorded if patient shows signs of collapse in between the procedure
• Early warning signs (these changes need to be reported immediately)
– Temperature higher than 100.4 F or lower than 96.8 F
– Heart rate greater than 90 beats per minute
– Respirations greater than 20 breaths per minute
– Significant blood pressure changes
• Bleeding index is not a vial signREFERENCE
Vital Signs Medical Emergencies – Malamed - Question 84 of 150
84. Question
A patient presents to the dental office for extraction of his fractured anterior tooth. He reported he is under medication for high blood pressure . The dental assistant recorded the vitals. What should be the patient’s systolic blood pressure reading if he has Stage 2 hypertension?
CorrectANSWER
140- 159OTHER OPTIONS
• Mentioned belowSYNOPSIS
• The American College of Cardiology and American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2017 Guideline)
• 120 – 80 – Normal
• 120 – 129 systolic and 80 diastolic – Elevated
• 130 – 139 systolic and 80-89 diastolic – Hypertension Stage 1
• 140 – 90 or higher Stage 2
• 180 – 120 Hypertensive crisisREFERENCE
MODERN DA 12th Edition Chapter 27 Vital Signs Page No 1171 – 1208IncorrectANSWER
140- 159OTHER OPTIONS
• Mentioned belowSYNOPSIS
• The American College of Cardiology and American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2017 Guideline)
• 120 – 80 – Normal
• 120 – 129 systolic and 80 diastolic – Elevated
• 130 – 139 systolic and 80-89 diastolic – Hypertension Stage 1
• 140 – 90 or higher Stage 2
• 180 – 120 Hypertensive crisisREFERENCE
MODERN DA 12th Edition Chapter 27 Vital Signs Page No 1171 – 1208 - Question 85 of 150
85. Question
Which of the following is not a potential benefit of fluoride?
CorrectANSWER
It can reduce the risk of oral cancerOTHER OPTIONS
• Not applicableSYNOPSIS
• There is no evidence that fluoride can reduce cancer risk.
• It can reduce the risk of heart disease, as there is a link between the bacteria that cause gum disease and heart disease.
• By keeping the mouth healthy, fluoride lowers the risk of gum and heart disease.
• It also lowers dental costs by reducing the need for restorative work and other interventions.REFERENCE
Oral Health and Preventive TechniquesIncorrectANSWER
It can reduce the risk of oral cancerOTHER OPTIONS
• Not applicableSYNOPSIS
• There is no evidence that fluoride can reduce cancer risk.
• It can reduce the risk of heart disease, as there is a link between the bacteria that cause gum disease and heart disease.
• By keeping the mouth healthy, fluoride lowers the risk of gum and heart disease.
• It also lowers dental costs by reducing the need for restorative work and other interventions.REFERENCE
Oral Health and Preventive Techniques - Question 86 of 150
86. Question
Which of the following is true of the fluoride in swallowed toothpaste?
CorrectANSWER
It is nearly 100 percent absorbed in the stomachOTHER OPTIONS
• Not applicableSYNOPSIS
• It is nearly 100 percent absorbed in the stomach.
• The fluoride in toothpaste has nearly 100 percent bioavailability when swallowed.
• This is especially true for NaF and SnF toothpastes.REFERENCE
Oral Health and Preventive TechniquesIncorrectANSWER
It is nearly 100 percent absorbed in the stomachOTHER OPTIONS
• Not applicableSYNOPSIS
• It is nearly 100 percent absorbed in the stomach.
• The fluoride in toothpaste has nearly 100 percent bioavailability when swallowed.
• This is especially true for NaF and SnF toothpastes.REFERENCE
Oral Health and Preventive Techniques - Question 87 of 150
87. Question
What is the major role of vasoconstrictor in LA?
CorrectANSWER
Reduce LA toxicityOTHER OPTIONS
• NilSYNOPSIS
• Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects.
– A decrease in the peak plasma concentration of the local anesthetic agent thereby reducing toxicity.
– Increase in the duration and the quality of anesthesia.
– Reduction of the minimum concentration of anesthetic needed for nerve block.
– Decrease blood loss during surgical procedures.REFERENCE
Handbook of LA- Stanely F MalamedIncorrectANSWER
Reduce LA toxicityOTHER OPTIONS
• NilSYNOPSIS
• Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects.
– A decrease in the peak plasma concentration of the local anesthetic agent thereby reducing toxicity.
– Increase in the duration and the quality of anesthesia.
– Reduction of the minimum concentration of anesthetic needed for nerve block.
– Decrease blood loss during surgical procedures.REFERENCE
Handbook of LA- Stanely F Malamed - Question 88 of 150
88. Question
Which is the most common cause of failure of overdenture?
CorrectANSWER
Periodontal problemsOTHER OPTIONS
• Explained belowSYNOPSIS
• There are a number of complications that can arise once overdentures are fitted in the mouth. These can range from post-insertion tissue changes to fracture of the prosthesis.
• Damage to Periodontal Tissues
– The most common reason for changes within the periodontal tissues is the lack of adequate oral hygiene.
– Plaque buildup around overdenture abutments or precision attachments can lead to inflammation and hyperplasia of the gingiva.
– This can present as painful, red, and swollen tissues, especially at the gingival margin.
– As a result, the gingival recession may occur leading to exposure of the root surfaces to the oral environment.
– A study that looked at patients wearing overdentures found that the rate of tooth loss was in the order of 20percent and was most commonly due to periodontal disease. Many of these failures could have been prevented with better oral hygiene methods.
• Other reasons for failure are decay, resorption, denture stomatitis, and fractured prosthesis.REFERENCE
WikipediaIncorrectANSWER
Periodontal problemsOTHER OPTIONS
• Explained belowSYNOPSIS
• There are a number of complications that can arise once overdentures are fitted in the mouth. These can range from post-insertion tissue changes to fracture of the prosthesis.
• Damage to Periodontal Tissues
– The most common reason for changes within the periodontal tissues is the lack of adequate oral hygiene.
– Plaque buildup around overdenture abutments or precision attachments can lead to inflammation and hyperplasia of the gingiva.
– This can present as painful, red, and swollen tissues, especially at the gingival margin.
– As a result, the gingival recession may occur leading to exposure of the root surfaces to the oral environment.
– A study that looked at patients wearing overdentures found that the rate of tooth loss was in the order of 20percent and was most commonly due to periodontal disease. Many of these failures could have been prevented with better oral hygiene methods.
• Other reasons for failure are decay, resorption, denture stomatitis, and fractured prosthesis.REFERENCE
Wikipedia - Question 89 of 150
89. Question
Which among the following may be a cause of bad breath?
CorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Bad breath is caused by odor-producing bacteria that grow in the mouth.
• When you don’t brush and floss regularly, bacteria accumulate on the bits of food left in your mouth and between your teeth.
• The sulfur compounds released by these bacteria make your breath smell.
• Many other diseases and illnesses can cause bad breath, including Seasonal allergies, Respiratory tract infections such as pneumonia or bronchitis, Long-term, (chronic) sinus infections, Postnasal drip, Diabetes, Chronic acid reflux.REFERENCE
Dental Health and Bad Breath. By Alfred D. Wyatt.IncorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Bad breath is caused by odor-producing bacteria that grow in the mouth.
• When you don’t brush and floss regularly, bacteria accumulate on the bits of food left in your mouth and between your teeth.
• The sulfur compounds released by these bacteria make your breath smell.
• Many other diseases and illnesses can cause bad breath, including Seasonal allergies, Respiratory tract infections such as pneumonia or bronchitis, Long-term, (chronic) sinus infections, Postnasal drip, Diabetes, Chronic acid reflux.REFERENCE
Dental Health and Bad Breath. By Alfred D. Wyatt. - Question 90 of 150
90. Question
Which is the most cost-effective method for caries prevention?
CorrectANSWER
Community-based programsOTHER OPTIONS
• Other options are not applicableSYNOPSIS
• Community-based Strategies to Prevent Tooth Decay include
– Community Water Fluoridation
– School-based Sealant Programs
• Community-based programs such as community water fluoridation and school-based dental sealant programs are a particularly effective and cost-savings way to help achieve this goal.
• For example, increasing the percentage of children at high risk for tooth decay who participate in school sealant programs to 50 percent would prevent more than half of caries that these children would otherwise have and save public health dollars.REFERENCE
Community-Based Oral Health Programs- University of PacificIncorrectANSWER
Community-based programsOTHER OPTIONS
• Other options are not applicableSYNOPSIS
• Community-based Strategies to Prevent Tooth Decay include
– Community Water Fluoridation
– School-based Sealant Programs
• Community-based programs such as community water fluoridation and school-based dental sealant programs are a particularly effective and cost-savings way to help achieve this goal.
• For example, increasing the percentage of children at high risk for tooth decay who participate in school sealant programs to 50 percent would prevent more than half of caries that these children would otherwise have and save public health dollars.REFERENCE
Community-Based Oral Health Programs- University of Pacific - Question 91 of 150
91. Question
Patient attends to dental clinic complaining of discomfort when he drinks hot or cold drink, especially in cervical area of teeth. Which of the following is the most likely diagnosis?
CorrectANSWER
Dentin hypersensitivityOTHER OPTIONS
• Acute apical periodontitis – Most cases of apical periodontitis are asymptomatic. Pain, tenderness to biting pressure, percussion or palpation as well as swellings are typical clinical expressions of symptomatic apical periodontitis. The symptoms may vary from mild to severe.
• Sclerotic dentin – It is formed either as a reactive process or aging and is seen in the occlusal and apical part, the latter being more common. Stimuli may not only induce the additional formation of reparative dentin but also lead to protective changes in the existing dentinSYNOPSIS
• Dentin hypersensitivity has been defined as the pain arising from exposed dentin, typically in response to chemical, thermal, tactile or osmotic stimuli that cannot be explained as arising from any other form of dental defect or pathology
– The clinical manifestations are
• Sensitivity to temperature variations.
• Unpleasant reactions to hot foods and drinks.
• Pain or discomfort from cold foods and drinks.
• Pain during brushing or flossing.
• Sensitivity to acidic and sweet foods and drinksREFERENCE
Symptoms of Tooth Sensitivity – Pocket dentistryIncorrectANSWER
Dentin hypersensitivityOTHER OPTIONS
• Acute apical periodontitis – Most cases of apical periodontitis are asymptomatic. Pain, tenderness to biting pressure, percussion or palpation as well as swellings are typical clinical expressions of symptomatic apical periodontitis. The symptoms may vary from mild to severe.
• Sclerotic dentin – It is formed either as a reactive process or aging and is seen in the occlusal and apical part, the latter being more common. Stimuli may not only induce the additional formation of reparative dentin but also lead to protective changes in the existing dentinSYNOPSIS
• Dentin hypersensitivity has been defined as the pain arising from exposed dentin, typically in response to chemical, thermal, tactile or osmotic stimuli that cannot be explained as arising from any other form of dental defect or pathology
– The clinical manifestations are
• Sensitivity to temperature variations.
• Unpleasant reactions to hot foods and drinks.
• Pain or discomfort from cold foods and drinks.
• Pain during brushing or flossing.
• Sensitivity to acidic and sweet foods and drinksREFERENCE
Symptoms of Tooth Sensitivity – Pocket dentistry - Question 92 of 150
92. Question
What should be the recommended procedure to be done before placement of the restoration when the margin of the cavity is extended to within 2 mm of the crestal bone ?
CorrectANSWER
Crown lengtheningOTHER OPTIONS
• NilSYNOPSIS
• Crown lengthening is a surgical procedure aimed at removal of periodontal tissue to increase the clinical crown height.
• Its aim is to re-establish the biologic width in a more apical position.
• Its indications include
– Subgingival caries,
– Crown or root fractures,
– Altered passive eruption,
– Cervical root resorption and
– Short clinical abutment.REFERENCE
Textbook of operative dentistry by Nisha Garg.IncorrectANSWER
Crown lengtheningOTHER OPTIONS
• NilSYNOPSIS
• Crown lengthening is a surgical procedure aimed at removal of periodontal tissue to increase the clinical crown height.
• Its aim is to re-establish the biologic width in a more apical position.
• Its indications include
– Subgingival caries,
– Crown or root fractures,
– Altered passive eruption,
– Cervical root resorption and
– Short clinical abutment.REFERENCE
Textbook of operative dentistry by Nisha Garg. - Question 93 of 150
93. Question
Where should the reduction have to be done if patient had premature contact between the mesiobuccal cusp of lower molar with the central fossa of the upper molar ?
CorrectANSWER
Distobuccal cusp of the upper molarOTHER OPTIONS
• NilSYNOPSIS
• If there is an occlusal discrepancy (premature contact), the idea is to maintain the functional cusp height while removing material to re-contour the non-functional cusps.
• According to the BULL rule, modification should be made to the buccal cusps of the upper posterior teeth and the lingual cusps of the lower posterior teeth. BULL stands for buccal upper lower lingual.
• For example, to illustrate the BULL rule, the palatal cusp of a maxillary first molar contacts prematurely in a centric position as well as in the working eccentric position. But the contact is correct in an eccentric or balancing position the solution would be to deepen the central groove or marginal ridge of the opposing mandibular tooth to manage the centric interference and to reshape the mandibular lingual cusp to account for the working interference.REFERENCE
Textbook of Prosthodontics by NallaswamyIncorrectANSWER
Distobuccal cusp of the upper molarOTHER OPTIONS
• NilSYNOPSIS
• If there is an occlusal discrepancy (premature contact), the idea is to maintain the functional cusp height while removing material to re-contour the non-functional cusps.
• According to the BULL rule, modification should be made to the buccal cusps of the upper posterior teeth and the lingual cusps of the lower posterior teeth. BULL stands for buccal upper lower lingual.
• For example, to illustrate the BULL rule, the palatal cusp of a maxillary first molar contacts prematurely in a centric position as well as in the working eccentric position. But the contact is correct in an eccentric or balancing position the solution would be to deepen the central groove or marginal ridge of the opposing mandibular tooth to manage the centric interference and to reshape the mandibular lingual cusp to account for the working interference.REFERENCE
Textbook of Prosthodontics by Nallaswamy - Question 94 of 150
94. Question
A patient came to your clinic with class III caries was present in the upper incisor and access opening was done. What is the most conservative restoration used?
CorrectANSWER
CompositeOTHER OPTIONS
• Not applicableSYNOPSIS
• Advantages of using composite resin to restore defective teeth.
1. They require very little tooth preparation.
– GIC, Amalgam, Crowns, veneers, and other porcelain restorations require removing some healthy tooth structure to accommodate them.
– With the development of stronger bonding materials, composite resins can restore even many large defects in teeth caused by decay or trauma with little structural removal and still remain durable.
