ANSWER
Megaloblastic anaemia

OTHER 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 cells

SYNOPSIS
• 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 supplements

REFERENCE
Anaemia – American Society of HAematology

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
CBCT

OTHER OPTIONS
• Bitewing – For interproximal lesions
• Occlusal – Diagnosis of cysts and canine impactions

SYNOPSIS
• 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 fractures

REFERENCE
Radiographic diagnosis of root fractures- a systematic review, meta-analyses and sources of heterogeneity – British Institute of Radiology – Dentomaxillofacial Radiology

ANSWER
RCT

OTHER 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 MTA

SYNOPSIS
• 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

ANSWER
Punch holes placed too far

OTHER OPTIONS
• Punch holes placed too near – The holes are stretched open around the teeth, permitting leakage

SYNOPSIS
• 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.

ANSWER
All are correct

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
60 minutes

OTHER OPTIONS
• Nil

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 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

ANSWER
Poly ether

OTHER OPTIONS
• All the other given options are Hydrophobic

SYNOPSIS
• 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

ANSWER
Orthodontic extrusion

OTHER OPTIONS
• Crown lengthening – for non-esthetic area

SYNOPSIS
• 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

ANSWER
Pulpotomy

OTHER OPTIONS
• DPC is contra-indicated in primary teeth
• Apexification and apexogenesis are done in young permanent tooth

SYNOPSIS
• 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 success

REFERENCE
Guideline for Pulp Therapy for Primary and Immature Permanent teeth- AAPD

ANSWER
Lateral periodontal cyst

OTHER 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 jaws

SYNOPSIS
• 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

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.
• 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
Acute exacerbation of chronic apical periodontitis 

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Extraction when BP becomes 120 – 80

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 treatment

REFERENCE
Medical Emergencies – Dentistry Today

ANSWER
Peridontal pocket 5.5

OTHER OPTIONS
• Explained below

SYNOPSIS
• 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 possible

REFERENCE
Pocket Dentistry

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
Enamel hypoplasia

OTHER 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 cavities

REFERENCE
Shafers Textbook of Oral pathology

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
Cortical decalcified freeze dried bone graft

OTHER OPTIONS
• Explained below

SYNOPSIS
• 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 areas

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Any of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Cast post and core doesn’t always require auxiliary retention

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Stage 2 Periodontitis

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Intrusive Luxation and laceration

OTHER 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

ANSWER
Ameloblastoma

OTHER 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 tooth

SYNOPSIS
• 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

ANSWER
Any of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Local aggressive periodontitis

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
No treatment

OTHER 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 Retreatment

REFERENCE
Ingles Endodontics

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
Skeletal class II

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Sinus perforation

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Mastictory trauma

OTHER 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

ANSWER
Will refer to an implantologist

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
2

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 accordingly

REFERENCE
Malamed SF- Handbook of Local Anesthesia

ANSWER
Less intensity than non-smoker

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Plasma cells

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Apexification

OTHER 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.

ANSWER
Autonomy

OTHER 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 equally

SYNOPSIS
• 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

ANSWER
Remake the crown

OTHER 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

ANSWER
BSSO

OTHER OPTIONS
• Nil

SYNOPSIS
• 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,

ANWER
All the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
6months

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Cleft lip with a cleft palate

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Injured permanent incisor teeth with exposed vital pulp tissue and immature apices

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Ludwigs angina

OTHER 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

ANSWER
Hemophilia

OTHER OPTIONS
• Leukemia- . A high percentage elevated PT.
• Thrombocytopenia – Prolonged Plasma thromboplastin time (PTT) and prothrombin time (PT).
• Prolonged BT and slightly prolonged PTT

SYNOPSIS
• 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.

ANSWER
Rotation present

OTHER OPTIONS
• Nil

SYNOPSIS
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

ANSWER
Scleroderma

OTHER 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.

ANSWER
30-40percent

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 occlusion

REFERENCE
Trauma from Occlusion – Carranzas Clinical Periodontology

ANSWER
Intraligamentary

OTHER 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 trismus

SYNOPSIS
• 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 pulpitis

REFERENCE
Overcoming the failure of anesthesia in the mandibular teeth – Saudi Medical Journal

ANSWER
Maxillary Sinusitis

OTHER 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

ANSWER
Do RCT followed by crown amputation

OTHER OPTIONS
• NIL

SYNOPSIS
• 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

ANSWER
Reverse pull

OTHER 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

ANSWER
Face mask

OTHER OPTIONS
• Reverse head gear – Reverse-pull headgear is an orthodontic appliance used in growing patients to correct an underbite and help the upper jaw develop

SYNOPSIS
• 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

ANSWER
Fine trabecular bone

OTHER 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 advocated

REFERENCE
Misch classification of bone density

ANSWER
Steep

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Stillmans cleft

OTHER 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

ANSWER
OKC

OTHER 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 cyst

SYNOPSIS
• 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 layer

REFERENCE
Shafer’s textbook of oral pathology

ANSWER
PVS

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Polycarbonate crowns

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 adaptability

REFERENCE
Polycarbonate crowns for primary teeth revisited- Restorative options, technique and case reports- Karthik Venkataraghavan

