(use Dr. fun for second day, master day 2, unicorn)

Caterpillar corrected sabaEL magnificospeedy snail corona RQDr. Fun july 2020mamba mentalityDO strawberry next and dr xylitol

https://drive.google.com/drive/folders/1SDOzODbx45_fpikBVfB62NuosGKiUppB?fbclid=IwAR03_LFWpvkFxNFUnCTlY5Iyre7MUOjewDPWhucjAR-FfrtZ9yMjgE76qgY

ENDO:Intraoral dental sinus: Parulis (made up of granulation tissues, AKA gumboil from chronic abscess sinus/fistula) no tx other than ENDO, from chronic periapical abcess from necrotic tooth, if it doesn’t drain then I and DMost likely cause pulp necrosis after trauma to the tooth: Pulp hyperemiaperforation prognosis worst: below osseous crest then furcationDoing endo which part of MX Incisors perforate (root curved disto-lingually)? MesialDoing endo which part of Mx PM perforate? Mesialdoing endo, which part of Mn M1 perforate: D of mesial canal then M of distalcontraindication in endo: recent MI, uncontrolled DMcontraindication of pulec/pulpo in: leukemia.after RCT marked reduction in size in bone: 6 mt-1 year to makeDentist restoring tooth with amalgam after RCT should place amalgam 3mm insideBlood pigments, pulp hyperemia, internal resorption, cervical external resorption after bleaching: red tinge, pulp necrosis: grey color, pulp calcification: yellow colorPercussion: presence of inflammation in PDL or notPalpation: spread of inflammation to periodontium from PDL or not EPT- responsiveness of nervesThermal test (hot & cold)- pulp vitality. Hot (irrev), cold (rev)How do you differentiate between an endo/perio lesion: EPTDifferential diagnosis of acute periodontal abcess & acute periradicular abscess? EPTin Periapical abscess: gram-negative obligate anaerobic tx: penv/amoxi +metro, clindareccurent abcess: e.fecalis + facultative anaerobes (amoxi+metro-strinct anaerobes), clinda

Patient with tooth that has sensitivity that lingers with thermal test, sinus tract, and positive to percussion, what does the patient have? Irreversible pulpitis with chronic periapical abcess Dx lingering pain to cold and sensitivity to percussion: irreversible pulpitis with Periapical periodontitisDx not responsive to cold, not to percussion, and palpation is tender: necrotic pulp and chronic apical periodontitis.

Your going to do RCT for upper lateral with Periapical abscess for which of the following possibility you have to take informed consent from the patient? (benefits, risks, prognosis)1 Broken instrument2 long term prognosis3 perforation4 ledge formationAns all of the above

Which teeth do you perform pulp evaluation on? a. tooth onlyb. tooth and neighboring toothC. tooth, neighboring teeth, contralateral toothd. tooth, neighboring teeth, opposing toothAns C

Endodontic pain is characterized by all except:Dull, aching painSharp, shooting painThrobbing PainElectrical PainAns D (galvanic shock)

Prolonged, unstimulated night pain suggests which of the following conditions of the pulp? A. Pulp necrosisB. Mild hyperemiaC. Reversible pulpitisD. No specific conditionAns A

The most important principal governing the location and outline of the lingual or occlusal opening into the pulp chamber is: 1 preserving tooth structure2. direct access along straight lines3. complete removal of roof and pulp chamber4. removal of all caries and defective restorations materialsans 2

Apical detector is use for all of these except:a. length of the canal b. reduce uses of periapical rx for lengthening checkingc. detects accessory canals d. dilacerationsAns C and D

a Periapical lesion was discovered 1.5 years after an uncondensed, single cone root canal filling was placed in max central incisor. Two year after careful Periapical curettage, lesion is larger than it was before surgery. Likely cause?1.Systemic involvement2.Inadequate curettage3.Failure of resect apex4.Undiagnosed perio lesion5.Leakage from poorly filled canalAns 5

Best to test pulp status for newly erupted tooth with open apex 1 hot test2 cold test3 Electrical pulp test4 percussion Ans 4

Which can differentiate between acute apical abscess and acute periodontal abscess?PalpationRx, Anesthesic testPercussionEPTAns 5 Avulse permanent tooth immediately comes to the clinic what is your first response?A implant itB take radiographyAns: implant it, Then take x-ray (# 1 determining factor of prognosis of avulsed tooth is time, the sooner the better, within 20 min is the best chance of survival of PDL)

Which of the following is the diameter, in millimeters, of a 21 mm long, #35 K-file at D16?A- 0.35B- 0.41C- 0.67D- 0.74And C (assume 2% taper unless stated otherwise 0.35+(2%x16)=0.67 mm) =D1 +(2%x16)

During endo treatment dentist made a ledge what is the reason?1-changing large file often2-using small file 3-curved rootans 1.

During the preparation of a Class II cavity, which of the following permanent teeth pulphorns will be the most subject to accidental exposure?A. Distofacial of a maxillary first molar

B. Distofacial of a mandibular first molarC Facial of a mandibular first premolarD. Lingual of a mandibular first premolarAns C

Which root of the following is LEAST likely to form ledge on it 1 long2 curved3 short4 narrowAns 3 (short, broad no calcification least likely)

for which factor is least likely to refer endo caseA. DilacerationsB. CalcificationC. Inability to obtain anesthesiaD. Mesial inclination of molarans: D

which of the following nerve fibers of pulp are responsible for thermal conduction?a) A beta b) A delta c) A beta and A delta nerve fibers d) A alpha and A delta nerve fiberse) C fibers& A deltaAns E

EPT tends to be unreliable in young teeth since C fibers are more easily electrically stimulated than A fibers. In Young teeth A fibers appear later than C fibers.A) Both statements are TRUE.B) Both statements are FALSE.C) The first statement is TRUE, the second is FALSE.D) The first statement is FALSE, the second is TRUE.Ans D

Most important detail that would most affect the outcome of a fractured tootha) 48 hour delay of treatment b) fracture being far away from apexc) larger than normal pocketd) infectionans B talking about fractures here, not avulsions (where time and medium of storage are most important) fracture line will determine tx and also prognosis of the tooth. (simple fracture in enamel and dentine only vs complicated fracture of Cr and root)worse prognosis of tx as we go coronally towards alv crest. better prognosis if its near apex.

Which of the following anatomic structures CANNOT be seen on periapicalradiographs?A- Mental foramenB- Hamular processC- Mandibular foramenD- Anterior nasal spineE- Intermaxillary (median palatine) sutureAns C (also can’t see coronoid notch)

A patient experienced a blow to the mouth. Radiographs show a horizontal mid-root fracture of a maxillary central incisor. The tooth is NOT mobile and NOT symptomatic; however, it does not respond to pulp testing. No radiographic lesion is present. The best treatment is to1) institute root canal treatment to include both segments of the tooth.2) extract the coronal segment and surgically remove the apical segment.3) surgically remove the apical segment and reverse fill the coronal segment.4) render no treatment at this time and periodically recheck clinically and radiographically.Ans 4

RQ Which one has best prognosis of RCT1) internal resorption with close to perforation2) external resorption3) Gutta percha expanding beyond apex4) incompletely debride canalAns 3 (s.s) internal resorp would be better but if close to perforation, its weak structure and could fracture.