2. Most composite resin restorations are single-visit procedures.
3. They have excellent color-matching capabilities.
4. Composite resins can be an effective temporary fix for young injured teethREFERENCE
Composite Restorations – Pocket DentistryIncorrectANSWER
CompositeOTHER OPTIONS
• Not applicableSYNOPSIS
• Advantages of using composite resin to restore defective teeth.
1. They require very little tooth preparation.
– GIC, Amalgam, Crowns, veneers, and other porcelain restorations require removing some healthy tooth structure to accommodate them.
– With the development of stronger bonding materials, composite resins can restore even many large defects in teeth caused by decay or trauma with little structural removal and still remain durable.
2. Most composite resin restorations are single-visit procedures.
3. They have excellent color-matching capabilities.
4. Composite resins can be an effective temporary fix for young injured teethREFERENCE
Composite Restorations – Pocket Dentistry - Question 95 of 150
95. Question
What is the advantage of zinc polycarboxylate cement over zinc phosphate?
CorrectANSWER
BiocompatibilityOTHER OPTIONS
• Not applicableSYNOPSIS
• Polycarboxylate cement demonstrates true adhesion to tooth structure and is biocompatible compared to zinc phosphate.
• The powder is primarily zinc oxide, and the liquid is polyacrylic acid or a copolymer of that acid.
• Although the final pH of the set cement is comparable to that of zinc phosphate cement, its biological properties are excellent.
• For this reason, polycarboxylate cement is useful as a base or as a luting agent, particularly when the cavity preparation is close to the pulp.
• In addition, as the cement sets against the tooth structure, a chemical bond is formed between the cement liquid and the calcium in the hydroxyapatite in enamel and dentin.REFERENCE
Dental Materials- B. Keith MooreIncorrectANSWER
BiocompatibilityOTHER OPTIONS
• Not applicableSYNOPSIS
• Polycarboxylate cement demonstrates true adhesion to tooth structure and is biocompatible compared to zinc phosphate.
• The powder is primarily zinc oxide, and the liquid is polyacrylic acid or a copolymer of that acid.
• Although the final pH of the set cement is comparable to that of zinc phosphate cement, its biological properties are excellent.
• For this reason, polycarboxylate cement is useful as a base or as a luting agent, particularly when the cavity preparation is close to the pulp.
• In addition, as the cement sets against the tooth structure, a chemical bond is formed between the cement liquid and the calcium in the hydroxyapatite in enamel and dentin.REFERENCE
Dental Materials- B. Keith Moore - Question 96 of 150
96. Question
The increase in the post length results in ?
CorrectANSWER
Increased fracture resistanceOTHER OPTIONS
• Not applicableSYNOPSIS
• The fracture resistance of endodontically treated teeth was significantly influenced by the post-material and post length.
• The initial failure load with Fibre post was significantly lower than that of metal posts.
• Post length increased the fracture resistance of the teeth to an extent of two-thirds the root length restored with metal posts and thereafter it decreased.
• Fracture resistance of the teeth proportionately increased with increase in fibre post length.
• Complete core de-bonding was seen with short-length posts.REFERENCE
Effect of Post Material and Length on Fracture Resistance of Endodontically Treated Premolars -An In-Vitro Study -Journal of International Oral HealthIncorrectANSWER
Increased fracture resistanceOTHER OPTIONS
• Not applicableSYNOPSIS
• The fracture resistance of endodontically treated teeth was significantly influenced by the post-material and post length.
• The initial failure load with Fibre post was significantly lower than that of metal posts.
• Post length increased the fracture resistance of the teeth to an extent of two-thirds the root length restored with metal posts and thereafter it decreased.
• Fracture resistance of the teeth proportionately increased with increase in fibre post length.
• Complete core de-bonding was seen with short-length posts.REFERENCE
Effect of Post Material and Length on Fracture Resistance of Endodontically Treated Premolars -An In-Vitro Study -Journal of International Oral Health - Question 97 of 150
97. Question
Which property causes breaking of endodontic files while doing biomechanical preparation?
CorrectANSWER
Flexural fatigueOTHER OPTIONS
• Not applicableSYNOPSIS
• Flexural fatigue arises when an endodontic file rotating in a curved canal without any obstruction experiences repeated cycles of compression and tension at the maximum curved part of the canal.
• This induces stress which finally leads to file fracture in the canal.REFERENCE
Fatigue failure of NiTi Files – A ReviewIncorrectANSWER
Flexural fatigueOTHER OPTIONS
• Not applicableSYNOPSIS
• Flexural fatigue arises when an endodontic file rotating in a curved canal without any obstruction experiences repeated cycles of compression and tension at the maximum curved part of the canal.
• This induces stress which finally leads to file fracture in the canal.REFERENCE
Fatigue failure of NiTi Files – A Review - Question 98 of 150
98. Question
While doing post preperation, the dentist accidently made perforation in palatal canal. What is the management?
CorrectANSWER
MTAOTHER OPTIONS
• NilSYNOPSIS
• Accidental root or pulp chamber perforation is amongst the major complications of endodontic and restorative treatment that results in loss of integrity of root and adjacent periodontium and is considered to be the second greatest cause of endodontic failure.
• Among the various materials used for perforation repair MTA has been applied with good treatment outcomes owing to its properties of
– Biocompatibility
– Low provocation of inflammation
– Good seal even in presence of moisture OR blood and
– A high pH (12.5) which promotes the growth of cementum and regeneration of periodontal ligament.
• MTA is primarily composed of calcium and phosphate ions which are also the main constituents of the dental hard tissues.
• This resemblance in chemical composition to the tooth structure, the ability of MTA to release Ca ions, and its capacity to form hydroxyapatite are stated to be the factors responsible for its sealing ability biocompatibility, and dentinogenic activity.REFERENCE
Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin A clinical report- Rhythm BainsIncorrectANSWER
MTAOTHER OPTIONS
• NilSYNOPSIS
• Accidental root or pulp chamber perforation is amongst the major complications of endodontic and restorative treatment that results in loss of integrity of root and adjacent periodontium and is considered to be the second greatest cause of endodontic failure.
• Among the various materials used for perforation repair MTA has been applied with good treatment outcomes owing to its properties of
– Biocompatibility
– Low provocation of inflammation
– Good seal even in presence of moisture OR blood and
– A high pH (12.5) which promotes the growth of cementum and regeneration of periodontal ligament.
• MTA is primarily composed of calcium and phosphate ions which are also the main constituents of the dental hard tissues.
• This resemblance in chemical composition to the tooth structure, the ability of MTA to release Ca ions, and its capacity to form hydroxyapatite are stated to be the factors responsible for its sealing ability biocompatibility, and dentinogenic activity.REFERENCE
Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin A clinical report- Rhythm Bains - Question 99 of 150
99. Question
What is the distance between the maxillary and mandibular teeth in a normal rest position called?
CorrectANSWER
Freeway spaceOTHER OPTIONS
• Neutral zone – In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature of the tongue are equal and balanced with the forces exerted by the buccinator muscle of the cheek laterally and the orbicularis oris muscle anteriorly.
• Overjet – The horizontal distance between the labial surface of the lower incisor and the upper incisor edge
• Overbite – The vertical distance between the lower incisal edge and upper incisal edgeSYNOPSIS
• The Freeway space, or interocclusal clearance, is described as the space between the maxillary and mandibular occlusal surfaces when the mandible is in the rest position and should be 2–4 mm (British Society for the Study of Prosthetic Dentistry, 1996).REFERENCE
Textbook of prosthodontics – Deepak NallaswamyIncorrectANSWER
Freeway spaceOTHER OPTIONS
• Neutral zone – In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature of the tongue are equal and balanced with the forces exerted by the buccinator muscle of the cheek laterally and the orbicularis oris muscle anteriorly.
• Overjet – The horizontal distance between the labial surface of the lower incisor and the upper incisor edge
• Overbite – The vertical distance between the lower incisal edge and upper incisal edgeSYNOPSIS
• The Freeway space, or interocclusal clearance, is described as the space between the maxillary and mandibular occlusal surfaces when the mandible is in the rest position and should be 2–4 mm (British Society for the Study of Prosthetic Dentistry, 1996).REFERENCE
Textbook of prosthodontics – Deepak Nallaswamy - Question 100 of 150
100. Question
In which type of roots does the patient with orthodontic band shows more resorption ?
CorrectANSWER
Tooth with curved rootOTHER OPTIONS
• Not applicableSYNOPSIS
• The geometrical forms of roots can affect the distribution of the force through the alveolar bone and root.
• The force is more concentrated on localized areas in trigonal sharp apexes than in roots with a normal shape.
• Generally, teeth with root dilacerations are prone to root resorption, particularly in maxillary lateral incisorsREFERENCE
Root Resorption in Orthodontics – Turkish Journal of OrthodonticsIncorrectANSWER
Tooth with curved rootOTHER OPTIONS
• Not applicableSYNOPSIS
• The geometrical forms of roots can affect the distribution of the force through the alveolar bone and root.
• The force is more concentrated on localized areas in trigonal sharp apexes than in roots with a normal shape.
• Generally, teeth with root dilacerations are prone to root resorption, particularly in maxillary lateral incisorsREFERENCE
Root Resorption in Orthodontics – Turkish Journal of Orthodontics - Question 101 of 150
101. Question
Which is the most successful technique for behaviour management used with children?
CorrectANSWER
Tell Show DoOTHER OPTIONS
• Not applicableSYNOPSIS
• Communication between the doctor or staff and the child and parent is vital to successful outcomes in the dental office.
• The Tell-Show-Do technique remains the most commonly used technique in pediatric dentistry and is still considered the technique with which dentists and parents are comfortable and justifies being the method of choice as the backbone of child education and behavior guidance during the first dental visit
• The TELL phase involves an age-appropriate explanation of the procedure.
• The SHOW phase is used to demonstrate a procedure up to the point where the instrument is performed.
• The DO phase is then initiated and the treatment is performed.REFERENCE
International Journal of Pediatric DentistryIncorrectANSWER
Tell Show DoOTHER OPTIONS
• Not applicableSYNOPSIS
• Communication between the doctor or staff and the child and parent is vital to successful outcomes in the dental office.
• The Tell-Show-Do technique remains the most commonly used technique in pediatric dentistry and is still considered the technique with which dentists and parents are comfortable and justifies being the method of choice as the backbone of child education and behavior guidance during the first dental visit
• The TELL phase involves an age-appropriate explanation of the procedure.
• The SHOW phase is used to demonstrate a procedure up to the point where the instrument is performed.
• The DO phase is then initiated and the treatment is performed.REFERENCE
International Journal of Pediatric Dentistry - Question 102 of 150
102. Question
What is the treatment for a child patient with swelling distal to lower second molar suspecting eruption cyst?
CorrectANSWER
No treatmentOTHER OPTIONS
• Not applicableSYNOPSIS
• An eruption cyst is a bluish lump that can appear when a primary (baby) or permanent tooth is in the process of coming in.
• The lump forms when fluid accumulates between the part of the tooth that will first emerge and the special gum tissue around it.
• It happens most frequently with lower molars, although it can happen when any permanent tooth comes in.
• As the AAPD guidelines describe, an eruption cyst typically resolves on its own, and in most cases, the new tooth will emerge easily through the fluid-filled lump.
• If the cyst does not rupture on its own or if it becomes infected, there’s an easy solution. The dentist will administer a local anesthetic, and painlessly make a small cut in the sac to help the tooth erupt.
• Although they may look abnormal, an eruption cyst is usually harmless and can be taken care of by the dentist or oral surgeon.REFERENCE
Eruption Cyst – Journal of Pediatric Dentistry AAPDIncorrectANSWER
No treatmentOTHER OPTIONS
• Not applicableSYNOPSIS
• An eruption cyst is a bluish lump that can appear when a primary (baby) or permanent tooth is in the process of coming in.
• The lump forms when fluid accumulates between the part of the tooth that will first emerge and the special gum tissue around it.
• It happens most frequently with lower molars, although it can happen when any permanent tooth comes in.
• As the AAPD guidelines describe, an eruption cyst typically resolves on its own, and in most cases, the new tooth will emerge easily through the fluid-filled lump.
• If the cyst does not rupture on its own or if it becomes infected, there’s an easy solution. The dentist will administer a local anesthetic, and painlessly make a small cut in the sac to help the tooth erupt.
• Although they may look abnormal, an eruption cyst is usually harmless and can be taken care of by the dentist or oral surgeon.REFERENCE
Eruption Cyst – Journal of Pediatric Dentistry AAPD - Question 103 of 150
103. Question
Which is the principal feature of a sealant that is required for its success?
CorrectANSWER
Adequate retentionOTHER OPTIONS
• High viscosity – Decreases the flow of material thereby less penetration and retention of sealant. Sealant should have a low viscositySYNOPSIS
• Pit and fissure sealant has been considered as a highly effective caries preventive dental treatment.
• The principal feature required for achieving success in caries prevention is adequate retention.
• The success of pit and fissure sealant depends on its long-term retention on the tooth surface.
• The prerequisite for retention is that the enamel surface be modified either with an acid conditioning agent or some other technique such as air abrasionREFERENCE
Evaluation of retention of pit and fissure sealants placed with and without air abrasion pretreatment – Journal of Clinical and Experimental DentistryIncorrectANSWER
Adequate retentionOTHER OPTIONS
• High viscosity – Decreases the flow of material thereby less penetration and retention of sealant. Sealant should have a low viscositySYNOPSIS
• Pit and fissure sealant has been considered as a highly effective caries preventive dental treatment.
• The principal feature required for achieving success in caries prevention is adequate retention.
• The success of pit and fissure sealant depends on its long-term retention on the tooth surface.
• The prerequisite for retention is that the enamel surface be modified either with an acid conditioning agent or some other technique such as air abrasionREFERENCE
Evaluation of retention of pit and fissure sealants placed with and without air abrasion pretreatment – Journal of Clinical and Experimental Dentistry - Question 104 of 150
104. Question
What are the functions of the periodontal ligament?
CorrectANSWER
All the aboveOTHER OPTIONS
• NilSYNOPSIS
• Supportive functions
– Attaches teeth to the bone
– Transmit occlusal forces to the bone
– Maintain gingival tissues in their proper relationship to the teeth
– Shock absorption
– Protect the blood vessels and nerves from injury by mechanical forces
• Sensory functions
– Transmits sensory, Pressure and pain sensations by trigeminal pathways
• Nutitive supply to Cementum, bone and gingiva through blood vessels and lymphatics
• Formative function
– Helps in the formation and resorption of Cementum and boneREFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
All the aboveOTHER OPTIONS
• NilSYNOPSIS
• Supportive functions
– Attaches teeth to the bone
– Transmit occlusal forces to the bone
– Maintain gingival tissues in their proper relationship to the teeth
– Shock absorption
– Protect the blood vessels and nerves from injury by mechanical forces
• Sensory functions
– Transmits sensory, Pressure and pain sensations by trigeminal pathways
• Nutitive supply to Cementum, bone and gingiva through blood vessels and lymphatics
• Formative function
– Helps in the formation and resorption of Cementum and boneREFERENCE
Carranza’s Clinical Periodontology - Question 105 of 150
105. Question
An 18 years old patient presents with complaining of pain, bad breath and bleeding gingiva. On examination the oral hygiene is good. This began over the weekend while studying for the final exam. What would be your diagnosis?
