ANSWER
Irreversible pulpitis

OTHER OPTIONS
• Reversible Pulpitis – Non lingering pain that subsides on removal of stimuli
• Pulp necrosis – No response to vitality test

SYNOPSIS
• Irreversible pulpitis is when the inflammation has completely damaged the pulp, which can’t be saved. 
• Symptoms of irreversible pulpitis include
– Nocturnal pain
– Spontaneous pain
– Sensitivity to cold that lasts more than 30 seconds
– Sensitivity to heat
– Pain when the tooth is tapped
– Swelling around tooth and gums
– Fever
– Pain on lying down
– Pain that is radiating
– Trouble finding which tooth is causing the pain‌
• As inflammation builds in the tooth, the pulp can die. This can happen with irreversible pulpitis and, once this occurs, the pain will stop.

REFERENCE
Dental Pulp Testing, A Review.- International Journal of Dentistry. 2009

ANSWER
Reversible pulpitis

OTHER 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 stuffs

SYNOPSIS
• 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 or non lingering pain
• 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

ANSWER
Cementum deposition on apex

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Hypercementosis is an idiopathic, non-neoplastic condition characterized by the excessive buildup of normal cementum (calcified tissue) on the roots of one or more teeth.
• A thicker layer of cementum can give the tooth an enlarged appearance, which mainly occurs at the apex or apices of the tooth.
• The local factors implicated to cause hypercementosis are occlusal trauma, inflammation secondary to pulpal or periodontal disease, tooth mobility, repair of root fracture and transplantation of teeth
• Patients with hypercementosis require no treatment.
• Because of a thickened root, occasional problems have been reported during the extraction of an affected tooth.

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
Single molar space

OTHER OPTIONS
• Not applicable

SYNOPSIS
– Indications of Band and loop Space maintainers
• In case of premature loss of any primary molar in primary dentition, or mixed dentition with permenant successor not erupting clinically for the next 2 years and its root length is formed less than one third
• Premature loss of a primary second molar as the permanent first molar is erupted clinically
• Bilateral loss of single primary molar before eruption of permanent incisors

REFERENCE
Textbook of Pedodontics – Shobha Tandon

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Cheek biting

OTHER OPTIONS
• Tongue bite – Lack of lingual overjet – teeth generally placed lingual to lower ridge. Treated by remove lower lingual cusps, or reset teeth.
• Gagging – Over extended post dam

SYNOPSIS
• The most common cause of cheek biting is due to presence of inadequate overjet between the maxillary and mandibular anterior teeth.
• It can be corrected by increasing the over jet by reducing the buccal surface of lower posterior teeth.
• Cheek biting is also due to loss of vertical dimension, because of this cheeks tend to occlude between the occlusal surface of the denture

REFERENCE
Identification of complete denture problems – A summary – J. F. McCord

ANSWER
Grind buccal of lower teeth

OTHER OPTIONS
• Nil

SYNOPSIS
• Cheek biting usually occurs due to
– Insufficient overjet, in the posterior region
– Very lax cheek
– Reduced vertical dimension
• Treatment includes
– Increase buccal overjet
– Remove the last molars
– Grind the buccal surface of lower posteriors

REFERENCE
Textbook of Prosthodontics – Deepak Nallaswamy

ANSWER
Penicillin

OTHER OPTIONS
• Radiograph – Taking radiographs during the first trimester of pregnancy affects the development of the fetus.
• Extraction – Extraction is contraindicated in the first trimester of pregnancy.

SYNOPSIS
• Penicillin is the antibiotic of choice for a pregnant woman.
• Penicillin is not harmful to the fetus when taken by pregnant mothers.
• It is not incorporated into the bony tissue or in the teeth of children.

REFERENCE
Dental Decks part 2

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• Some antibiotics are known to be teratogenic and should be avoided entirely during pregnancy. These include streptomycin and kanamycin (which may cause hearing loss) and tetracycline (which can lead to weakening, hypoplasia, and discoloration of long bones and teeth).
• If valproate is taken during pregnancy, know that there is a higher risk that the child may have birth defects or may score lower on cognitive tests (tests that measure mental ability and capacity, such as IQ tests) in childhood than any other anti-seizure medicine during pregnancy.

REFERENCE
Medicines in Pregnancy

ANSWER
Trauma

OTHER OPTIONS
• Explained below

SYNOPSIS
• Secondary dentin is dentin deposited in the pulp chamber after the formation of primary dentin has been completed.
• Secondary dentin deposition may be part of physiologic aging and may result from such innocuous stimuli as chewing or slight trauma.
• Tertiary dentin (also referred to as reactive or reparative dentin) is produced in reaction to various stimuli, such as attrition, caries, or a restorative dental procedure

REFERENCE
Dentin Deposition – Ten Cate’s Oral Histology

ANSWER
RCT to root stumps

OTHER OPTIONS
• Explained below

SYNOPSIS
• The most common complication in patients on bisphosphonate therapy is osteonecrosis of the 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 a 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

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• The most important qualities a good dentist should have are 
– Being knowledgeable,
– Being an expert in their field,
– Being trustworthy.
– A dentist should have excellent communication skills and be compassionate

REFERENCE
Qualities of a Good Dentist. By Global Pre-Meds

ANSWER
Milk

OTHER OPTIONS
• Saline – may be used for short-term storage but is not the best medium
• Water – has inadequate characteristics to be used as a storage medium for avulsed teeth because it has bacterial contamination, hypotonicity and nonphysiological pH, and osmolality, which favors the PDL cell lysis

SYNOPSIS
• Milk can be employed as a storage media for avulsed teeth. It meets the following criteria for an interim storage media
(1) It has physiologic pH,
(2) Ability to preserve the viability of PDL cells,
(3) It has a low bacterial count and
(4) Commonly available.
• Milk cannot revitalize the dead cells but helps in preserving the vitality of PDL cells.
• Milk can maintain the viability, mitogenicity, and clonogenic capacity of PDL cells for as long as 24 hours.
• The fat content of milk has an effect on its ability to maintain PDL cell viability. The milk with low-fat content was found to be better than the milk with high-fat content.
• According to Saglas et al., storage of teeth in low-fat milk with ice as storage media is more effective than at room temperature
• In the presence of ice in milk, the apoptotic cell death of the periodontal ligament is further inhibited.
• In conclusion HBSS and chilled milk are the most appropriate, clinically recommended storage media for avulsed teeth.

REFERENCE
Natural products as storage media for avulsed tooth- Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore,

ANSWER
Enamel hypoplasia

OTHER OPTIONS
• Dentinogenesis imperfecta (DI) – It 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 cavities

REFERENCE
Shafers Textbook of Oral pathology

ANSWER
Apexogenesis

OTHER OPTIONS
• Apexification – For non-vital tooth
• Direct pulp capping – For incipient pulp exposure
• RCT – In closed apex cases

SYNOPSIS
• Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end in young permanent tooth in cases of large traumatic exposure of pulp.
• It is a procedure where vital tissue within the tooth is maintained to facilitate the continued development of the immature root.
• A portion of the inflamed pulp is removed and filled with a bioceramic material that maintains vitality in the roots. Healthy tissue then allows for continued root development.
• Vital pulp capping with MTA in apexogenesis has superior long-term sealing ability and stimulates the formation of a higher quality and greater amount of reparative dentin. 
• The calcified bridge formed by MTA is continuous and has no evidence of tunnel defects.

REFERENCE
Apexogenesis and apexification with mineral trioxide aggregate (MTA)- a report of two cases -Endodontic Practice

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Figure of 8 suture

OTHER OPTIONS
• Horizontal mattress suture – This technique tightens both sides of the wound. This is beneficial to close soft tissues. This is the easiest way to fix two papillae with a single knot
• Interrupted suture – This is the most commonly used suture technique in Dental procedures like Impactions, Tooth extractions, etc.
• Continuous Suture – If there is a long incision, the continuous suture technique is preferred

SYNOPSIS
• Figure of 8 suture
• This is a modified version of the horizontal mattress suture.
• While closing both sides of the soft tissue, this suture helps preserve the position of the clot

REFERENCE
Suture techniques And Materials in Oral Surgery

ANSWER
Any of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• Trigeminal neuralgia is a neurological condition in which the trigeminal nerve (the nerve that controls facial sensation) is damaged or compressed by a nearby blood vessel.
• Carbamazepine and oxcarbazepine are considered first-line therapy in trigeminal neuralgia (TN).
• Lamotrigine and baclofen are second-line therapy.
• Other treatments are third line and the evidence for their efficacy is scant.

