ANSWER
4-6 weeks

OTHER OPTIONS
● Not applicable

SYNOPSIS
● The standard splinting time for a dentoalveolar fracture ranges from 4 to 6 weeks to allow adequate bony and periodontal healing.
● In cases with severe bone loss or high mobility, it may extend up to 8 weeks, while minor isolated segments are sometimes stabilized for 4 weeks.
● Simple cracks need less time than loose, multi-tooth displaced segments.
● Pediatric patients may heal faster, but treatment is adapted to mixed dentition.
● Associated InjuriesConcomitant root fractures or soft-tissue damage can alter the total immobilization window.

REFERENCE
International Association of Dental Traumatology IADT) Guidelines or Board Exam Review

ANSWER
Warthin tumor

OTHER OPTIONS
● Pleomorphic adenoma – Most common benign salivary gland tumor overall, but typically presents in younger females and lacks strong association with smoking.
● Mucoepidermoid carcinoma – Most common malignant salivary gland neoplasm, typically painful, fixed, or locally invasive.
● Adenoid cystic carcinoma – Malignant tumor known for perineural invasion, pain, and facial nerve involvement.

SYNOPSIS
● Warthin tumor is a benign salivary gland tumor limited almost exclusively to the parotid gland.
● Strong demographic predisposition toward older male patients with a significant smoking history.
● Typically presents as a slow-growing, soft, mobile, and painless parotid mass.

REFERENCE
Oral and Maxillofacial Pathology Board Guidelines

ANSWER
Face mask

OTHER OPTIONS
● Twin block appliance – Used primarily for functional correction of skeletal Class II malocclusion.
● Herbst appliance – Fixed functional appliance used for mandibular advancement in Class II cases.
● Chin cup – Directs force to retrain orrestrict mandibular growth rather than protracting a deficient maxilla.

SYNOPSIS
● Maxillary protraction face mask delivers forward force to stimulate maxillary anterior growth.
● Optimal results achieved when initiated early during active growth age 7-9).
● Directly addresses skeletal Class III etiology caused by maxillary hypoplasia.

REFERENCE
Contemporary Orthodontics or Board Guidelines

ANSWER
Gown – Mask – Eye protection – Gloves

OTHER OPTIONS
● Not applicable

SYNOPSIS
● The standard sequence for donning putting on) personal protective equipment PPE) as outlined by the Centers for Disease Control and Prevention is hand hygiene first, followed by the isolation gown, mask or respirator, eye protection goggles or face shield), and gloves last.

REFERENCE
CDC Infection Control Guidelines in Dental Settings

ANSWER
20-30 seconds

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Alcohol-based hand rubs require 20-30 seconds of active rubbing across all hand surfaces until completely dry.
● Hand washing with soap and water requires 40-60 seconds.
● Primary method for routine hand hygiene when hands are not visibly soiled.

REFERENCE
WHO Guidelines on Hand Hygiene in Health Care

ANSWER
Lingual nerve

OTHER OPTIONS
● Inferior alveolar nerve – Supplies lower teeth, chin, and lower lip via mental nerve.
● Buccal nerve – Supplies sensory innervation to buccal mucosa and cheek gingiva.
● Hypoglossal nerve – Provides motor supply to intrinsic and extrinsic tongue muscles except palatoglossus).

SYNOPSIS
● Lingual nerve is a major branch of the posterior division of the mandibular nerve V3).
● The lingual nerve primarily supplies general sensory innervation touch, pain, and temperature) to the mucosa of the floor of the mouth and the anterior two-thirds of the tongue.
● Carries taste fibers from anterior 2 or 3 of tongue via Chorda Tympani (CN VII).

REFERENCE
Netter’s Head and Neck Anatomy for Dentistry

ANSWER
Intermediate tendon of the digastric muscle

OTHER OPTIONS
● Platysma muscle – Superficial muscle of facial expression spanning the neck anteriorly.
● Buccinator muscle – Forms the muscular structure of the cheek wall.
● Mylohyoid muscle – Forms the floor of the mouth separating sublingual and submandibular spaces.

SYNOPSIS
● Submandibular triangle bounded by inferior border of mandible and anterior orposterior bellies of digastric.
● Digastric intermediate tendon is attached to hyoid bone via a fibrous loop.
● Key anatomical landmark during neck dissections and submandibular gland surgery.
● The intermediate tendon of the digastric muscle is closely related to the submandibular and cervical regions near the angle of the mandible, serving as the functional junction dividing the anterior and posterior bellies of the digastric muscle and anchoring to the hyoid bone via a fibrous loop.

REFERENCE
Surgical Anatomy of the Head and Neck

ANSWER
Irritation fibroma

OTHER OPTIONS
● Pyogenic granuloma – Highly vascular, bleeds easily, composed of soft red granulation tissue.
● Peripheral ossifying fibroma – Contains calcified bone orosteoid osteoma within fibrous tissue.
● Gingival papilloma – Exhibits finger-like projections caused by HPV infection.

SYNOPSIS
● Most common benign soft tissue exophytic lesion of the oral cavity.
● Results from chronic local trauma or low-grade irritation.
● Characterized histologically by dense collagenous fibrous connective tissue covered by stratified squamous epithelium.

REFERENCE
Neville Oral and Maxillofacial Patholo

ANSWER
Cone-beam computed tomography

OTHER OPTIONS
● Periapical radiograph – 2D imaging modality limited by superimposition.
● Occlusal radiograph – Provides 2D cross-sectional view but lacks volumetric 3D resolution.
● Panoramic radiograph – 2D screening view subject to distortion and magnification artifacts.

SYNOPSIS
● CBCT allows precise 3D localized mapping of impacted teeth in all anatomical planes.
● Crucial for detecting early root resorption on adjacent lateral incisors.
● Reduces surgical risk during exposure and orthodontic traction design.

REFERENCE
AAOMR Clinical Recommendations for CBCT

ANSWER
Posteroanterior cephalogram

OTHER OPTIONS
● Orthopantomogram – 2D panoramic view with significant magnification distortion.
● Lateral cephalogram – Standard view for sagittal and vertical relationships, not transverse asymmetry.
● Occlusal radiograph – Limited localized view unsuitable for full facial skeletal assessment.

SYNOPSIS
● PA cephalometry provides bilateral frontal comparison of facial morphology.
● PA cephalograms display bilateral facial structures side-by-side for asymmetry evaluation.
● Gold standard for assessing transverse discrepancies and mandibular ormaxillary shifts.
● Essential in planning orthognathic surgery for facial asymmetry.

REFERENCE
Proffit’s Contemporary Orthodontics

ANSWER
Ceramic Bracket

OTHER OPTIONS
● Excessive orthodontic force – Causes root resorption or pain rather than localized enamel notch wear.
● Coated arch wire – Soft polymer orresin coating does not cause mechanical tooth structure loss.
● Premature contacts – Causes traumatic occlusion, mobility, or wear facets, but not isolated V-shaped bracket wear notches.

SYNOPSIS
● Ceramic brackets are significantly harder than natural tooth enamel.
● Incisal contact with opposing ceramic brackets during occlusion leads to rapid localized enamel abrasion.
● Resin or metal slot inserts orbite ramps are recommended to prevent direct tooth-bracket contact.

REFERENCE
Orthodontic Materials and Clinical Applications

ANSWER
Posterior Nasal Spine

OTHER OPTIONS
● Sella – Midpoint of the sella turcica located in the sphenoid bone.
● Nasion – Most anterior point of the frontonasal suture.
● Porion – Superior point of the external auditory meatus.

SYNOPSIS
● PNS marks the posterior boundary of the palatal plane.
● ANS Anterior Nasal Spine) and PNS together define the Palatal Plane in cephalometrics.
● Key anatomical landmark in evaluating vertical facial height and jaw inclination.

REFERENCE
Jacobson’s Radiographic Cephalometry

ANSWER
Is caused mainly by mechanical friction with foreign objects

OTHER OPTIONS
● Occurs mainly on incisal edges – Wear on incisal orocclusal surfaces from tooth-to-tooth contact is Attrition.
● Occurs more commonly in mandibular arch – Abrasion affects cervical regions of both arches depending on brushing habits.
● Occurs only on occlusal surfaces – Occlusal loss without foreign object friction is Attrition or Erosion.

SYNOPSIS
● Abrasion results from mechanical wear from external items e.g., hard toothbrushes, abrasive pastes, bobby pins).
● Classically presents as V-shaped cervical notches with sharp margins.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Distobuccal root of maxillary molar

OTHER OPTIONS
● Mesiobuccal root – Larger root that provides critical stability to the molar structure.
● Palatal root – Largest, strongest root essential for prosthetic support.
● Distal root of mandibular molar – Applies to mandibular molars hemisection), not maxillary root amputation.

SYNOPSIS
● Distobuccal root has the smallest anatomical surface area and root length.
● Frequent site of localized advanced furcation involvement Class III).
● Resection leaves strong palatal and mesiobuccal roots to support crown restorations.

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Calcium hydroxide liner followed by glass ionomer cement base

OTHER OPTIONS
● MTA only – MTA takes hours to set and lacks immediate mechanical strength under amalgam condensation.
● Calcium hydroxide only – Highly soluble and weak under condensation forces without a protective base.
● Calcium hydroxide and MTA – Redundant capping agents without structural base support under amalgam.

SYNOPSIS
● For deep caries with a remaining dentin thickness RDT) of less than 0.5 mm under an amalgam restoration, the traditional and clinically established material combination is a calcium hydroxide liner followed by a glass ionomer cement base
● Calcium hydroxide CaOH)2) stimulates dentinal bridging reparative dentinogenesis) due to high pH.
● Glass ionomer cement GIC) base provides thermal insulation, seals margins, and resists condensation pressure.
● Standard liner-base combination for deep indirect pulp capping beneath metallic restorations.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Angle Class I

OTHER OPTIONS
● Angle Class II – Mesiobuccal cusp occludes anterior mesial) to the buccal groove.
● Angle Class III – Mesiobuccal cusp occludes posterior distal) to the buccal groove.
● Class IV – Non-standard classification in Edward Angle’s system.

SYNOPSIS
● Angle Class I molar relationship serves as the baseline reference for normal dental occlusion.
● The mesiobuccal cusp of the maxillary first molar occludes in the buccal groove of the mandibular first molar.
● Maxillary canine occludes between mandibular canine and first premolar.
● Accompanied by harmonious facial profile unless crowded or malaligned.