CorrectANSWER
Acute necrotizing ulcerative gingivitis or ANUGOTHER OPTIONS
• Not applicableSYNOPSIS
• Acute necrotizing ulcerative gingivitis (ANUG) occurs most frequently in smokers and patients who are under stress.
• Other risk factors are poor oral hygiene, nutritional deficiencies, immunodeficiency, and sleep deprivation.
• Because of its particular nature (sudden onset of acute pain, ease of diagnosis), NUG is the periodontal disease associated with the most studied psychosocial factors.
• A link was established between NUG and psychogenic factors such as stress, anxiety, and depression in the 1970s.
• These factors predispose to NUG by promoting bacterial growth and decreasing host defenses.
• This decrease would result in increased levels of corticosteroids and catecholamines via ANS.
• This could decrease gingival microcirculation and salivary flux and improve the nutrition of the Prevotella intermedia.
• Concomitantly, these hormones cause the suppression of leucocyte and lymphocyte functions, which subsequently promote bacterial invasion.
• It has also been reported that, compared to the patients in the control group, patients with NUG have a reduction of the following
– Chemotaxis of polymorphonuclear leukocytes and phagocytosis
– The proliferation of lymphocytes during stimulation by a nonspecific mitogen
• A multidisciplinary management (physician, dentist, psychologist) is needed to identify subjects with chronic stress and to put in place countermeasures to decrease the deleterious effect stress has on the periodontiumREFERENCE
Impact of chronic stress on periodontal health – Journal of Oral Medicine And Oral SurgeryIncorrectANSWER
Acute necrotizing ulcerative gingivitis or ANUGOTHER OPTIONS
• Not applicableSYNOPSIS
• Acute necrotizing ulcerative gingivitis (ANUG) occurs most frequently in smokers and patients who are under stress.
• Other risk factors are poor oral hygiene, nutritional deficiencies, immunodeficiency, and sleep deprivation.
• Because of its particular nature (sudden onset of acute pain, ease of diagnosis), NUG is the periodontal disease associated with the most studied psychosocial factors.
• A link was established between NUG and psychogenic factors such as stress, anxiety, and depression in the 1970s.
• These factors predispose to NUG by promoting bacterial growth and decreasing host defenses.
• This decrease would result in increased levels of corticosteroids and catecholamines via ANS.
• This could decrease gingival microcirculation and salivary flux and improve the nutrition of the Prevotella intermedia.
• Concomitantly, these hormones cause the suppression of leucocyte and lymphocyte functions, which subsequently promote bacterial invasion.
• It has also been reported that, compared to the patients in the control group, patients with NUG have a reduction of the following
– Chemotaxis of polymorphonuclear leukocytes and phagocytosis
– The proliferation of lymphocytes during stimulation by a nonspecific mitogen
• A multidisciplinary management (physician, dentist, psychologist) is needed to identify subjects with chronic stress and to put in place countermeasures to decrease the deleterious effect stress has on the periodontiumREFERENCE
Impact of chronic stress on periodontal health – Journal of Oral Medicine And Oral Surgery - Question 106 of 150
106. Question
A 32 year old patient is been diagnosed as ataxic epileptic. What is the most common dental problems in such patients?
CorrectANSWER
Gingival hyperplasia due to medicationOTHER OPTIONS
• Not applicableSYNOPSIS
• Drug-induced gingival enlargement is the term used to describe medication-related gingival hypertrophy or hyperplasia
• This is a condition commonly induced by three main classes of drugs – Anticonvulsants, Antihypertensive calcium channel blockers, and the Immunosuppressant cyclosporine.
• Gingival overgrowth is one of the most common side effects associated with the administration of PHT (5,5-diphenylhydantoin), the most frequently used antiepileptic drug
• Clinically, gingival overgrowth is almost exclusively related to dentate areas which suggests that factors such as dental plaque and gingival inflammation may be important in the development of the condition.
Several clinical reports have confirmed that in susceptible individuals overgrowth is most severe in the presence of gingival inflammationREFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case ReportsIncorrectANSWER
Gingival hyperplasia due to medicationOTHER OPTIONS
• Not applicableSYNOPSIS
• Drug-induced gingival enlargement is the term used to describe medication-related gingival hypertrophy or hyperplasia
• This is a condition commonly induced by three main classes of drugs – Anticonvulsants, Antihypertensive calcium channel blockers, and the Immunosuppressant cyclosporine.
• Gingival overgrowth is one of the most common side effects associated with the administration of PHT (5,5-diphenylhydantoin), the most frequently used antiepileptic drug
• Clinically, gingival overgrowth is almost exclusively related to dentate areas which suggests that factors such as dental plaque and gingival inflammation may be important in the development of the condition.
Several clinical reports have confirmed that in susceptible individuals overgrowth is most severe in the presence of gingival inflammationREFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case Reports - Question 107 of 150
107. Question
Which of the following drug does not cause gingival enlargement?
CorrectANSWER
AspirinOTHER OPTIONS
• Explained belowSYNOPSIS
• Drug-induced gingival enlargement is the term used to describe medication-related gingival hypertrophy or hyperplasia
• This is a condition commonly induced by three main classes of drugs – Anticonvulsants (Phenytoin), Antihypertensive calcium channel blockers(Nifedipine), and the Immunosuppressant (cyclosporine).
• Aspirin, also known as acetylsalicylic acid, is a nonsteroidal anti-inflammatory drug used to reduce pain, fever, and or inflammation, and as an antithrombotic.
• It does not induce gingival enlargementREFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case ReportsIncorrectANSWER
AspirinOTHER OPTIONS
• Explained belowSYNOPSIS
• Drug-induced gingival enlargement is the term used to describe medication-related gingival hypertrophy or hyperplasia
• This is a condition commonly induced by three main classes of drugs – Anticonvulsants (Phenytoin), Antihypertensive calcium channel blockers(Nifedipine), and the Immunosuppressant (cyclosporine).
• Aspirin, also known as acetylsalicylic acid, is a nonsteroidal anti-inflammatory drug used to reduce pain, fever, and or inflammation, and as an antithrombotic.
• It does not induce gingival enlargementREFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case Reports - Question 108 of 150
108. Question
What is the first step in vertical resective osseous surgery?
CorrectANSWER
Vertical groovingOTHER OPTIONS
• Not applicableSYNOPSIS
• Osseous resective surgery (ORS) is one of the treatment modalities used to gain access to the root surfaces and boney defects, visualize removal of plaque and calculus from the root surfaces, and reestablish proper bone and soft tissue contours in order to facilitate removal of plaque by the patient as well as dental professionals.
• Steps in Resective Osseous Surgery
– Vertical Grooving
– Radicular Blending
– Horizontal Grooving
– Scribing
– Gradualizing interproximal boneREFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
Vertical groovingOTHER OPTIONS
• Not applicableSYNOPSIS
• Osseous resective surgery (ORS) is one of the treatment modalities used to gain access to the root surfaces and boney defects, visualize removal of plaque and calculus from the root surfaces, and reestablish proper bone and soft tissue contours in order to facilitate removal of plaque by the patient as well as dental professionals.
• Steps in Resective Osseous Surgery
– Vertical Grooving
– Radicular Blending
– Horizontal Grooving
– Scribing
– Gradualizing interproximal boneREFERENCE
Carranza’s Clinical Periodontology - Question 109 of 150
109. Question
Which is the most commonly used blade in oral surgery?
CorrectANSWER
No.15 bladeOTHER OPTIONS
• No.9 blade – broad, hatchet-shaped blade is utilised within Podiatry
• No11 blade – Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back
• No.12 blade – A small, pointed, crescent-shaped blade sharpened on the inside edge of the curveSYNOPSIS
• The No.15 blade has a small curved cutting edge and is the most popular blade shape ideal for making short and precise incisions.
• It has a front-facing straight blade with flat backREFERENCE
Oral Surgery, Instruments- Bhatia K, Aruede G.IncorrectANSWER
No.15 bladeOTHER OPTIONS
• No.9 blade – broad, hatchet-shaped blade is utilised within Podiatry
• No11 blade – Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back
• No.12 blade – A small, pointed, crescent-shaped blade sharpened on the inside edge of the curveSYNOPSIS
• The No.15 blade has a small curved cutting edge and is the most popular blade shape ideal for making short and precise incisions.
• It has a front-facing straight blade with flat backREFERENCE
Oral Surgery, Instruments- Bhatia K, Aruede G. - Question 110 of 150
110. Question
Which instrument is used for subgingival scaling?
CorrectANSWER
Gracey curettesOTHER OPTIONS
• Universal curettes- Universal curettes are designed for moderate calculus removal on supragingival and subgingival tooth surfaces. The blade of a universal curette has a round toe and back, and two cutting edges for scaling, making it an efficient design for scaling the entire mouth.
• Sickle scalers- Mainly used to remove interproximal supragingival or subgingival calculus located just below the gingival margin.
• Periodontal probe- The probing of periodontal pockets is critical in the detection of periodontal disease.SYNOPSIS
• Originally designed to be finishing curettes for fine scaling and root planing, Gracey curettes were developed in the 1940’s by Dr. Clayton Gracey in coordination with Hugo Friedman, the founder of Hu-Friedy.
• Each Gracey blade is offset at 70˚ and has one cutting edge- the lower edge. The combination of this unique blade and 9 different shank designs for specific tooth surfaces provide improved adaptation and deposit removal in scaling procedures.
• Instrumentation The blade of a Gracey curette is correctly adapted when the lower cutting edge is against the tooth, and the terminal shank is parallel to the tooth surface being scaled. Apply lateral pressure against the tooth root and pull upward, maintaining the parallel shank. The blade is offset from the shank at 70°. This creates one cutting edge which is referred to as the lower edge. Gracey curettes are used in a set to completely scale the dentition.REFERENCE
Carranza’s Clinical Periodontology- 9th editionIncorrectANSWER
Gracey curettesOTHER OPTIONS
• Universal curettes- Universal curettes are designed for moderate calculus removal on supragingival and subgingival tooth surfaces. The blade of a universal curette has a round toe and back, and two cutting edges for scaling, making it an efficient design for scaling the entire mouth.
• Sickle scalers- Mainly used to remove interproximal supragingival or subgingival calculus located just below the gingival margin.
• Periodontal probe- The probing of periodontal pockets is critical in the detection of periodontal disease.SYNOPSIS
• Originally designed to be finishing curettes for fine scaling and root planing, Gracey curettes were developed in the 1940’s by Dr. Clayton Gracey in coordination with Hugo Friedman, the founder of Hu-Friedy.
• Each Gracey blade is offset at 70˚ and has one cutting edge- the lower edge. The combination of this unique blade and 9 different shank designs for specific tooth surfaces provide improved adaptation and deposit removal in scaling procedures.
• Instrumentation The blade of a Gracey curette is correctly adapted when the lower cutting edge is against the tooth, and the terminal shank is parallel to the tooth surface being scaled. Apply lateral pressure against the tooth root and pull upward, maintaining the parallel shank. The blade is offset from the shank at 70°. This creates one cutting edge which is referred to as the lower edge. Gracey curettes are used in a set to completely scale the dentition.REFERENCE
Carranza’s Clinical Periodontology- 9th edition - Question 111 of 150
111. Question
Which brushing technique is best for plaque removal?
CorrectANSWER
Bass or Sulcular TechniqueOTHER OPTIONS
• Stillman’s method – Gingival recession cases
• Charter’s method – For Orthodontic patients and in patients after periodontal surgery
• Fones technique – In childrenSYNOPSIS
• It is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin
• Indications
– Open interproximal areas
– Cervical areas beneath the height of contour of enamel
– Exposed root surface
– Recommended for patients with or without periodontal involvement
• Technique
– The bristles are held at a 45 degree angle toward the gum line.
– Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the gum line.
– Only small groups of teeth can be done at a time.
– Once an area is complete, move on to the next set of teeth.REFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
Bass or Sulcular TechniqueOTHER OPTIONS
• Stillman’s method – Gingival recession cases
• Charter’s method – For Orthodontic patients and in patients after periodontal surgery
• Fones technique – In childrenSYNOPSIS
• It is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin
• Indications
– Open interproximal areas
– Cervical areas beneath the height of contour of enamel
– Exposed root surface
– Recommended for patients with or without periodontal involvement
• Technique
– The bristles are held at a 45 degree angle toward the gum line.
– Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the gum line.
– Only small groups of teeth can be done at a time.
– Once an area is complete, move on to the next set of teeth.REFERENCE
Carranza’s Clinical Periodontology - Question 112 of 150
112. Question
A patient came with an avulsed permanent tooth with a closed apex within 30 minutes of trauma. The tooth was stored in milk and PDL was good. What would be the time of splinting?
CorrectANSWER
2 weeksOTHER OPTIONS
• NilSYNOPSIS
• The IADT guideline recommends a flexible splint for 2 weeks for avulsion injuries.
• For teeth that have been avulsed and the extraoral dry time is greater than 60 minutes, the recommendation is a flexible splint for 4 weeks.REFERENCE
Splinting of teeth following trauma a review and a new splinting recommendation – Australian Dental Journal Volume 61, Issue S1IncorrectANSWER
2 weeksOTHER OPTIONS
• NilSYNOPSIS
• The IADT guideline recommends a flexible splint for 2 weeks for avulsion injuries.
• For teeth that have been avulsed and the extraoral dry time is greater than 60 minutes, the recommendation is a flexible splint for 4 weeks.REFERENCE
Splinting of teeth following trauma a review and a new splinting recommendation – Australian Dental Journal Volume 61, Issue S1 - Question 113 of 150
113. Question
Which technique will you use for the next visit for a patient who has trismus after multiple IANBs?
CorrectANSWER
Vazirani Akinosi techniqueOTHER OPTIONS
• Gow-Gates technique- The Gow-Gates block is also known as a third division block or V3 nerve block, as it is a true block of the entire mandibular nerve. Having the patient open widely al¬lows the condyle to move anteriorly and in an inferior direction, bringing it closer to the nerve trunk. The ultimate target is the neck of the condyle below the insertion of the lateral pterygoid.SYNOPSIS
• The Vazirani-Akinosi technique is also known as the closed mouth mandibular block or tuberosity block.
• This injection is typically administered to a patient presenting with trismus and an inability to open.