REFERENCE
Essentials of Pharmacology for Dentistry – K D Tripathi

ANSWER
Microvascular Decompression

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Trigeminal neuralgia is a neurological condition in which the trigeminal nerve (the nerve that controls facial sensation) is damaged or compressed by a nearby blood vessel.
• Microvascular decompression (MVD) surgery has become the suggested treatment for trigeminal neuralgia which is the result of impingement on the nerve by a blood vessel.
• It is considered microsurgery, meaning it requires a much smaller incision, surgical site, and instruments to perform.
• It also means there is a shorter recovery time than other intracranial procedures.

REFERENCE
MVD as a Trigeminal Neuralgia Treatment – Neurosurgeons of New Jersy

ANSWER
Stratum corneum

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Alveolar mucosa 
– The area of tissue beyond the mucogingival junction.
– It seems less firmly attached and redder than the attached gingiva. 
– It is non-keratinized and provides a softer and more flexible area for the movement of the cheeks and lips.
• Attached gingiva 
– This tissue is adjacent to the free gingiva
– It is keratinized and firmly attached to the bone structure.
– It can range from 3-12 mm in height.
• The keratinized epithelium possesses a stratum corneum layer
• The stratum corneum is made up of flattened non-viable, non-nucleated epithelial cells containing keratin which is absent in non-keratinized epithelium

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Apply cold for 24 hrs and hot pads after 24 hours intermittent

OTHER OPTIONS
• Nil

SYNOPSIS
• Apply ice packs to the face in the area of extraction for a few minutes on, then a few minutes off for the first 24 hours following surgery.
• After the first 24 hours, discontinue ice and use a heating pad or moist heat compress to bring the swelling down.
• Most importantly, for 48 hours following your extraction, do not smoke, spit, use a straw, drink carbonated beverages, or alcohol, and avoid strenuous exercise.
• Avoid blowing your nose and sneezing (if you must sneeze, do so with your mouth open to prevent any sinus damage) for the first week.
• These activities can dislodge the blood clot and result in a very painful dry socket.

REFERENCE
Post Operative Instructions for Extraction Patient .

ANSWER
Fibrous dysplasia

OTHER 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 triangle

SYNOPSIS
• 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

ANSWER
Ease of use and personal preference

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Using a specific type of dental floss is a matter of personal choice because all of them effectively remove plaque when used appropriately.
– Waxed vs. Unwaxed floss – Waxed floss is slightly thicker than regular floss but slides easily between tight teeth contacts because of its waxy coating. You may want to use waxed floss to prevent fraying if you have braces. However, be mindful that the wax coating may cause sensitivity reactions in rare cases.
– Dental tape vs. floss – Since the dental tape is broad and flat it is recommended when there are significant gaps between the teeth or if your regular floss slides in too easily.
– Water floss vs. floss – Pressurized water jets can flush out food and debris trapped in the gum spaces. Thus water floss is an easy-to-use alternative when people lack the manual dexterity to use regular string floss or under braces and implants.
– String floss vs. Floss Picks – Floss picks are a convenient option to carry with you when traveling. However, floss picks are not as effective as regular string floss in reducing plaque since they cannot reach all the corners and surfaces of your teeth. So only use them if you don’t have string floss around.
– Super floss vs. Floss Threader – Both super floss and floss threaders have a stiff end that helps to insert the floss between braces under bridges and retainers. The main difference is that you have to buy your string floss separately with a floss threader.

REFERENCE
Best Dental Floss And Types How To Choose The Right One For You? – Dr. Shaista Salam

ANSWER
Acetaminophen

OTHER OPTIONS
• Aspirin – Aspirin has analgesic and anti-inflammatory effects only at intermediate and large doses. At larger doses, the chronic use of aspirin leads to renal vasoconstriction, interstitial nephritis, and a decline in renal function.
• Meperidine – Meperidine is a synthetic opioid that is hepatically metabolized and renally excreted. Normeperidine, its major metabolite, accumulates in chronic kidney disease and causes central nervous system excitability, predisposing patients to seizures.
• Morphine – Morphine-6-glucuronide, an active metabolite of morphine, can accumulate in patients with chronic kidney disease and can have dangerous sedating effects. It crosses the blood-brain barrier slowly, and its effects are not quickly reversed by hemodialysis.

SYNOPSIS
• The preferred medication for analgesia in patients with chronic kidney disease unless otherwise contraindicated is acetaminophen.
• Although its mechanism is not fully understood, acetaminophen is believed to reduce pain by inhibiting the cyclooxygenase isoenzyme at the peroxidase site, ultimately resulting in a reduction of prostaglandin production.
• It is 20 percent to 50 percent protein bound and undergoes hepatic metabolism, making accumulation to toxic concentrations or kidney damage in the setting of chronic kidney disease less likely. 
• Some recent case reports suggest that acetaminophen may be dialyzable.

REFERENCE
Pain Management in Pediatric Chronic Kidney Disease – The Journal of Pediatric Pharmacology and Therapeutics

ANSWER
Pregnancy tumor

OTHER OPTIONS
• Periodontal cyst – It is a relatively uncommon cyst that is slow growing, non-expansile developmental odontogenic cyst derived from one or more rests of the dental lamina, containing an embryonic lining of 1-3 squamouspercuboidal cell thickness and distinctive focal thickenings
• Carcinoma in situ – It is a term used to define and describe cancer that is only present in the cells where it started and has not spread to any nearby tissues.
• Radicular cyst – It is the most common inflammatory odontogenic cyst. It is associated with non-vital teeth. The tooth might be deeply carious, traumatized, or improperly restored.

SYNOPSIS
• The pregnancy-associated pyogenic granuloma is not a tumor but an exaggerated inflammatory response during pregnancy to an irritation resulting in a solitary polypoid capillary hemangioma which can easily bleed on mild provocation.
• These granulomas present clinically as a painless, protuberant, mushroom-like exophytic mass attached by a sessile or pedunculated base arising from the gingival margin or more commonly from an interproximal papilla.
• It is more common in the maxilla and may develop as early as the first trimester ultimately regressing or completely disappearing following parturition.

REFERENCE.
Textbook of Oral Medicine Oral Diagnosis and Oral Radiology- Ravikiran Ongole

ANSWER
X-ray

OTHER OPTIONS
• Acetylsalicylic acid – Aspirin and other drugs containing salicylate are not recommended during pregnancy, especially during the last three months.
• Penicillins – Generally considered safe during pregnancy.

SYNOPSIS
• Exposure to extremely high-dose radiation in the first two weeks after conception might result in a miscarriage.
• During the first-trimester different body organs in the fetus are forming. It is the most critical time for teratogenicity.
• Dental prophylaxis with detailed instructions and a visual examination of the oral cavity without x-rays should be performed if the patient is pregnant.

REFERENCE
White and Pharoah’s Oral Radiology Principles and Interpretation – 8th Edition

ANSWER
Kills bacteria

OTHER OPTIONS
Refer synopsis

SYNOPSIS
• Most antimicrobial soaps use either triclosan or triclocarban as an ingredient to kill microorganisms.
• Triclosan is labeled a biocide, which means that it uses a non-specific mode of action to kill microbes.
• It is thought to destroy biological structures at random.

REFERENCE
Wikipedia

ANSWER
2 to 8 minutes

OTHER OPTIONS
Not acceptable

SYNOPSIS
• Clotting time is defined as the time interval between puncture to the blood vessel to the formation of fibrin thread.
• The normal range of clotting time is 2 to 8 minutes.

REFERENCE
Laboratory Diagnosis and Test Protocols

ANSWER
I bar clasp

OTHER 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 continuous or 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 the I-bar system and introduced the RPI and RPA systems.
• The rest is on the proximal side away from the edentulous space.
• An I-bar retainer is used instead of an occlusally approaching retainer for direct retention.

REFERENCE
Textbook of Prosthodontics-Deepak Nallaswamy

ANSWER
Mesiopalatal cusp of maxillary permanent molars

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
• The Cusp of Carabelli is a characteristic morphological trait often seen on the palatal surface of the mesiopalatal cusp of maxillary permanent molars.
• The cusp of Carabelli, is also known as Carabelli tubercle, tuberculum anomaly of Georg Carabelli.
• This is a morphological variation that takes the form of a fifth cusp or it can grade down to a series of grooves, depressions, or pits on the mesial portion of the lingual surface.
• This cusp is found lingual to the mesiolingual cusp of the maxillary first permanent molar.