Each of the following is basic objectives in the cleaning and shaping of a root canal EXCEPT one. Which one is this EXCEPTION?A) Removal of the infected soft and hard tissueB) Give disinfecting irrigants access to the apical canal spaceC) Create space for the delivery of medicaments and subsequent obturationD) Removal of the smear layer by opening the dentinal tubulesE) Retain the integrity of the radicular structuresAns D

The pain characteristic that may provide information regarding its etiology while taking pain history is:A) IntensityB) QualityC) OnsetD) Temporal patternE) Alleviating factorsans C

Each of the following statements about chronic hyperplastic pulpitis is true EXCEPT one. Which one is this EXCEPTION?A) Most commonly present in Young adults and childrenB) Prognosis for the pulp is unfavorableC) Less current than normal is required to elicit a response by Electric pulp testerD) Tooth may respond to thermal test when ethyl chloride is usedE) Polypoid tissue is less sensitive than normal pulp tissue and more sensitive than gingival tissueans C

Once the ledge is bypassed with an instrument, further instrumentation should be done w: A) Circumferential filingB) Clockwise three-quarter turnsC) Clockwise quarter turnsD) Twiddling like motionE) Paint on brush strokesans A

if you have pain, what would be the hardest to anesthetize?a. Irreversible pulpitis and maxillaryb. Irreversible pulpitis and mandibularc. Necrotic pulp and maxillaryd. Necrotic pulp and mandibularAns B

Succuess of indirect pulp capping depends on 1 age of the patient2 exposure location3 coronal seal4 thickness of CAOHAns 3

additional treatment beside RCT for a sinus tract1 surgical excision2 nothing3 antibiotics Ans 2

You re implant Avulsed tooth with non rigid fixation how long you will leave it1 5-7 days2 10-14 days3 18-21 days4 28-30 daysAns 2

Most Perforations on max lateral root during RCT is

1 mesial2 distal3 buccal4 lingual Ans 1

71-Which of the following is NOT characteristic of external root resorption1. Appears irregular in X-ray2. Could be accompanied with ortho movement 3. Can happen in re-implanted teeth4. Asymptomatic5. none of the aboveAns 5 non of the above b/c 1 and 2 are true for sure maybe 4 (s.s)

replacement resorption is characterized by: 1. pain2. Apical fibrosis 3. Acute inflammation 4. ankylosisans 4, also dull metallic sound, infra-occlusion

Which of the following can cause submerge 1 ankylosis2 internal root resorption3 missing teethAns 1

Best prognosis of broken file at the apical third 1 vital with no preapical lesion2 Vital with preapical lesion3 non vital with preapical lesion4 non vital with no preapical lesion Ans 1

Broken file in apical third while instrumenting w/o radioL what to do 1 extract2 apeocectomy3 obturate and fellow up Ans 3

PDL mostly affected by 1 avulsion and intrusion2 extrusion3 lateral laxation4 ConcussionAns 1 ( thanx god there was no avulsion option )

Pulp Necrosis occurs in avulsion, intrusion** 90% of time. intrusion in primary teeth: no tx, let spontaneous re-eruption. Unless bud underneath then EXTin permanent teeth w/ immature apex: no tx, spontaneous reeruption (if more than 6mm repos)intrusion in permanent teeth with mature apex: more than 3mm orthodontic extrusion or immediate surgical reposition should be considered always do these with splint (2 week)

Q10: Which of the following is the best treatment for a traumatically intruded primary tooth which in not impinging on the permanent tooth bud?A- ExtractionB- Allow tooth to spontaneously re-eruptC- Reposition tooth orthodonticallyD- Reposition tooth surgicallyANS: B

little girl has ALL, radiolucency in furcation of primary M2 what to do? EXTPulpPulpecAns. 1 ok so in child w/ leukemia pulpotomy/pulpectomy is contraindicated, but for permanent teeth no if it can be completed within one day. Ideally do EXT 2 weeks prior to cancer tx. adult contraindication to ENDO: leukemia RCT is NOT a contraindication, recent MI and uncontrolled DM, COPD, renal failre, CHF etc (asa4)

Cracked tooth with no pulpal involvement, treatment? RCTExtra-coronal (crown)Reduce occlusionAns: B (but if option there to see if pulpal involvement or not do that first)

craze line vs. cracks differentiated by: transillumination. crack: tooth is cracked (M-D), the light will be blocked, allowing only a segment of the tooth structure to light up, or use X-ray at 90 degree and 45 degree if only has a craze line, the entire tooth structure will light up (only in enamel)VRF: CBCT best way to dx or x-ray, then probe defect after long standing, most common in Mx PM1, to diagnose “J”

PERIODONTICSMost common donor site of free gingival graft: PalateMain reason for failure of FGG: lack of blood supply, Infection (2nd most)2 most critical parameter for prognosis perio: CAL** and mobilityBacteria responsible for collagenase activity: P. gingivalisMost common perio: chronic (in black males)

Most common pattern of osseous defect in chronic periodontitis: Horizontal/craterMost common teeth lost by perio problem: MX M1Best allograft: FDBA cadaverChronic Periodontitis: Most common in Black males, people older than 65Post operative sensitivity after perio surgery decreased by: doing-plaque controlInitial re-evaluation after SRP: 4-8 weeks. Maintenance: 3 months Localized vertical bone loss on molars seen on which periodontitis: localized aggressive localized aggressive periodontitis bacteria? AA (8-12 healthy, doesn’t correlate to plaque)Generalized aggressive periodontitis : P.intermedia and E. corrodens (episodic rapid 12-25)Chronic perio: P.gingivalis, T. forsythiaANUG bacteria: fusobacterium(before), P. Intermedia t. denticolaantibiotics LAP: doxyciline or amoxicilin+metroAntibiotic for ANUG (only if systemic symptoms): amoxicilin+metro or Tetracyclinmost important indication of prognosis of periodontal tooth: CALMost important indication of perio stability after maintenance: plaqueIndication for success of tx: BOPDrug induced Gingival Hyperplasia: Dilantin (Anti-convulsant), #1, Phenytoin (Anti-convulsant), Cyclosporin, Nifedipine, Verapamil (Calcium Channel Blocker), Diltiazem (Calcium Channel Blocker)Desquamative gingivitis: liquen planus, pemphigoid, pemphigous, chronic ulcerative stomatitis, lupus, linear IgA, erythema multiformBiological width: 2mm, JE + CT (0.97+1.07)Biological width of implant: 3-4mmGTR: Coronal movement of PDL * complete regenerationAfter performing root planning, how does the new attachment form, or after periodontal surgery? Long Junctional epithelium (reparative)In health CEJ to alveolar crest: 2-3mmCAL (CEJ to base of pocket)= PDD+rececion Gracey scalers: area specific, cuts on one edge, semi cirucular in cross sx, 60 degree bevel, 13/14 for Distalimplant epithelium: hemidesmosom, osteointegrationHyperplastic tuberosity method: wedging technique (distal wedge)FGG: nutrients from recipient but healing by proli from epith adjacent from donor (indication widen keratinized giniva, apical to free gingival margin, make it more thick)Calculus: 12 days to formPedicle seconds, adhesion attachment mins, plaque colonization 12-24hrs (first facultative gram +ive aerobs, then filaments until day 7 then after 1 week gram - anaerobes) plaque first formed in interproxDuring Sr/p: dentin, cementum and calculus removaldisadvantage of cancellous autograft: lack of strengthproblems with chemotaxis in neutrophil: can lead to Aggressive perioAttached gingiva thickest in lateral maxilla (most) and least in mandibular first premolar and canine(least): true

P. Intermedia is shown to increase in all of the following except A pregnancy induced gingival enlargement

B ANUGC Down syndromeD diabetes E orthodontic therapyAns E

Least inflammation associated with?Chronic inflammationAtrophic gingivaAggressive periodontitisDesquamative ginigvitis Ans D

2. What is the primary indication for splinting?a. Mobile teeth and pt’s discomfort and better control of occlusion if front are mobileb. Trauma from occlusionc. improve OH d. Prevent unopposed tooth from migratinge. Prevent migrating after diasthema closureAns A (advantage of external splint over internal splint: conservation of tooth structure)Indications for splinting: (1) mobility of teeth that is increasing or that impairs patient comfort, (2) migration of teeth (3) prosthetics where multiple abutments are necessary.

What not related with the splinting multiple mobile teeth? To comfort pt & facilitating chewingPrevent more bone lossTo keep the graft in place (stent)Ans B

Compared to a full thickness flap, a partial thickness(split-thickness) flap will A. increase the loss of marginal bone.B. reduce infraosseous defects.C. provide improved surgical access.D. increase the amount of attached gingiva.E. reduce healing time

Which of the following is NOT a characteristic of a modified Widman Flap procedure?A- Submarginal incisionB- Replaced flap C- Inverse bevel incisionD- Flap margin placement at the osseous crestAns D

10. You rise a full mucoperiosteal flap to instrument in the pocket, after reposition of the flap where resorption occurs more?A. Radicular bone (not crest but bone covering the tooth, 1mm)

B. Interdental crestC. Apical to the sulcus

most common sign of tooth trauma from occlusion: a) tooth sensitivityb) tooth mobilityANS B=fremitus(X-ray: PDL Widening, lamina dura thickening, angular bone loss, root resorp, hypercementosis) for fremitus can also selectively grind down . then we see sensitivity, widened PDL, thicken lamina dura

Most common to cause mobility?TraumaAdvanced perioPeriapical pathology

Patient came to visit your office, complain that she shows too much gum when smiles. How to fix the patient’s problem?A. Le fort 1B. Gingival flapC. GingivectomyD. Crown lengtheningAns: D because most cases due to passive eruption. if its due to vertical hyperplasia of maxilla A, if do to drug induced gingival hyperplasia gingivectomy if excessive attached gingiva. if not enough attached gingiva and bone is ok, do apically position flap. if due to delayed/altered passive eruption and too much bone esthetic Cr lengthening (if alv crest to CEJ is less than 3mm, cut bone so apically positioned flap + osteotomy)

posterior tooth has a large carious lesion extending subgingivally. Which of the following is the best initial treatment? A- Endodontic therapyB- Crown lengthening surgeryC- Caries excavationD- Crown fabricatio nAns C

Biological width after Cr lengthening: could be osteotomy + APF or osteotomy+ gingivecA general rule of thumb for a crown preparation is that you should have 3 mm between the margin of the preparation and the crest of bone to ensure adequate crown length. You will need 2/1.5 mm more for the prep to remain on sound tooth structure. The amount of tooth necessary required to expose for proper retention is 5 mm.