• If a patient with trismus requires anesthesia on mandibular posterior teeth, this is the only option available other than an extraoral block.
• This technique anesthetizes the inferior alveolar, incisive, mental, lingual and mylohyoid nerves, as well as the motor nerves innervating the muscles of mastication. Anesthetizing the motor branches allows progressive relaxation of the muscles, affording an opportunity to complete work on posterior mandibular teeth.
• Advantages lower positive aspiration rate than the conventional block, and effectiveness in the presence of a bifid nerve or canal.
• Challenges of the technique it can be difficult to visualize the path of the needle, as well as its depth.REFERENCE
Techniques for Mandibular Block Anesthesia- William R. BachandIncorrectANSWER
Vazirani Akinosi techniqueOTHER OPTIONS
• Gow-Gates technique- The Gow-Gates block is also known as a third division block or V3 nerve block, as it is a true block of the entire mandibular nerve. Having the patient open widely al¬lows the condyle to move anteriorly and in an inferior direction, bringing it closer to the nerve trunk. The ultimate target is the neck of the condyle below the insertion of the lateral pterygoid.SYNOPSIS
• The Vazirani-Akinosi technique is also known as the closed mouth mandibular block or tuberosity block.
• This injection is typically administered to a patient presenting with trismus and an inability to open.
• If a patient with trismus requires anesthesia on mandibular posterior teeth, this is the only option available other than an extraoral block.
• This technique anesthetizes the inferior alveolar, incisive, mental, lingual and mylohyoid nerves, as well as the motor nerves innervating the muscles of mastication. Anesthetizing the motor branches allows progressive relaxation of the muscles, affording an opportunity to complete work on posterior mandibular teeth.
• Advantages lower positive aspiration rate than the conventional block, and effectiveness in the presence of a bifid nerve or canal.
• Challenges of the technique it can be difficult to visualize the path of the needle, as well as its depth.REFERENCE
Techniques for Mandibular Block Anesthesia- William R. Bachand - Question 114 of 150
114. Question
Which tooth requires special attention when preparing the occlusal aspect for restoration?
CorrectANSWER
Lower 1st premolarOTHER OPTIONS
• Not applicableSYNOPSIS
• Mandibular premolars present significant anatomic challenges because of the extreme variations in their morphology.
• The root canal system of the mandibular first premolar is wider buccolingually than mesiodistally.
• Two pulp horns are present – a large, pointed buccal horn and a small, rounded lingual horn.
• So care must be taken not to expose the pulp while preparing the occlusal aspect in a lower first premolar.REFERENCE
Textbook of operative dentistry by Nisha Garg.IncorrectANSWER
Lower 1st premolarOTHER OPTIONS
• Not applicableSYNOPSIS
• Mandibular premolars present significant anatomic challenges because of the extreme variations in their morphology.
• The root canal system of the mandibular first premolar is wider buccolingually than mesiodistally.
• Two pulp horns are present – a large, pointed buccal horn and a small, rounded lingual horn.
• So care must be taken not to expose the pulp while preparing the occlusal aspect in a lower first premolar.REFERENCE
Textbook of operative dentistry by Nisha Garg. - Question 115 of 150
115. Question
Which of the following treatment is indicated for the removal of 3 mm ameloblastoma involving the inferior border of the mandible?
CorrectANSWER
ResectionOTHER OPTIONS
• Fulguration -A procedure that uses heat from an electric current to destroy abnormal tissue, such as a tumor or other lesion. It may also be used to control bleeding during surgery or after an injury
• Cryosurgery – A procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue. A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas.SYNOPSIS
• Ameloblastoma treatment usually includes surgery to remove the tumor.
• Ameloblastoma often grows into the nearby jawbone, so surgeons may need to remove the affectedpart of the jawbone. An aggressive approach to surgery reduces the risk that ameloblastoma will come back. Surgery to repair the jaw.
• The methods of treatment consisted of radical surgery i.e., segmental resection and conservative treatments i.e., enucleation with bone curettage.
• Radical surgical resection of ameloblastoma is the treatment of choice, followed by the reconstruction of the defects, allowing good functional and aesthetic outcome.
• The methods of treatment consisted of radical surgery i.e., segmental resection and conservative treatments i.e., enucleation with bone curettage.REFERENCE
Surgical management of ameloblastoma Conservative or radical approach
Ramakant Dandriyal, Atul Gupta, Swati Pant, and Hitesh Hans BawejaIncorrectANSWER
ResectionOTHER OPTIONS
• Fulguration -A procedure that uses heat from an electric current to destroy abnormal tissue, such as a tumor or other lesion. It may also be used to control bleeding during surgery or after an injury
• Cryosurgery – A procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue. A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas.SYNOPSIS
• Ameloblastoma treatment usually includes surgery to remove the tumor.
• Ameloblastoma often grows into the nearby jawbone, so surgeons may need to remove the affectedpart of the jawbone. An aggressive approach to surgery reduces the risk that ameloblastoma will come back. Surgery to repair the jaw.
• The methods of treatment consisted of radical surgery i.e., segmental resection and conservative treatments i.e., enucleation with bone curettage.
• Radical surgical resection of ameloblastoma is the treatment of choice, followed by the reconstruction of the defects, allowing good functional and aesthetic outcome.
• The methods of treatment consisted of radical surgery i.e., segmental resection and conservative treatments i.e., enucleation with bone curettage.REFERENCE
Surgical management of ameloblastoma Conservative or radical approach
Ramakant Dandriyal, Atul Gupta, Swati Pant, and Hitesh Hans Baweja - Question 116 of 150
116. Question
Which is the serial extraction order for making the upper denture?
CorrectANSWER
Posteriors first then anteriorsOTHER OPTIONS
• Canine first and then posteriors – Canines are extracted at the last because they help in maintaining stability and integrity of alveolar mucosa.SYNOPSIS
• Maxillary teeth are extracted first which is a rule we always follow and also the rule that posterior teeth extracted before extracting anterior teeth. The sequence of teeth to be extraction full mouth extraction.
• Maxillary posterior teeth 1st and 2nd premolar ,2nd and 3rd molar except 1st molar.
• Maxillary anterior central and lateral except canine.
• Mandibular posterior 1st and 2nd premolar, 2nd and 3rd molar except 1st molar.
• Mandibular anteriors central and lateral except canine.REFERENCE
Sequence of Extraction for Complete Maxillary teeth. Dr varunIncorrectANSWER
Posteriors first then anteriorsOTHER OPTIONS
• Canine first and then posteriors – Canines are extracted at the last because they help in maintaining stability and integrity of alveolar mucosa.SYNOPSIS
• Maxillary teeth are extracted first which is a rule we always follow and also the rule that posterior teeth extracted before extracting anterior teeth. The sequence of teeth to be extraction full mouth extraction.
• Maxillary posterior teeth 1st and 2nd premolar ,2nd and 3rd molar except 1st molar.
• Maxillary anterior central and lateral except canine.
• Mandibular posterior 1st and 2nd premolar, 2nd and 3rd molar except 1st molar.
• Mandibular anteriors central and lateral except canine.REFERENCE
Sequence of Extraction for Complete Maxillary teeth. Dr varun - Question 117 of 150
117. Question
A patient diagnosed with iron deficiency anemia, esophageal webs, and difficulty in swallowing. Identify the condition.
CorrectANSWER
Plummer Vinson SyndromeOTHER OPTIONS
• Malignant tumors are cancerous (ie, they invade other sites). They spread to distant sites via the bloodstream or the lymphatic system.
• Benign esophageal stricture is a narrowing of the esophagus
• Esophageal rings- is an abnormal ring of tissue that forms where the esophagus (the tube from the mouth to the stomach) and stomach meet.SYNOPSIS
• A disorder marked by anemia caused by iron deficiency, and a web-like growth of membranes in the throat that makes swallowing difficult.
• Having Plummer-Vinson syndrome may increase the risk of developing esophageal cancer.
• Also called Paterson-Kelly syndrome and sideropenic dysphagia.REFERENCE
Plummer-Vinson syndrome- NIHIncorrectANSWER
Plummer Vinson SyndromeOTHER OPTIONS
• Malignant tumors are cancerous (ie, they invade other sites). They spread to distant sites via the bloodstream or the lymphatic system.
• Benign esophageal stricture is a narrowing of the esophagus
• Esophageal rings- is an abnormal ring of tissue that forms where the esophagus (the tube from the mouth to the stomach) and stomach meet.SYNOPSIS
• A disorder marked by anemia caused by iron deficiency, and a web-like growth of membranes in the throat that makes swallowing difficult.
• Having Plummer-Vinson syndrome may increase the risk of developing esophageal cancer.
• Also called Paterson-Kelly syndrome and sideropenic dysphagia.REFERENCE
Plummer-Vinson syndrome- NIH - Question 118 of 150
118. Question
Which is the most common salivary gland tumor?
CorrectANSWER
Pleomorphic adenomaOTHER OPTIONS
• Mucoepidermoid carcinoma- Mucoepidermoid carcinoma is one of the most common malignant salivary gland tumors.
• Acinic cell adenocarcinoma is a malignant salivary gland tumor characterized by histologic appearance showing serous acinar differentiation.SYNOPSIS
• The pleomorphic adenoma or benign mixed tumor is the most common salivary neoplasm and accounts for over half of the tumors in the parotid and submandibular glands.
• The tumor presents as a slow-growing, painless, firm and non-tender mass that is mobile in early stages.
• The tumor may have intermittent growth periods.
• As size increases, the tumor becomes more irregular and nodular upon palpation.
• The overlying skin seldom ulcerates.REFERENCE
Textbook of oral medicine,oral diagnosis and oral radiology- Ravikaran OngoleIncorrectANSWER
Pleomorphic adenomaOTHER OPTIONS
• Mucoepidermoid carcinoma- Mucoepidermoid carcinoma is one of the most common malignant salivary gland tumors.
• Acinic cell adenocarcinoma is a malignant salivary gland tumor characterized by histologic appearance showing serous acinar differentiation.SYNOPSIS
• The pleomorphic adenoma or benign mixed tumor is the most common salivary neoplasm and accounts for over half of the tumors in the parotid and submandibular glands.
• The tumor presents as a slow-growing, painless, firm and non-tender mass that is mobile in early stages.
• The tumor may have intermittent growth periods.
• As size increases, the tumor becomes more irregular and nodular upon palpation.
• The overlying skin seldom ulcerates.REFERENCE
Textbook of oral medicine,oral diagnosis and oral radiology- Ravikaran Ongole - Question 119 of 150
119. Question
While performing the extraction of upper second premolar the dentist used the MSA nerve block.What type of technique is the middle superior alveolar nerve block?
CorrectANSWER
SupraperiostealOTHER OPTIONS
• Intraligamentary Injection- The technique’s primary advantage is that it provides pulpal anesthesia for 30 to 45 minutes without an extended period of soft tissue anesthesia, thus being extremely useful when bilateral treatment is planned.
• Intraseptal technique – Anesthetizes surrounding nerve endings in the tissues of a particular tooth.SYNOPSIS
• Supraperiosteal injection (commonly known as local infiltration) is indicated whenever dental procedures are confined to a localized area in either the maxilla or mandible.
• The terminal endings of the nerves innervating the region are anesthetized.
• The techniques of ASA and MSA blocks were first given in 1998 by Friedman and Huchman.
• Advantages of the technique
– No added collateral anesthesia to the lips, the face, or even the facial muscles as well.
– The need for multiple injections is also eliminated because of this technique in this segment, and the numbness associated with anesthesia is also moderate, which may prevent any sort of self-inflicted injury at the dentist in the clinic or patient discomfort.
• The MSA nerve block is useful for procedures in which the maxillary premolar teeth or the mesiobuccal root of the first molar requires anesthesia.REFERENCE
Anterior Middle Superior Alveolar Nerve Block in Dentistry- RavichandranIncorrectANSWER
SupraperiostealOTHER OPTIONS
• Intraligamentary Injection- The technique’s primary advantage is that it provides pulpal anesthesia for 30 to 45 minutes without an extended period of soft tissue anesthesia, thus being extremely useful when bilateral treatment is planned.
• Intraseptal technique – Anesthetizes surrounding nerve endings in the tissues of a particular tooth.SYNOPSIS
• Supraperiosteal injection (commonly known as local infiltration) is indicated whenever dental procedures are confined to a localized area in either the maxilla or mandible.
• The terminal endings of the nerves innervating the region are anesthetized.
• The techniques of ASA and MSA blocks were first given in 1998 by Friedman and Huchman.
• Advantages of the technique
– No added collateral anesthesia to the lips, the face, or even the facial muscles as well.
– The need for multiple injections is also eliminated because of this technique in this segment, and the numbness associated with anesthesia is also moderate, which may prevent any sort of self-inflicted injury at the dentist in the clinic or patient discomfort.
• The MSA nerve block is useful for procedures in which the maxillary premolar teeth or the mesiobuccal root of the first molar requires anesthesia.REFERENCE
Anterior Middle Superior Alveolar Nerve Block in Dentistry- Ravichandran - Question 120 of 150
120. Question
An adult patient comes with white fuzzy patches on the sides of tongue that looks folded or ridged. On examination that cant be removed by scapping or brushing. The patient has a habit of tobacco chewing for years. What will be the diagnosis?
CorrectANSWER
LeukoplakiaOTHER OPTIONS
• Lichen planus- is a relatively common chronic dermatologic disease that often affects the oral mucosa. Reticular lichen planus shows a characteristic pattern of interlacing white lines (also
referred to as Wickhams striae).
• Erythroplakia- the altered mucosa appears as a well-demarcated erythematous macule or plaque with a soft velvety texture.
• Oral thrush- they are pseudomembranous candidiasis is characterized by the presence of adherent white plaques that resemble cottage cheese or curdled milk on the oral mucosa.SYNOPSIS
• Oral leukoplakia is defined by the World Health Organization (WHO) as a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.
• Causes can be tobacco use alcohol UV radiation microbes such as candida and treponema.
• Early and mild lesions appear as slightly elevated gray or gray-white plaques which may appear somewhat translucent fissured or wrinkled and are typically soft and flat. They usually have sharply demarcated borders but occasionally blend gradually into normal mucosa.
• Treatment- Complete removal can be accomplished with equal effectiveness by surgical excision electrocautery cryosurgery or laser ablation. Long-term follow-up after removal is extremely important because recurrences are frequent and because additional leukoplakias may develop.REFERENCE
Textbook of Oral Pathology- Neville.IncorrectANSWER
LeukoplakiaOTHER OPTIONS
• Lichen planus- is a relatively common chronic dermatologic disease that often affects the oral mucosa. Reticular lichen planus shows a characteristic pattern of interlacing white lines (also
referred to as Wickhams striae).