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

ANSWER
Direction of bone resorption in maxilla is similar to that in mandible

OTHER OPTIONS
• Nil

SYNOPSIS
• Alveolar ridge resorption after teeth extraction is a chronic progressive and cumulative disease of bone reconstruction. Extensive residual ridge resorption is one of the many problems in prosthetic dentistry rehabilitation .
• Residual ridge resorption starts with the tooth and its periodontal membrane loss responsible for the bone formation . Periodontal membrane loss leads to decreasing metabolism in the alveolar ridge and to biochemical resorption of the bone caused by the dental plaque endotoxines prostaglandines and human stimulating factors of alveolar ridge resorption.
• Tooth loss causes resorption of the upper part of the mandible (alveolar ridge) and is the main factor influencing the clinical height of the residual mandible.
• According to Klemetti initially resorption starts on the alveolar part of the mandible and the rest of the mandible remains unchanged . Factors such as resorption post-menopause or osteoporosis do not change the lower part of the mandible. The main reason for this may be the function of the chewing muscles.
• According to Klemetti’s investigation if frontal teeth remain in the mandible the bite forces in the distal part of the mandible are not strong enough to produce greater resorption both in denture wearers and non-wearer.

REFERENCE
Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers- Dubravka

ANSWER
Dentin dysplasia type II

OTHER OPTIONS
• Dentinogenesis imperfecta – It is a disorder of tooth development. This condition causes the teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent.
• Amelogenesis imperfecta – This is a rare group of hereditary conditions that affect enamel tissue intrinsically. All teeth of both dentitions are affected. Enamel is typically yellow in color, reduced in volume, and pitted. Dentin and pulps are normal.
• Dentin dysplasia type I – Dentin dysplasia Type I is a rare hereditary disturbance in dentin formation characterized by teeth with short blunted roots, complete pulpal obliteration, periapical abscesses or cysts without an obvious causative factor, and spontaneous exfoliation. The normal enamel but atypical dentin formation with abnormal pupal morphology and the half-moon-shaped pulp chamber is seen.

SYNOPSIS
• Dentin dysplasia type II is a dental abnormality characterized by abnormal development (dysplasia) of dentin. primary teeth may be discolored appearing to be yellow, brown, grey-amber, or a brownish-blue color.
• The teeth are sometimes having a translucent opalescence. In most cases, the permanent teeth have a normal color.
• Dentin dysplasia type II shows obliteration of the pulp chambers and the erupting secondary central incisors are of normal appearance.

REFERENCE
Oral Pathology A Textbook of Oral Pathology by Shafer W, Hine M.and Levy B. 4th edition, W.B Saunders Co. Philadelphia 2009 Edu. Elsevier India, New Delhi.

ANSWER
Dentin dysplasia type I

OTHER OPTIONS
• Dentinogenesis imperfecta – is a disorder of tooth development. This condition causes the teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent.
• Amelogenesis imperfecta – Is a Rare group of hereditary conditions that affect enamel tissue intrinsically. All teeth of both dentitions are affected. Enamel is typically yellow in color, reduced in volume, and pitted. Dentin and pulps are normal.
• Dentin dysplasia type II – Dentin dysplasia type II is a dental abnormality characterized by abnormal development (dysplasia) of dentin. primary teeth may be discolored appearing to be yellow, brown, grey-amber, or a brownish-blue color. The teeth are sometimes having a translucent opalescence. In most cases, the permanent teeth have a normal color.

SYNOPSIS
• Dentin dysplasia Type I is a rare hereditary disturbance in dentin formation characterized by teeth with short blunted roots, complete pulpal obliteration, periapical abscesses or cysts without an obvious causative factor, and spontaneous exfoliation.
• The normal enamel but atypical dentin formation with abnormal pupal morphology and the half-moon-shaped pulp chamber is seen.

REFERENCE
Oral Pathology A Textbook of Oral Pathology by Shafer W, Hine M.and Levy B. 4th edition, W.B Saunders Co. Philadelphia 2009 Edu. Elsevier India, New Delhi.

ANSWER
Cleaning, disinfection, packing, sterilization, and storage

OTHER OPTIONS
• Not applicable

SYNOPSIS
Order of sterilization
• Cleaning
• Disinfection
• Packing
• Sterilization
• Storage

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Consult with physician and then decide.

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
• No dental treatment other than urgent care should be rendered for a patient with acute viral hepatitis
If a patient with active hepatitis, positive-HBsAg (HBV carrier) status, or positive HCV status requires emergency treatment, use the following precautions
• Consult the patient’s physician regarding status.
• If bleeding is likely during or after treatment, measure prothrombin time (PT) and bleeding time. Hepatitis may alter coagulation- change treatment accordingly
• All personnel in clinical contact with the patient should use full barrier technique, including masks, gloves, glasses or eye shields, and disposable gowns
• Use as many disposable covers as possible, covering light handles, drawer handles, and bracket trays. Headrest covers should also be used
• All disposable items (e.g., gauze, floss, saliva ejectors, masks, gowns, gloves) should be placed in a lined wastebasket. After treatment, these items and all disposable covers should be bagged, labeled, and disposed of, following proper guidelines for bio-hazardous waste
• Aseptic techniques should be followed at all times. Minimize aerosol production by not using ultrasonic instrumentation, air syringe, or high-speed handpieces. Remember that saliva contains a distillate of the virus. Pre-rinsing with chlorhexidine gluconate for 30 s is highly recommended
• When the procedure is complete, all equipment should be scrubbed and sterilized. If an item cannot be sterilized or disposed of, it should not be used.
• All working surfaces and environmental surfaces should be wiped with 2 percent activated glutaraldehyde (Cidex).

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson.

ANSWER
Bupivacaine

OTHER OPTIONS
• Lidocaine – Lidocaine is known to have an onset of less than 2 min, a duration of 1 h to 2 h, and a maximum dose of 5 mg per kg, which improves to the onset of less than 2 min, a duration of 2 h to 6 h and toxicity of 7mgperkg with the addition of epinephrine.
• Articaine – Articaine pulpal anesthesia lasts between 30 and 120 min, duration longer than lidocaine, mepivacaine, and prilocaine.
• Novocaine – Since Novocaine by itself has a very short duration of action lasting 30 to 60 minutes.

SYNOPSIS
• Compared with lidocaine, bupivacaine has a significantly longer duration of action and a slower time to onset.
• Bupivacaine has an onset of 5 min, a duration of 2 h to 4 h, and a maximum dose of 2 mg per kg.

REFERENCE
Handbook of Local Anesthesia Stanley F. Malamed 5th edition.

ANSWER
Mandibular incisors

OTHER OPTIONS
• Mandibular posteriors – The mandibular molar teeth contact areas, are located more in the center of the proximal area.

SYNOPSIS
• A labial view indicates that the contact areas of the mandibular anterior teeth are uniform in nature and occur at the incisal third of the tooth crowns.

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

ANSWER
2 mm

OTHER OPTIONS
• Nil

SYNPOSIS
• The natural seal that develops around both protecting the alveolar bone from infection and disease is known as the biologic width.
• 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.
• This term was based on the work of Gargiulo et al. who described the dimensions and relationship of the dentogingival junction in humans.
• The biologic width is essential for preservation of periodontal health and removal of irritation that might damage the periodontium .
• The millimeter that is needed from the bottom of the junctional epithelium to the tip of the alveolar bone is held responsible for the lack of inflammation and bone resorption and as such the development of periodontitis.
• The dimension of biologic width is not constant it depends on the location of the tooth in the alveolus varies from tooth to tooth and also from the aspect of the tooth. It has been shown that 3 mm between the preparation margin and alveolar bone maintains periodontal health for 4 to 6 months.

REFERENCE
Biologic width and its importance in periodontal and restorative dentistry – Babitha Nugala

ANSWER
Thyrotoxicosis

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 injection.
REFERENCE
Management of hyperthyroid patients in dental emergencies a case report- Kyung-Jin Lee

ANSWER
Polymerisation shrinkage

OTHER OPTIONS
• Nil

SYNOPSIS
• Post-operative sensitivity in teeth after doing a composite restoration is caused by residual stress buildup due to polymerization shrinkage resulting in de-bonding of the restoration ensuing in an enamel crack microleakage at the margins of the restoration and secondary caries resulting in postoperative sensitivity.