Which of these have the best response to root amputation? Mx M1which have best response to root hemisection/premolarization? Mx M1older people loose which tooth first to perio: MX M1

Which of the following conditions indicates that a periodontal, rather than an endodontic problem, exists?

A. Acute pain to percussion with no swelling B. Pain to lateral percussion with a wide sulcular pocket C. A deep narrow sulcular pocket to the apex with exudate (endo-perio/root fracture)D. Pain to palpation of the buccal mucosa near the tooth apexAns B

Which of the following has worst perio prognosis?class 2 mobilitydeep class 2 furcationdeep probing with suppurationans C (class III mobility, sever CAL,class III mobility)

Which one is LEAST cause for extraction 1 grad 2 mobility2 deep endo-perio caused by perio3 non restorable tooth4 vertical root fracture Ans 1

which cell doesn’t present in all stages of chronic periodontitis? A- PMNLB-eosiophhilsC- plasma cellsD- lymphocytes Ans B

Healing after a gingivectomy?a) Primary Intentionb) Secondary Intentionc) Tertiary IntentionAns 2

what is common between chronic periodontitis and generalized aggressive periodontitis?1-the teeth that are involved2-the rate of progression of the disease 3-the response to the local factors ans 1 (local fact like Ab, GAD can use systemic Ab for chronic we give SDD doxy subclinical)

aggressive periodontitis is characterized by 1 loss of bone around 1st molars2 loss of bone around canines3 horizontal bone loss4 associated with plaque Ans 1

Most common tooth lost by perio problems 1 max premolars

2 max molars3 man premolar4 man anteriors Ans 2

Improperly drained puss from perio pocket leads toA. AbscessB. CystC. GranulomaAns A (Acute abscess, Chronic Granuloma, can go back and forth from there, from there can go to acute osteomyelitis or cyst)

What will interfere more with a lateral position flap?A. Frenum attachment B. Amount of keratinized gingivaC. Amount of nonkeratinized gingivaD. Amount of mucogingival junctionAns A (gingival thickness and width of attached gingiva at donor)

A posterior tooth has a large carious lesion extending subgingivally. Which of the following is the best initial treatment?A- Endodontic therapyB- Crown lengthening surgery C- Caries excavation D- Crown fabricationAns C

Periodontal destruction: 1) is a continuous process.2) occurs in episodic and intermittent manner3) shows periods of destruction and quiescence4) destructive periods are marked by increased non motile gram +ive microbes 5) quiescence period is marked by gram +ive non motile microbes. A 1 onlyB 2 3 5C 2 4 5 D 3 4 5Ans B.

Of following conditions, inflammatory gingival enlargement is least characteristic of: 1. Desquamative gingivitis2. pregnancy3. hereditary fibramatosis 4. Phenytoin induced hyperplasia 5. Leukemia

ans 3

95- Appearance of an osseous crater in a bitewing x-ray will show:A. More bone than what is actually lost B. Less bone than what is actually lost C. Like a cervical burnoutD. No differenceAns b

Which systemic disease does not especially predispose to perio? A. Cyclic neutropenia B. Trisomy 21C. LeukemiaD. sarcoidosisE. Diabetes mellitusF. AIDsG. HIVH. osteoporsisAns: (LAD1, LAD2, AIDS, papillon lefevre syndrome, chidiak hegashi LAP diabetes, smoking, are all risk factor chronic (risk factors which predisposes you) and risk indicator (which is not causally associated but can potentiate higher risk) and HIV/osteoporosis/socioeconomic level are risk indicator... not a risk factor donno tbh….

26-When you take Graft from a Pig it considers as 1 xenograft2 allograft3 autograftAns 1

64- Which interleukin is related to bone destruction? 1 IL12 IL23 IL64 IL10 Ans 1

Red edematous gingiva, no rete peg, marginal gingivitis , what initial treatment1 oral hygiene and plaque control2 scaling and root planningAns 1

Which one has least benefit from antibiotic besides mechanical debridement 1 LAP2 GAP3 Chronic periodontitis 4 periodontal abscessAns 3

Best prognosis for GTR b/w these options: 1. Hemiseptum2. 3 walled defect (trough)3. Furcation II class 4. Tunnel furcation ans. 2 (trough) then 3 (class II furcation) shallow 3 wall better with osteectomy

Best prognosis of GTR: 1 wall, 2 wall 3 wall 4 wall (then II furcation)worst prognosis of GTR: 1 wall

Which of the following is true regarding treatment and prognosis? A. Perio lesion from pulp lesion has better prognosis B. Endo lesion from perio lesion has better prognosisC. Perio treatment before endo has better prognosisD. Perio surgery has better prognosis for perio-endo lesions ans A.

Recent studies prove periodontal disease related with A. Cardiovascular disease B. Cancer C. HypertensionAns A

For big osseous defect in mandible which graft is the best 1 Allograft2 Autograft3 Dried frozenAns 2

Which of the following red complex bacteria 1 Treponema denticola2 s mutans3 A.actinomycetcomitans4 provetella intermedia Ans 1 (Treponema denticola, p. gingivalis, Tarentella forsyth)

you did scaling and root planning to pt after that he went back with perfect plaque control but still have bleeding on probing and 6 mm pocket depth what is the next step1 another scaling and root planning 2 no thing3 open flap surgery4 oral hygiene instructionsAns 3

In periodontitis, the loss of bone always correlates toA depth of periodontal pocketB severity of ulceration of pocket wallC presence or absence of exudate D allE noneAns. E, none

Q. Which part of the cutting edge of the curret should be adapted to the line angle of the tooth?A- Lower thirdB- Middle thirdC- Upper thirdD- Entire cutting edge ANS:A

Q. Which of the following is the best initial treatment for a patient with localized aggressive periodontitis?A- Dental prophylaxis plus subgingival irrigationB- Dental prophylaxisC- Scaling and root planingD- Scaling and root planing plus systemic antibiotics Ans: D (initial just srp + antib as adjunt. Check in re-eval phase 4-8 weeks after),prophy given if pt already taking penicillin, give another class like clinda ** for sure on ADA

what is the primary etiologic factor in generalized aggressive perio (GAP): a. altered lymphocytes b. generalized subgingival calculusc. impaired PMNd. bacterial plaque

ans D (still plaque there containing AA in LAPand GAP is e corrodens but amount not associated with destruction)

Best toothbrushing techniqueStillmanCharterSulcular

In examining a maintenance patient, the dentist observes residual calculus, bleeding on probing, and probing depths less than 5 mm. The dentist should do which of the following?A- Scaling and root planingB- Osseous surgeryC- Continued maintenanceD- Open flap debridementAns A

The most predictable for treatment of perio disease? 1. Scaling & root planning 2. The modified Widman flap 3. Free gingival flap 4. Apically positioned flapans A

FLAPS:

Indications for electrosurgery: coagulation, hemostasis, removal of hyperplasic tissue, gingival cords, CR lengtheningContraindications to electrosurgery: thin attached gingiva (dishicense/fenestration), in pt with TENs unit, cardiac pace maker, insulin pump, delayed healing (diabetes, cushing)Gingivoplasty indication: reshaping of papilla and gingiva to give form for function, ANUGTo surgically remove pocket wall: external bevel gingivectomy and undisplaced flap (internal bevel gingivectomy) *undisplaced most usedincision of Gingivectomy: Coronal to mucogingival junction, and removes pocket coronal to pocket base (reduces pocket depth, A beveled incision is made apical to the pocket base)indication of gingivectomy: in drug induced hyperplasia, fibrous hyperplasia, pseudopockets and supraboney pocketcontraindications to gingivectomy: infrabony pockets (defects), lack of attached keratinized gingiva, compromised esthetics. If base of pocket is located apical to osseous crest or at MG junction, do perio flap), high caries indexDeciding between full/partial thickness flap: depends on amount of keratinized gingiva (>2mm for split minimum)

Gingivectomy is NOT indicated when the base of the pocket is locatedA- Apical to the alveolar crest B- Below the free gingival grooveC- Coronal to the cementoenamel junctionD- Apical to the cervical convexity of the tooth crown

Which is most likely the major consideration prior to performing a gingivectomy?A- Amount of attachment lossB- Measurement probe depthC- Level of the alveolar crestD- Width of the attached gingivaAns D Width of attached gingiva will give Pocket depth and Location of the mucogingival junction

NARROWEST BAND of attached gingiva is found on FACIAL SURFACES of the mandibular canine & first premolar, and lingual surfaces adjacent to mandibular incisors & canines. Narrow attached gingival zones may also occur at the MB root of maxillary first molars (associated with prominent roots and sometimes with bony dehiscences), and at mandibular third molars.