• Erythroplakia- the altered mucosa appears as a well-demarcated erythematous macule or plaque with a soft velvety texture.
• Oral thrush- they are pseudomembranous candidiasis is characterized by the presence of adherent white plaques that resemble cottage cheese or curdled milk on the oral mucosa.SYNOPSIS
• Oral leukoplakia is defined by the World Health Organization (WHO) as a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.
• Causes can be tobacco use alcohol UV radiation microbes such as candida and treponema.
• Early and mild lesions appear as slightly elevated gray or gray-white plaques which may appear somewhat translucent fissured or wrinkled and are typically soft and flat. They usually have sharply demarcated borders but occasionally blend gradually into normal mucosa.
• Treatment- Complete removal can be accomplished with equal effectiveness by surgical excision electrocautery cryosurgery or laser ablation. Long-term follow-up after removal is extremely important because recurrences are frequent and because additional leukoplakias may develop.REFERENCE
Textbook of Oral Pathology- Neville. - Question 121 of 150
121. Question
Which dental abnormality would a patient with Down syndrome present?
CorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Down syndrome is the best-known chromosomal disorder and is caused by the presence of three copies of chromosome 21.
• The incidence of congenital cardiac defects is about 40per cent and because of these patients high susceptibility to periodontal disease knowledge of a heart condition is essential for dental treatment
• Skeletal findings are an underdeveloped midface creating a prognathic occlusal relationship.
• Oral findings include mouth breathing open bite appearance of macroglossia fissured lips and tongue angular cheilitis delayed eruption times missing and malformed teeth oligodontia small roots microdontia crowding and low level of caries.
• Children with Down syndrome experience a high incidence of rapid destructive periodontal disease which may be related to local factors such as tooth morphology bruxism malocclusion
and poor oral hygiene
• The low caries prevalence in Down syndrome children appears to be due to immune protection caused by the elevated salivary S. mutans specific IgA concentrations.REFERENCE
Dental caries and salivary immunoglobulin A in Down syndrome children- SR Lee HK Kwon
Textbook of Pediatric Dentistry- McDonaldIncorrectANSWER
All of the aboveOTHER OPTIONS
• NilSYNOPSIS
• Down syndrome is the best-known chromosomal disorder and is caused by the presence of three copies of chromosome 21.
• The incidence of congenital cardiac defects is about 40per cent and because of these patients high susceptibility to periodontal disease knowledge of a heart condition is essential for dental treatment
• Skeletal findings are an underdeveloped midface creating a prognathic occlusal relationship.
• Oral findings include mouth breathing open bite appearance of macroglossia fissured lips and tongue angular cheilitis delayed eruption times missing and malformed teeth oligodontia small roots microdontia crowding and low level of caries.
• Children with Down syndrome experience a high incidence of rapid destructive periodontal disease which may be related to local factors such as tooth morphology bruxism malocclusion
and poor oral hygiene
• The low caries prevalence in Down syndrome children appears to be due to immune protection caused by the elevated salivary S. mutans specific IgA concentrations.REFERENCE
Dental caries and salivary immunoglobulin A in Down syndrome children- SR Lee HK Kwon
Textbook of Pediatric Dentistry- McDonald - Question 122 of 150
122. Question
An adult male presented with multiple sebaceous cysts on back and neck shows multiple intestinal polyps. What will be the diagnosis?
CorrectANSWER
Gardner’s SyndromeOTHER OPTIONS
• Paget’s disease is a disease of bone that can affect 1 bone or several bones.Early symptoms of Paget’s disease include bone pain, joint pain (especially in the back, hips and knees), and headache. Physical signs include enlargement and bowing of the thighs (femurs) and lower legs (tibias), and enlargement of the skull in the area of the forehead.
• Osteoma Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandibleOsteomas are most commonly found in the skull and facial bones. Multiple osteomas may be associated with Gardner’s Syndrome. These lesions are usually painless and recurrence is uncommon after local excision
• Chediak higashi syndrome (CHS) is a rare, inherited, complex, immune disorder that usually occurs in childhood characterized by reduced pigment in the skin and eyes (oculocutaneous albinism),immune deficiency with an increased susceptibility to infections, and a tendency to bruise and bleed easily.SYNOPSIS
• Gardner syndrome is a form of familial adenomatous polyposis (FAP) that is characterized by multiple colorectal polyps and various types of tumors, both benign (noncancerous) and malignant (cancerous).
• Other signs and symptoms of Gardner syndrome include dental abnormalities- osteomas (benign bone growths)- various skin abnormalities such as epidermoid cysts, fibromas (a benign tumor of the connective tissue), and lipomas- and desmoid tumors.
• It is caused by changes in the APC gene and inherited in an autosomal dominant manner. Management may include high risk screening, prophylactic surgeries andoror certain types of medications.REFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
Gardner’s SyndromeOTHER OPTIONS
• Paget’s disease is a disease of bone that can affect 1 bone or several bones.Early symptoms of Paget’s disease include bone pain, joint pain (especially in the back, hips and knees), and headache. Physical signs include enlargement and bowing of the thighs (femurs) and lower legs (tibias), and enlargement of the skull in the area of the forehead.
• Osteoma Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandibleOsteomas are most commonly found in the skull and facial bones. Multiple osteomas may be associated with Gardner’s Syndrome. These lesions are usually painless and recurrence is uncommon after local excision
• Chediak higashi syndrome (CHS) is a rare, inherited, complex, immune disorder that usually occurs in childhood characterized by reduced pigment in the skin and eyes (oculocutaneous albinism),immune deficiency with an increased susceptibility to infections, and a tendency to bruise and bleed easily.SYNOPSIS
• Gardner syndrome is a form of familial adenomatous polyposis (FAP) that is characterized by multiple colorectal polyps and various types of tumors, both benign (noncancerous) and malignant (cancerous).
• Other signs and symptoms of Gardner syndrome include dental abnormalities- osteomas (benign bone growths)- various skin abnormalities such as epidermoid cysts, fibromas (a benign tumor of the connective tissue), and lipomas- and desmoid tumors.
• It is caused by changes in the APC gene and inherited in an autosomal dominant manner. Management may include high risk screening, prophylactic surgeries andoror certain types of medications.REFERENCE
Shafer’s Textbook of Oral Pathology - Question 123 of 150
123. Question
What are the hypomineralized structures run longitudinally from the dentinoenamel junction to the enamel called?
CorrectANSWER
Enamel TuftsOTHER OPTIONS
• Enamel spindles are formed when odontoblast processes extend across the dentinoenamel junction (DEJ) and are trapped in the enamel when ameloblasts begin secreting enamel matrix.
• Enamel lamellae are a type of hypomineralized structure in teeth that extend either from the dentinoenamel junction to the surface of the enamel, or vice versa.
• Lines of von Ebner – Von Ebner lines are visible in dentine as a result of the refractive Becke effect, indicating an abrupt, though possibly small, change in refractive index at the junctions between adjacent layers of dentine.SYNOPSIS
• Enamel tufts are hypomineralized ribbon-like structures that run longitudinally to the tooth axis and extend from the dentinoenamel junction one fifth to a third into the enamel.
• They are called ‘‘tufts’’ due to their wavy look within the enamel microstructure.
• Enamel tufts are small, branching defects that are found only at the DEJ, protruding into the enamel towards the enamel surface. Enamel spindles however, are in fact odontoblast processes that extend into the enamelREFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
Enamel TuftsOTHER OPTIONS
• Enamel spindles are formed when odontoblast processes extend across the dentinoenamel junction (DEJ) and are trapped in the enamel when ameloblasts begin secreting enamel matrix.
• Enamel lamellae are a type of hypomineralized structure in teeth that extend either from the dentinoenamel junction to the surface of the enamel, or vice versa.
• Lines of von Ebner – Von Ebner lines are visible in dentine as a result of the refractive Becke effect, indicating an abrupt, though possibly small, change in refractive index at the junctions between adjacent layers of dentine.SYNOPSIS
• Enamel tufts are hypomineralized ribbon-like structures that run longitudinally to the tooth axis and extend from the dentinoenamel junction one fifth to a third into the enamel.
• They are called ‘‘tufts’’ due to their wavy look within the enamel microstructure.
• Enamel tufts are small, branching defects that are found only at the DEJ, protruding into the enamel towards the enamel surface. Enamel spindles however, are in fact odontoblast processes that extend into the enamelREFERENCE
Shafer’s Textbook of Oral Pathology - Question 124 of 150
124. Question
A 65 years old man complaints of ill fitting maxillary and mandibular complete denture shows slow and progressive swelling of jaws with no other associated symptoms like pain, discharge and non responsive to any medication. What will be the most common cause?
CorrectANSWER
Paget’s DiseaseOTHER OPTIONS
• Psoriasis – Psoriasis is a skin condition that causes flaky patches of skin which form scales.
• Kaposis sarcoma – Kaposi’s sarcoma is a type of cancer that forms in the lining of blood and lymph vessels. The tumors (lesions) of Kaposi’s sarcoma typically appear as painless purplish spots on the legs, feet or face
• Chronic sclerosing osteomyelitis – Sclerosing osteomyelitis of Garré is a rare inflammatory disease of chronic nature characterized by thickening of the cortices and loss of the medullary canal. It mainly affects young children and adults and the region of the mandible, but in rare cases, the metaphysis of long bones is affectedSYNOPSIS
• Paget’s disease is a disease of bone that can affect 1 bone or several bones.
• Early symptoms of Paget’s disease include bone pain, joint pain(especially in the back, hips and knees), and headache.
• Physical signs include enlargement and bowing of the thighs (femurs) and lower legs (tibias), and enlargement of the skull in the area of the forehead.
• Paget disease of the jaw is a rare clinical entity and can present with jaw pain and swelling after the fifth decade of life.REFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
Paget’s DiseaseOTHER OPTIONS
• Psoriasis – Psoriasis is a skin condition that causes flaky patches of skin which form scales.
• Kaposis sarcoma – Kaposi’s sarcoma is a type of cancer that forms in the lining of blood and lymph vessels. The tumors (lesions) of Kaposi’s sarcoma typically appear as painless purplish spots on the legs, feet or face
• Chronic sclerosing osteomyelitis – Sclerosing osteomyelitis of Garré is a rare inflammatory disease of chronic nature characterized by thickening of the cortices and loss of the medullary canal. It mainly affects young children and adults and the region of the mandible, but in rare cases, the metaphysis of long bones is affectedSYNOPSIS
• Paget’s disease is a disease of bone that can affect 1 bone or several bones.
• Early symptoms of Paget’s disease include bone pain, joint pain(especially in the back, hips and knees), and headache.
• Physical signs include enlargement and bowing of the thighs (femurs) and lower legs (tibias), and enlargement of the skull in the area of the forehead.
• Paget disease of the jaw is a rare clinical entity and can present with jaw pain and swelling after the fifth decade of life.REFERENCE
Shafer’s Textbook of Oral Pathology - Question 125 of 150
125. Question
How will be the formation of hard palate occurs during embryonic life?
CorrectANSWER
By the fusion of palatine process of maxilla and horizontal plates of palatine bone.OTHER OPTIONS
• Meckel’s cartilage – Cartilage of the first branchial arch associated with formation of mandible.SYNOPSIS
• The palate forms the roof of the mouth and separates the oral cavity from the nasal cavity. The palate undergoes complex morphological changes during embryogenesis to achieve its final form and divides into an anterior immobile hard bony segment and a posterior mobile soft palate that does not contain bone
• The hard palate comprises the anterior two-thirds of the palate and is an immobile hard bony segment whose underlying bony structure consists of the palatine processes of the maxilla and the horizontal plates of the palatine bones.REFERENCE
Human Embryology and Developmental Biology – Bruce M CarlsonIncorrectANSWER
By the fusion of palatine process of maxilla and horizontal plates of palatine bone.OTHER OPTIONS
• Meckel’s cartilage – Cartilage of the first branchial arch associated with formation of mandible.SYNOPSIS
• The palate forms the roof of the mouth and separates the oral cavity from the nasal cavity. The palate undergoes complex morphological changes during embryogenesis to achieve its final form and divides into an anterior immobile hard bony segment and a posterior mobile soft palate that does not contain bone
• The hard palate comprises the anterior two-thirds of the palate and is an immobile hard bony segment whose underlying bony structure consists of the palatine processes of the maxilla and the horizontal plates of the palatine bones.REFERENCE
Human Embryology and Developmental Biology – Bruce M Carlson - Question 126 of 150
126. Question
What attachment is used for an implant-supported overdenture?
CorrectANSWER
LocatorOTHER OPTIONS
• Bar – Provides retention, implant splinting, and wide-ranging load distribution that results in a movement reduction of the implants.
• Magnets – Magnetic attachments reduce the transfer of horizontal stress to the implants and bone during the insertion and removal of the denture.SYNOPSIS
• Locators are popular attachments for implant-retained or implant-supported overdenture because of their low level of thickness (2.5 mm height) and ability to self-align, which can correct up to 40 degree of implant angulations.
• They can be used in narrow inter-arch space.
• Locators offer excellent retention and stability, and they allow for easy hygiene maintenance.
• The telescopic attachment, which offers a self-seating mechanism, is suitable for patients with reduced manual dexterity, such as those with Parkinson’s disease.
• Periodic replacement of the male nylon component is required.
• Some prosthetic complications such as locator attachments, periodic repair, and higher maintenance double-crown locator attachments require sufficient inter-arch space and the metal display of attachments.REFERENCE
Various Attachments for Implant OverdenturesIncorrectANSWER
LocatorOTHER OPTIONS
• Bar – Provides retention, implant splinting, and wide-ranging load distribution that results in a movement reduction of the implants.
• Magnets – Magnetic attachments reduce the transfer of horizontal stress to the implants and bone during the insertion and removal of the denture.SYNOPSIS
• Locators are popular attachments for implant-retained or implant-supported overdenture because of their low level of thickness (2.5 mm height) and ability to self-align, which can correct up to 40 degree of implant angulations.
• They can be used in narrow inter-arch space.
• Locators offer excellent retention and stability, and they allow for easy hygiene maintenance.
• The telescopic attachment, which offers a self-seating mechanism, is suitable for patients with reduced manual dexterity, such as those with Parkinson’s disease.
• Periodic replacement of the male nylon component is required.
• Some prosthetic complications such as locator attachments, periodic repair, and higher maintenance double-crown locator attachments require sufficient inter-arch space and the metal display of attachments.REFERENCE
Various Attachments for Implant Overdentures - Question 127 of 150
127. Question
A 14-year-old female patient presents with an unerupted right maxillary canine. Radiographs demonstrate a unilocular radiolucency encompassing the crown of the impacted right maxillary canine. Which one of the following is the most likely diagnosis?