REFERENCE
Sturdivant’s Art and Science of Operative Dentistry (Hardcover) by Theodore M. Roberson (Editor), Harold O. Heymann (Editor), Edward J. Swift Jr.(Editor)Publisher Mosby

ANSWER
All the above

OTHER OPTIONS
• Nil

SYNOPSIS
• Diagnosing causes of porcelain fractures
• When fracture or dislodgement of porcelain facing occurs the dentist should be able to identify one of the following apparent causes of the failure and recommend changes in future restorations to the appropriate person
• Fracture of the total porcelain facing leaving metal surface only.
Causes
– Incorrect degassing of metal by technician.
– Incorrect placement of metal conditioner by technician.
• Fracture of the majority of the porcelain facing leaving slight amount of opaque.
Causes
– Incorrect placement of m etal conditioner by technician.
– Incorrect firing of opaque coat of porcelain by technician usually the temperature is too low .
– Inadequate bulk of metal connector.
• Fracture of porcelain only not exposing any metal.
Causes
– Trauma to crowns caused by occlusion or external force.
– Metal framework cast too small by the technician. Frameworks should be only 1 m m to 1.5mm less in contour than the eventual crown or pontic.

REFERENCE
How to avoid problems with porcelain-fused-to-metal restorations- Council on Dental Materials and Devices

ANSWER
Bad odor and pain.

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
Signs and symptoms of dry socket include the following
1. Moderate to severe pain localized to the area or frequently radiating to the ear.
2. A foul odor or taste in the absence of purulence or suppuration.
3. Symptoms that occur 3 to 5 days after tooth extraction.
4. Absence of swelling, purulence, or lymphadenitis.
5. Duration of 5 to 40 days.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Connective tissue graft under split-thickness flap

OTHER OPTIONS
• Nil

SYNOPSIS
• Gingival recession presents when the gingival margin is located apical to the cementoenamel junction (CEJ), resulting in exposure of the root surface
• The use of a subepithelial connective tissue graft (SCTG) in conjunction with a coronally advanced flap (CAF) is a successful method of gaining root coverage and augmenting gingival thickness
• After giving LA, a sulcular incision is placed and a full-thickness flap was carefully elevated using a Kirkland knife.
• Beneath the mucosa, a split-thickness flap was created. Adequate tension-free coronal advancement that permitted full root coverage was verified.
• Root surface irregularities were reduced using sharp hand instruments until they were smooth.
• Graft is placed with connective tissue side facing facially
• The gingiva was secured into position by weaving the suture distally. The final suture knot was tied over the original suture knot

REFERENCE
Treatment of a Miller Class II Gingival Recession Defect – Inside Dentistry

ANSWER
Kinematic face bows are used to locate the terminal hinge axis of condylar rotation

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The hinge axis face-bow with adjustable caliper ends that indicates the exact axis of rotation of the condyles.
• This face bow record the true hinge axis
• Used for the fabrication of fixed partial dentures and full mouth rehabilitation.

REFERENCE
Fundamentals of Fixed Prosthodontics 3rd Edition by Shillinburg.

ANSWER
Pericoronitis

OTHER OPTIONS
• Periodontal abscess – A smooth, shiny swelling of the gingiva pain, with the area of swelling tender to touch a purulent exudate, and an increase in probing depth.
• Reversible pulpitis – Sharp sensitivity to cold, sometimes to sweets, and sometimes to biting.
• Irreversible pulpitis – Difficulty locating the tooth from which the pain originates, even confusing the maxillary and mandibular arches.

SYNOPSIS
• The symptoms of acute pericoronitis include
– Severe pain near back teeth.
– Swelling of gum tissue.
– Pain when swallowing.
– The discharge of pus.
– Trismus.
• Chronic pericoronitis can include the following symptoms
– Bad breath.
– Bad taste in your mouth.
– Mild or dull ache lasting for one or two days.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Hypercementosis

OTHER OPTIONS
• Condensing osteitis – Condensing osteitis consists of abnormal bone growth and lesions that may result from tooth inflammation or infections.
• Secondary cementum deposition – The secondary cementum develops mainly on the apical portion of the root in mammals, when the tooth reaches the occlusal plane.

SYNOPSIS
• The excessive buildup of cementum on the roots of a tooth is a pathological condition known as hypercementosis.
• Cementum thickness can increase on the root end to compensate for attritional wear of the occlusalperincisal surface and passive eruption of the tooth.

REFERENCE
Oral Pathology A Textbook of Oral Pathology by Shafer W., Hine M.and Levy B. 4th edition, W.B Saunders Co. Philadelphia 2009 Edu. Elsevier India, New Delhi.

ANSWER
All the above

OTHER OPTIONS
• Nil

SYNOPSIS
• As tooth matures, the pulp size and volume are gradually reduced.
• Instead of a large wide open apical root, the dental pulp is closed and the pulp is diminished.
• There is an overall reduction of cellular components.
• Other age-related changes in the pulp are compromised circulation and innervation, fat droplet deposition, odontoblastic vacuolization, reticular atrophy, pulpal fibrosis, hyaline degeneration, mucoid degeneration, and diffuse calcification.

REFERENCE
Pathways of the Dental Pulp 10th Edition by Cohen and Burns

ANSWER
Vitality test.

OTHER OPTIONS
• Palpation test – The sensitivity of the gums around the tooth by palpating, or gently massaging the gums over the roots of the tooth or teeth suspected of causing your pain.
• Percussion test – Tapping gently along the long axis of the tooth with a blunt instrument.
• Radiographs – Help to diagnose tooth-related problems like caries, fractures, rct, or any previous restorations, abnormal appearance of pulp cavity, or peri radicular tissues periodontal diseases, and the general bone pattern.

SYNOPSIS
• Pulp testing is often referred to as vitality testing. Pulp testers should only be used to assess the vital or non-vital pulp.
• Various types of pulp tests are
1 Thermal test – Painful sensation even after removal of stimulus or no response is considered abnormal.
– Cold test – spray with cold air, use ethyl chloride, frozen carbon dioxide(dry ice), wrap an ice piece in the wet gauge, dichlorodifluoromethane(freon)
– Heat test – warm air, heated gutta- percha stick, hot burnisher, hot compound, frictional heat produced by rotating polishing rubber disc, use of laser beam,
2 Electric pulp test.
3 Test cavity
4 Anesthesia testing
5 Bite test

REFERENCE
Pathways of the Dental Pulp 10th Edition by Cohen and Burns

ANSWER
All of the above

OTHER OPTIONS
• All answers are true regarding IOPAR

SYNOPSIS
• In diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used.
• Clinically common radiograph used to determine the position of an impacted canine is the occlusal radiograph or Clark’s method using two periapical radiographs.
• Periapical X-rays detect any unusual changes in the root and surrounding bone structures.

REFERENCE
White and Pharoah’s Oral Radiology Principles and Interpretation 8th Edition.

ANSWER
Streptococcus sabrinus

OTHER OPTIONS
• Staphylococcus aureus – Skin and soft tissue infections such as abscesses (boils), furuncles, and cellulitis.
• E Coli – Escherichia coli is one of the most frequent causes of many common bacterial infections, including cholecystitis, bacteremia, cholangitis, urinary tract infection (UTI), and traveler’s diarrhea, and other clinical infections such as neonatal meningitis and pneumonia.

SYNOPSIS
• Streptococcus mutans and Streptococcus sabrinus, are associated with dental caries in humans.
• Their acidogenic and aciduric capacity is directly associated with the cariogenic potential of these bacteria.

REFERENCE
Sturdivant’s Art and Science of Operative Dentistry (Hardcover) by Theodore M. Rob.

ANSWER
Apical and coronal orifice of the root canal

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Three-dimensional well-fitted root canal with a fluid-tight seal is the main objective of root canal obturation.
• Three-dimensional fluid-tight seal of the root canal system
– Prevents percolation and microleakage of periapical exudate into the root canal space.
– Prevents infection by completely obliterating the apical foramen and other portals of communication.
– Creates a favorable environment for the process of healing to take place.

REFERENCE
Pathways of the Dental Pulp 10th Edition by Cohen and Burns

ANSWER
All of the above

OTHER OPTIONS
• Not applicable

SYNOPSIS
Disadvantages of gutta-percha
• Lack of rigidity – bending of gutta-percha is seen when lateral pressure is applied. so difficult to use in smaller canals
• Inability to control the obturating material – easily displaced by pressure.
• Lack of adhesive quality.