The primary factor for selecting periodontal flap surgery rather than gingivectomy isA. presence of gingival edema.B. pocket depth.C. presence of subgingival calculus.D. need for access to the bony defect.ans D

External bevel of gingivectomy apical to:1. Mucoalveolar junction2. Gingival fiber3. Epi attachment4. Alveolar boneAns 3

The base of the incision in the gingivectomy technique is located A. in the alveolar mucosa. B. at the mucogingival junction. C. above the mucogingival junction. D. coronal to the periodontal pocket. E. at the level of the CEJ junctionans: C

Gingivectomy, external bevel incisionA. 90 degree incision facial or lingual toward the toothB. just Apical to pocket depthC. Coronal to Mucogingival junction, just aboveAns: B

Modified Widman flap: Variation of replaced flap (not displaced). Full-thickness flap used for purpose of open flap debridement, facilitating instrumentation and regenerative procedures. Heals by primary intention and with long JE. Not intended to reduces pocket depth, but when

removing pocket wall it reduces pocket depth b/c it establishes a new attachment at a more coronal level. Preserves an adequate zone of attached gingiva. indications: shallow/moderate pockets w bases coronal to MG junction, high esthetic regions

modified widman flap isA. Partial thickness flap apical to mucogingival junctionB. Full thickness flap apical to mucogingival jC. Partial thickness flap coronal to mgjD. Full thickness flap coronal to mgjD

The modified Widman flap:1)in addition to improving accessibility for instrumentation, removes the pocket wall, thereby reducing or eliminating the pocket2)facilitates instrumentation but does not attempt to reduce pocket depth3)improves accessibility and eliminates the pocket, but does the latter by apically positioning the soft tissue wall of the pocket4)none of the aboveAns 1

With a modified Widman Flap, you mostly reduce bone if:1-Adapt the flap margin2-Ossesous restructuring3-removal of infected ossesous tissue4-removal of malignancy tissueans 1 (usually we do not do osseous recontouring in MWF only in WF)

Which of the following is NOT a characteristic of a modified Widman Flap procedure?A- Submarginal incisionB- Replaced flap C- Inverse bevel incisionD- Flap margin placement at the osseous crest Ans D (this is done in widman where flap places apically, not modified widman. In MW it placed at same position)

The modified widman flap achieves pocket depth reduction by a) Shrinkage onlyb) Removing the pocket wall c) Displacing the flap coronally d) Displacing the flap apicallyAns A occurs in healing

AFP objective: of this type of full-thickness flap is to surgically eliminate deep pockets by positioning the flap apically while retaining the keratinized gingiva. Surgical acess, tx of infraboney pockets, root planning. Usually used with osseous surgery. Needs vertical insicions. On palatal must cut tissue. Work horse and high predictability

AFP indications: surgically eliminate mod/deep pockets, furcation, Cr lengthening. AFP Contraindicatation: w/ root caries and where root exposure is unaesthetic.

Best position for apically displaced flap?A.at the alveolar crestB.at 2mm apical to alveolar crestC.at 1 mm apical to alveolar crestD.at one mm coronal to alveolar crestans B

Correction of an inadequate zone of attached gingiva on several adjacent teeth is best accomplished:a. apically repositioned flap. b. laterally positioned sliding flap. c. double-papillar pedicle graft d. coronally positionede. free gingival graftAns E

Which of the following flap designs allows the best surgical access to the apical aspect of a tooth root with the least reflection of soft tissue?1)Envelope2)Semilunar3)Vertical releaseans 2

What has the biggest effect on the flap?A Initial incisionB Extensive ness of reflectionC Post op oral hygiene D Final position of the flapAns C

flap in all the mandible which structure may damage 1 mental nerve2 facial3 orbicularis oris muscle attachment 4 mentalis muscle attachmentAns 1 (common in mandibular vestibuloplasty)

Incision made in vestibuloplasty with mucosal graft a. Subperiostalb. Supraperiostalc. Submucosald. Supramucosal

Ans B (to increase relative height of alveolar ridge by apically positioning buccinators, mentalis and mylohyioid)

What is the most common form of wound healing after a periodontal flap surgery?A- Long junctional epitheliumB- New connective tissue attachmentC- Connective tissue adhesionD- Regeneration of the new periodontal ligament, cementum and boneAns A

Surgical flap access therapy is indicated and most beneficial when usedA- For those early to moderate defects not resolved with initial therapyB- As the initial treatment for patients having extremely heavy subgingival calculusC- To eliminate pocketing more rapidly so the patient can proceed with treatmentD- To improve plaque control effectiveness in patients having difficult achieving good plaque controlANS:A

A variation of the laterally positioned flap is called:(1)a coronally positioned flap(2)a modified Widman flap(3)a double papilla flap(4)a free gingival flap

36 infrabony/vertical/angular defect is best determined by: A. Probing measurementB. RadiographC. Full flap exploration D. other option ans C.

Of the 4 critical zones of pockets surgery, Phase I therapy solve many of the problems on this particular zone. Which is this zone? A zone 1 soft tissue, pocket wallB zone 2 tooth surfaceC zone 3 underlying boneD zone 4 attached gingivaAns b

Which of the following is incorrect?A padicle flap requires donor site to have thick and wide gingivaB free connective tissue graft requires thick tissue at donor site C sandwich type flap require gingival thickness at donor site D pouch and tunnel require gingival thickness at recipient site

Ans C

Only undisplaced flaps can be used on palateFor a flap to be displaced apically, coronally or laterally, it must be a full thickness flapA 1 is correct and 2 is incorrect B 1 is incorrect and 2 is correct C both correct D both incorrectAns B

Crestal incisor and sulcular incisions are always Internal bevel incision Sub marginal incision can be internal bevel or external bevel.A) 1st correct, 2nd is incorrect B ) 1st incorrect and 2nd is correct C) both correct D) both incorrectAns C

In Apically positioned full thickness flap, vertical incision may or may not be neededIn coronally displaced full thickness flap, Vertical incisions are a mustA) 1 is correct, 2 is incorrect B 1 is incorrect, 2 is correctC) both correct D) both incorrectAns C APF can be used without vertical incision. For coronal, vertical incision are required.

Free gingival graft indication (FGG): widen attached gingiva apical to free gingival margin covering dishecense/fenestration, prevent further recession. Where >2mm of attached gingiva exists. FGG epithelium sloughs and dies and new ones comes from adjacent mucosa and surviving basal cell. 1 week epithelium 2 weeks tissue appears but until 10-16 weeks matures. FGG dependent on the bed of recipient blood vessels periosteum. Fails b/s distruption of blood suppy then infection. Usually done with frenectomy. free mucosal graft/ CT graft indication: widen attached gingiva coronal to free gingival groove to increase. Root coverage where <2mm of attached gingiva. FMG epithelium type comes from donor site (palate)

After a free gingival graft, primary source of nutrition for graft during the first 24 hours isA primary vascular anastomosisB residual nutrients within the graftC diffusion of nutrients from the underlying connective tissueD diffusion of nutrients from adjacent vessels of the periodontal ligamentans C

epithelium of a FGG undergoes degeneration at the recipient siteGenetic information as to the nature of the epithelium overlying the connective tissue is contained within the graft connective tissue

A- Both statement are trueB- Both statement are falseC- The first statement is true, the second is falseD- The first statement is false, the second is true

Best Plastic flap surgery for root cover1 lateral pedicle graft2 coronal positioned flap 3 Free gingival flap4 connective tissue flapAns 4-gold std. (pedicle graft/coronal if there’s enough keratinized tissue to cover, miller I and II ) coronally advanced flap is not indicated for recession >3 mm.)