CorrectANSWER
AOTOTHER OPTIONS
• NilSYNOPSIS
• Adenomatoid odontogenic tumor (AOT), generally considered to be an uncommon tumor, occurs mostly in association with an unerupted maxillary cuspid
• The mean age of these patients was approximately 18 years
• The site of occurrence is greater in the maxilla.
• A large proportion of these tumors produced an obvious clinical swelling although they were generally asymptomatic.
• Adenomatoid odontogenic tumor may occur within the jaw bones or the gingiva.
• Peripheral lesions present as a painless, gingival-colored mass that ranges from 1–1.5 cm in diameter.
• Central AOTs present a well-demarcated, almost always unilocular radiolucency that generally exhibits a smooth corticated (and sometimes sclerotic) border.REFERENCE
Shafers textbook of Oral Pathology.IncorrectANSWER
AOTOTHER OPTIONS
• NilSYNOPSIS
• Adenomatoid odontogenic tumor (AOT), generally considered to be an uncommon tumor, occurs mostly in association with an unerupted maxillary cuspid
• The mean age of these patients was approximately 18 years
• The site of occurrence is greater in the maxilla.
• A large proportion of these tumors produced an obvious clinical swelling although they were generally asymptomatic.
• Adenomatoid odontogenic tumor may occur within the jaw bones or the gingiva.
• Peripheral lesions present as a painless, gingival-colored mass that ranges from 1–1.5 cm in diameter.
• Central AOTs present a well-demarcated, almost always unilocular radiolucency that generally exhibits a smooth corticated (and sometimes sclerotic) border.REFERENCE
Shafers textbook of Oral Pathology. - Question 128 of 150
128. Question
What is the common pathognomonic feature of osteomyelitis?
CorrectANSWER
SequestrationOTHER OPTIONS
• Osteoporosis-A condition in which bones become weak and brittle.SYNOPSIS
• Osteomyelitis is an acute or chronic infl ammatory process in the medullary spaces or cortical surfaces of bone that extends away from the initial site of involvement.
• Clinical features
– Fever
– Leukocytosis
– Lymphadenopathy
– Significant sensitivity,
– Soft tissue swelling of the affected area
– A fragment of necrotic bone that has separated from the adjacent vital bone is termed a sequestrum.
– On occasion, fragments of necrotic bone may become surrounded by new vital bone, known as an involucrum.
• Radiographic features
– Ill-defined radiolucency .
– Periosteal new bone formation also may be seenREFERENCE
Oral and Maxillofacial Pathology- Brad W. NevilleIncorrectANSWER
SequestrationOTHER OPTIONS
• Osteoporosis-A condition in which bones become weak and brittle.SYNOPSIS
• Osteomyelitis is an acute or chronic infl ammatory process in the medullary spaces or cortical surfaces of bone that extends away from the initial site of involvement.
• Clinical features
– Fever
– Leukocytosis
– Lymphadenopathy
– Significant sensitivity,
– Soft tissue swelling of the affected area
– A fragment of necrotic bone that has separated from the adjacent vital bone is termed a sequestrum.
– On occasion, fragments of necrotic bone may become surrounded by new vital bone, known as an involucrum.
• Radiographic features
– Ill-defined radiolucency .
– Periosteal new bone formation also may be seenREFERENCE
Oral and Maxillofacial Pathology- Brad W. Neville - Question 129 of 150
129. Question
Deep vein thrombosis is assessed by?
CorrectANSWER
Homans signOTHER OPTIONS
• Nikolsky’s sign is pathognomic for pemphigus
• Murphy’s sign (also known as Sweeney’s sign) is a maneuver during a physical examination as part of the abdominal examination.SYNOPSIS
• Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT).
• A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT.
• Technique
– In performing this test the patient will need to actively extend his knee.
– Once the knee is extended the examiner raises the patient’s straight leg to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand.
– Deep calf pain and tenderness may indicate presence of DVT.
• Homan’s sign has low sensitivity and specificity in diagnosing DVT, it can be of value if used in addition to more accurate diagnostic procedures like ultrasonography and venographyREFERENCE
Homan’s Sign Test- PhysiopediaIncorrectANSWER
Homans signOTHER OPTIONS
• Nikolsky’s sign is pathognomic for pemphigus
• Murphy’s sign (also known as Sweeney’s sign) is a maneuver during a physical examination as part of the abdominal examination.SYNOPSIS
• Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT).
• A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT.
• Technique
– In performing this test the patient will need to actively extend his knee.
– Once the knee is extended the examiner raises the patient’s straight leg to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand.
– Deep calf pain and tenderness may indicate presence of DVT.
• Homan’s sign has low sensitivity and specificity in diagnosing DVT, it can be of value if used in addition to more accurate diagnostic procedures like ultrasonography and venographyREFERENCE
Homan’s Sign Test- Physiopedia - Question 130 of 150
130. Question
A patient comes to the clinic with a complaint of sensitivity to teeth. He has a habit of hard brushing to remove his tobacco stains. Identify the reason?
CorrectANSWER
AbrasionOTHER OPTIONS
• Attrition – Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces.
• Abfraction – Abfraction is a form of non-carious tooth tissue loss that occurs along the gingival margin.In other words, abfraction is a mechanical loss of tooth structure that is not caused by tooth decay, located along the gum line. There is theoretical evidence to support the concept of abfraction, but little experimental evidence exists.
• Dental erosion, also known as tooth erosion, is the chemical loss of mineralized tooth substance caused by exposure to acids not derived from oral bacteria. Erosive demineralization is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial.SYNOPSIS
• Abrasion is derived from Latin word abradere which means to scrap off. Abrasion is the loss of tooth substance through some abnormal mechanical process, habits and abrasive substance.
• Etiology of abrasion
• Faulty oral hygiene practice
– Horizontal brushing technique or improper brushing technique
– Overzealous brushing
– Use of toothbrush with hard bristles
– Use of abrasive toothpaste or toothpowder
– Excessive time, force and frequency of brushing
– Excessive use of interproximal brushes
• Abnormal oral habits
– Use of toothpicks
– Finger nail biting
• Clinical features
• Abrasion results in saucer-shaped or wedge-shaped indentation with a smooth, shiny surface.
• Commonly affected teeth are canines and premolars.
• Usually occurs on the exposed root surfaces but may also occur elsewhere, such as on incisal surface in pipe smokers and tailors holding needle with anterior teeth.
• Most commonly seen toothbrush abrasions are uNILateral in nature.
• Lesion has sharply defined margins and internal angles.REFERENCE
Textbook of Operative Dentistry- Nisha GargIncorrectANSWER
AbrasionOTHER OPTIONS
• Attrition – Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces.
• Abfraction – Abfraction is a form of non-carious tooth tissue loss that occurs along the gingival margin.In other words, abfraction is a mechanical loss of tooth structure that is not caused by tooth decay, located along the gum line. There is theoretical evidence to support the concept of abfraction, but little experimental evidence exists.
• Dental erosion, also known as tooth erosion, is the chemical loss of mineralized tooth substance caused by exposure to acids not derived from oral bacteria. Erosive demineralization is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial.SYNOPSIS
• Abrasion is derived from Latin word abradere which means to scrap off. Abrasion is the loss of tooth substance through some abnormal mechanical process, habits and abrasive substance.
• Etiology of abrasion
• Faulty oral hygiene practice
– Horizontal brushing technique or improper brushing technique
– Overzealous brushing
– Use of toothbrush with hard bristles
– Use of abrasive toothpaste or toothpowder
– Excessive time, force and frequency of brushing
– Excessive use of interproximal brushes
• Abnormal oral habits
– Use of toothpicks
– Finger nail biting
• Clinical features
• Abrasion results in saucer-shaped or wedge-shaped indentation with a smooth, shiny surface.
• Commonly affected teeth are canines and premolars.
• Usually occurs on the exposed root surfaces but may also occur elsewhere, such as on incisal surface in pipe smokers and tailors holding needle with anterior teeth.
• Most commonly seen toothbrush abrasions are uNILateral in nature.
• Lesion has sharply defined margins and internal angles.REFERENCE
Textbook of Operative Dentistry- Nisha Garg - Question 131 of 150
131. Question
The success of osseointegration depends on?
CorrectANSWER
All of the aboveOTHER OPTIONS
• Explained belowSYNOPSIS
• Osseointegration was defined by Brånemark as the direct connection of living bone with the surface of an implant subjected to a functional load.
• Success of Osseointegration depends on
– The material used in the implant,
– The machining conditions
– The surface finish
– The type of bone that receives the implant
– The surgical technique
– Design of the prosthesis
– The patient care.REFERENCE
Factors Affecting the Success of Dental Implants- Carlos Nelson EliasIncorrectANSWER
All of the aboveOTHER OPTIONS
• Explained belowSYNOPSIS
• Osseointegration was defined by Brånemark as the direct connection of living bone with the surface of an implant subjected to a functional load.
• Success of Osseointegration depends on
– The material used in the implant,
– The machining conditions
– The surface finish
– The type of bone that receives the implant
– The surgical technique
– Design of the prosthesis
– The patient care.REFERENCE
Factors Affecting the Success of Dental Implants- Carlos Nelson Elias - Question 132 of 150
132. Question
What is the management for white spots after the removal of orthodontic brackets?
CorrectANSWER
All the aboveOTHER OPTIONS
• Explained belowSYNOPSIS
• White spots can develop pretty fast with patients undergoing orthodontic treatment that uses brackets and bands.
• Sometimes when we eat foods and drink beverages that are high in sugars and acids, it’s hard to brush effectively enough to remove all traces of them from your teeth and your orthodontic gear.
• This leads to a big buildup of bad bacteria which can turn into plaque and cavities.
• There are a few ways you can make the white spots disappear.
1. Do Nothing – Sometimes with regular brushing and good oral hygiene, the spots will go away all on their own.
2. Re-Mineralization – This common solution usually involves applying a cream to your teeth that contains the minerals the bad bacteria took from your teeth. This treatment can cause spots to fade or disappear completely.
3. Tooth Whitening – This special chemical treatment can have a quick and direct impact on your white spots. It can normalize and boost the color of your teeth for a straight, bright, and white smile.
4. Dental Veneers – Some patients opt for cosmetic dental veneers that are placed directly over the front of your teeth. Veneers are durable and will make your smile look completely refreshed and natural.REFERENCE
How Can I Get Rid of White Spots on My Teeth After Braces?IncorrectANSWER
All the aboveOTHER OPTIONS
• Explained belowSYNOPSIS
• White spots can develop pretty fast with patients undergoing orthodontic treatment that uses brackets and bands.
• Sometimes when we eat foods and drink beverages that are high in sugars and acids, it’s hard to brush effectively enough to remove all traces of them from your teeth and your orthodontic gear.
• This leads to a big buildup of bad bacteria which can turn into plaque and cavities.
• There are a few ways you can make the white spots disappear.
1. Do Nothing – Sometimes with regular brushing and good oral hygiene, the spots will go away all on their own.
2. Re-Mineralization – This common solution usually involves applying a cream to your teeth that contains the minerals the bad bacteria took from your teeth. This treatment can cause spots to fade or disappear completely.
3. Tooth Whitening – This special chemical treatment can have a quick and direct impact on your white spots. It can normalize and boost the color of your teeth for a straight, bright, and white smile.
4. Dental Veneers – Some patients opt for cosmetic dental veneers that are placed directly over the front of your teeth. Veneers are durable and will make your smile look completely refreshed and natural.REFERENCE
How Can I Get Rid of White Spots on My Teeth After Braces? - Question 133 of 150
133. Question
Which nerve block is recommended for the mesiobuccal root of the maxillary first molar?
CorrectANSWER
Middle superiorOTHER OPTIONS
• Anterior superior block – used for maxillary anterior tooth anesthesia till the premolars.
• Infraorbital- is given to anaesthetize the anterior part of maxilla.
• Posterior superior- used to anesthetise Maxillary molars except mesiobuccal root of first molar.SYNOPSIS
• The MSA nerve block is useful for procedures in which the maxillary premolar teeth or the mesiobuccal root of the first molar requires anesthesia.
• MSA is a supraperiosteal injection (commonly known as local infiltration) is indicated whenever dental procedures are confined to a localized area.
• Advantages of the technique
– No added collateral anesthesia to the lips, the face, or even the facial muscles as well.
– The need for multiple injections is also eliminated because of this technique in this segment, and the numbness associated with anesthesia is also moderate, which may prevent any sort of self-inflicted injury at the dentist in the clinic or patient discomfort.REFERENCE
Anterior Middle Superior Alveolar Nerve Block in Dentistry- RavichandranIncorrectANSWER
Middle superiorOTHER OPTIONS
• Anterior superior block – used for maxillary anterior tooth anesthesia till the premolars.
• Infraorbital- is given to anaesthetize the anterior part of maxilla.
• Posterior superior- used to anesthetise Maxillary molars except mesiobuccal root of first molar.SYNOPSIS
• The MSA nerve block is useful for procedures in which the maxillary premolar teeth or the mesiobuccal root of the first molar requires anesthesia.
• MSA is a supraperiosteal injection (commonly known as local infiltration) is indicated whenever dental procedures are confined to a localized area.
• Advantages of the technique
– No added collateral anesthesia to the lips, the face, or even the facial muscles as well.
– The need for multiple injections is also eliminated because of this technique in this segment, and the numbness associated with anesthesia is also moderate, which may prevent any sort of self-inflicted injury at the dentist in the clinic or patient discomfort.REFERENCE
Anterior Middle Superior Alveolar Nerve Block in Dentistry- Ravichandran - Question 134 of 150
134. Question
A premolar with a recently placed crown shows grade II mobility. But the periodontal and periapical findings were normal. What is the reason ?
CorrectANSWER
Primary occlusal traumaOTHER OPTIONS
• Secondary occlusal trauma – Secondary occlusal trauma is injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support. It occurs in the presence of attachment loss, bone loss, and normal or excessive occlusal force(s).
• Insufficient ferrule – leads to poor fracture resistance
• Periodontitis – Periodontitis is a severe gum infection that can lead to tooth loss and other serious health complications.SYNOPSIS
• Occlusal trauma is a term used to describe an injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone, and cementum, as a result of occlusal force(s).
• Occlusal trauma may occur in an intact periodontium or in a reduced periodontium caused by periodontal disease.
• Primary occlusal trauma is an injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support.
• It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal force(s)
• The signs and symptoms experienced by patients with occlusal trauma are
– Mobility of teeth,
– Temperomandibular joint pain,
– Pain on mastication
• Early diagnosis, proper treatment plan and correction of malocclusion can lead to a successful outcome.REFERENCE
Carranzas Clinical PeriodontologyIncorrectANSWER
Primary occlusal traumaOTHER OPTIONS
• Secondary occlusal trauma – Secondary occlusal trauma is injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support. It occurs in the presence of attachment loss, bone loss, and normal or excessive occlusal force(s).