REFERENCE
Pathways of the Dental Pulp 10th Edition by Cohen and Burns

ANSWER
Moisture retention

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Carbon Steel can get damaged due to moisture exposure.
• Only Stainless Steel instruments and plastics that can bear the heat be sterilized.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Sialolithiasis

OTHER OPTIONS
• Mucocele – Oral mucocele is a painless fluid-filled cyst on the inner surface of the mouth.
• Pleomorphic adenoma – Pleomorphic adenoma, the most common salivary gland tumor, is also known as a benign mixed tumor.
• Fibroma – Fibromas are noncancerous tumors made up of fibrous tissue.

SYNOPSIS
• Sialolithiasis is a benign condition involving the formation of stones within the ducts of the major salivary glands.
• Symptoms of Sialolithiasis
– Swelling of the affected saliva glands which normally occurs with meals.
– Difficulty opening the mouth.
– Difficulty swallowing.
– A painful lump under the tongue.
– Gritty or strange-tasting saliva.
– Dry mouth.
– Pain and swelling usually around the ear or under the jaw.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Apicoectomy

OTHER OPTIONS
• Inform the patient and do follow-up – Not applicable in this case.
• Re-RCT – May be needed when the symptoms persist on an RCT-treated tooth.

SYNOPSIS
• Overextended gutta-percha cones could increase the failure of endodontic therapy. • Commonly surgical procedures are indicated to remove this overextended material if symptomatic.
• The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Hypoglycemic shock

OTHER OPTIONS
• Keto acidosis – Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones. The condition develops when the body can’t produce enough insulin.
• Syncope – Hypoglycemic syncope is uncommon, affecting 1.9 percent of diabetic patients using insulin therapy. It is characterized clinically by brief periods of unconsciousness with slow recovery and without loss of postural muscle tone.

SYNOPSIS
• The most common intraoperative complication of DM is a hypoglycemic episode.
• The risk is highest during peak insulin activity when the patient does not eat before an appointment, or when oral hypoglycemic medication and or insulin levels exceed the needs of the body.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Incision and drainage.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Acute periradicular abscess, is highly symptomatic. inflammatory response of the periapical connective tissues.
• It originates when the pulpal tissues initiate an inflammatory response to trauma or caries and may eventually lead to pulpal necrosis.
• In the management of localized acute apical abscess in the permanent dentition, the abscess should be drained through a pulpectomy or incision and drainage.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
Late lower jaw growth

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Late lower incisor crowding is thought to be due to late lower jaw growth.
• The Lower jaw growth occurs well into adulthood.
• The magnitude of these adult,s growth changes is small (1-2mm) however they are significant enough to cause movement in the lower incisors that results in crowding.

REFERENCE
Contemporary Orthodontics, Fourth Edition, William R. Proffit, Henry W. Fields and David M. Sarver 2006, Saint Louis Mosby, Inc.

ANSWER
ANUG

OTHER OPTIONS
• Herpetic gingivostomatitis – Herpetic gingivostomatitis is a manifestation of herpes simplex virus type 1 (HSV-1) and is characterized by high-grade fever and painful oral lesions.
• Erythema multiforme – a skin reaction that can be triggered by an infection or some medicines.
• Streptococcal gingivostomatitis – an acute inflammation of the oral mucosa caused by beta-hemolytic streptococcus from Group A.

SYNOPSIS
• ANUG has been defined as an acute recurring gingival infection of complex etiology, characterized by necrosis of the tips of the gingival papillae, spontaneous bleeding, and pain.
• Several names have been assigned to it such as trench mouth, acute ulcerative gingivitis, vincents stomatitis, vincents angina, Plaut-vincent’s stomatitis, fusospirocheatal gingivitis, necrotic gingivitis, putrid stomatitis.

REFERENCE
Dentistry for the Child and Adolescent By Macdonald, R.E.AND Avery, D.R 8TH Edition, 2005 Mosby Co, Inc

ANSWER
Record mouth opening and closing

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
• To record the anteroposterior and mediolateral spatial positions of the maxillary occlusal cusps in relation to the transverse opening and closing of the patient’s mandible.
•Two types of face bows are recognized in the field of prosthodontics, arbitrary and kinematic.
• Kinematic face bows are used to locate the terminal hinge axis of condylar rotation.
• An arbitrary face bow called the earbow, uses the ear canal as a locating point.
• One of the important movements the facebow helps to recreate is the arc of opening and closing.

REFERENCE
Fundamentals of Fixed Prosthodontics 3rd Edition by Shillingburg

ANSWER
Cemental hyperplasia

OTHER 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

ANSWER
Smoothen the surface and place calcium hydroxide

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Goal to cover exposed dentin, can use calcium hydroxide composition.
• Smoothen the surface and place calcium hydroxide.

REFERENCE

ANSWER
Clarithromycin

OTHER OPTIONS
• Ampicillin, Amoxicillin-clavulanate, and Nafcillin are penicillin antibiotics.

SYNOPSIS
Clarithromycin is a macrolide antibiotic. It can be taken by people who are allergic to penicillin.

SYNOPSIS
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
6 to 6.5

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The lower the pH, the higher the calcium and phosphate concentrations required to reach saturation with respect to hydroxyapatite.
• This is called the critical pH, the point where equilibrium exists.
• There is no mineral dissolution and no mineral precipitation.
• The critical pH of enamel is around 5.5 and that of fluorapatite is around 4.5.
• Root dentin is more vulnerable to acidic dissolution than enamel because of its higher critical pH for demineralization (6.2 to 6.4) than that of enamel (5.5)
• This varies with individual patients.
• Below critical pH, demineralization occurs while above critical pH, remineralization occurs.
• The critical pH is significantly higher for children than for adults

REFERENCE
Dental Remineralisation to Oral Health

ANSWER
Decrease the permeability of ion channel to sodium

OTHER OPTIONS
• Not applicable

SYNOPSIS
• LA prevents the generation and conduction of nerve impulses by blocking sodium ion influx through voltage-gated sodium channels and preventing the transmission of the advancing wave of depolarization down the length of the nerve.
• LA does not alter the resting transmembrane potential and has little effect on the threshold potential.

REFERENCE
Local Anesthesia in Dentistry

ANSWER
Implant

OTHER OPTIONS
• Not relevant in this case

SYNOPSIS
• Long-term success of oral implants in partially edentulous cases has been the basis for other clinicians to broaden the use of implants to younger patients in whom teeth are missing due to agenesis and or trauma.
• Anodontia either primary or acquired occasionally creates the opportunity for the use of dental implants.
• Since removable dentures and acid etch bridges are uncomfortable and cumbersome, young patients and their parents often insist to reduce the waiting time and insert implants as soon as possible.
• Furthermore, the risk of ongoing alveolar bone resorption after tooth extraction encourages the clinician to go ahead with the oral implants immediately.

REFERENCE
Implants in adolescents- Rohit A. Shah, Dipika K. Mitra

ANSWER
Ball end probe

OTHER OPTIONS
• Universal currete – A universal curette is a double-ended instrument used for periodontal scaling, calculus debridement, and root planing.
• Double-end perio probe – The periodontal probe is to measure pocket depths around a tooth in order to establish the state of health of the periodontium.

SYNOPSIS
• CPITN assesses the presence or absence of gingival bleeding on probing, supra or subgingival calculus, and periodontal pockets by using a 0.5 mm ball tip WHO probe.

REFERENCE
Carranza’s Clinical Periodontology by Michael G. Newman DDS, Henry Takei DDS, Fermin A. Carranza Dr. Odont

ANSWER
All of the above

OTHER OPTIONS
• Explained below

SYNOPSIS
• Addition of epinephrine to lidocaine causes
– Increases the duration of anesthesia
– Reduces the risk of bleeding during surgery.
– Reduce toxicity

REFERENCE
Use of local anesthetics with an epinephrine additive

ANSWER
RCT and splint

OTHER OPTIONS
• Other options doesnot apply

SYNOPSIS
• 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 replantation

REFERENCE
Therapeutic Protocols for Avulsed Permanent Teeth- Review and Clinical Update Diana Ram, Dr Odont

ANSWER
Ibuprofen

OTHER OPTIONS
• Ampicillin – Antibiotic

SYNOPSIS
• Ibuprofen alone is statistically superior to aspirin.
• Ibuprofen is used as an analgesic in painful conditions, antipyretic, soft tissue injuries, fractures, postoperative pain arthritis and gout, chronic pulpitis, periodontal abscess, and gingival abscess.