MATERIALS: Most strong porcelain: firing under compressionWhat increases with age: chromaWhat decreases with age: valueWhat’s more important: valueHow to prevent Metamerism? Look under diff lightWhat can’t occur when we add stain? Increase value (we cannot increase value/brightness)Wavelength: Hue (to change hue use orange)how to reduce value: add complementary color (purple)Most important dimension of color, dental restorations/whiteness/darkness of teeth: valueMargin discoloration of Veneer:• Day: Amine• Week: silane• Month: microleakage and MicrocrackGreen discoloration of entire porcelain: Silver, at margin: copperMost dimentionally stable impression: Addition silicone (PVS) can stay for 1 week, has best everything but sulfure in latex can inhibit. No byproducts but Hydrogen gas if moistureCondensation silicone: give ethanol as byproductLeast dimentionally stable: condensation silicone and hydrocolloidmost rigid/stiff: polyether (shortest working time, fastest setting time), hydrophilic, imbibition with water (worst hydrocolloid)Strongest resistance to tearing: polysulfide (by product is water, syneresis)Best wettability(adhesion): hydrocolloids, polyether (least condensation silicone)Best casting: hydrocolloid then PVSZoe: add water to accelerate and oil to retardRMGI What is the advantage beside fluoride release: Anticariogenic, chemical bondGIC: chemically adherent to tooth structure(acid base)Color stability in resin: UDMA (less amine as TEGMA is for viscosity)Resin initiator of polymerization in light cure: camphorquinoneResin initiator in self cure: benzoyl peroxide

Patient has a premolar A2 PFM crown and its not good at esthetics because teeth are all B1 main problem in the crown?

a) valueb) chromac) translucenyd) hue

Main difference and advantage of using GMT instead of Enamel hatchet?a. bi-angled cutting surfaceb. angle of the bladec. push/pull action instead ofAns b

Color family is 1 hue2 value3 chroma4 pigmentationAns 1 (how to change hue: Add orange)

Color property which give strength, intensity, saturation to the color 1 Value2 Chroma3 hue4 translucency Ans 2

What property makes a substance liquid over compression? a. isometricb. isotropicc. thixotropicAns C

What is not an advantage of rubber dam when compared to not using it: A. Improved properties of materials,B. shortens operative timeC. facilitates the use of water sprayans. B

Placement of rubber dam affects color selection by?a. Dehydration of toothb. Rubber dam make tooth look lighterc. Rubber dam interfere with the light creating shadowsAns A

Which one of the flowing require LONGEST time for acid etching1 Zirconia (no etch)2 Feldspathic (etch 120 sec)

3 Lithium disilicate (etch 20 sec)4 leucite Ceramic (etch 60 sec)Ans 2 (120 s, zirconia/aluminum don’t need b/c don’t have silica)

Which one is Composite monomer:1 Methacrylate2 Dimethacrylate3 methyl methacrylateAns 2 (MMA monomer for acrylic resin, PMMA polymer for acrylic resin)

when pouring gypsum material into an impression, which material causes the LEAST amount of bubbles?1. Polysulphide2. Polyether3. Silicone4. Irreversible hydrocolloidAns 4 (best wettability, castability)

All of the following can do in Veneer, except?A. Try in pasteB. Silane application on surfaceC. Bonding agent applicationD. Etch enamel with hydrofluoric acid

What should be added in Composite to increase it color stability?A-BIS-GMAB-UDMAC-PMMAD-HEMAE-TEGDMAAns: Colour B, viscosity TEGMA

Tooth past anti sensitivity 1 Cacl22 KNO4 (potassium nitrate) (Naf, Snf2)Ans 2 (lauryl sulfate for detergent, pyrophosphate for antitartar)

Highest coefficient of Thermal expansionEnamelAmalgamResinGoldAns: resin (COTE) unfilled resin even more

Highest thermal conductivity: gold, then amalgam. (need bases), GIC then Resin

high modulus of elasticity, low elongation, high strength is 1 ductility2 brittle3 tough4 malleable Ans 3

Which of the following is responsible for creating a green discoloration in the marginal area of the metal ceramic restoration?A- CopperB- Silver (if whole crown)C- CobaltD- PalladiumAns A. if margin, B if whole

Oil or water on impression for treatment casts causesA. An increase of the qualityB. No alterationC. A decrease of the qualityD. Bubbles on the castE. None of the aboveAnd D

Which cement is the easiest to remove after procedure? Zinc Phosphate cement/ZOEAlginate impression in 100% humidity, what will occur? imbibitionCondensation silicone release: Ethyl alcohol

The most stable elastic impression in moisture environment? a. Polyetherb. Additional silicone (PVS)c. Condensation siliconed. Polysulfideans b

indium other oxygenated material added to porcelain why?Increase retentionDecrease opacityIncrease bonding Ans. 3

gypsum need to high water/powder ratioType IType IIType IIIType IV

Ans. Type I

https://files.sld.cu/protesis/files/2018/06/chapter10-rests-and-preparations.pdf

EDTA Function: chelating agent. Causes no harm to periapex. Dissolves inorganic

Impression not for fixed prosthesisa. Reversible Hydrocolloidb. PSVc. irreversible hydrocolloidAns C

When doing composite, what inhibits polymerization? A. Zinc oxideB. EugenolC. WaterAns B

The most difficult to remove with high speed handpiece? Gold alloy type 3High noble goldNoble goldBase metalAns: base metal(ADA type IV gold: strongest of all gold (75% nobel) yield strength >340base metal: was nonprecious metal before: < 25% noble metal content (no gold required) yield strenghth 820. Base metal has higher everything meting point, stronger etc.. compared to gold EXCEPT lower specific gravity)

OPERATORY: Critical Enamel pH: 5.5 (dentin and cementum 6.2-6.7) with fl (enamel goes to 4.5) Caries initiation: Streptococcus Mutans for initiation esp on pit and fissure number one caries progression: Lactobacillus for progression (and smooth surface) Root caries: s. mutans and actinomyces First to be seen in plaque: sterp. Sanguis ** arrested carries: shiny black chronic leathery brown dark rampant: leathery and soft surface increased type of caries in last years: root, b/c of gingival recessions optimal fl-: 0.7 (but in states, 0.7 ppm-1.2ppm depending on location set by EPA)

a. http://www.ada.org/~/media/ADA/Files/Fluoridation_Facts.pdf?la=en b. most common is 1ppm (1mg) because of temperature

class IV resin: 45 degrees, 0.2-2mm bevel, 0.2mm axial wall depth into dentine class V: anterior GIC (GIC, eroded anterior, class V anterior, class III but low stress) posterior class V: amalgam class III distal canine: never resin, best is gold or min amalgam

liners: 1-25 micrometers (varnish same copalite) zone 2,3 of dentine there’s remineralization need to stop bleaching 7 days before resin bonds (sclerotic dentine doesnt bond) desensitizer: GLUMMA primer: HEMA (MMA) bond/adhesive: is unfilled bis-GMA class II gingival bevel for gold inlay: 40 degrees (gold inlay has slightly smaller marginal gap

when compared to resin) minimum tooth reduction in working cusp: 2.5 for amalgam, 1.5 gold, in general Class 5 you can keep unsupported enamel in gold most caries: Mn M1 least caries: Mn I ditching 0.5 in amalgam observe if more like 0.6mm then replace (if amalga has reccurent

carries, remove a little and put some more)Bonding is difficult to where: Sclerotic dentin is not removed Restoration covering the cusp: Resistance formafter big MOD patient come back with pain in drinking cold and after examination .. the tooth has pain in cold stimulus that subside quickly and bite exam was normal .. tooth is not sensitive to percussion ; diagnosis ? reversible pulpitisOnlay: indicated for hyper/hypoeruption, when need to cover 1/3 intercuspal, primary retention: parallelism of vertical surface (axial walls). Sharp point and line angles increase onlay retention. Never shoe functional cusp always cap (complete) gold WC clearance: 1.5mm NWC: 1 mmInlay: better contour, better contact better everything than amalgam (make sure no undercuts)Gold cast: need 45 bevel to improve marginal adaptationResin etch technique: conserves tooth structure, reduces microleakage, improves esthetics, and provides micro-mechanical retention have best initial seal but decrease over time (amalgam gets better overtime)Advantage of resin of amalgam: more conservative, but disadvantage: less wear resistanceComposite Filler Particle Functions: Decrease coefficient of thermal expansion & polymerization shrinkage. Increase tensile and compressive strengths, hardness, and improve wear resistance. (hybrid stronger than microfiller but micro smoother) (matrix UDMA, bis-GMA) and silane (coupling agent)VCL: 470 nm (retinal damage)Main cause of amalgam failure: delayed expantion b/c insufficient trituration & condensation, and amalgam contamination by moisture during trituration and condensationMain cause of fracture of amalgam: not enough depth (number one failure in kids)