REFERENCE
Proffit’s Contemporary Orthodontics

ANSWER
Class III

OTHER OPTIONS
● Class I – Normal anteroposterior jaw and molar relationship.
● Class II – Distal relationship of mandibular teeth relative to maxillary teeth.
● Class IV – Invalid orthodontic classification category.

SYNOPSIS
● The underlying molar classification is Class III.
● An anterior crossbite coupled with a mesial molar step where the lower permanent molar or primary second molar is positioned mesial to the upper counterpart) reflects a forward-positioned lower arch characteristic of a Class III mesioclusion relationship.
● May involve maxillary skeletal deficiency, mandibular prognathism, or a combination.

REFERENCE
Contemporary Orthodontics

ANSWER
Embedding a wrought-wire clasp into the acrylic resin base

OTHER OPTIONS
● Soldering the broken retentive arm – Soldering cast clasps severely weakens metal structure leading to early re-fracture.
● Recasting the entire framework – Unnecessarily expensive and complex when localized repair is feasible.
● Grinding the clasp area – Removes remaining clasp element without restoring required tooth retention.

SYNOPSIS
● Embedding a wrought-wire clasp into the acrylic denture base restores lost retention.
● Embedded 18-gauge wrought wire provides excellent flexibility and mechanical retention in resin.
● Fast, economical, and durable in-office RPD repair technique.
● Avoids subjecting the denture framework to high-temperature thermal distortion.

REFERENCE
McCracken’s Removable Partial Prosthodontics

ANSWER
Combination clasp (wrought-wire retentive arm)

OTHER OPTIONS
● Cast I-bar clasp – Rigid cast structure designed only for standard 0.25 mm 0.010 in) undercuts.
● Ring clasp – Cast clasp used on isolated molars with standard undercuts, lacks extreme flexibility.
● Cast circumferential bar clasp – Rigid cast metal that distorts if forced into deep undercuts.

SYNOPSIS
● Wrought-wire has circular cross-section allowing omnidirectional flexibility.
● Wrought wire in combination clasps offers high flexibility to engage deeper undercuts without exceeding elastic limit.
● Can safely engage deeper undercuts 0.50 mm or 0.020 in) without overstressing abutment tooth.
● Ideal for periodontally compromised teeth or distal extension removable partial dentures.

REFERENCE
McCracken’s Removable Partial Prosthodontics

ANSWER
1-1.5 mm

OTHER OPTIONS
● Less than 0.5 mm – Insufficient thickness leading to fragile, thin ceramic margins prone to chipping.
● 0.5-0.7 mm – Standard width for metal-ceramic chamfer margins, inadequate for monolithic orveneered ceramic.
● 2 mm – Over-preparation of tooth structure compromising pulp vitality and tooth strength.

SYNOPSIS
● A 1.0 to 1.5 mm shoulder provides structural bulk to prevent ceramic fracture.
● 90-degree internal rounded shoulder margin provides 1.0–1.5 mm ceramic bulk for structural durability.
● Minimizes stress concentration at the restorative margin.
● Ensures adequate space for esthetic ceramic layering without over-contouring.

REFERENCE
Rosentiel’s Contemporary Fixed Prosthodontics

ANSWER
Veneering layer chipping

OTHER OPTIONS
● Framework fracture – Zirconia core framework possesses extremely high flexural strength >900-1200 MPa).
● Marginal leakage – Adhesive resin bonding orluting provides excellent marginal seal.
● Complete loss of retention – Retentive rates remain high when appropriate surface conditioning is performed.

SYNOPSIS
● Mismatch in Thermal Expansion Coefficient CTE) between zirconia core and veneering porcelain leads to chipping.
● Most common long-term clinical failure mode reported in systematic reviews.
● Monolithic zirconia crowns with stain orglaze significantly reduce this risk.

REFERENCE
Prosthodontic Literature Reviews or Fixed Prosthodontics

ANSWER
Interdental brush

OTHER OPTIONS
● Water irrigation only – Excellent adjunct but secondary to mechanical biofilm removal by brushes.

SYNOPSIS
● Type II moderate loss) and Type III complete loss) interdental papillae require interdental brushes.
● Brushes expand into concave root surface features to disrupt interproximal plaque biofilm.
● Selected as gold standard for interdental hygiene in treated periodontal patients.

REFERENCE
Carranza’s Clinical Periodontology

ANSWER
Paget disease of bone

OTHER OPTIONS
● Fibrous dysplasia – Characterized by ground-glass radiographic appearance with normal ormild enzyme changes.
● Osteosarcoma – Malignant bone tumor with sunburst periosteal reaction and localized pain.
● Osteopetrosis – Dense marble-like bone with diffuse radiopacity and obliteration of marrow spaces.

SYNOPSIS
● Paget disease causes bone remodeling, jaw expansion, and cotton-wool radiopacities.
● Classic signs – Maxillary expansion, widening alveolar ridge, spacing of teeth, dentures becoming tight.
● Biochemical marker – Significantly elevated serum alkaline phosphatase with normal serum calcium and phosphorus.

REFERENCE
Neville Oral and Maxillofacial Pathology

ANSWER
Surgical excision Enucleation) of the odontoma

OTHER OPTIONS
● Extraction of unerupted incisor followed by implant – Unnecessary destruction of a viable, normal permanent tooth.
● Observation and waiting for differential eruption – Odontoma acts as a physical barrier preventing eruption indefinitely.
● Segmental osteotomy – Invasive orthognathic procedure indicated for major jaw malformations.

SYNOPSIS
● Compound odontoma consists of multiple tooth-like denticles obstructing the eruption path.
● Surgical enucleation removes physical obstruction while preserving the underlying incisor.
● Orthodontic exposure and traction can be performed if spontaneous eruption does not occur.

REFERENCE
Pediatric Dentistry or Oral Surgery Board Guidelines

ANSWER
Three canals

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Standard anatomy – 2 roots Mesial and Distal) and 3 canals Mesiobuccal, Mesiolingual, Distal).
● Mesial root almost universally contains 2 canals terminating in separate or joined foramina.
● Distal root usually contains 1 large oval canal, though a second distal canal Distobuccal orDistolingual) may exist.

REFERENCE
Cohen’s Pathways of the Pulp

ANSWER
Decreased retention and instability due to muscle displacement

OTHER OPTIONS
● Increased lip support – While lips are pushed outward, extreme labial placement creates unnatural facial distortion.
● Discomfort of supporting tissues – Primary issue is muscular displacement and leverage instability rather than tissue sore spots.
● Improved phonetics – Distorts labiodental sound production F and V sounds).

SYNOPSIS
● Neutral zone is the area where outward lip orcheek forces balance inward tongue forces.
● Teeth placed outside this zone experience active dislodging forces during muscle activity.
● Results in fulcrum tipping, loss of peripheral seal, and lower denture instability.

REFERENCE
Prosthodontic Treatment for Edentulous Patients Boucher)

ANSWER
Too incisally

OTHER OPTIONS
● Too lingually – Causes slurring of sibilant ‘S’ sounds against hard palate.
● Too cervically – Causes insufficient lip contact, leading to indistinct or air-leaking labiodental sounds.
● Increased vertical dimension – Affects closest speaking space and causes clattering of teeth during speech.

SYNOPSIS
● F and V sounds are labiodental fricatives formed by upper incisal edges contacting wet-dry line of lower lip.
● Overly long incisally placed) maxillary central incisors dig heavily into lower lip, turning ‘F’ into ‘V’.
● Modified by shortening incisal length or moving teeth superiorly.

REFERENCE
Prosthodontic Treatment for Edentulous Patients

ANSWER
Dentoalveolar fracture

OTHER OPTIONS
● Subluxation – Tooth injury with increased mobility and tenderness without tooth displacement or bone fracture.
● Intrusive luxation – Tooth driven apically into alveolar socket with alveolar process intact.
● Extrusive luxation – Partial displacement of individual tooth out of socket.

SYNOPSIS
● Key clinical pathognomonic signs – Multiple adjacent teeth move together as a single unit.
● Diagnostic imaging – Radiographs show horizontal or oblique fracture line in alveolar bone.
● Treatment – Rigid or semi-rigid splinting for 4-6 weeks to allow bone union.

REFERENCE
IADT Guidelines or Oral and Maxillofacial Trauma

ANSWER
Molar incisor hypomineralization.

OTHER OPTIONS
● Amelogenesis imperfecta – Generalised hereditary defect affecting all teeth in primary and permanent dentition.
● Fluorosis – Diffuse, symmetric opacities across all teeth exposed to high fluoride during development.
● Dentinogenesis imperfecta – Affects dentin matrix, presenting as opalescent translucent amber teeth.

SYNOPSIS
● MIH is a systemic developmental defect of enamel affecting 1 to 4 permanent first molars, frequently accompanied by incisors.
● Clinical presentation – Enamel opacities ranging from white-yellow to yellow-brown with post-eruptive enamel breakdown.
● Aetiology – Systemic illness or fever during the first 3 years of life when these tooth germs mineralise.

REFERENCE
Pediatric Dentistry Board Guidelines

ANSWER
Amelogenesis imperfecta

OTHER OPTIONS
● Dentinogenesis imperfecta – Genetic dentin defect resulting in bulbous crowns and obliterated pulp canals.
● Dental fluorosis – High fluoride intake causes fluorotic mottling, teeth are caries-resistant and non-hypersensitive.
● Enamel hypoplasia – Environmental localized enamel pits or grooves restricted to specific time of injury.

SYNOPSIS
● Amelogenesis imperfecta is a genetic defect affecting enamel formation across all teeth.
● Affects enamel matrix protein formation amelogenin, enamelin.
● Diffuse involvement of both primary and permanent dentitions across all tooth surfaces.
● Characterised by hypoplastic thin, hypomaturation, or hypocalcified enamel leading to severe sensitivity and attrition.

REFERENCE
Neville Oral Pathology

ANSWER
Sinus lift procedure (sinus floor elevation)

OTHER OPTIONS
● Ridge augmentation only – Onlay grafting adds height on ridge surface but distorts crown-to-root ratio and interarch space.
● Extraction of adjacent teeth – Does not add vertical bone height beneath the maxillary sinus floor.
● Orthodontic correction – Cannot create new alveolar bone height in edentulous posterior maxilla.