REFERENCE
Essentials of Dental Pharmacology – K D Tripathi

ANSWER
Abutment

OTHER OPTIONS
• Connector – corresponds to the connection site where the implant body connects to the abutment and restoration,
• Retainer – Imp-lants can also act as retainers for dentures and partials if you have issues with them falling or slipping out of place
• Pontic – Pontic is the artificial tooth in the fixed or removable partial dentures- that is, the suspended portion of the fixed partial denture (bridge) replacing the missing natural tooth or teeth

SYNOPSIS
• In dentistry, an abutment is a connecting element.
• The abutment is the connector piece between a dental implant and an artificial tooth.
• It links the crown, dental bridge, or denture to the implant.

REFERENCE
Contemporary Implant Dentistry- Carl E Misch

ANSWER
The crown may be straight but the tooth may be tilted

OTHER OPTIONS
• Nil

SYNOPSIS
• Getting access to root canal space may require the removal of a crown, posts, and other restorative materials first.
• Then the original root canal filling is removed, and the root canal space is re-cleaned and sealed.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Standard sterilization with prolonged disinfection

OTHER OPTIONS
• Nil

SYNOPSIS
• HBs Ag-positive serum is easily inactivated by boiling and by steam under pressure however, HBs Ag-coated beads require increased steam under pressure.
• For sterilizing HBs Ag-contaminated materials, 30 minutes at 132 degrees C is recommended.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
All of the above

OTHER OPTIONS
• All options are correct

SYNOPSIS
• The aim of obturation is to establish a fluid-tight barrier with the aim of protecting the periradicular tissues from microorganisms that reside in the oral cavity.

REFERENCE
Pathways of the Dental Pulp 10th Edition by Cohen and Burns

ANSWER
Honesty

OTHER OPTIONS
• Nil

SYNOPSIS
• Honesty, integrity, and fairness form the cornerstones of accepted professional and personal behavior.

REFERENCE
Textbook of preventive and community dentistry

ANSWER
Calcifying odontogenic cyst

OTHER OPTIONS
• Not related to ghost cells

SYNOPSIS
• Highman and Ogden (1944) first described ghost cell in pilomatricomas.
• They described ghost cells as dyskeratotic cells, which are similar to viable cells but have a distinct outline.
• It was also found that the origin of ghost cells were from the epithelium.
• It can originate from any layer of the epithelium.
• These cells do not have intercellular junctions
• Ghost cells generally lack nuclear and cytoplasmic details and are characteristically seen in CCOT, craniopharyngiomas, and pilomatricomas.
• Other lesions exhibiting ghost cells are odontomas, dentinogenic ghost cell tumors, dentinogenic ghost cell carcinoma, ameloblastoma, ameloblastic fibroma.
• During the development of CCOT, the transformation of an odontogenic epithelial cell into a ghost cell first starts by the enlargement of mural cells, followed by other epithelial cells in the cystic lining into abnormally keratinized cells.

REFERENCE
Ghost cell lesions – Journal of Pharmacy Bioallied Sciences

ANSWER
When first primary tooth erupts

OTHER OPTIONS
• NIL

SYNOPSIS
• As soon as the child has a tooth, plaque can begin building up on the surface of the tooth and causing decay.
• The American Academy of Pediatric Dentistry recommends to start brushing a child’s teeth as soon as the very first tooth comes in.

REFERENCE
Tips for Brushing Baby and Toddler Teeth

ANSWER
Class II div 1

OTHER OPTIONS
Not applicable

SYNOPSIS
• The etiology of maxillary incisor trauma includes oral predisposing factors, which have been identified as
– Increased overjet
– Incompetence lip coverage of the upper anterior teeth in Class II division 1 malocclusion.

REFERENCE
Contemporary Orthodontics, Fourth Edition, William R. Proffit, Henry W. Fields and David M. Sarver 2006, Saint Louis Mosby, Inc.

ANSWER
Hermetic seal

OTHER OPTIONS
• Tug back – Tug back is defined as a slight frictional resistance of a master point to withdrawal.
• Fluid-free seal – Resin cement sealed the root canals significantly better when compared with zinc oxide eugenol and glass ionomer sealers.

SYNOPSIS
• The aim of root canal obturation is to provide a hermetic seal and thus prevent reinfection of the root canal space, which will lead to treatment failure.
• The tricalcium silicate-based sealer cement was introduced due to its hydraulic nature.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Fill the space between the solid core material and pulp canal walls.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The main function of a sealer is to fill the spaces between the core material and the walls of the root canal and between the gutta-percha cones, in an attempt to form a coherent mass of obturating material without voids.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Aggressive periodontitis

OTHER OPTIONS
• Occlusal trauma – It is the injury to the periodontium resulting from occlusal forces that exceed the reparative capacity of the attachment apparatus. It is reversible if identified and treated properly.
• Chronic periodontitis – In cases of chronic Periodontitis in which the clinical attachment loss is not very severe (slight-to-moderate periodontitis), the prognosis is good, provided the inflammation can be controlled through the removal of local plaque-retentive factors and good oral hygiene.

SYNOPSIS
• The prognosis for patients with aggressive periodontitis depends on whether the disease is generalized or localized.
• The generalized form which is usually associated with some systemic diseases has a worse prognosis
• Early radiographs have to be obtained to get a prognosis of the disease.

REFERENCE
Carranza’s Clinical Periodontology by Michael G. Newman DDS, Henry Takei DDS, Fermin A. Carranza Dr. Odont

ANSWER
All of the above

OTHER OPTIONS
• All are true

SYNOPSIS
• Halitosis is a term used to describe a noticeably unpleasant odor exhaled in breathing.
• Causes of physiologic halitosis
– Mouth breathing
– Medications
– Aging and poor dental hygiene fasting or starvation
– Tobacco
– Foods
• Causes for pathologic halitosis
– Oral and other contributing factors such as
1 Periodontal infection – odor from the subgingival dental biofilm. ANUG, pericoronitis.
2 Tongue coating harbors microorganisms
3 Stomatitis xerostomia
4 Faulty restorations retaining food and bacteria
5 Unclean dentures.
6 Oral pathologic lesions like oral cancers, and candidiasis.
7 Parotitis, cleft palate.
8 Aphthous ulcers dental abscesses.
– Systemic and extra-oral factors
1 Nasal infections like rhinitis, sinusitis, tumors, and foreign bodies.
2 Diseases of GIT like hiatus hernia, carcinoma, and GERD.
3 Pulmonary infections like bronchitis pneumonia, TB, carcinomas
4 Certain hormonal changes occur during ovulation menstruation, pregnancy, and menopause.
5 Systemic diseases like diabetic Mellitus, hepatic failure, renal failure, uremia, blood dyscrasias, rheumatic diseases, dehydration and fever, and cirrhosis of the liver.

REFERENCE
Carranza’s Clinical Periodontology by Michael G. Newman DDS, Henry Takei DDS, Fermi A. Carranza Dr. Odont

ANSWER
Speech

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
• Premature loss of primary teeth can cause orthodontic problems such as crowding, ectopic eruption, or tooth impaction, which can result in malocclusion.
• It can also affect children’s phonation, causing speech distortion

REFERENCE
Dentistry for the Child and Adolescent By Macdonald, R.E.AND Avery, D.R 8TH Edition, 2005 Mosby Co, Inc

ANSWER
Using finger over the ridge

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Sharp bony edges are assessed by replacing the flap and palpating over it with a finger.
• A rongeur or bone file may be used to smooth all sharp edges.

REFERENCE
Peterson Principle of Oral and Maxillofacial Surgery By Peterson

ANSWER
50

OTHER OPTIONS
• NIL

SYNOPSIS
• Eriksson and Albrektsson found that bone heated at 47 degrees C for one minute leads to significantly reduced bone regeneration and that bone temperatures of 50 degrees C almost completely impair it.
• Cell death as a result of heat damage is immediately apparent at 70 degrees C.
• Krause’s findings support this, he found that osteoclasts began to die when bone temperatures reached 50 degrees C and that protein cannot be regenerated once temperatures reach 70°C.
• As a result of this, 50 degrees C has been defined as the critical value below which bone temperature must be kept.