Gives the color to teeth: Dentin, Enamel (translucency)protection for root caries? Fluoride gel in custom tray 0.4% Stannouss fl (causes staining) or neutral sodium fl 1% (most common over the counter) must be kept in for 4min (SnF acidic and bad for porcelain ph is 2)

Animal has caries and feed them cariogenic food via stomach tube. What will happen to the caries intraorally? Decrease, stopped, increase, unaltered

White spot lesions are:

Only Seen when dried with air-dried with air syringeSubenamel porositiesRestored with Composite <- no, we don’t restore them.Ans A

Which of these decreases the vertical development of dental caries? a. Xylitolb . chlorhexidinec. Flossd. FluorideAns DGreen and orange discoloration of anterior teeth is due to? A-Diet B- Bad oral hygieneC- Mixed MedicationD- Other optionsAns B

What is not internal line angle in a distal Class II: distoaxial

The means by which dental patients are treated to eliminate the caries process is calledA- Antibiotic prophylaxisB- Primary prevention (fl, sealant)C- Secondary prevention (rein, amalgam)D- Tertiary prevention (rehab)ANS: C

Smooth surface lesions resulting from flexure of the tooth structure are known as which of the following?A- AbrasionB- ErosionC- AbfractionD- Attrition ANS: C

How many pins should you place in amalgam?A.1 pin for each cuspB.2 pins for each cuspC.1 pin in proximal sideD.2 pin in proximal sideAns A (1 mm from DEJ, 2mm from cavosurface, 2mm inside in dentine, 2mm )

Arrested caries:A leathery brownB Dark and soft

C Shiney back darkAns:C

What is the LEAST likely reason for postoperative sensitivity after a Class I occlusal composite restoration is placed?A- Gap formation which allows bacterial penetration into the dentin tubulesB- Gap formation which allows an outward flow of fluid from through the dentin tubulesC- Direct toxic effects of a 15 second acid etc on the pulpD- Cuspal deformation due to contraction forces of polymerization shrinkageAns D

Which of the following represents the most frequent cause of failure of dental amalgam restorations?A- Moisture contaminationB- Improper cavity designC- Improper condensationD- Inadequate triturationANS: A failure is due to moisture contamination

Which of the following represents the most frequent cause of fracture of dental amalgam restorations?A- Moisture contaminationB- Improper cavity designC- Improper condensationD- Inadequate triturationAns B: fracture is due to improper cavity design

What is true about c factor?It is ratio of the unbounded to bondedIt is the lowest for class 1With the increase in bonded surf, increase shrinkageWith the decrease in bonded surf, increase shrinkageAns. C it is the ratio of bonded to unbounded surfaces (highest in class I and class V)

Worst detection of caries?A- X rayB- colorC- caries detectorD- probeans D. probe

Which of the following would be LEAST likely to lead to the development of root surface caries on facial surfaces?A- Low salivary flowB- Elevated levels of sucrose consumptionC- Streptococcus sanguias dominating adjacent plaque

D- History of head/neck radiation therapyans C

All true of Strep. Mutans except? A. Can live in plaque B. Can live on gingival C. Can live in a child with no teeth D. Has to live on a non-shedding surface E. Can live in a denture teethAns. C

Each of the following is a cause of postoperative marginal ridge fracture associated with amalgam restoration EXCEPT one. Which one is this EXCEPTION?A) Axiopulpal line angles not roundedB) Marginal ridge left too highC) Incorrect occlusal embrasure formD) Improper removal of matrixE) Under carvingAns E (final carving done when band taken off)

you have mesial and distal caries on max 1st molar you decided to make it MOD rather than separated cavities because of1 remaining width of oblique ridge less than 1.5 mm 2 for more retention3 for resistance4 to gain occlusal anatomyAns 1

22-Which of the following have the most effect on caries formation 1 ph salaiva2 diet3 specific bacteria 4 timeAns 3

Pulp reactions to caries include all of the following, EXCEPT A. decrease in dentin permeabilityB. tertiary dentin formationC. evaporation of the intratubular fluid. D. inflammatory and immune reactionsans C

Most common tooth to have caries 1 max 1stpremolar2 max 1 molar3 man 1st molar

4 man 1st premolarAns 3

Least likely to have caries 1 man anteriors2 max anteriors3 man premolar4 man premolars Ans 1

Caries in radiotherapy patients MOSTLY in 1 cervical2 occlusal3 proximal4 AllAns 1

Which of the following is the single most important factor affecting pulpal response to tooth preparation?A- HeatB- Remaining dentin thicknessC- DesiccationD- Invasion of bacteriaans. B (from mastery)

Displacement of Odontoblastic processes is caused by: a.Deccisationb.Chemicalc.Mechanicald.Thermalans A (causes fast out flow of fluid which causes pain)

32- Where you shouldn’t you put a temporary filling 1 have no time to finish treatment today2 cusp of the molar is broken3 emergency and need a root canal4 pt has many caries lesions that has to be done today Ans 2

The day after a routine Class V composite was placed, the patient reports discomfort from the tooth. Which of the following is most likely responsible for this complaint?1)No liner or base used2)Over-etching with phosphoric acid3)Exposure of root dentin during the finishing procedures4) too deep the axial depth of the preparationans 3

33 -Pt went to educational clinic with deep class 3 in upper lateral, while the student preparing the cavity the time is over so he should put temporary filling which one he should use1 GIC2 IRM3 zinc oxide (cavite) 4 zinc polycarboxylateAns 2

40-year- old patient has 32 unrestored teeth. The only defects are deep- stained grooves in posterior teeth. The grooves are uncoalesced. What is the treatment of choice?A- Periodic observationB- Pit and fissure sealant (sealants arrest/stop incipient caries)C- Preventive resin restorationD- Application of topical fluorideAns a

Patient has a new amalgam restoration, most likely experience in proximal hours: A. Cold B. Heat C. Sweeteners D. Galvanic shockAns A.

Why replace composite anterior 1 discoloration2 marginal detach3 fractureAns 1. (the most common reason to replace composite is caries, then discoloration. If caries, then this is answer but marginal detachment does not mean caries)

If a rubber dam is abnormally wrinkled between teeth, the probable reason is A-overlapping or crowding of the teeth involved.B-teeth with abnormally broad contacts.C-the holes were punched too far apart.D-the holes were punched too close together. E-the holes were not punched large enough. Ans c

class 1 composite restoration 1. Pulpal depth 2 mm2. Cavo-surface angle 453. Sharp line angles4. Only do pit and fissures where caries isAns 4 (cavo-surface in composite should be obtuse greater than 90)

What is the correct method of excavation of deep caries close to pulp?A-Large bur from periphery to the centerB-large bur from center to peripheryC-small bur from periphery to centerD-small bur from center to the periphery Ans A

Indirect composite inlay has the following advantages over the direct composite EXCEPT:a. Efficient polymerization.b. Good contact proximally.c. Gingival seal. d. Good retentionAns D (no dentinal undercuts**)

Which of the following shows least microleakage.A ceramic inlay B direct composite resin inlayC indirect composite inlayD direct composite.Ans A

12-Polishing bur1 more fluts less depth2 Less flutes less depth3 More flutes more depth 4 Less flutes less depthAns 1 (polishing: 12-30, 4-8: cutting, to polish composite with aluminum oxide burs)

Which material is good for both class II and class V cavity?A. Amalgam B. GICC. CompositeD. Zn phosphateAns A (in post class V GIC, in anterior composite)

patient present with 1.5 mm Diastema between #8 & 9, no carious lesion, what is the besttreatment for her.A. Indirect composite veneerB. Direct composite veneerC. Porcelain veneersD. Composite restoration in interproximalAns D ( with diasthema wait till canine out, recipricol anchorage with ortho and then cut frenum)