• Insufficient ferrule – leads to poor fracture resistance
• Periodontitis – Periodontitis is a severe gum infection that can lead to tooth loss and other serious health complications.SYNOPSIS
• Occlusal trauma is a term used to describe an injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone, and cementum, as a result of occlusal force(s).
• Occlusal trauma may occur in an intact periodontium or in a reduced periodontium caused by periodontal disease.
• Primary occlusal trauma is an injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support.
• It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal force(s)
• The signs and symptoms experienced by patients with occlusal trauma are
– Mobility of teeth,
– Temperomandibular joint pain,
– Pain on mastication
• Early diagnosis, proper treatment plan and correction of malocclusion can lead to a successful outcome.REFERENCE
Carranzas Clinical Periodontology - Question 135 of 150
135. Question
Which principle does ensure that professionals have a duty to be fair in their dealings with patients?
CorrectANSWER
JusticeOTHER OPTIONS
• Nonmaleficence- Considered to be the foundation of social morality. Actions of the healthcare provider should not harm the patients in anyway
• Autonomy It is the principle that dictates that health care professionals respects patients right to make decisions concerning the treatment plan.
• Veracity- The patient – doctor relationship is based on trust.SYNOPSIS
• Justice-
• Provide equal treatment to all without any prejudice
• Violation of justice – Discrimination between patients based on caste, creed, socioeconomic status, health condition .
• Principle of justice is to protect the weak and to ensure equality in rights and benefits, for both groups and individuals.REFERENCE
Textbook of community dentistry Soben peterIncorrectANSWER
JusticeOTHER OPTIONS
• Nonmaleficence- Considered to be the foundation of social morality. Actions of the healthcare provider should not harm the patients in anyway
• Autonomy It is the principle that dictates that health care professionals respects patients right to make decisions concerning the treatment plan.
• Veracity- The patient – doctor relationship is based on trust.SYNOPSIS
• Justice-
• Provide equal treatment to all without any prejudice
• Violation of justice – Discrimination between patients based on caste, creed, socioeconomic status, health condition .
• Principle of justice is to protect the weak and to ensure equality in rights and benefits, for both groups and individuals.REFERENCE
Textbook of community dentistry Soben peter - Question 136 of 150
136. Question
What should be the width of the cavity for small cavity preparation for amalgam restoration in the upper premolar?
CorrectANSWER
One-fourth intercuspal distanceOTHER OPTIONS
• One-third intercuspal distance – ideal for molarsSYNOPSIS
• The ideal width for an amalgam cavity in premolar is one-fourth of the intercuspal distance.
• Minimum amount of marginal tooth structure to be preserved is 2mm in molars and 1.6mm in premolars
• Depth of amalgam restoration – 1.5 – 2mm
• Cavosurface angle for amalgam – 90 degreeREFERENCE
Sturdevant’s Art and Science of Operative DentistryIncorrectANSWER
One-fourth intercuspal distanceOTHER OPTIONS
• One-third intercuspal distance – ideal for molarsSYNOPSIS
• The ideal width for an amalgam cavity in premolar is one-fourth of the intercuspal distance.
• Minimum amount of marginal tooth structure to be preserved is 2mm in molars and 1.6mm in premolars
• Depth of amalgam restoration – 1.5 – 2mm
• Cavosurface angle for amalgam – 90 degreeREFERENCE
Sturdevant’s Art and Science of Operative Dentistry - Question 137 of 150
137. Question
What is the use of the given instrument ? (key point – ortho band pusher)
CorrectANSWER
Final placement of the bandOTHER OPTIONS
• During initial stage of band placement – During the first appointment, separators are placed in anticipation of bands in order to create space for the bands to be seated
Once space has been created, the correct size band can be selected for the patient during the second appointment.SYNOPSIS
• A band pusher is a long handled instrument with an angled rectangular serrated tip which is used for fitting and positioning an orthodontic band on a tooth.
• The band pusher is used to eliminate all space between the band and the tooth.
• It is used to push Orthodontic bands into place during try in and cementing phases that is during final stage of band placementREFERENCE
Orthodontic Band Selection and Placement – University of Toronto-Faculty of DentistryIncorrectANSWER
Final placement of the bandOTHER OPTIONS
• During initial stage of band placement – During the first appointment, separators are placed in anticipation of bands in order to create space for the bands to be seated
Once space has been created, the correct size band can be selected for the patient during the second appointment.SYNOPSIS
• A band pusher is a long handled instrument with an angled rectangular serrated tip which is used for fitting and positioning an orthodontic band on a tooth.
• The band pusher is used to eliminate all space between the band and the tooth.
• It is used to push Orthodontic bands into place during try in and cementing phases that is during final stage of band placementREFERENCE
Orthodontic Band Selection and Placement – University of Toronto-Faculty of Dentistry - Question 138 of 150
138. Question
Picture of mucocele – How will you manage?
CorrectANSWER
ExcisionOTHER OPTIONS
• Irradiation – Irradiation is the process by which an object is exposed to radiation.
• Cauterization – It is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other potential medical harm, such as infections when antibiotics are unavailable.SYNOPSIS
• An oral mucocele is a harmless mucus-filled cyst on the inside of the mouth.
• The cysts are usually painless and look like smooth, round lesions.
• Trauma such as biting your lip cause most oral mucoceles.
• Mucocoele typically doesn’t need treatment because the cyst should go away by itself.
• For cysts that repeatedly come back or for large mucoceles, the recommended treatment options are
– Cryotherapy – Application of extreme cold to freeze and destroy the mucocele cyst.
– Laser treatment – Using a special laser to remove the lesion.
– Surgical excision – An oral surgeon or dentist will cut out and remove the cyst. They may also remove the salivary glandREFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
ExcisionOTHER OPTIONS
• Irradiation – Irradiation is the process by which an object is exposed to radiation.
• Cauterization – It is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other potential medical harm, such as infections when antibiotics are unavailable.SYNOPSIS
• An oral mucocele is a harmless mucus-filled cyst on the inside of the mouth.
• The cysts are usually painless and look like smooth, round lesions.
• Trauma such as biting your lip cause most oral mucoceles.
• Mucocoele typically doesn’t need treatment because the cyst should go away by itself.
• For cysts that repeatedly come back or for large mucoceles, the recommended treatment options are
– Cryotherapy – Application of extreme cold to freeze and destroy the mucocele cyst.
– Laser treatment – Using a special laser to remove the lesion.
– Surgical excision – An oral surgeon or dentist will cut out and remove the cyst. They may also remove the salivary glandREFERENCE
Shafer’s Textbook of Oral Pathology - Question 139 of 150
139. Question
A patient with abrasion on the teeth and gingivitis complains of bleeding on brushing. On examination, the patient’s oral hygiene measures show brushing twice and using floss too. What change has to be advised for him for better periodontal health?
CorrectANSWER
Change the brushing techniqueOTHER OPTIONS
• Not applicableSYNOPSIS
• Changing the brushing technique can improve the condition of this patient
• Bass Method or Sulcular cleaning method is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin
• Indications
– Open interproximal areas
– Cervical areas beneath the height of the contour of enamel
– Exposed root surface
– Recommended for patients with or without periodontal involvement
• Technique
– The bristles are held at a 45-degree angle toward the gum line.
– Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the gum line.
– Only small groups of teeth can be done at a time.
– Once an area is complete, move on to the next set of teeth.REFERENCE
Carranza’s Clinical PeriodontologyIncorrectANSWER
Change the brushing techniqueOTHER OPTIONS
• Not applicableSYNOPSIS
• Changing the brushing technique can improve the condition of this patient
• Bass Method or Sulcular cleaning method is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin
• Indications
– Open interproximal areas
– Cervical areas beneath the height of the contour of enamel
– Exposed root surface
– Recommended for patients with or without periodontal involvement
• Technique
– The bristles are held at a 45-degree angle toward the gum line.
– Very slight pressure and vibratory motions are made so that the bristles go slightly beneath the gum line.
– Only small groups of teeth can be done at a time.
– Once an area is complete, move on to the next set of teeth.REFERENCE
Carranza’s Clinical Periodontology - Question 140 of 150
140. Question
EBV causes all except?
CorrectANSWER
PapillomaOTHER OPTIONS
• Burkitt’s lymphoma – Burkitt’s lymphoma is a type of non-Hodgkin lymphoma (NHL) caused by EBV
• Carcinoma of the nasopharynx – Nasopharyngeal carcinoma is a rare tumor of the head and neck which originates in the nasopharynx. The closest association with EBV infection is seen in undifferentiated nasopharyngeal carcinoma
• Infectious mononucleosis – Infectious mononucleosis, also called mono, is a contagious disease. Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis, but other viruses can also cause this disease.SYNOPSIS
• A papilloma is a benign epithelial tumor growing exophytically (outwardly projecting) in nipple-like and often finger-like fronds.
• Clinical features –
– Cauliflower-like projections that arise from the mucosal surface.
– It may appear white or normal colored.
– It may be pedunculated or sessile.
-The average size is between 1–5 cm.
– Neither sex is significantly more likely to develop them.
– The most common site is the palate-uvula area followed by the tongue and lips.
– Durations range from weeks to 10 years.
• Differential diagnosis
– Intraoral verruca vulgaris
– Condyloma acuminatum
– Focal epithelial hyperplasia.
• Treatment-conservative surgical excision, recurrence is rare.REFERENCE
Shafer’s textbook of oral pathologyIncorrectANSWER
PapillomaOTHER OPTIONS
• Burkitt’s lymphoma – Burkitt’s lymphoma is a type of non-Hodgkin lymphoma (NHL) caused by EBV
• Carcinoma of the nasopharynx – Nasopharyngeal carcinoma is a rare tumor of the head and neck which originates in the nasopharynx. The closest association with EBV infection is seen in undifferentiated nasopharyngeal carcinoma
• Infectious mononucleosis – Infectious mononucleosis, also called mono, is a contagious disease. Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis, but other viruses can also cause this disease.SYNOPSIS
• A papilloma is a benign epithelial tumor growing exophytically (outwardly projecting) in nipple-like and often finger-like fronds.
• Clinical features –
– Cauliflower-like projections that arise from the mucosal surface.
– It may appear white or normal colored.
– It may be pedunculated or sessile.
-The average size is between 1–5 cm.
– Neither sex is significantly more likely to develop them.
– The most common site is the palate-uvula area followed by the tongue and lips.
– Durations range from weeks to 10 years.
• Differential diagnosis
– Intraoral verruca vulgaris
– Condyloma acuminatum
– Focal epithelial hyperplasia.
• Treatment-conservative surgical excision, recurrence is rare.REFERENCE
Shafer’s textbook of oral pathology - Question 141 of 150
141. Question
You noticed palatal ulcers in a patient making him hard to eat and drink. The patient added that the same type of sores is present in the genital area too. What diagnostic test you will advice for him?
CorrectANSWER
ImmunofluorescenceOTHER OPTIONS
• Schirmer test – Schirmer’s test is used to determine whether the eye produces enough tears to keep it moist. The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture
• Pathergy test – The pathergy test is a nonspecific hypersensitivity skin reaction induced by a needle prick that is performed to look for evidence of this phenomenon.
• ELISA – An enzyme-linked immunosorbent assay, also called ELISA or EIA, is a test that detects and measures antibodies in your blood.SYNOPSIS
• Immunofluorescence assay (IFA) is a standard virologic technique to identify the presence of antibodies by their specific ability to react with viral antigens expressed in infected cells
• Here the symptoms look like that of a herpes infection.
• Immunofluorescence assay is a rapid test for the detection of herpes virus in suspected herpetic patientsREFERENCE
Shafer’s Textbook of Oral PathologyIncorrectANSWER
ImmunofluorescenceOTHER OPTIONS
• Schirmer test – Schirmer’s test is used to determine whether the eye produces enough tears to keep it moist. The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture
• Pathergy test – The pathergy test is a nonspecific hypersensitivity skin reaction induced by a needle prick that is performed to look for evidence of this phenomenon.
• ELISA – An enzyme-linked immunosorbent assay, also called ELISA or EIA, is a test that detects and measures antibodies in your blood.SYNOPSIS
• Immunofluorescence assay (IFA) is a standard virologic technique to identify the presence of antibodies by their specific ability to react with viral antigens expressed in infected cells
• Here the symptoms look like that of a herpes infection.
• Immunofluorescence assay is a rapid test for the detection of herpes virus in suspected herpetic patientsREFERENCE
Shafer’s Textbook of Oral Pathology - Question 142 of 150
142. Question
A child comes to your clinic after fall down from stairs. During examination you have found that her teeth shows no mobility but have luxation. Which is the best treatment option?
CorrectANSWER
Flexible fixationOTHER OPTIONS
• NilSYNOPSIS
• The established treatment of luxation of teeth in children is to allow passive repositioning or actively reposition the luxated tooth followed by splinting for 1-2 weeks.This can be done with flexible fixation. In severe conditions when the crown is dislocated in labial direction extraction is the treatment of choice. In the tooth with minor occlusal interference the slight grinding is advocated.
• The treatment modalities aforementioned had following limitations
(1) To allow passive repositioning may further jeopardise the prognosis of luxated tooth with severe occlusal interference.
(2) Active repositioning procedure cannot apply in cases with delayed presentation after traumatic injury. Active repositioning of lateral luxation was usually associated with developing pulp necrosis.
(3) Severe grinding of tooth causes exposure of dentinal tubules and sometimes even exposure of pulp leading to loss of vitality of the tooth.
(4) Extraction of anterior tooth especially in young children can lead to poor phonetics aesthetics and loss of function thereby causing psychological and social problems for children.REFERENCE
A novel approach in management of lateral luxation of primary tooth- Abhijit D WankhadeIncorrectANSWER
Flexible fixationOTHER OPTIONS
• NilSYNOPSIS
• The established treatment of luxation of teeth in children is to allow passive repositioning or actively reposition the luxated tooth followed by splinting for 1-2 weeks.This can be done with flexible fixation. In severe conditions when the crown is dislocated in labial direction extraction is the treatment of choice. In the tooth with minor occlusal interference the slight grinding is advocated.
• The treatment modalities aforementioned had following limitations
(1) To allow passive repositioning may further jeopardise the prognosis of luxated tooth with severe occlusal interference.
(2) Active repositioning procedure cannot apply in cases with delayed presentation after traumatic injury. Active repositioning of lateral luxation was usually associated with developing pulp necrosis.
(3) Severe grinding of tooth causes exposure of dentinal tubules and sometimes even exposure of pulp leading to loss of vitality of the tooth.
(4) Extraction of anterior tooth especially in young children can lead to poor phonetics aesthetics and loss of function thereby causing psychological and social problems for children.REFERENCE
A novel approach in management of lateral luxation of primary tooth- Abhijit D Wankhade - Question 143 of 150
143. Question
A 17 years old boy presented with an avulsed permanent tooth for less than 1 hour. What is the treatment of choice?