SYNOPSIS
● Sinus elevation with bone grafting creates vertical height internally within the sinus.
● Lateral window sinus lift required when residual bone height is < 4-5 mm beneath sinus membrane. ● Schneiderian membrane is carefully elevated and bone graft material packed beneath it. ● Allows staged or simultaneous implant placement with adequate primary stability. REFERENCE Misch's Contemporary Implant Dentistry

ANSWER
Maxillary deficiency

OTHER OPTIONS
● Mandibular deficiency – Mandible typically exhibits normal growth potential in isolated cleft lip orpalate cases.
● Excessive maxillary growth – Cleft patients experience growth restriction, never overgrowth.
● Increased vertical facial height only – Cleft patients typically show midface retrusion and reduced vertical development.

SYNOPSIS
● Surgical repair of the palate leaves dense fibrotic scarring along the hard palate.
● Surgical scar tissue acts as a mechanical restraint, restricting anteroposterior and transverse maxillary growth.
● Patients frequently develop midface deficiency, Class III malocclusion, and crossbites requiring orthognathic surgery.

REFERENCE
Grabb and Smith’s Plastic Surgery or Orthodontic Board Review

ANSWER
Vertical and horizontal overlap of anterior teeth

OTHER OPTIONS
● Vertical overlap only – Incomplete factor, overbite alone does not dictate incisal guidance angle without overjet.
● Horizontal overlap only – Overjet alone does not establish anterior disclusion during mandibular protrusion.
● Curve of Spee – Anteroposterior occlusal curve of posterior teeth, a posterior determinant factor.

SYNOPSIS
● Anterior determinants (overbite and overjet) control disclusion of posterior teeth during protrusive or lateral movements.
● Posterior determinants are the temporomandibular joints’ condylar guidance and mandibular fossa anatomy.
● Proper anterior guidance protects posterior teeth from damaging lateral horizontal forces (Mutually Protected Occlusion).

REFERENCE
Okeson’s Management of Temporomandibular Disorders and Occlusion

ANSWER
Group function occlusion

OTHER OPTIONS
● Mutually protected occlusion – General term describing anterior disclusion of posteriors, but canine guidance on an isolated implant causes overload.
● Canine-guided occlusion – Concentrates all lateral shear forces onto a single implant, risking screw loosening or osseointegration failure.
● Balanced occlusion – Indicated exclusively for removable complete dentures to maintain stability.

SYNOPSIS
● Single implants lack a periodontal ligament to provide proprioceptive damping against lateral forces.
● Canine guidance on a canine implant creates severe lateral tipping forces on the implant fixture.
● Group function distributes lateral excursive loads across adjacent natural premolars and teeth, shielding the implant.

REFERENCE
Misch’s Contemporary Implant Dentistry

ANSWER
200 cells permm3

OTHER OPTIONS
● Not applicable

SYNOPSIS
● CD4+ T-lymphocyte count < 200 cells ormm3 or CD4 percentage < 14% criteria for clinical AIDS diagnosis. ● Associated with high risk of opportunistic oral infections - Kaposi sarcoma, PCP, oral candidiasis, HSV. ● Dental treatment requires prophylactic considerations and consultation regarding bleeding or infection risks. REFERENCE CDC Classification System for HIV Infection

ANSWER
Acetaminophen

OTHER OPTIONS
● Aspirin – Non-selective COX inhibitor that causes direct gastric mucosal erosion and inhibits platelet aggregation.
● Ibuprofen – Standard NSAID that inhibits COX-1, decreasing protective gastric mucus and worsening ulcer disease.
● Naproxen – Potent non-selective NSAID with high incidence of GI ulceration and bleeding.

SYNOPSIS
● Acetaminophen Paracetamol) acts primarily centrally in the CNS and lacks peripheral anti-inflammatory COX-1 inhibition.
● Safe for patients with peptic ulcer disease, GERD, or history of GI bleeding.
● Maximum safe daily adult dose is 3000–4000 mg orday to avoid hepatotoxicity.

REFERENCE
Scully’s Medical Problems in Dentistry

ANSWER
Encourage milk consumption immediately

OTHER OPTIONS
● Give plenty of water only – Dilutes stomach contents slightly but does not chemically neutralize or precipitate toxic fluoride ions.
● Avoid calcium-containing foods – Incorrect, calcium is the primary antidote for fluoride binding in the GI tract.
● Give additional fluoride supplements – Exacerbates fluoride toxicity, leading to metabolic acidosis and cardiac collapse.

SYNOPSIS
● Calcium in milk binds fluoride ions to form insoluble calcium fluoride in the stomach.
● Free fluoride ions bind with soluble calcium (Ca2+) or magnesium ions to form insoluble Calcium Fluoride (CaF2).
● Milk, calcium hydroxide, or aluminium-containing antacids precipitate fluoride, preventing GI absorption into the bloodstream.
● First-aid treatment for toxic fluoride ingestion (< 5 mg per kg) before emergency transfer. REFERENCE American Academy of Pediatric Dentistry AAPD) Fluoride Guidelines

ANSWER
Immediate reimplantation of the tooth

OTHER OPTIONS
● Discard the tooth and place a space maintainer – Unjustified; immediate replantation has a high success rate when extra-oral time is < 60 minutes. ● Perform pulpectomy outside the mouth and then reimplant - Unnecessary handling damages delicate PDL cells and increases ankylosis risk. ● Perform pulpotomy and reimplant - Inappropriate endodontic therapy for avulsed permanent teeth. SYNOPSIS ● Extra-oral dry time < 60 minutes and storage in cold milk preserves viable periodontal ligament cells. Golden time for replantation is 20 minutes. ● Immediate replantation, flexible splinting for 2 weeks, and systemic antibiotics are the gold standard protocol. ● Endodontic root canal treatment is initiated in-office 7-10 days later for mature apex teeth. REFERENCE IADT Guidelines for Management of Traumatic Dental Injuries

ANSWER
Migraine headache

OTHER OPTIONS
● Cluster headache – Severe periorbital, non-throbbing pain with autonomic signs tearing, rhinorrhea, nasal congestion).
● Tension headache – Dull, pressing band-like bilateral discomfort, lacks severe nausea or photophobia.
● Trigeminal neuralgia – Brief, electric shock-like lancinating pain triggered by light tactile stimulation.

SYNOPSIS
● Migraine without aura presents with unilateral, pulsating or throbbing moderate-to-severe headache lasting 4-72 hours.
● Pathognomonic associated symptoms – Nausea, vomiting, photophobia (light sensitivity), and phonophobia *(sound sensitivity).
● Aggravated by routine physical activity, relieved by rest in a quiet, dark room.

REFERENCE
International Classification of Headache Disorders ICHD-3)

ANSWER
Erythema migrans

OTHER OPTIONS
● Erythroplakia – Persistent red mucosal patch with high premalignant dysplasia risk, does not wander or resolve spontaneously.
● Candidiasis – Fungal infection presenting as wipeable white plaques or generalised chronic erythema.
● Lichen planus – Immune-mediated lesion featuring bilateral Wickham’s striae, erosions, or desquamative gingivitis.

SYNOPSIS
● Benign inflammatory condition characterised by loss of filiform papillae producing smooth red patches.
● Lesions are bordered by narrow yellow-white hyperkeratotic margins.
● Characteristically resolves in one area and reappears in another (‘ wandering’ pattern), usually asymptomatic.

REFERENCE
Neville Oral and Maxillofacial Pathology

ANSWER
Polyvinyl siloxane

OTHER OPTIONS
● Alginate – Irreversible hydrocolloid subject to imbibition and syneresis, low tear strength.
● Impression compound – Rigid thermoplastic material used for preliminary complete denture impressions.
● Zinc oxide eugenol – Rigid non-elastic impression paste used only for edentulous mucostatic impressions.

SYNOPSIS
● Polyvinyl siloxane PVS produces zero volatile byproducts during polymerisation.
● Features – superior dimensional stability, allowing delayed or multiple cast pourings without deformation.
● High elastic recovery and excellent tear strength near thin crown preparation margins.

REFERENCE
Craig’s Restorative Dental Materials

ANSWER
Class IV

OTHER OPTIONS
● Class I – Bilateral edentulous areas located posterior to remaining natural teeth.
● Class II – Unilateral edentulous area located posterior to remaining natural teeth.
● Class III – Unilateral edentulous area with natural teeth remaining both anterior and posterior to it.

SYNOPSIS
● Kennedy Class IV is a single bilateral edentulous space crossing the dental midline anteriorly.
● Crucial rule – Applegate Rule 5 – Class IV cannot have modification spaces, additional posterior spaces convert it to Class I, II, or III.
● Poses specific esthetic, leverage, and force-distribution challenges in removable prosthodontics.

REFERENCE
McCracken’s Removable Partial Prosthodontics

ANSWER
Non eugenol dressing

OTHER OPTIONS
• Eugenol-containing dressings (e.g., Kirkland pack) – Can cause tissue irritation, burning sensation, and hypersensitivity. Not ideal for post-gingivectomy healing.

SYNOPSIS
• After gingivectomy, a periodontal dressing is applied to
– Protect the surgical site
– Reduce postoperative pain and bleeding
– Facilitate healing
• Non-eugenol dressings (e.g., Coe-Pak) are preferred because
– Do not cause irritation or allergic reactions (unlike eugenol-based dressings).
– Provide better tissue adaptation and less postoperative discomfort.
– Easier to remove after healing.

REFERENCE
Carranza’s Clinical Periodontology, 13th Edition

ANSWER
Implant analogue

OTHER OPTIONS
● Healing abutment – Used intraorally to shape soft tissue emergence profile.
● Impression coping – Attached to implant in mouth to capture spatial orientation within impression material.
● Cover screw – Protective intraoral cap placed over implant body during submerged healing.

SYNOPSIS
● Implant analogue is a precise metal replica of the implant platform and internal connection.
● Screwed onto impression coping inside the impression before pouring dental stone.
● Replicates the exact 3D spatial position of the implant body on the master working model.

REFERENCE
Misch’s Contemporary Implant Dentistry

ANSWER
Osteoradionecrosis (ORN)

OTHER OPTIONS
● Osteomyelitis – Infectious bone inflammation caused by pyogenic bacteria without radiation history.
● Medication-related osteonecrosis – Caused by anti-resorptive bisphosphonates( denosumab) or anti-angiogenic medications.
● Fibrous dysplasia – Developmental skeletal disorder where normal bone is replaced by fibrous tissue.