PROSTHODONTICsWe use type III semiadjustable articulator; can stimulate lateral, protrusive and bennet mvmt. Use facebow and intraoral Max-mand records Acron Articulator: The condyle element is in the lower member, resemble most accurately theTMJ anatomy, good for fixed prosthodonticsThe average settings or values of the Condylar inclination on the articulator for sagittal and lateral condyle path inclinations horizontal condylar guidance 30 and (15 degrees bennet angle from non working side formed in saggital plane viewed in horizontal, working is bennet mvmt/side shift which is 30 HCG)Curve of Spee: Anterior – Posterior curvature of the mandibular occlusal planeCurve of Wilson: Mesio – lateral U-shaped curve of Upper & Lower posterior teethContacts in Balanced Occlusion:• Cusp-to-fossa contact in centric occlusion in an ideal class I occlusion (reduce Mx L cusp

tip in centric) ( Mandibular buccal is secondary centric holding cusps)• During lateral excursions: working interference BULL inner and LUBL outer• During lateral excursion: LUBL inner• protrusive interference: DUML (facial cusps)• centric interference (fwd slide): MUDLMIC/CO: tooth guided positionCR: ligamentous guided positionVDR/interocclusal distance: muscles guided positionPosterior determinant of occlusion during protrusion: condylar guidanceAnterior determinant of occlusion during protrusion: incisal guidance Canine guidance during lateral mvmts: by Canine on working and condyle on balance sideAnterior guidance: incisal +canine guidance (set with pin and guide table with acrylic resin)Mutually protected occlusion: ant teeth protect post, post protect anterior

For denture pt we want group function or bilateral balanced occlusion (ANT GUIDANCE should be avoided in denture for bilateral balanced)Protrusive record 3-6mm: measures condyle guidance and setting condylar angle on articulatorTo set medial on superior condylar guides on arcon artifculator: take lateral interocclusal recordChristenson phenomenon: when posterior teeth open during protrusion, want to avoid in bilateral balanced occlusion (post opening increased in IG increased and with horizontal CG but IG effects front more and HCG posterior more) hannau quint: CondylarG + Insical G = P of occlusion+ Comp Curve+ Cusp HeigthCG brought by pt, out of our control but with articulator can max increase CG by 5 mm, so as CG increases so must CCCompensating curve: under dentist’s control* Helps to provide a balanced occlusionIn centric position: bilateral balanced occlusion. All cusps are integratedMore prominent CC required when theres steep CG assoc with low IGOcclusal Plane: tip of Ant teeth, post should be 2/3 of retromolar pad heightcusp angulation: usually 30 or cusplesscondyles go in CR: Antero-superior with thinnest avascular portion of discCR records: SHOULD NOT BE PERFORATED, confined to cusp tips (worst is soft wax)

IOR-interocclusal reccord: show have min resistance to jaw closure and low flow mixing (for aginate casted use wax, for elastomeric casted use PVS)camper line: tragus to ala of nose (use fox plane with this) sets max occlusal rim (parallel to interpupillary)Flabby tissues in anterior maxilla for a complete denture impression = Passive/mucostaticlingual flange of mandibular denture is determined by = Mylohyoidquestion about working and non working interference? understand the inclines for each side.Lingual flange of mandibular denture (molar area) is determined by: MylohyoidMandibular flange (lateral to retromolar areas) is determined by: Masseter

COMPLETE DENTURE:

Primary support for mandible: buccal shelf, limited laterally by external oblique ridge secondary support for mandible: alveolar ridge (retromolar pad/basal bone adds support and retention and doesn’t resorb)Primary support for maxilla: residual ridge and palate secondary support for maxilla is ruggae Stability: ridge height and vestibuleStability of denture: flange, occlusion, musculatureSupport of denture: baseRetention maxillary: palatal suction from vaccume provides peripheral sealRetention mandible: covering extensive area & vestibule extention and lingual sealpast post palatal seal: dislodge and drop. If terminate anterior to this, on the hard palate, no seal is created, the denture is unretentive. Median palatal suture/torus needs reliefCustom tray 2mm short for boarder molding (use ZOE all in one go or modeling compound)Impression: most important is stability and lack of displacementBoarder molding for maxilla: **behind max tuberosity DB by hamular/coronoid notch, Boarder molding for mandible: *DB corner by masseter, DL superior pharyngeal constrictor, retromylohioid area: palatoglossus and SPC, mylohyoid, anterior lingual genioglossus and mylohyoid, sublingual gland labial by mentalis(extention) and labial frenum(thickness), buccal vestibular by orbicularis and buccinators and depressor anguliposterior palatal seal: Anterior boundry (Valsalva butterfly) posterior boundary (vibrating line usually 2mm in front of fovea delineates hard and soft palate) between these is post dam post dam: anterior boundry V groove, scribed 1.5 in base and 1.5 in height so account for shrinkage porosity, palatal glands help with peripheral seal and retention, it is in immovable tissue. If excessive post dam thickness, denture unseatsflatter the palate, the flatter post damBead and boxing of adequate width for cast = 0.75mm or 3/8” Cast thickness = 16 mm from the highest spot on the and 5 mm from sidesTingeling at lower lip: reduce buccal flange (mental foramen impinged)tingling palate: reduce incisive papillaSoar throat: impinging retromyloheioid (SPC and palatoglossus)Ant max teeth should be set are 8-10 mm infront of max papilla so facial to ridgeCheek biting: cause by horizontal edge to edge of teethClicking: increased VDO (check s sound)

Trouble swallowing: inc VDO, dec interocclusal spaceBiting corner of mouth: canine and premolar set too fwdBiting lip: increase horizontal overlapTongue biting: post teeth set too linguallyRidge soar: premature occlusal contacts (use disclosing wax to see)Dislodge mandible: if teeth on ascending ramus, if OVEREXTENDED DB flange (masseter)Dislodge maxilla: if corornoid area too thick, if post dam too deep.Gagging: bad palatal seal, too far back, increased VDOwhisteling S sound: palatal arch too high or narrow, vertical overlap not enough, too much horizontal overlapLISTHP: incisor too far back, palate too thickmax and mn premolars contach during sibilant sounds tx: fix VDOtake face bow to locate hinge axis point only (needed if we wanna increase VDO preserve on articulator with plaster index (preferred) or 10x wax. Can increase by 5degree)Children with dentures, pagets and acromegaly may need dentures changed often.Pts w debilitating disease need: maximum extention, narrow occlusal table, passive impression, no porcelain, good occlusion, reinforce OH, recall 6 mnth minReline for immediate : 5 and 10 monthevaluate after entrega after 24 hr (hypersalivation is normal)occlusal disharmony: must remout in CR and adjust out of mouthporosity in denture: insuff pressure on flask, rapid elevation in temp, packing and processing of sandy acrylic

patient has problem in swallowing, while making an impression for complete denture ... which area in mandiblular denture is hard to register? Masseteric notch

Best to preserve root supported over denture 1 daily fluoride2 metal coping 3 amalgam postAns 2 with stannous fl 0.4% gel

would relieve a mandibular denture in the area of the buccal frenum to allow which muscle to function properly?BuccinatorOrbicularis orisTriangular (and buccinator and orbibularis) (mandibular labial flange is limited by mentalis muscle)labial frenum - orbicularis oris for lower (for upper nothing)for upper buccal it is levator anguli, buccinators pulls back, orbicularis pulls fwd

Each of the following governs the extension of the buccal flange while making a mandibular impression on an edentulous arch EXCEPT one. Which is the exception?1) Buccinator muscle2) masseter muscle3) buccal shelf

4) External oblique ridge5) Mucobuccal FoldAns: 4

Primary support for complete denture?A- Rugae in maxilla & Buccal shelf in mandible B- Alveolar ridge of both maxilla & mandibleC- Other optionsAns C

Management of epulis fissuratum/inflammatory papillary hyperplasia is very important because:a. Its very painfulb. It has neoplastic activityc. It affects denture retentiond. It affects denture stabilitye. Superinfection is a regular complication.Ans D (stability=flange/stable base)TX of hyperplasic tissues may involve: tissue rest, soft relign, changing habit (taking out at night), but ultimately need surgical removal if extensive

Management denture stomatitis (candida) is very important:a. Its very painfulb. It has neoplastic activityc. It affects denture retentiond. It affects denture stabilitye. Superinfection is a regular complication.Ans A

Each of the following is a common cause of denture gagging EXCEPT one. Which is the EXCEPTION?A- Inadequate posterior palatal sealB- Excessive vertical dimensionC- Bulkiness of dentureD- Excessive anterior guidanceAns D.

In developing balanced occlusion of complete dentures during tooth arrangement, a steep condylar path associated with a low degree of incisal guidance requires that the compensating curve be1. flat.2. prominent. 3. shallow. 4.reverse.