REFERENCE
Thermal Osteonecrosis Caused by Bone Drilling in Orthopedic Surgery- Alexander Muacevic

ANSWER
Internal resorption and RCT

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Internal resorption is an unusual form tooth resorption that begins centrally within the tooth, apparently initiated in most cases by a peculiar inflammation of the pulp.
• Etiology of internal resorption
– Long-standing chronic inflammation of the pulp
– Caries-related pulpitis
• Traumatic injuries
• Luxation injuries
• Iatrogenic injuries (Preparation of tooth for a crown, deep restorative procedure, application of heat over pulp, pulpotomy using calcium hydroxide).
• Idiopathic.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Lingual nerve

OTHER OPTIONS
• Other options do not apply

SYNOPSIS
• The lingual nerve carries sensory innervation from the anterior two-thirds of the tongue. It contains fibers from both the mandibular division of the trigeminal nerve (CN V3 ) and the facial nerve (CN VII).
• The lingual nerve lies at first beneath the lateral pterygoid muscle, medial to and in front of the inferior alveolar nerve.
• The nerve then passes between the medial pterygoid muscle and the ramus of the mandible, and crosses obliquely to the side of the tongue beneath the constrictor pharyngis superior and styloglossus, and then between the hyoglossus and deep part of the submandibular gland, it finally runs from laterally to medially inferiorly crossing the duct of the submandibular gland, and along the tongue to its tip becoming the sublingual nerve, lying immediately beneath the mucous membrane.
• So as the spicule is over the lingual side, the chances of lingual nerve injury are more.

REFERENCE
Lingual nerve- Anatomy

ANSWER
Support

OTHER OPTIONS
• Stability – It is defined as, the quality of a denture to be firm, steady, or constant, to resist displacement by functional stresses, and not to be subject to change of position when forces are applied.
• Retention – It is the ability of the denture to withstand displacement against its path of insertion.

SYNOPSIS
• Support is defined as, the resistance to vertical forces of mastication, occlusal forces, and other forces applied in a direction towards the denture-bearing area.

REFERENCE
Textbook of Prosthodontics- Deepak Nallaswamy

ANSWER
Implant-supported prosthesis

OTHER OPTIONS
• RPD – instability of the restoration during both speech and function
• FPD – have to compromise adjacent teeth

SYNOPSIS
• Single missing teeth with adjacent strong teeth can be replaced by implants.
• Placing implant abutments in sufficient numbers to fabricate a completely implant-supported prosthesis has several advantages.
– Caries free abutments.
– No need for endodontic therapy.
– Greater survival rate.
– Hygienic.

REFERENCE
Contemporary Implant Dentistry- Carl E. Misch- 3rd Edition

ANSWER
Plummer Vinson Syndrome

OTHER 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 – It is the narrowing of the esophagus.
• Esophageal rings – 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

ANSWER
Intraoral intramaxillary appliance

OTHER OPTIONS
• Not applicable

SYNOPSIS
• It is indicated in the case of buccally placed canines and canines placed high in the vestibule. they are used to move the canine in a distal as well as palatal direction.
• It consists of a coil of 3 mm diameter, an active arm, and a retentive arm.
• The buccal canine retractor can be of two types supported and self-supported.
• The supported canine retractors lack stability and are therefore enclosed for a time, while the supported canine retractors can be activated up to 2 mm at a time.

REFERENCE
Contemporary Orthodontics, Fourth Edition, William R. Proffit, Henry W. Fields and David M. Sarver 2006, Saint Louis Mosby, Inc.

ANSWER
B and C

OTHER OPTIONS
• Refer synopsis

SYNOPSIS
• Over instrumentation and Wrong working length determination can cause pain during root canal treatment.

REFERENCE
Endodontics By Ingel 6th edition

ANSWER
Oral hairy leukoplakia

OTHER OPTIONS
• Oral Lichen planus – Oral lichen planus may appear as white, lacy patches, red, swollen tissues, or open sores. These lesions may cause burning, pain, or other discomforts.
• Hairy tongue – Black hairy tongue is caused by an overgrowth of dead skin cells, causing lengthening of the papillae, and staining from bacteria, yeast, food, tobacco, or other substances in the mouth
• Benign migratory glossitis -Geographic tongue (also known as benign migratory glossitis) is an inflammatory disorder that usually appears on the top and sides of the tongue. Typically, affected tongues have a bald, red area of varying sizes that are surrounded, at least in part, by an irregular white border

SYNOPSIS
• Oral hairy leukoplakia is a condition triggered by the Epstein-Barr virus (EBV). 
• White patches are the main symptom of oral hairy leukoplakia. The patches are
– White and corrugated, or folded, in appearance
– Hairy, hair-like growths come from the folds in the patches
– Permanent, you can’t remove the patches with a toothbrush or with another oral care tool
– Sometimes, the patches cause discomfort and taste changes.
• Because oral hairy leukoplakia is usually related to an HIV infection, complications are related to HIV.
• Sticking to the prescribed HIV treatment plan and dental hygiene routine can control the discomfort.

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
Incisive nerve block

OTHER OPTIONS
• Anterior superior alveolar nerve block – It is a maxillary nerve block
• Other options are explained below.

SYNOPSIS
• The incisive nerve block anesthetizes both the mental and incisive nerves.
• It provides anesthesia to pulpal, periosteum, and buccal soft tissues, but not lingual soft tissues.
• Often, we prefer not to provide a mandibular block (inferior alveolar block, Gow-Gates block) if the patient does not require anesthesia for molar teeth.
• The incisive block is a good alternative in such cases.
• It provides very good anesthesia to the teeth anterior to the mental foramen on one side without the discomfort of anesthesia to the tongue.
• This is particularly useful when we wish to complete the mandible in one visit, and for at least one side, molar anesthesia is not indicated.
• Advantages of this technique are
– Easy injection
– A high success rate
– Sufficient hemostasis
– Largely atraumatic.

REFERENCE
Handbook of LA – Stanley F Malamed

ANSWER
Arch length tooth size discrepancy

OTHER OPTIONS
• NIL

SYNOPSIS
• Angles class I malocclusion is characterized by the presence of a normal interarch molar relation.
• The mesiobuccal cusp of the maxillary first permanent molar occludes in the buccal groove of the mandibular first molar.
• Class I malocclusion can be a discrepancy either within the arches or in the transverse or vertical relationship between the arches.
• The patient may exhibit dental irregularities such as crowding, spacing, rotations, and a missing tooth.

REFERENCE
Contemporary Orthodontics, Fourth Edition, William R. Proffit, Henry W. Fields and David M. Sarver 2006, Saint Louis Mosby, Inc.

ANSWER
Antibiotics and Extraction of the offending tooth

OTHER OPTIONS
• Explained below

SYNOPSIS
• Pericoronitis is an inflammation of the soft tissue surrounding the partially erupted or impacted mandibular third molars.
• Pericoronitis symptoms range from mild to severe and may include bad breath, pus, and facial swelling.
• Management of pericoronitis may be done by the following methods
– Irrigation of the affected area to flush out any food particles, bacteria, or other debris.
– Oral antibiotics can help clear up a pericoronitis infection.
– Use of mouthwash that contains chlorhexidine, a topical antiseptic.
– Some cases may recommend removing the gum flap (operculum).
– In case of persistent discomfort, extraction of the offending tooth is associated with a faster clinical and biological resolution of the infection.
• Thus, when the causative tooth is non-restorable or impacted, it should be extracted without delay.
• The timing of the follow-up appointment after prescribing antibiotics may be a factor in lowering the number of complications and improving the outcomes for patients experiencing pain or discomfort

REFERENCE
Pericoronitis – Gloria Kwon, Marc Serra.

ANSWER
Hypersensitivity to denture material

OTHER OPTIONS
• Denture stomatitis – Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture.
• Candidiasis – It is known that denture stomatitis may occur in response to plaque accumulation on dentures. One of the chief pathogenic microorganisms causing this type of inflammation is Candida albicans. A common symptom of oral candidiasis is a pain in the oral mucosa complicated by angular stomatitis

SYNOPSIS
• The most common and frequently reported problem with patients having allergic reactions to denture base acrylic resin is mouth soreness and burning sensation.
• Areas presenting with burning sensation include the palate, tongue, oral mucosa, and the oropharynx
• Allergic tests carried out on the skin of patients have also confirmed that the denture base acrylic resin is responsible for allergic reactions. • Thus, whenever a denture wearer presents with the signs and symptoms outlined above, the possibility of an allergic reaction must always be considered, and a thorough investigation carried out to achieve an accurate diagnosis.
• For the immediate and delayed type of hypersensitivity reactions, patch testing, blood tests, or allergen-specific IgE tests can be carried out.
• The cytotoxic effects caused by denture base acrylic resins are mainly caused by the substances leaching out from these resins.
• The main substance which is leached out by the process of diffusion from these materials is the unreacted residual monomer.
• Constant contact of saliva with the material causes expansion of the openings present between the polymer chains causing the unreacted monomer to diffuse out.
• Thus, the substances which are leached out from the denture bases into the saliva are transferred to the oral structures causing adverse allergic reactions.