SYNOPSIS
● ORN key criteria – Exposed bone in irradiated field (> 60 Gy) failing to heal over 3-6 months.
● Pathophysiology – Marx theory – Hypoxia, Hypocellularity, and Hypovascularity (3 H’s).
● Mandible affected significantly more than maxilla due to rich maxillary vascular supply and dense cortical mandibular structure.

REFERENCE
Neville Oral and Maxillofacial Pathology

ANSWER
Mesiolingual and distobuccal cusps

OTHER OPTIONS
● Mesiobuccal and distobuccal cusps – Connects via buccal marginal ridge orcusp ridge, not oblique ridge.
● Mesiolingual and distolingual cusps – Connects lingual cusps along lingual surface.
● Mesiobuccal and distolingual cusps – Transverse diagonal alignment incorrect for maxillary molar anatomy.

SYNOPSIS
● Oblique ridge runs diagonally from the mesiolingual to the distobuccal cusp.
● Anatomical feature present on maxillary molars( primary 2nd molar, and permanent 1st or 2nd molars).
● Prominent elevated enamel ridge crossing occlusal surface obliquely.
● Forms the distal boundary of the central fossa and anterior boundary of the distal triangular fossa.

REFERENCE
Wheeler’s Dental Anatomy, Physiology, and Occlusion

ANSWER
Pulp necrosis with normal apical tissues

OTHER OPTIONS
● Irreversible pulpitis with symptomatic apical periodontitis – Thermal testing yields lingering pain, and percussion causes severe tenderness.
● Reversible pulpitis with acute apical abscess – Reversible pulpitis responds with sharp non-lingering pain to cold, non-necrosed.
● Previously treated tooth with apical periodontitis – Implies prior endodontic obturation, and periapical lesion is present.

SYNOPSIS
● Non-responsive pulp vitality test confirms necrosis; absence of periapical signs confirms normal apex.
● Normal apical tissues – Tooth is non-tender to percussion or palpation and exhibits intact PDL space radiographically.

REFERENCE
American Association of Endodontists AAE) Diagnostic Terminology

ANSWER
Symptomatic irreversible pulpitis with symptomatic apical periodontitis

OTHER OPTIONS
● Symptomatic irreversible pulpitis with normal apical tissues – Lacks tenderness to percussion and radiographic PDL widening.
● Pulp necrosis with normal apical tissues – Pulp necrosis does not produce lingering thermal pain responses.
● Reversible pulpitis with symptomatic apical periodontitis – Reversible pulpitis produces short, non-lingering pain that subsides immediately upon stimulus removal.

SYNOPSIS
● Symptomatic Irreversible Pulpitis – Lingering thermal pain lasting > 10-15 seconds after cold or heat stimulus removal.
● Symptomatic Apical Periodontitis – Inflammation spread to periapical tissues causing tenderness to biting or percussion.
● Radiographic finding – Widened periodontal ligament space surrounding root apex.

REFERENCE
AAE Endodontic Diagnostic Guidelines

ANSWER
Factor IX

OTHER OPTIONS
● Factor VIII – Deficiency causes Haemophilia A (Classic Haemophilia), accounting for ~80-85% of cases.
● Factor XI – Deficiency causes Haemophilia C (Rosenthal syndrome).
● Factor VII – Deficiency causes rare congenital Factor VII deficiency (extrinsic pathway defect).

SYNOPSIS
● Hemophilia B is an X-linked recessive congenital bleeding disorder.
● Characterised by deficiency or dysfunction of blood coagulation Factor IX.
● Dental considerations – Requires replacement therapy with factor concentrate before invasive surgical procedures.

REFERENCE
Little and Falace’s Dental Management of the Medically Compromised Patient

ANSWER
Partial thromboplastin time (aPTT)

OTHER OPTIONS
● Bleeding time – Assesses primary hemostasis platelet plug formation and vascular function), normal in haemophilia.
● Prothrombin time (PT) – Evaluates extrinsic and common pathways Factors I, II, V, VII, X).
● Platelet count – Evaluates platelet quantity, normal in hemophilic patients.

SYNOPSIS
● Activated Partial Thromboplastin Time (aPTT) measures the Intrinsic pathway (Factors VIII, IX, XI, XII) and Common pathway.
● Haemophilia A (Factor VIII deficiency) prolongs aPTT, while PT or INR and platelet counts remain completely normal.
● Essential laboratory monitoring prior to dental surgery in patients with bleeding disorders.

REFERENCE
Scully’s Medical Problems in Dentistry

ANSWER
Uremic halitosis

OTHER OPTIONS
● Increased bacterial plaque – Plaque accumulation is driven by hygiene habits, not urea accumulation directly.
● Periodontal abscess – Localized pyogenic infection not directly caused by salivary chemical changes.
● Reduced salivary flow only – Xerostomia occurs but uremic halitosis is the specific metabolic symptom of urea breakdown.

SYNOPSIS
● End-Stage Renal Disease results in high circulating blood urea nitrogen (BUN).
● Elevated urea concentration leaks into saliva, where oral urease enzymes hydrolyze urea into ammonia.
● Manifests as characteristic uremic halitosis (ammonia orurine-like breath odor) and metallic dysgeusia.

REFERENCE
Little and Falace’s Dental Management of Medically Compromised Patients

ANSWER
Hydrochlorothiazide

OTHER OPTIONS
● Nifedipine – Calcium channel blocker strongly associated with drug-induced gingival overgrowth, not xerostomia.
● Propranolol – Non-selective beta-blocker, can alter salivary composition but less potent diuretic xerostomic driver.
● Losartan – ARB with lower incidence of oral side effects compared to diuretics.

SYNOPSIS
● Hydrochlorothiazide is a thiazide diuretic that increases renal sodium and water excretion.
● Systemic fluid volume reduction leads to decreased salivary gland output and persistent dry mouth.
● ManagementHydration, saliva substitutes, fluoride supplementation to prevent rampant cervical caries.

REFERENCE
Scully’s Medical Problems in Dentistry

ANSWER
At the crest of the free gingival margin

OTHER OPTIONS
● 2 mm subgingival – Violates biologic width causing severe chronic gingival inflammation and bone resorption.
● 0.5 mm subgingival – Acceptable in high lip-line cases but harder to isolate reliably for adhesive bonding.
● 1 mm supragingival – Exposes restorative margin unacceptably in anterior esthetic zone.

SYNOPSIS
● Equigingival (at gingival crest) placement balances esthetic concealment of veneer margin with biological health.
● Facilitates absolute rubber dam isolation and moisture control required for resin cement bonding.
● Enamel preservation at margins ensures optimal micromechanical bond strength.

REFERENCE
Contemporary Fixed Prosthodontics

ANSWER
Supragingivally

OTHER OPTIONS
● Deep subgingivally – Violates biologic width, impedes isolation, and promotes chronic gingivitis.
● At the base of the gingival sulcus – Risks damaging epithelial attachment during crown preparation.
● Within the junctional epithelium – Causes irreversible periodontal tissue injury and attachment loss.

SYNOPSIS
● Supragingival margins are placed on sound tooth structure above the free gingival margin.
● Easiest to prepare, impression, finish, clean, and evaluate for marginal fit.
● Gold standard location for non-aesthetic posterior teeth to preserve periodontal health.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Autonomy

OTHER OPTIONS
● Beneficence – Duty to act for the benefit of the patient (‘doing good’).
● Non-maleficence – Duty to do no harm.
● Justice – Duty to treat people fairly and distribute healthcare resources equitably.

SYNOPSIS
● Patient Autonomy (‘self-governance’) mandates informed consent and respect for patient decisions.
● Clinicians must present valid diagnosis, treatment options, risks, and benefits.
● Patient retains ultimate legal and ethical right to accept or decline proposed treatment.

REFERENCE
ADA Code of Ethics and Professional Conduct

ANSWER
Autonomy

OTHER OPTIONS
● Justice – Ethical duty of fairness and non-discrimination.
● Beneficence – Principle of acting in the best medical ordental interest of the patient.
● Veracity – Principle of honesty and truthfulness in patient communication.

SYNOPSIS
● Disclosing patient images without explicit written consent violates patient confidentiality which is covered under the principle of autonomy.
● Disclosing identifiable patient information or images without formal written consent breaches privacy.
● Applies across all platforms including educational presentations and social media publications.

REFERENCE
ADA Principles of Ethics and Code of Professional Conduct

ANSWER
Endodontic treatment – Orthodontic extrusion – Crown placement

OTHER OPTIONS
● Not applicable.

SYNOPSIS
● Step 1 – Root canal treatment performed first to manage pulp, allow post placement, and prevent pain.
● Step 2 – Forced orthodontic extrusion pulls tooth structure coronally to re-establish ferrule length.
● Step 3 – Stabilization period followed by final crown prep and permanent restoration placement.

REFERENCE
Proffit’s Contemporary Orthodontics or Endodontics

ANSWER
Minor apical constriction

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Apical constriction (minor apical diameter) is the narrowest portion of the root canal system.
● Positioned typically 0.5 mm to 1.0 mm short of the radiographic oranatomical apex.
● Provides natural matrix barrier to confine obturation materials inside canal space.

REFERENCE
Cohen’s Pathways of the Pulp

ANSWER
Powered or Electric toothbrush

OTHER OPTIONS
● Dental floss only – Requires fine motor control and bilateral finger dexterity impossible with severe tremors.
● Manual toothbrush – Requires controlled manual wrist and arm movements compromised by resting tremors.
● Antimicrobial mouthwash only – Chemically reduces plaque slightly but cannot mechanically remove sticky biofilm.

SYNOPSIS
● Parkinson’s disease causes resting tremors, bradykinesia, and loss of fine motor dexterity.
● Powered(electric) toothbrushes feature large easy-grip handles and automated oscillating heads.
● Allows effective mechanical plaque removal without requiring complex manual brushing motions.

REFERENCE
Scully’s Medical Problems in Dentistry

ANSWER
5% sodium fluoride varnish

OTHER OPTIONS
● 0.2% sodium fluoride mouth rinse daily – High risk of swallowing in special needs children with impaired swallowing reflexes.
● 2% sodium fluoride gel – Requires tray delivery for 4 minutes with high salivary accumulation and ingestion risk.
● 1.23% acidulated phosphate fluoride gel – Acidic gel poses swallowing toxicity and can etch ceramic orcomposite restorations.

SYNOPSIS
● 5% Sodium Fluoride (22,600 ppm F) varnish adheres quickly to enamel upon contact with saliva.
● Fast paint-on application requires minimal patient cooperation.
● Significantly reduces risk of accidental acute systemic ingestion in pediatric orspecial needs patients.