CorrectANSWER
RCT done extraoral and then reimplantOTHER OPTIONS
• Reimplant and rigid splint – Avulsed teeth should be replanted in the socket as soon as possible. The long-term success depends mainly on the extraoral period. Under the circumstances, best results will be achieved if the tooth remains out of the socket for less than 20 minutesSYNOPSIS
• 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 case-extra oral time less than 20 minutes-replant immediately after gentle washing and extra oral time more than 20 minutes endo treatment should be performed before replantationREFERENCE
Therapeutic Protocols for Avulsed Permanent Teeth: Review and Clinical Update Diana Ram, Dr OdontIncorrectANSWER
RCT done extraoral and then reimplantOTHER OPTIONS
• Reimplant and rigid splint – Avulsed teeth should be replanted in the socket as soon as possible. The long-term success depends mainly on the extraoral period. Under the circumstances, best results will be achieved if the tooth remains out of the socket for less than 20 minutesSYNOPSIS
• 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 case-extra oral time less than 20 minutes-replant immediately after gentle washing and extra oral time more than 20 minutes endo treatment should be performed before replantationREFERENCE
Therapeutic Protocols for Avulsed Permanent Teeth: Review and Clinical Update Diana Ram, Dr Odont - Question 144 of 150
144. Question
Patient complaints of the gingival recession on a PFM crown placed subgingivally. What may be the cause?
CorrectANSWER
Biological width violationOTHER OPTIONS
• NilSYNOPSIS
• The biological width is defined as the dimension of the soft tissue, which is attached to the portion of the tooth coronal to the crest of the alveolar bone.
• It is the natural seal that develops around both, protecting the alveolar bone from infection and disease
• Nevins and Skurow stated that when subgingival margins are indicated, the restorative dentist must not disrupt the junctional epithelium or connective tissue apparatus during preparation and impressing taking.
• The authors recommended limiting subgingival margin extension to 0.5-1.0 mm because it is impossible for the clinician to detect where the sulcular epithelium ends and the junctional epithelium begins.
• Invasion of biologic periodontal space for additional retention will cause iatrogenic periodontal disease with a premature loss of restoration.
• Restorative margin placement within the biologic width is detrimental to periodontal health and acts as a plaque retentive factor.REFERENCE
Biologic width and its importance in periodontal and restorative dentistry- Babitha NugalaIncorrectANSWER
Biological width violationOTHER OPTIONS
• NilSYNOPSIS
• The biological width is defined as the dimension of the soft tissue, which is attached to the portion of the tooth coronal to the crest of the alveolar bone.
• It is the natural seal that develops around both, protecting the alveolar bone from infection and disease
• Nevins and Skurow stated that when subgingival margins are indicated, the restorative dentist must not disrupt the junctional epithelium or connective tissue apparatus during preparation and impressing taking.
• The authors recommended limiting subgingival margin extension to 0.5-1.0 mm because it is impossible for the clinician to detect where the sulcular epithelium ends and the junctional epithelium begins.
• Invasion of biologic periodontal space for additional retention will cause iatrogenic periodontal disease with a premature loss of restoration.
• Restorative margin placement within the biologic width is detrimental to periodontal health and acts as a plaque retentive factor.REFERENCE
Biologic width and its importance in periodontal and restorative dentistry- Babitha Nugala - Question 145 of 150
145. Question
A patient who is on dicumarol therapy require a tooth extraction. Which laboratory test is the most valuable in evaluating this patient’s surgical risk?
CorrectANSWER
Prothrombin timeOTHER OPTIONS
• NilSYNOPSIS
• Dicumarol like warfarin, is a 4-hydroxycoumarin derived anticoagulant that is used for treatment of thromboembolic conditions
• PT and INR is used to monitor the effectiveness of these anticoagulants
• It is used to assess the risk of bleeding or the coagulation status of patients undergoing dental surgical procdures
• There is no need to alter the dosage of these anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2- 4.
• Dental extractions should be done in least traumatic manner and local measures should be used to control post operative hemorrhage if any.REFERENCE
Extraction in patients on Oral Anticoagulant therapy – Journal of OMFSIncorrectANSWER
Prothrombin timeOTHER OPTIONS
• NilSYNOPSIS
• Dicumarol like warfarin, is a 4-hydroxycoumarin derived anticoagulant that is used for treatment of thromboembolic conditions
• PT and INR is used to monitor the effectiveness of these anticoagulants
• It is used to assess the risk of bleeding or the coagulation status of patients undergoing dental surgical procdures
• There is no need to alter the dosage of these anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2- 4.
• Dental extractions should be done in least traumatic manner and local measures should be used to control post operative hemorrhage if any.REFERENCE
Extraction in patients on Oral Anticoagulant therapy – Journal of OMFS - Question 146 of 150
146. Question
A patient with missing maxillary anterior teeth presented for replacing them. Full ceramic FPD has delivered but the patient came back with gingival inflammation after 2 days. What may be the reason?
CorrectANSWER
Improper design of the restorationOTHER OPTIONS
• NilSYNOPSIS
• A dental crown can potentially irritate the neighboring gum tissue, leading to inflammation and also gum recession which can cause pain and sensitivity.
• Crowns and FPDs increase the incidence of advanced gingival inflammation adjacent to restorations particularly if restorations had
– intracrevicular finish line placement
– poor marginal adptation
– rough surface
• Maintaining good oral hygiene with regular brushing and flossing also helps the gum tissues stay healthy, preventing them from receding.
• Additionally, keeping the area around your new dental crown clean using a water flosser can also be of great benefit to your gum tissues.REFERENCE
Potential Complications With Dental Crowns by Dr. HardingIncorrectANSWER
Improper design of the restorationOTHER OPTIONS
• NilSYNOPSIS
• A dental crown can potentially irritate the neighboring gum tissue, leading to inflammation and also gum recession which can cause pain and sensitivity.
• Crowns and FPDs increase the incidence of advanced gingival inflammation adjacent to restorations particularly if restorations had
– intracrevicular finish line placement
– poor marginal adptation
– rough surface
• Maintaining good oral hygiene with regular brushing and flossing also helps the gum tissues stay healthy, preventing them from receding.
• Additionally, keeping the area around your new dental crown clean using a water flosser can also be of great benefit to your gum tissues.REFERENCE
Potential Complications With Dental Crowns by Dr. Harding - Question 147 of 150
147. Question
An 8yr old boy came to your clinic for routine dental checkup.On clinical examination you found the teeth with generalized yellowish-brown discoloration with pits and grooves. What could be the propable diagnosis?
CorrectANSWER
Amelogenesis imperfectaOTHER OPTIONS
• Dentinogenesis imperfecta Increasing attrition leads to deposition of secondary dentin resulting in the obliteration of the pulp chamber in AI. DI may be excluded from the diagnosis as it exhibits bulbous crowns, narrow roots, obliteration of pulp chambers in the absence of attrition and normal radio density of enamel.
• Dental fluorosis Type II C (snow-capped teeth) may be mistaken for fluorosis but does not have the accentuated perichymata seen in fluorosis. If fluorosis is suspected, usually the premolars and second permanent molars may be spared and the history will reveal excessive fluoride intake.
• Tetracycline discoloration- When exposed to tetracycline, a childs newly erupted teeth appear fluorescent yellow. Exposure to sunlight, though, causes a change in color, and the teeth become brownish or grayish over time. Since sunlight affects final tooth color, its not uncommon to have greater discoloration in the front or anterior teeth.SYNOPSIS
• Amelogenesis imperfecta (AI) represents a group of inherited, congenital defects that primarily affect only enamel formation and are not accompanied by morphologic or metabolic defects in other body systems other than tooth form or eruption.
• Mutations in the amelogenin gene (AMELX) and enamelin gene (ENAM) are believed to cause X-linked AI and autosomal inherited forms of AI respectively.
• Affects both dentitions (deciduous and permanent) sometimes only a part of the dentition may be affected.
• Teeth exhibit a yellow to dark brown discoloration, the consistency varying from cheesy to hard.
• The teeth exhibit pits and grooves and in some cases, enamel may be entirely absent.REFERENCE
Textbook of oral medicine,oral diagnosis and oral radiology- Ravikaran Ongole.IncorrectANSWER
Amelogenesis imperfectaOTHER OPTIONS
• Dentinogenesis imperfecta Increasing attrition leads to deposition of secondary dentin resulting in the obliteration of the pulp chamber in AI. DI may be excluded from the diagnosis as it exhibits bulbous crowns, narrow roots, obliteration of pulp chambers in the absence of attrition and normal radio density of enamel.
• Dental fluorosis Type II C (snow-capped teeth) may be mistaken for fluorosis but does not have the accentuated perichymata seen in fluorosis. If fluorosis is suspected, usually the premolars and second permanent molars may be spared and the history will reveal excessive fluoride intake.
• Tetracycline discoloration- When exposed to tetracycline, a childs newly erupted teeth appear fluorescent yellow. Exposure to sunlight, though, causes a change in color, and the teeth become brownish or grayish over time. Since sunlight affects final tooth color, its not uncommon to have greater discoloration in the front or anterior teeth.SYNOPSIS
• Amelogenesis imperfecta (AI) represents a group of inherited, congenital defects that primarily affect only enamel formation and are not accompanied by morphologic or metabolic defects in other body systems other than tooth form or eruption.
• Mutations in the amelogenin gene (AMELX) and enamelin gene (ENAM) are believed to cause X-linked AI and autosomal inherited forms of AI respectively.
• Affects both dentitions (deciduous and permanent) sometimes only a part of the dentition may be affected.
• Teeth exhibit a yellow to dark brown discoloration, the consistency varying from cheesy to hard.
• The teeth exhibit pits and grooves and in some cases, enamel may be entirely absent.REFERENCE
Textbook of oral medicine,oral diagnosis and oral radiology- Ravikaran Ongole. - Question 148 of 150
148. Question
An old patient reports with missing right lower posteriors. And the operator opted for a cantiliver bridge.What are its disadvantages?
CorrectANSWER
Torquing forces on the abutmentOTHER OPTIONS
• NilSYNOPSIS
• A cantilever fixed partial denture is used when support can be obtained only from one side of the edentulous space.
• There disadvantages include
– Produces torquing forces on the abutment
– Cannot be used to restore long span edentulous spaces
– Minor design errors can affect the abutments in a large scale.REFERENCE
Textbook of Prosthodontics- Deepak Nallaswamy.IncorrectANSWER
Torquing forces on the abutmentOTHER OPTIONS
• NilSYNOPSIS
• A cantilever fixed partial denture is used when support can be obtained only from one side of the edentulous space.
• There disadvantages include
– Produces torquing forces on the abutment
– Cannot be used to restore long span edentulous spaces
– Minor design errors can affect the abutments in a large scale.REFERENCE
Textbook of Prosthodontics- Deepak Nallaswamy. - Question 149 of 150
149. Question
You were presented with a case of difficulty in opening the mouth and difficulty swallowing. On examination, it shows a painful lump under the tongue and patient-reported a strange-tasting saliva. Swelling of the affected side occurs with meals. Identify the diagnosis?
CorrectANSWER
SialolithiasisOTHER OPTIONS
• Mucocele- Oral mucoceles generally occur due to trauma to your salivary glands or a salivary gland opening (duct) blockage.
• Lymphangioma- are noncancerous fluid-filled cysts that form in children, often on the head and neck. These cysts form when lymph fluid backs up and doesn’t flow normally through tissues.
• Pleomorphic adenoma- are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland.SYNOPSIS
• Sialolithiasis is a condition in which stones (calculi) form in your salivary gland or ducts, blocking the flow of saliva.
• These stones, usually made of calcium phosphate and hydroxyapatite, can cause facial pain and swelling.
• Symptoms may occur on one side (unilateral) or both sides (bilateral).
• In some cases, sialoliths can obstruct the salivary ducts, leading to inflammation, superimposed bacterial infection termed sialadenitis, or in rare cases, abscess formation.
• There are various presenting symptoms, with the most common being cyclical postprandial swelling of the affected gland and decreased salivary flow.REFERENCE
Sialolithiasis- Hammett JT, Walker CIncorrectANSWER
SialolithiasisOTHER OPTIONS
• Mucocele- Oral mucoceles generally occur due to trauma to your salivary glands or a salivary gland opening (duct) blockage.
• Lymphangioma- are noncancerous fluid-filled cysts that form in children, often on the head and neck. These cysts form when lymph fluid backs up and doesn’t flow normally through tissues.
• Pleomorphic adenoma- are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland.SYNOPSIS
• Sialolithiasis is a condition in which stones (calculi) form in your salivary gland or ducts, blocking the flow of saliva.
• These stones, usually made of calcium phosphate and hydroxyapatite, can cause facial pain and swelling.
• Symptoms may occur on one side (unilateral) or both sides (bilateral).
• In some cases, sialoliths can obstruct the salivary ducts, leading to inflammation, superimposed bacterial infection termed sialadenitis, or in rare cases, abscess formation.
• There are various presenting symptoms, with the most common being cyclical postprandial swelling of the affected gland and decreased salivary flow.REFERENCE
Sialolithiasis- Hammett JT, Walker C - Question 150 of 150
150. Question
You were presented with a case of 3 years old boy with complaints of a white spot on the gingival third of both maxillary primary canines. What would be the management?
CorrectANSWER
Anticipatory guidanceOTHER OPTIONS
• NilSYNOPSIS
• Anticipatory Guidance provides a framework for prevention that goes beyond caries to address all aspects of children’s oral health.
• In pediatric health care anticipatory guidance is the process of providing practical health information to parents in anticipation of significant, physical, emotional and psychological milestone.
• It also includes
– Alerting them to impending change.
– Teaching them their role in maximizing their children’s development.
• In this scenario, the child has to start the preventive measures to minimise the progression of caries.And the parents are given anticipatory guidance regarding the condition.REFERENCE
Anticipatory Guidance- Joseph McManusIncorrectANSWER
Anticipatory guidanceOTHER OPTIONS
• NilSYNOPSIS
• Anticipatory Guidance provides a framework for prevention that goes beyond caries to address all aspects of children’s oral health.
• In pediatric health care anticipatory guidance is the process of providing practical health information to parents in anticipation of significant, physical, emotional and psychological milestone.
• It also includes
– Alerting them to impending change.
– Teaching them their role in maximizing their children’s development.
• In this scenario, the child has to start the preventive measures to minimise the progression of caries.And the parents are given anticipatory guidance regarding the condition.REFERENCE
Anticipatory Guidance- Joseph McManus
Leaderboard: Evergreen Test
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Last Week Performance Board
Leaderboard: DHA FEB 2022
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