REFERENCE
Allergic effects of the residual monomer used in denture base acrylic resins – European Journal of Dentistry

ANSWER
Crosscut at low speed

OTHER OPTIONS
• 3 by 4 coarse garnet disc at low speed – Produces smooth finish.
• Plain cut bur at high speed – For producing preparations with straight parallel sides and flat floors, gaining access to carious dentin, establishing preparation form, and creating retentive locks. Cross-cut burs have more cutting edges.
• Flutted carbide bur – Ideal for contouring the gingiva post scalpel, electrosurgical or laser excision of excessive gingival overgrowth. Used commonly in veterinary dentistry for dogs with gingival hyperplasia.

SYNOPSIS
• Crosscuts at low speed produce rough surfaces.

REFERENCE
Sturdivant’s Art AND Science of Operative Dentistry (Hardcover) by Theodore M. Roberson (Editor), Harold O. Heymann (Editor), Edward J. Swift Jr.(Editor)Publisher Mosby

ANSWER
2 to 4 years

OTHER OPTIONS
• Not applicable

SYNOPSIS
• The majority of trauma occurred between the ages of 2 and 4.
• The most commonly affected tooth was the maxillary left central incisor, followed by the maxillary right central incisor.
• The majority of dental trauma is tooth (crown) fracture, tooth avulsion, or tooth subluxation.

REFERENCE
Dentistry for the Child and Adolescent By Macdonald, R.E.AND Avery, D.R 8TH Edition, 2005 Mosby Co, Inc

ANSWER
Passivity

OTHER OPTIONS
• Explained below

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

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

ANSWER
Remove the dentigerous cyst

OTHER OPTIONS
• Extraction – not recommended in this case

SYNOPSIS
• An unerupted canine is common.
• The radiolucency seen in the radiograph of an unerupted canine indicates the presence of a dentigerous cyst around the unerupted crown.
• If failed to treat there is a chance to increase fluid accumulation in the cyst and will cause jaw enlargement resulting in irregular dentition, facial deformity, and other serious consequences
• Treatment, in this case, will be
– Surgical removal of dentigerous cyst
– Orthodontic correction of impacted canine

REFERENCE
The correlation between the three-dimensional radiolucency- Junliang Chen

ANSWER
Facial nerve

OTHER OPTIONS
• Auriculo temporal nerve – Injury causes Freys Syndrome
• Maxillary artery – If local anesthetic with a vasoconstrictor is mistakenly administered intravascularly, expected consequences can include inadequate anesthesia, shooting pain, skin pallor or ischemia, andor heart palpitations

SYNOPSIS
• The inferior alveolar nerve block is a Mandibular nerve block given to anesthetize the Mandibular teeth, due to its proximity to other Nerves and muscles, and salivary glands it has many complications if the technique in which it is given is wrong.
• Due to the proximity of the Inferior alveolar nerve block needle position to the facial nerve and the Parotid through which it passes is the result of this complication where we can see the characteristic complications when the Facial nerve is anesthetized
• Transient Hemifacial Paralysis – the muscles supplied by that side of the facial nerve are affected and cannot contract, resulting in loss of muscle action of the affected side of the face.
– Where the eyelids cannot be closed by the patient
– Loss of maintaining of lips position on the affected side and drooping of the lips on the affected side is seen
• If this condition is ever encountered, be calm and explain the problem and assure him or her that it is temporary and will be back to normal in 3 hours after the effect of local anesthesia is gone.
• Prescribe any Lubricating Eye drops and ask the attendant or the patient to keep putting 2 drops every 15 mins on the affected eye to keep the eyes wet as the eyelids cannot be closed due to paralysis of the facial nerve.
• Ask the patient to use a clean cloth to keep over the eye to prevent dust from entering the open eye.
• Lastly, ask the patient to stay in the clinic for 3 hours if possible to monitor the condition after the effect of local anesthesia wears off

REFERENCE
IANB Complications – Junior Dentist

ANSWER
Moderate

OTHER OPTIONS
• Explained below

SYNOPSIS
• .According to WHO Global Data Bank
• DMFT – 0-1.1 – Very Low Risk
• DMFT – 1.1-2.6 – Low Risk
• DMFT – 2.7-4.4 – Moderate Risk
• DMFT – 4.5 – 6.5 – High Risk
• DMFT – 6.6 and above – Very High Risk

REFERENCE
A Textbook of Public Health Dentistry – CM Marya

ANSWER
Globulomaxillary cyst

OTHER OPTIONS
• Apical periodontal cyst – Lateral periodontal cyst (LPC), originating from epithelial rests in the periodontal ligament, is a noninflammatory cyst on the lateral surface of the root of a vital tooth. LPC is generally asymptomatic and presents a round or oval uniform lucency with well-defined borders radiographically
• Primordial cyst – Primordial cysts are infrequent cystic mandibular lesions, which are thought to result from the degeneration of dental follicles. No tooth is therefore present, and the cyst is a well-defined, small and static lesion, most commonly located posteriorly in the region of the third molar or angle of the mandible.

SYNOPSIS
• The globulomaxillary cyst is a cyst that appears between a maxillary lateral incisor and the adjacent canine. It exhibits an inverted pear-shaped radiolucency on radiographs or X-ray films.
• The globulomaxillary cyst often causes the roots of adjacent teeth to diverge.

REFERENCE
Shafer’s Tetbook of Oral Pathology

ANSWER
Von Recklinghausen’s disease of the skin

OTHER OPTIONS
• Paget’s disease of skin – Paget’s disease is an uncommon epidermal cancer, affecting all skin regions wherever apocrine glands are present, It appears as a red, scaly rash on the skin of the nipple and areola. 
• Hereditary ectodermal dysplasia – Ectodermal dysplasias (ED) are a group of disorders in which two or more of the ectodermal derived structures – the skin, sweat glands, hair, nails, teeth and mucous membranes – develop abnormally.
• Papillon-Lefèvre syndrome – Papillon-Lefevre syndrome is a rare autosomal recessive disorder caused by cathepsin C gene mutation leading to the deficiency of cathepsin C enzymatic activity. The disease is characterized by palmoplantar hyperkeratosis, loss of deciduous and permanent teeth and increased susceptibility to infections

SYNOPSIS
• .Neurofibromatosis 1 (NF1), historically called von Recklinghausen’s disease, is a genetic disorder characterized by an increased risk of developing noncancerous (benign) and cancerous (malignant) tumors, as well as various other physical and neurological manifestations
• Over half of the patients with Von Recklinghausen disease will show abnormal findings on imaging of the brain, the orbit, or both.
• The lesions may consist of hamartomas or of neoplasms, such as gliomas of the optic nerve and of the parenchyma of the brain
• Symptoms of VRD affecting the skin include the following
– Cafe au lait macules are tan spots in different sizes and shapes.
– They can be found in multiple places on the skin.
– Freckles can occur under the arms or in the groin area.
• There is no known treatment or cure for neurofibromatosis or schwannomatosis. Medication can be prescribed to help with pain. In some cases, growths may be removed surgically or reduced with radiation therapy.

REFERENCE
Shafer’s Textbook of oral pathology

ANSWER
Erythema multiforme

OTHER 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

ANSWER
Both A and B

OTHER OPTIONS
• EBV – Burkitts Lymphoma

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

ANSWER
Target lesion

OTHER OPTIONS
• Whickham striae – Lichen planus
• Cafe-au-lait spots – Neurofibromatosis

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.

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• The management of erythema multiforme involves
– symptomatic treatment with topical steroids or antihistamines and
– treating the underlying etiology, if known.
– Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy.
– Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes

REFERENCE
Textbook of Oral medicine, Oral diagnosis and Oral radiology- Ravikaran Ongole.