REFERENCE
AAPD Fluoride Therapy Guidelines

ANSWER
Leakage

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Holes too far apart – Causes excess dam material between the teeth, resulting in wrinkling or bunching.
• Holes too close together – Causes the dam material to stretch tightly, resulting in gaps, tearing, and leakage.

REFERENCE
Mosbys review NBDE part 2

ANSWER
Inform the patient immediately and follow standard PEP protocols

OTHER OPTIONS
● Do not inform the patient or record the incident – Ethical and legal violation concealing occupational exposure risk.
● Do not inform the patient, but record the incident – Violates consent and prevents necessary patient baseline viral testing.
● Inform the patient, but omit recording in medical notes – Incomplete medical documentation exposes clinic to severe legal liability.

SYNOPSIS
● Protocol for occupational exposure needle-stick orscalpel injury –
● 1. Wash site immediately with soap and water.
● 2. Document exposure incident and inform exposure control officer.
● 3. Inform patient, request consent for baseline HBV, HCV, and HIV testing, and initiate Post-Exposure Prophylaxis PEP) within hours.

REFERENCE
CDC Bloodborne Pathogens & Postexposure Prophylaxis Protocols

ANSWER
Pseudomembranous oral candidiasis

OTHER OPTIONS
● Leukoplakia – Non-wipeable white plaque that cannot be characterized clinically orpathologically as any other disease.
● Oral lichen planus – Non-wipeable lacy white lines Wickham’s striae) on buccal mucosa.
● White sponge nevus – Autosomal dominant hereditary condition presenting as thick non-wipeable spongy white plaques.

SYNOPSIS
● Classic acute fungal infection caused by Candida albicans overgrowth.
● Key pathognomonic feature – Soft white curd-like plaques wipe off with gauze, leaving raw erythematous orbleeding surface.
● Associated with immunosuppression, broad-spectrum antibiotics, corticosteroid inhalers, or diabetes.

REFERENCE
Neville Oral and Maxillofacial Pathology

ANSWER
Angioedema

OTHER OPTIONS
● Orofacial granulomatosis – Chronic non-painful persistent lip swelling showing non-caseating granulomas on biopsy.
● Fibroma – Slow-growing hyperplastic fibrous tissue nodule secondary to chronic irritation.
● Oral mucocele – Localized fluid-filled salivary mucin extravasation phenomenon on lower lip.

SYNOPSIS
● Angioedema involves rapid, severe non-pitting swelling of deep dermal, subcutaneous, or submucosal tissues.
● ACE inhibitors e.g., Lisinopril) increase systemic bradykinin levels, triggering vasodilation.
● Can progress to life-threatening airway compromise laryngeal edema) requiring emergency epinephrine.

REFERENCE
Little and Falace’s Dental Management of Medically Compromised Patients

ANSWER
Handle, shank, blade or nib

OTHER OPTIONS
● Blade, bur, latch – Mixes hand instrument and rotary latch-type bur terminology.
● Tip, bur, motor – Components belonging to handpieces and electric motors.
● Head, neck, turbine – Anatomical structure of a high-speed air turbine handpiece.

SYNOPSIS
● Handle shaft – Grasping portion held by practitioner.
● Shank – Connects handle to working end, angled to keep working end aligned with long axis.
● Blade or Nib – Active working end blade on cutting instruments, nib on non-cutting instruments like condensers).

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry

ANSWER
Glazing

OTHER OPTIONS
● Pickling – Chemical acid bath used to remove oxidation scale from gold alloy castings.
● Sandblasting – Micro-abrasion technique used to roughen internal metal orzirconia surface before cementation.
● Acid etching – Application of hydrofluoric acid to etch glass-ceramics before resin bonding.

SYNOPSIS
● Glazing is the final firing stage where surface ceramic melts slightly to form a smooth, impervious glass layer.
● Seals microscopic surface flaws and cracks, significantly increasing flexural strength.
● Provides a smooth, hygienic finish that minimizes plaque accumulation and opposing enamel abrasion.

REFERENCE
Phillips’ Science of Dental Materials

ANSWER
Inferior alveolar, lingual, and long buccal nerve blocks

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Inferior Alveolar Nerve Block IANB – Anesthetizes mandibular molar pulp, periodontal ligament, and surrounding bone.
● Lingual Nerve Block – Anesthetizes lingual gingival tissues and floor of mouth.
● Long Buccal Nerve Block – Anesthetizes buccal soft tissue adjacent to mandibular molar.

REFERENCE
Malamed’s Handbook of Local Anesthesia

ANSWER
Marrow spaces are wide

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Because of wider marrow spaces in the child, an odontogenic infection can rapidly spread through the bone, possibly damaging the erupting teeth.
• Most odontogenic infections in the child are not serious and can be easily managed by removing the source of infection with pulp therapy or removing the involved tooth.
• Although uncommon, serious complications can occur when the infection spreads beyond the dentition, including cellulitis, cavernous sinus thrombosis, brain abscess, temporary blindness, airway obstruction, and mediastinal spread of infection.
• Classic signs and symptoms of infection include redness, pain, swelling, and local and systemic temperature increases.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 405

ANSWER
Red

OTHER OPTIONS
● Blue – Handle colour for 30k file or 60k file.
● White – Handle colour for 15k file or 50k file.
● Purple – Handle colour for 10k file.

SYNOPSIS
● ISO colour coding standardises endodontic instrument dimensions for clear identification.
● Sizes 15 to 40 follow the sequence White Yellow Red Blue Green Black.
● Size 25 files consistently feature a red handle identifier.

REFERENCE
Ingle’s Endodontics, 7th Edition, Chapter 16

ANSWER
13 percentage

OTHER OPTIONS
● 3 percentage – Below required threshold for high-copper amalgams.
● 7 percentage – Traditional low-copper amalgam concentration.
● 50 percentage – Abnormally high concentration for dental amalgams.

SYNOPSIS
● High-copper amalgams contain greater than 12% copper to eliminate the corrosion-susceptible gamma-2 phase.
● This significantly reduces marginal breakdown and creep.
● Improves longevity and mechanical properties of the restoration.

REFERENCE
Phillips’ Science of Dental Materials, 13th Edition, Chapter 18

ANSWER
Osseointegrated implants

OTHER OPTIONS
• All other partial dentures can be given to children as it doesn’t interfere with bone growth

SYNOPSIS
• In a growing patient, implants are contraindicated due to the risk of infra-occlusion with continued vertical facial growth.
• Implant placement is best left until skeletal maturity.
• Standard dental implants are not normally used in children as they act as ankylosed teeth and may disturb the growth of the jaws.
• Orthodontic implants, however, may be placed, for example, in the midline of
the palate.
• Orthodontic appliances can then be attached to these implants, which are removed at the end of treatment.
• There are three reasons for avoiding implants in young patients
1. The implant does not move with the growing alveolus it acts as an ankylosed tooth. Thus implants should not be placed until vertical growth of the jaws is virtually complete around 18 years of age. The exception to this rule is the lower intercanine region which can receive implants earlier in exceptional cases of hypodontia, for example, X-linked ectodermal dysplasia.
2. Implants can interfere with the normal growth of the jaws.
3. Young bone does not behave in the same way as mature bone. Due to squashing
and crushing, the axis of an inserted implant may deviate widely from the axis of the tap.

REFERENCE
Oxford book of Pediatric dentistry Page 492

ANSWER
Careful monitoring

OTHER OPTIONS
• No need for any particular treatment until symptomatic.

SYNOPSIS
• Occurrence of obliteration in permanent teeth increased over time, with most cases diagnosed more than 3 years following the trauma.
• Although pulp canal obliteration is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment in primary or permanent teeth except follow-up.
• In teeth with an open apex, there is a greater possibility of maintaining pulp vitality or revascularization of the neurovascular supply compared to mature teeth, due to the intense cell activity capable of promoting the defense and regeneration of affected tissues.

REFERENCE
Pulp canal obliteration to primary and permanent teeth following trauma-Bianca Santos

ANSWER
Permanent molar 

OTHER OPTIONS
• Direct pulp capping is contraindicated in primary teeth because of the risk of developing internal root resorption.

SYNOPSIS
• Direct Pulp Capping is the placement of a medicament or non-medicated material on an exposed pulp that is occurred in course of excavating the last portions of deep dentinal caries or because of trauma.
• Indications of Direct Pulp Capping
Pulp-capping procedures should be limited to asymptomatic (absence of pain)permanent teeth, vital young permanent teeth, with the possible exception of discomfort caused by the intake of food, the teeth should have
– True pinpoint exposure (small mechanical exposure less than 1 mm) surrounded by sound dentin produced accidentally by trauma during cavity preparation.
– Mechanical or carious exposures less than 1 mm, in an asymptomatic vital young permanent tooth.
– The exposure site should have bright red hemorrhage easily controlled by dry cotton pellet with minimal pressure.
– Lack of bleeding at the exposure site (the amount of bleeding considered normal in the absence of a hyperemic or an inflamed pulp.
• Contraindications
1) Curiously exposed deciduous teeth
2) Spontaneous pain or severe toothache at night
3) Swelling
4) Fistula
5) Tenderness to percussion
6) Pathologic mobility
7) Root resorption-external or internal
8) Periapical or interradicular radiolucency
9) Pulp calcifications
10) Profuse hemorrhage from the exposure site
11) Pus or exudate from exposure site.
• Presently, the materials most commonly used are calcium hydroxide, emdogain, and mineral trioxide aggregate – MTA.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 337, 338

ANSWER
Pleomorphic adenoma

OTHER OPTIONS
● Basal cell adenoma – Rare benign salivary gland tumor.
● Adenoid cystic carcinoma – Malignant salivary gland tumor.
● Warthin tumor – Second most common benign salivary tumor.

SYNOPSIS
● Pleomorphic adenoma accounts for 60% to 70% of all salivary gland neoplasms.
● It most commonly arises in the superficial lobe of the parotid gland.
● Histologically shows mixture of epithelial and mesenchymal-like elements.

REFERENCE
Neville’s Oral and Maxillofacial Pathology, 4th Edition, Chapter 11

ANSWER
1.5 mm

OTHER OPTIONS
● 0.5 mm – Insufficient height to provide resistance against root fracture.
● 1 mm – Suboptimal ferrule height.
● 3 mm – Preferred when feasible but 1.5-2.0 mm is standard optimum minimum.