ANSWER
Pulp exposure on tooth 47

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
12 months

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 months

REFERENCE
Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WIC

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
7-14 days

OTHER OPTIONS
• Other options do not apply

SYNOPSIS
• 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

ANSWER
Perio probe

OTHER 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

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 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

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
Extraction of upper and lower first premolars

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 extractions

REFERENCE
Orthodontic Camouflage Treatment in an Adult Patient with a Class II, Division 1 Malocclusion – A Case Report -Journal of Clinical and Diagnostic Research

ANSWER
Correcting processing errors

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Disc displacement without reduction

OTHER 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 opens

SYNOPSIS
• 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 intervention

REFERENCE
TMJ Disc Displacements – Journal of Oral and Maxillofacial Surgery

ANSWER
Reduces the ramus height

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Intra sulcular

OTHER 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

ANSWER
Rideal walker test

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Zinc polycarboxylate

OTHER 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

ANSWER
Glass Ionomer cement

OTHER 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 resin

SYNOPSIS
• 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

ANSWER
Hass

OTHER 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 springs

SYNOPSIS
• 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

ANSWER
Prednisolone

OTHER OPTIONS
• Other options do not apply

SYNOPSIS
• 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

ANSWER
Place it back gently

OTHER OPTIONS
• Explained below

SYNOPSIS
• 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

ANSWER
Alginate

OTHER OPTIONS
• Mentioned below

SYNOPSIS
• 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 viscosity

REFERENCE
Managing Complications of Radiation Therapy in Head and Neck Cancer Patients- Part III. Provision of Dentures – Faculty of Dentistry, Universiti Kebangsaan Malaysia

ANSWER
Continue with the procedure

OTHER OPTIONS
• Mentioned below

SYNOPSIS
• 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

ANSWER
Standard

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Hyperventilation

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Red skin

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 blushing

REFERENCE
Assisting in a Medical Emergency – Wilkins

ANSWER
Bleeding Index

OTHER OPTIONS
• Mentioned below

SYNOPSIS
• 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 sign

REFERENCE
Vital Signs Medical Emergencies – Malamed

ANSWER
140- 159

OTHER OPTIONS
• Mentioned below

SYNOPSIS
• 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 crisis

REFERENCE
MODERN DA 12th Edition Chapter 27 Vital Signs Page No 1171 – 1208

ANSWER
It can reduce the risk of oral cancer

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
It is nearly 100 percent absorbed in the stomach

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Reduce LA toxicity

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Periodontal problems

OTHER OPTIONS
• Explained below

SYNOPSIS
• 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

ANSWER
All of the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Community-based programs

OTHER OPTIONS
• Other options are not applicable

SYNOPSIS
• 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

ANSWER
Dentin hypersensitivity

OTHER 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 dentin

SYNOPSIS
• 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 drinks

REFERENCE
Symptoms of Tooth Sensitivity – Pocket dentistry

ANSWER
Crown lengthening

OTHER OPTIONS
• Nil

SYNOPSIS
• 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.

ANSWER
Distobuccal cusp of the upper molar

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Composite

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 teeth

REFERENCE
Composite Restorations – Pocket Dentistry

ANSWER
Biocompatibility

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Increased fracture resistance

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Flexural fatigue

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
MTA

OTHER OPTIONS
• Nil

SYNOPSIS
• 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

ANSWER
Freeway space

OTHER 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 edge

SYNOPSIS
• 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

ANSWER
Tooth with curved root

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 incisors

REFERENCE
Root Resorption in Orthodontics – Turkish Journal of Orthodontics

ANSWER
Tell Show Do

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
No treatment

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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

ANSWER
Adequate retention

OTHER OPTIONS
• High viscosity – Decreases the flow of material thereby less penetration and retention of sealant. Sealant should have a low viscosity

SYNOPSIS
• 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 abrasion

REFERENCE
Evaluation of retention of pit and fissure sealants placed with and without air abrasion pretreatment – Journal of Clinical and Experimental Dentistry

ANSWER
All the above

OTHER OPTIONS
• Nil

SYNOPSIS
• 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 bone

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Acute necrotizing ulcerative gingivitis or ANUG

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 periodontium

REFERENCE
Impact of chronic stress on periodontal health – Journal of Oral Medicine And Oral Surgery

ANSWER
Gingival hyperplasia due to medication

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 inflammation

REFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case Reports

ANSWER
Aspirin

OTHER OPTIONS
• Explained below

SYNOPSIS
• 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 enlargement

REFERENCE
Phenytoin-induced gingival enlargement – a dental awakening for patients with epilepsy – BMJ Case Reports

ANSWER
Vertical grooving

OTHER OPTIONS
• Not applicable

SYNOPSIS
• 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 bone

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
No.15 blade

OTHER 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 curve

SYNOPSIS
• 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 back

REFERENCE
Oral Surgery, Instruments- Bhatia K, Aruede G.

ANSWER
Gracey curettes

OTHER 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

ANSWER
Bass or Sulcular Technique

OTHER OPTIONS
• Stillman’s method – Gingival recession cases
• Charter’s method – For Orthodontic patients and in patients after periodontal surgery
• Fones technique – In children

SYNOPSIS
• 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.