SYNOPSIS
● A minimum ferrule height of 1.5 to 2.0 mm of sound dentin surrounding the coronal walls improves structural resistance.
● Significantly prevents tooth fracture under occlusal forces.
● Ensures proper retention and force distribution.

REFERENCE
Rosenstiel’s Contemporary Fixed Prosthodontics, 5th Edition, Chapter 12

ANSWER
Pulpotomy

OTHER OPTIONS
• Pulp capping and reattachment of fragment – is done in permanent tooth.
• Pulpectomy – indicated with tooth with large pulp exposure and where radicular pulp is also involved.
• Apexification – process of inducing a calcified barrier at the apical care for young permanent non vital tooth with open apex.

SYNOPSIS
• When the carious process has reached the pulp or in incidences of direct pulpal exposure during excavation
of a carious lesion,or traumatic pulpal exposure, the pulpotomy procedure is indicated and is the treatment of choice.
• The pulpotomy procedure is based on the rationale that the radicular pulp tissue is healthy or is capable of healing after surgical amputation of the affected or infected coronal pulp.
• Any signs and or symptoms of inflammation extending beyond the coronal pulp is a contraindication for a pulpotomy.
• Thus, a pulpotomy is contraindicated when any of the following are present
– Swelling of pulpal origin,
– Fistula,
– Pathologic mobility,
– Pathologic external root resorption,
– Internal root resorption,
– Periapical or interradicular radiolucency,
– Pulp calcifications, or excessive bleeding from the amputated radicular stumps.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 340

ANSWER
Environment

OTHER OPTIONS
• Gender differences can also be seen in behavior when observing a twin boy and girl. But the greatest influence is of the environment.

SYNOPSIS
• The factors that affect a child behaviour in a dental clinic can be broadly classified into
1 Sociocultural and Developmental factors
2. Familial factors
3. Factors associated with the dentist or dental operatory.
Familial factors include environment, family and peer influence, maternal attitude and behavior
Environment – Home is the first school where the child learns.
• The influence of the environment on health or social determinants of health has been an area of recent interest.
• Studies have linked dental anxiety and resultant behavior management problems to socioeconomic status and household characteristics.
• Explanations for this behavior may include increased caries history, resultant invasive treatment, and lack of access to dentists with experience treating children.
• Behavior management problems have also been linked to single-parent homes, possibly due to increased economic and social pressures in these environments.
• Emerging areas of study are the correlation between dental behavior and residence in an area at high risk for toxic stressors such as violence and low socioeconomic status.
• Thus the environment greatly influences behaviour differences between twins.

REFERENCE
Pediatric Dentistry Arthur.J.Nowak Page 354

ANSWER
Generalized dentin sclerosis by age.

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Permanent teeth are supposed to have a much longer period of function.
• During that course of time, they change considerably with age, especially during eruption and the first years thereafter.
• Due to alternating de- and remineralizing episodes, surface enamel matures post-eruptively.
• Hereby, mineral quality is improved and solubility is lowered.
• Due to the life-long activity of the odontoblasts, the pulp recedes, the dentin tubules obliterate and the dentin also acquires a higher degree of mineralization. Thus, caries progresses faster in enamel and dentin of newly erupted permanent teeth in children and adolescents than in adults.

REFERENCE
Early childhood caries – McDonald and Avery’s Dentistry for Child and Adolescent – 11th Edition

ANSWER
Slicing of distal bulge and guide the molar eruption

OTHER OPTIONS
• Extraction of primary second molar – results in space loss and ectopic eruption of the first permanent molar.
• Extraction of permanent first molar – not a valid choice.
• Forceful extraction of permanent first molar – not required.

SYNOPSIS
• Slicing of the distal bulge of the primary second molar is done to guide the eruption of the first permanent molar.
• Obtain distal reduction with a fine tapered diamond bur.
• It is important not to change the proportions of the tooth or create an overhang that will impede molar eruption.

REFERENCE
Pediatric dentistry Oxford Page 236

ANSWER
Localized aggressive periodontitis

OTHER OPTIONS
• Generalised periodontitis – is rare in children. it is the interproximal attachment loss that affects three or more permanent teeth other than incisors and first molars.
• Gingivitis – is common in children with generalized appearance.

SYNOPSIS
• LAP in the primary dentition formerly called localized prepubertal periodontitis, and is characterized by localized loss of attachment in the primary dentition.
• It occurs in children without evidence of systemic disease.
• The disease is most commonly manifested in the molar area, where localized, usually bilaterally symmetric loss of attachment occurs.
• It is usually accompanied by mild to moderate inflammation, and heavier than average plaque deposits may be visible.
• It is commonly first diagnosed during the late primary dentition or early transitional dentition.
• LAP of the primary dentition may progress to LAP in the permanent dentition.
• LAP in the primary dentition is associated with a bacterial infection and a specific, but minor, host immunological deficit.
• Some cases are associated with systemic genetic diseases.
• Antibiotic therapy combined with local debridement appears to be an effective treatment regimen.
• Metronidazole is the antibiotic of choice for LAP of the primary dentition.
• Tetracyclines are contraindicated.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 375, 376

ANSWER
Non-reliable 

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Two types of sensory fibres are present in the pulp – the myelinated A fibres and unmyelinated C fibres.
• The A fibres predominantly innervate the dentine.
• The C fibres innervate the body of the pulp.
• The Aδ fibres have lower electrical thresholds than the C fibres and respond to a number of stimuli which do not activate C fibres.
• Aδ fibres mediate acute, sharp pain and are excited by hydromechanical events in dentinal tubules such as drilling or air-drying.
• The C fibres mediate a dull, burning, and poorly located pain, and are activated only by stimuli reaching the pulp proper.
• C fibres have a high threshold and can be activated by intense heating or cooling of the tooth crown.
• In primary and young permanent teeth A delta fibres have delayed release.
• For electric and thermal testing to be effective, the pulp must have a sufficient number of mature neurons.
• However, both primary and immature permanent teeth are not fully innervated with alpha myelinated axons, the neural components which are responsible for the pulpal pain response.

REFERENCE
Assessment of pulp vitality – Journal of Dentistry

ANSWER
Incomplete innervations

OTHER OPTIONS
Detailed below

SYNOPSIS
• For electric and thermal testing to be effective, the pulp must have a sufficient number of mature neurons.
• However, both primary and immature permanent teeth are not fully innervated with alpha myelinated axons, the neural components which are responsible for the pulpal pain response.

REFERENCE
Assessment of pulp vitality – Journal of Dentistry

ANSWER
Anaesthetic test

OTHER OPTIONS
• Test cavity – This test may serve as a last resort in testing for pulp vitality. The test cavity is made by drilling through the enamel-dentine junction of an unanesthetized tooth with good isolation.
• Electric test – The objective of EPT is to stimulate intact Aδ nerves in the pulp-dentine complex by applying an electric current on the tooth surface.
• Percussion test – Percussion test cannot be used in pediatric patients because it is difficult to get periodontal response due to resorption of deciduous roots, and there will be furcal involvement in long standing inflammation of deciduous tooth unlike in the apical area as in permanent teeth.

SYNOPSIS
• When dental symptoms are poorly localized or referred, an accurate diagnosis is extremely difficult.
• Sometimes, patients may not even able to specify whether the symptoms are from the maxillary or mandibular arch.
• In such cases, and where pulp testing has proved inconclusive, an anaesthetic test may be helpful.
• The technique is as follows, using either infiltration or an intraligamentary injection, the most posterior tooth in the area suspected of causing the pain is anaesthetized.
• If pain persists once the tooth has been fully anaesthetized, the tooth immediately mesial to it is then anaesthetized, and so on, until the pain disappears.
• If the source of the pain cannot be even localized to the upper or lower jaw, an inferior alveolar nerve block injection is given cessation of pain indicates involvement of a mandibular tooth.
• This approach has an advantage over a test cavity, which may incur iatrogenic damage.

REFERENCE
Assessment of pulp vitality – a review-gopikrishna

ANSWER
Ankylosis

OTHER OPTIONS
• Subluxation – causes deviation of TMJ and not limited mouth opening.
• Trismus – a condition characterized by limited mouth opening.
• Muscular contraction – may cause limited mouth opening.

SYNOPSIS
• Deflection is commonly associated with an intracapsular disorder, such as disk displacement without reduction or TMJ ankylosis.
• Ankylosis, a rare but serious manifestation of TMJ trauma, occurs when there is a fusion of the mandible to the cranial base or zygoma.
• Given the variability of traumatic injuries to the masticatory system and the differing levels of individual response to injury, it is reasonable to screen for trauma in patients with a history of TMD.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 580

ANSWER
Greenstick bilateral condylar fracture

OTHER OPTIONS
• Tooth fracture – may occur due to a fall on the chin but more chances for bilateral condylar fracture.
• Mandibular body fracture – least possible to occur.

SYNOPSIS
• Mechanism of Injury – When a child falls on the chin, the force is transmitted posteriorly through the mandibular body towards condylar necks (weakest point) where it absorb the impact and leads to fracture of condyles.
• In children, because the bone is more flexible and not fully mineralized greenstick fractures (incomplete fractures) are common.
• Bilateral involvement occurs because the impact is transmitted symmetrically through both condyles.
• Clinical findings include
– Pain and tenderness over TMJ
– Restricted mouth opening
– Muscle spasm and pain
– Anterior open bite
– Deviation on opening
– No mobility in lower border
• Radiographic Findings
– Panoramic (OPG) – Greenstick or incomplete fracture lines at the condylar neck region.
• Management – Usually conservative in children
– Soft diet
– Analgesics
– Early gentle mobilization
– Regular follow-up to ensure normal growth of condyle

REFERENCE
Mcdonald and Avery – Pg 653

ANSWER
Dentoalveolar fracture

OTHER OPTIONS
• Subluxation – Subluxated teeth present increased mobility and widening of the periodontal space.
• Concussion – Teeth suffering from concussion injuries are sensitive to percussion without any additional sign.

SYNOPSIS
• The extent and position of the alveolar fracture should be verified clinically and radiographically.
• If there is displacement of the teeth to the extent that their apices have risen up and are now positioned over the labial or lingual or palatal alveolar plates, apical lock, then they will require extruding first to free the apices before repositioning.
• The segment of alveolus with teeth requires only 3-4 weeks of rigid splinting composite-wire type, with two abutment teeth on either side of the fracture, together with antibiotics, chlorhexidine, soft diet, and tetanus prophylaxis check.
• Pulpal survival is more likely if repositioning occurs within 1 hour of the injury.
• Root resorption is rare.

REFERENCE
Arthur J Nowak – Pediatric dentistry

ANSWER
All of the above

OTHER OPTIONS
● Refer Synopsis

SYNOPSIS
● Cephalosporins frequently cause gastrointestinal adverse effects.
● Symptoms include nausea, dyspepsia, and abdominal pain.
● Disruption of intestinal microflora commonly leads to diarrhea.

REFERENCE
Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th Edition, Chapter 55

ANSWER
Underdevelopment of the zygomatic complex and cheekbones

OTHER OPTIONS
● One side of the face is underdeveloped – Characteristic of Hemifacial Microsomia.
● Micrognathia and cleft palate – Features of Pierre Robin sequence.

SYNOPSIS
● Treacher Collins syndrome involves bilateral hypoplasia of the zygomatic arches and malar bones.
● Results in characteristically depressed cheekbones and downward slanting palpebral fissures.
● Originates from 1st and 2nd branchial arch defects.

REFERENCE
Proffit’s Contemporary Orthodontics, 6th Edition, Chapter 3

ANSWER
Thumb sucking

OTHER OPTIONS
● Nail biting – Causes localized incisor wear orchipping without massive open bite.
● Tongue thrusting – Secondary adaptive behavior or causes broader open bite.
● Lip biting – Typically causes retroclination of lower anteriors.

SYNOPSIS
● Persistent thumb sucking exerts continuous labial force on maxillary incisors.
● Causes proclination of upper anteriors and prevents vertical incisor eruption.
● Leads directly to anterior open bite.

REFERENCE
Proffit’s Contemporary Orthodontics, 6th Edition, Chapter 5

ANSWER
Surgical intervention

OTHER OPTIONS
● Re make – New denture will fail without prior removal of fibrous mass.
● Medication – Medical management cannot resolve hyperplastic fibrous tissue.
● Reduce overextension – Relieves acute irritation but does not eliminate hyperplastic tissue.

SYNOPSIS
● Epulis fissuratum (inflammatory fibrous hyperplasia) results from chronic denture irritation.
● Established hyperplastic fibrous folds require complete surgical excision.
● Tissue must be surgically corrected before fabricating a new denture.

REFERENCE
Boucher’s Prosthodontic Treatment for Edentulous Patients, 13th Edition, Chapter 6

ANSWER
Round

OTHER OPTIONS
● Tapered – Creates sharp line angles undesirable for rest seats.
● Inverted cone – Creates undercuts which prevent seat path of insertion.
● Fissure – Creates steep vertical walls rather than spoon-shaped floor.

SYNOPSIS
● Round diamond or carbide burs No. 2, 4, or 8) are used for occlusal rest seats.
● Creates smooth saucer-shaped or spoon-shaped rest seat floors.
● Prevents sharp line angles and stress concentrations.

REFERENCE
McCracken’s Removable Partial Prosthodontics, 13th Edition, Chapter 6

ANSWER
Carbide

OTHER OPTIONS
● Stainless steel – Lacks durability and efficiency in cutting enamel.
● Diamond – Cuts by abrasion which produces sub-surface enamel micro-cracks.
● None of the above – Incorrect as carbide is effective.

SYNOPSIS
● Carbide burs cut enamel cleanly by blade shear action rather than abrasive grinding.
● Results in smoother cavity walls.
● Produces significantly fewer enamel micro-cracks compared to diamond burs.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry, 7th Edition, Chapter 6

ANSWER
Pulpal irritation

OTHER OPTIONS
● Microleakage – Causes gradual sensitivity rather than immediate acute sharp pain.
● Delayed expansion – Occurs days or weeks later due to moisture contamination in zinc amalgams.

SYNOPSIS
● Acute sharp post-operative pain immediately after restoration placement indicates direct pulpal irritation.
● May result from deep preparation, high occlusion, or operative thermal trauma.
● Requires immediate occlusal check and pulpal evaluation.

REFERENCE
Sturdevant’s Art and Science of Operative Dentistry, 7th Edition, Chapter 11

ANSWER
Self limiting

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Herpes simplex virus type 1 HSV-1, is a large DNA virus that causes primary herpetic gingivostomatitis
• It is mostly acquired through direct skin contact or bodily fluids.
• Oral lesions may start as vesicles on the tongue, buccal mucosa, and gingiva, rapidly rupturing to become ulcers 1 to 3 mm in size, which may subsequently form a large ulcerated area covered by a yellowish-gray membrane.
• The infection is self-limiting, lasting 10 to 14 days, and healing without scarring.
• Children may present with severe local pain, which can lead to difficulties with fluid and food intake, putting them at risk for dehydration.
• Excessive drooling, halitosis, and sore throat are frequently present.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 72, 73

ANSWER
Ectodermal dysplasia

OTHER OPTIONS
• Down’s syndrome – trisomy in 21 chromosome , macroglossia , altered dentition.
• Dentin dysplasia – inherited dentin defect causing ghost tooth appearance.

SYNOPSIS
• Developmental agenesis of primary teeth is relatively rare.
• When several primary teeth fail to develop, other ectodermal deficiencies are usually evident.
• One of the more common types of ectodermal dysplasia is X-linked recessive hypohidrotic ectodermal dysplasia XLHED, also called anhidrotic ectodermal dysplasia and Christ-Siemens-Touraine syndrome.
• Because the absence of teeth predisposes the child to a lack of alveolar process growth, the construction of dentures is complicated.
• A deficiency in sweat glands predisposes to increased body temperature, and children with hypohidrosis or anhidrosis are extremely uncomfortable during hot weather.
• Many of them must reside in cool climates.
• Children with ectodermal dysplasia usually have normal mental capacity and a normal life expectancy.

REFERENCE
MCDonald

ANSWER
Regional odontodysplasia

OTHER OPTIONS
• Hypoplasia – developmental defects of enamel or dentin.
• Dentinogenesis imperfecta – inherited defect of dentin.
• Amelogenesis imperfecta – inherited defects of enamel.

SYNOPSIS
• This is an uncommon developmental anomaly, typically affecting the primary teeth and corresponding permanent successors within a segment of the dentition.
• The anterior teeth are more commonly affected than the posterior teeth and the defect may cross the midline.
• The term ghost teeth is sometimes applied to reflect the radiographic appearance seen.
• Affected patients may present with abscesses prior to the eruption of the teeth.
• The abnormal teeth have poorly developed crowns with enamel and dentine changes, large pulp chambers, and open apices.
• The permanent teeth may be less severely affected than the primary predecessors.
• The removal of teeth affected by regional odontodysplasia is often necessary.
• As this is often the case in the primary dentition, consideration then needs to be given to management of the affected permanent successors.

REFERENCE
Pediatric Dentistry Arthur .j.Nowak

ANSWER
Streptococcus mutans

OTHER OPTIONS
• Streptococcus salivarius – found in the oral cavity of newborns.
• Lactobacillus – another cariogenic bacteria found in oral cavity of newborns.
• E.coli – found in the newborn mouth.

SYNOPSIS
• Several infant factors contribute significantly to the colonization of S. mutans.
• First, although S. mutans may colonize the mouth before tooth eruption, the emergence of
teeth increases the non-shedding surfaces for adherence to S.mutans.
• Thus, with tooth eruption, the colonization rate of the infants increases as their ages increase.
• Second, infant dietary and oral hygiene habits also facilitate the colonization of S.mutans.
• On pre dentate infants, frequent exposure to sugars, especially from snacking and sweetened pacifiers, correlated significantly with S. mutans colonization.
• The earlier the colonization of S. mutans, the higher the caries risk.
• The age of colonization on its own may not be the most important aspect in caries development, since other factors, such as sugar consumption and oral hygiene, are also likely to play significant roles in determining caries risk.
• S. mutans colonization after tooth eruption is influenced by both maternal and infant factors.
• It is now well-recognized that the mother is usually the primary source of S. mutans for infection of her child and poor maternal oral hygiene and dietary habits increase the likelihood of transmission of the infection from mother to child.

REFERENCE
A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. Journal of Dental Research. 2003,82,7,504–508.

ANSWER
An implant is placed at the same time as the natural tooth is extracted

OTHER OPTIONS
● Not applicable

SYNOPSIS
● Immediate implant placement refers to surgical insertion of a dental implant directly into a fresh extraction socket.
● Performed during the same surgical visit as tooth extraction.
● Preserves bone structure and reduces overall treatment duration.

REFERENCE
Newman and Carranza’s Clinical Periodontology, 13th Edition, Chapter 74

ANSWER
To determine the coefficient factor of disinfectant

OTHER OPTIONS
● To determine chemical disinfection effectiveness on an inanimate surface – Broad function, test specifically calculates coefficient.

SYNOPSIS
● The Rideal-Walker test calculates the Phenol Coefficient factor of liquid disinfectants.
● Compares their germicidal efficacy against pure phenol using Salmonella typhi.
● Standardizes disinfectant efficiency ratings.

REFERENCE
Ananthanarayan and Paniker’s Textbook of Microbiology, 10th Edition, Chapter 3

ANSWER
Bronchial asthma

OTHER OPTIONS
• Cardiac disease – Can also be the answer. Usually tolerated in semi-reclined position, not strictly erect, concern is not airway but stress.

SYNOPSIS
• In bronchial asthma, the child may experience dyspnea (difficulty in breathing) especially when lying down (orthopnea).
• Supine position can cause
– Increased airway resistance
– Reduced diaphragmatic movement
– Worsening of breathlessness and coughing
– Hence, asthmatic patients should be treated in a semi-supine or upright position to ease breathing and reduce the risk of bronchospasm.

REFERENCE
McDonald & Avery, Dentistry for the Child and Adolescent, 11th ed.

ANSWER
Riga fede disease

OTHER OPTIONS
• Erythema multiforme – chronic vesiculo-ulcerative disease.
• ANUG – Epithelial necrosis of gingiva caused by porphyromonas gingivalis and other microbes. Interdental crater-like depressions are seen in gingiva
• Recurrent aphthous ulcer – A condition characterized by recurrent oral ulcerations.

SYNOPSIS
• Riga-Fede disease is a mouth ulcer seen in infants and is usually caused by rubbing the tongue over teeth.
• The ulcer may be uncomfortable but it is otherwise harmless. Less commonly other parts of the mouth may be involved.
• Prematurely erupted teeth are hypermobile because of limited root development.
• Some teeth may be mobile to the extent that there is a danger of displacement of the tooth and possible aspiration, in which case the removal of the tooth is indicated.

REFERENCE
Pg 366 MCDonald

ANSWER
Attrition

OTHER OPTIONS
• Dental erosion – may have a variety of etiologies aside from bulimia in this age group, such as sports and carbonated beverage intake or gastroesophageal reflux.
• Abrasion – the pathologic wearing away of tooth structure secondary to the mechanical action of an external agent.
• Abfraction – refers to loss of tooth structure from occlusal stresses that create repeated tooth flexure at a location away from the point of loading.

SYNOPSIS
• Attrition is the wearing of teeth during function.
• It is a normal physiologic process that occurs as teeth occlude with those in the opposing dental arch.
• Certain types of foods and associated habits may contribute to more or less wear for individuals.
• The effects of attrition on occlusion are compensated for by further functional eruption.
• Poor quality or absent enamel as in fluorosis, enamel hypoplasia or dentinogenesis imperfecta, premature contacts, intraoral abrasives, grinding habits etc can accelerate attrition.
• Normal levels of attrition do not require therapy.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 193, 194
Textbook of oral pathology Neville Page 60,61

ANSWER
Juvenile periodontitis

OTHER OPTIONS
• Gingivitis – Gingivitis is characterized by inflammation of the gingival tissues with no loss of attachment or bone.

SYNOPSIS
• Juvenile periodontitis, also known as aggressive periodontitis or early-onset periodontitis, is a rare and severe form of periodontal disease that affects children and young adults. It is characterized by a rapid progression of gum and bone destruction, leading to tooth loss if left untreated.
• The exact causes of juvenile or aggressive periodontitis are not yet fully understood. However, research suggests that several factors may contribute to the development of these conditions. These factors include
– Genetic predisposition
– Bacterial infections or poor oral hygiene
– Impaired immune response
– Lifestyle factors
• The disease typically begins around puberty and may affect the molars and incisors (front teeth) first. Unlike the more common form of periodontitis seen in adults, individuals with juvenile periodontitis often have minimal plaque and tartar buildup, making it distinct and challenging to diagnose.
• Signs and symptoms of juvenile periodontitis include
– Red, swollen, and bleeding gums
– Bad breath (halitosis)
– Gums that are tender and painful to touch
– Receding gums, making the teeth appear longer
– Formation of deep periodontal pockets
– Loose teeth or teeth that are separating
– Bite changes or malocclusion
– Discomfort or pain while chewing
– Pus between the teeth and gums
• If the disease is discovered at a very early stage, treatment can include subgingival scaling and root planing in conjunction with antibiotic therapy. If conservative treatment does not result in a resolution of the disease process, the dentist may switch to surgical therapy.
• Surgical treatment would involve flap elevation of the affected areas, followed by thorough root debridement.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 371

ANSWER
X-ray

OTHER OPTIONS
• Percussion test – Percussion test cannot be used in pediatric patients because it is difficult to get periodontal response due to resorption of deciduous roots, and there will be furcal involvement in long standing inflammation of deciduous tooth unlike in the apical area as in permanent teeth.

SYNOPSIS
• Radiographs should follow a careful clinical examination.
• Performing bitewing radiographs is necessary to assess the depth of the caries,the morphology of the pulp chamber, the height of the pulp horns, the integrity and depth of restorations, and the level of bone support.
• Bitewing views can also demonstrate the presence of a calcified bridge in the pulp chamber, indicating the formation of tertiary dentin by a vital pulp in response to caries or pulp treatment.
• On each periapical radiograph, inspection of the PDL continuity should be done to diagnose inflammatory and resorptive lesions.
• As in primary teeth, sensibility tests,sometimes called vitality or pulp tests, such as thermal and EPT have limited reliability in young permanent teeth, and do not
reflect the extent of pulp inflammation.
• Cavity test is not practical in a pedo patient.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 484

ANSWER
Duration

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• The types of dental changes that a digit habit may cause vary with
– The amount of force applied to the teeth or force magnitude.
– How the digit is positioned in the mouth or force direction
– How much time does the child engage in the habit or frequency in hours per day, and
– How long the habit persists, or duration in months or years.
• Thumb and finger habits make up the majority of oral habits.
• It is the duration of time sucking in months and years that probably plays the most critical role in tooth movement caused by a digit habit.
• The most frequently reported dental outcomes of an active digit habit are the following
1. Posterior crossbite
2. Anterior open bite
3. Increased overjet

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 386

ANSWER
Subluxation

OTHER OPTIONS
• Refer Synopsis

SYNOPSIS
• Luxation or displacement injuries are the most common types of injuries to primary teeth treated in the dental office.
• These injuries damage supporting teeth structures, including the periodontal ligament and the alveolar bone.
• The PDL is the physiologic hammock that supports the tooth in its socket.
• Maintaining its vitality is the primary objective in the management of all luxation injuries.
• Several types of luxation injury occur.
1. Concussion – The tooth is not mobile and is not displaced. The PDL absorbs the injury and is inflamed, which leaves the tooth tender to biting pressure and percussion. The percussion sound is normal.
2. Subluxation – The tooth is loosened but is not displaced from its socket. Percussion produces a dull sound.
3. Intrusion – The tooth is driven into its socket. This compresses the PDL and commonly causes a crushing fracture of the alveolar socket. Percussion produces a metallic sound.
4. Extrusion – This is a central dislocation of the tooth from its socket. The PDL is usually torn in this injury. Percussion produces a dull sound.
5. Lateral luxation – The tooth is displaced in a labial, lingual, or lateral direction. The PDL is torn, and contusion or fracture of the supporting alveolar bone occurs. percussion produces a metallic sound.
6. Avulsion – The tooth is completely displaced from the alveolus. The PDL is severed, and fractures of the alveolus may occur

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 228

ANSWER
Vasovagal shock

OTHER OPTIONS
• Insulin shock – If a diabetic patient, who appears well, has a sudden deterioration in cognition or loss of consciousness in the dental office, the condition is more likely to be due to acute hypoglycemia or insulin shock.
• Adrenal crisis – usually seen in patients on steroid therapy, symptoms include sweating tachycardia restlessness.

SYNOPSIS
• Tachycardia, sweating, and speech problems are symptoms of vasovagal shock.
• Syncope is the most common medical emergency in the dental office.
• Vasodepressor syncope, or the simple faint, is the most common type of syncope and causes loss of consciousness in the dental office.
• Management consists of positioning the patient supine, lowering the head, and raising the legs above the heart to augment blood flow to the brain by gravity.
• Cardiac output will be increased and adequate cerebral perfusion will be restored.
• Administration of oxygen is appropriate in any emergency involving a decrease in brain perfusion.

REFERENCE
Pediatric dentistry Arthur.J.Nowak Page 156

ANSWER
Anti Inflammatory drugs and follow up

OTHER OPTIONS
● Anti-inflammatory drugs and splinting – Splinting is unnecessary since teeth are non-mobile.
● Rigid splinting – Contraindicated when teeth show no mobility or displacement.
● Follow-up – Incomplete; supportive medication is needed for lip swelling.

SYNOPSIS
● Non-mobile vital teeth indicate simple concussion or soft tissue trauma.
● Management is supportive using anti-inflammatory drugs for lip swelling.
● Regular follow-up ensures no secondary pulpal necrosis develops over time.

REFERENCE
Andreasen’s Textbook and Colour Atlas of Traumatic Injuries to the Teeth, 5th Edition, Chapter 10

ANSWER
Send the patient to oral surgeon for biopsy

OTHER OPTIONS
● Excision – Biopsy or histopathology must precede definitive extensive excision.
● No need for treatment – Suspicious lesions must not be ignored.
● Pharmacological management – Inappropriate without definitive histopathological diagnosis.

SYNOPSIS
● Unexplained or suspicious mucosal lesions require definitive histological examination.
● Referring to an oral surgeon for biopsy ensures an accurate diagnosis.
● Prevents misdiagnosis or delayed treatment of malignant lesions.

REFERENCE
Neville’s Oral and Maxillofacial Pathology, 4th Edition, Chapter 19

ANSWER
Epstein barr virus

OTHER OPTIONS
● Cytomegalovirus – Associated with deep mucosal ulcerations in immunocompromised patients.
● Human herpesvirus 7 – Associated with roseola infantum, not oral hairy leukoplakia.
● HIV – The underlying predisposing disease or retrovirus, but EBV reactivation directly causes the lesion itself.

SYNOPSIS
● Epstein-Barr Virus (EBV, or HHV-4) reactivates during severe immunosuppression.
● Directly causes Oral Hairy Leukoplakia on the lateral borders of the tongue.
● Appears as non-removable white hyperkeratotic striations.

REFERENCE
Neville’s Oral and Maxillofacial Pathology, 4th Edition, Chapter 7

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
OKC

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Odontogenic keratocyst OKC) is the cyst arising from the cell rests of the dental lamina.
• It can occur anywhere in the jaw but is commonly seen in the posterior part of the mandible.
• Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for a radicular or lateral periodontal cyst.
• The exact reason for the high recurrence rate of OKC has not been established, it is thought to be due to incomplete removal of the primary lesion with thin epithelial lining, the presence of satellite cysts, and epithelial remnants.

REFERENCE
Shafer’s Textbook of Oral Pathology

ANSWER
Regional OdontoDysplasia

OTHER OPTIONS
• Not applicable

SYNOPSIS
• Regional odontodysplasia RO) is an uncommon, developmental anomaly of the dental hard tissues that affects ectodermal and mesodermal dental components with characteristic clinical and radiographic findings.
• The clinical manifestations of odontodysplasia are
– Localized occurrence within a particular segment in either or both dentitions
– Hypocalcification and hypoplasia of the enamel and dentin
– Discolored, small, and distorted affected teeth with various surface markings e.g., irregular contour with surface pits and grooves and yellowish or brownish discoloration)
– Delayed or failed eruption due to arrested root formation.
• The radiographic features have consistently demonstrated
– Thin and defective layers of enamel and dentin, resulting in a faint, fuzzy outline, creating a ghost-like appearance.
– The pulp chambers and canals are enlarged, and the roots appear short and stubby with open apices.
– True and false denticles may be seen in the pulp of affected teeth as well as adjacent, clinically normal teeth.

REFERENCE
Ghost teeth- Regional odontodysplasia of maxillary first molar associated with eruption disorders -Journal of Pharmacy and Bioallied Sciences