Lower Denture flange distal extension should 1 Cover 1/2 or 2/3 of retromolar pad2 cover all retromolar pad3 do not coverAns 2 (but if talking about occlusal rim only 1)

On delivering cast restoration the sequence shod be used: check internal fit then proximal contact then internal form, marginal integrity and last occlusion

An edentulous patient, and you want to measure VDO what sounds? S (occlusal rims should barely touch) checking plane of occlusion with?

Clicking of the dentures during speech most often indicates which of the following?A- Inadequate denture retentionB- Decreases occlusal vertical dimensionC- Insufficient interocclusal spaceD- Improper buccolingual position of the teethANS:C

In a maxillary complete denture opposing a mandibular bilateral distal extension, Why is the anterior of the wax rim of maxillary beveled?A- VDO and length of maxillary occlusal rim was adequate .B- VDO was incorrect but length of occlusal rim was adequate C- always bevel Max occlusal rimD- length of occlusal rim is adequate for esthetics but VDO was wrongANs b

Patient 74 years old wants new total dental prosthesis upper and lower (DAY 2)-Anatomic with 20 grade of cusps angulation-Anatomic with 30 grade of cusps angulation-Semi-Anatomic with 10 grade of cusps angulation-Non Anatomic with zero angulation

Flabby tissues in anterior maxilla for a complete denture impression = Passive/ mucostatic technique

In selection of maxillary teeth for overdenture abutments, the ideal location is:A.Maxillary canineB. Maxillary lateral incisorsC. Maxillary premolarsD. Maxillary central incisorsand D (to get tripod effect. Its CI and Canine for upper, C and PM for lower)

First sign of increase occlusion (VDO)

TMJMyofacialAttritionAbfractionAns: B (will have myofacial pain from strain of closing muscles, trauma to underlyeing tissues, decreased freeway space)

combination syndrome shows all except A.maxillary ridge resorptionB.flabby tissuesC.enlarged tuberositiesD. increased VDO Ans DCombination Syndrome: decreased VDO, flabby hypoplasic max ant, hyperplasic tuberosity

Minimum interocclusal space b/w max ridge/mandibular ridge: 3mm, if less, need qxWhich of the following is the most important factor in determining patient satisfaction with dentures?A- Dentist-patient relationshipB- Bone height for denture fitC- Patient personality traitsD- Technical quality of the dentureE- Cultural definitions of estheticsAns C

in non-working lateral interference which muscle can possibly experience spasm?1-Medial pterygoid2-lateral pterygoid3-Masseter 4-Temporalis

You will be constructing a new maxillary complete denture and a new mandibular overdenture for an edentulous patient. Why is the denture construction recommended prior to surgical implant placement? A. The denture can be used as a guide for location of the implants. B. Improved fit. C. Improved occlusion. D. Establishment of vertical dimension of occlusion. E. All of the above.Ans all

Which of the following refers to a decreased occlusal vertical dimension?A- Vertical dimension that leaves the teeth in a clenched, closed relation in normal position

B- Occluding vertical dimension that results in a excessive interocclusal clearance when the mandible is in rest positionC- Insufficient amount of interarch distance because of the bony ridgesD- Condition in which the patient cannot open mandible because of temporomandibular joint pathologyAns B (VDR-VDO=FS 2-3mm)

PROSTHODONTICS: FPDAnte’s Law: Root surface of abutment teeth have to be greater than root surface of Pontic, the longer the FPD, the poorer the prognosisDisadvantage of cantilever bridge? Rotational forcesdeflection of Pontic occlusogingival: directly related to cubic Pontic length minimal accepted C:R ratio: 1:1packing cord: Epi (avoid w/ HTA causes inc in BP), aluminium potassium sulfate, Zinc Chloride (causes necrosis of sulcular epi), electrosurgery (removes thin layer of sulcular epithelium contraindicated in pt w pacemaker/insulin pump)Gold Type I & II: Used for InlaysGold type III: Used for all metal ceramic crowns & BridgesTaper: 2-5 per axial wall

The best pontic design for best papilla support and superior esthetics is:A- OvateB- conicalC- adjusted saddleAns A (but reqiores surgical prep, 2nd best is modified ridge lap)

The strength of a soldered connector is best increased byA- Using a higher carat solderB- Electroplating the joint with gold prevent corrosionC- Increasing its dimension in a direction parallel to the applied forceD- Increasing its dimension in a direction perpendicular to the line applied forceE- Increasing the with of the joint by having a space of at least 0.5 inch between the parts to be solderedans c

Post: parallel sided more retentive than tapered, threaded more retentive than smoothPatient with lateral incisor, RCT, metal core, post and PFM. ferrule this tooth is for: 1- Retain the core 2- To hold the tooth and prevent fracture 3- prevent rotation of post and coreAns 2 (The ferrule (or height) of the preparation providing friction and retention (1.5 mm vertical sound tooth structure minimal above finish line circumferentially). Ferrule effect is envelopment of tooth structure by crown to prevent root fracture. if less needs core-buildup, Cr Lengthening or both)5 mm of suprabony tooth structure (is ferrule 1.5+core 1.5=length of wall minimum 3mm + biological width 2) =4-5

A FPD with single Pontic deflected certain amount, a span of two similar pontic will deflect: Same amountTwice as muchFour times as much8 times as muchAns D (its Pontic number cubed so if 2 Pontic answer is 8, if 3 pontics answer is 27)

Primary reason for doing a 3/4 crown?EPTAccessible for cleaningTooth structure preservedEasily seated during cementationAns 3

What cement to use for cementation of a Laminate porcelain veneer? a. Adhesive resinb. Other optionc. Glass ionomerD. RMGIAns A

Best root support FPD 1 long less bone loss2 Short less bone loss3 Conical more bone loss 4 Conical less bone lossAns 1

110. Lab over bulks porcelain, why? Not enough reduction on tooth (most common complain of lab is not enough reduction)

Auxilliary resistance from features in fixed dental prostheses such as boxes and grooves should ideally be located?A- FaciallyB- LinguallyC- OcclusallyD- ProximallyAns D ( for retention buccal A for mandible, palatal for max, wherever theres most bulk)

which abutment/cantilever system will have the most traumatic effect on the abutment?A) molar abutment and premolar PonticB) premolar abutment and molar PonticC) max lateral abutment, max central pontic

D) “max central abutment, max lateral Ponticans c. (conical shape of root will make it torque more but distal cantilever molar also bad)

123- What not to do in veneer: 1.try in paste for shade 2.apply silane to inner surface 3.apply bonding agent4.etch enamel with hydrofluoric acid Ans 4

Provisional for veneer? Bis-acrylWhat cement to use for cementation of a Laminate porcelain veneer? Light cure Adhesive resin

101 – how much the reduction from incisal edge in veneer 1 0.3mm2 0.5mm3 1.0mm4 1.5 mm Ans 3 (0.3 gingival, 0.5 midfacial)btw need to leave 4mm of GP for apical seal or 2/3 of root lengthposts should always be below 1/3 of tooth M-D widthPost: parallel sided more retentive than tapered, threaded more retentive than smooth

pin-retained restauration, the pin should be parallel to:A-long axis of the tooth B-nearest external surface C-pulpchamber D axial wall (2mm of dentine between DEJ and post, 2mm into dentine and 2mm into restoration)

most retentive post? 1-tapered 2-parrallel 3-serrated 4-smooth

130- The function/effect of post in post and coreA. Provide retention for a crownB. Enhance the strength of the tooth C. Provide retention for a coreD. Provide the root canal sealingE. ferrule effect Ans C

What angulation post would be placed for retention A. TaperB. Long axisC. Vertical

D. Follow the canalans: prefabricated metal posts: active (threaded) vs passive. threaded bad. parallel and tapered preferred. parallel has better retention, but requires more dentine removal, than taper. (height should be min 6mm) fiber-reinforced are not cemented, rather bonded (better retention)

417. what is the factor that prevent the fracture of tooth with post n core:A. remaining tooth structure B. Post lengthC. Post widthans. A

advantage of using a fiber-reinforced (quarts, carbon fiber) post for restoring an endodontically treated tooth:A- Has a modulus of elasticity similar to stainless steelB- Has a modulus of elasticity similar to dentinC- Is highly radiopaque and easy to visualize on a radiographD- Is stronger and more resistant to fracture than a cast metal postans B

Glass-fiber vs. custom made post:A - Better adaptationB - Increased EstheticC - Require less tooth structure removalD - Provides better resistance to tooth structureAns: all of the abovesafer, more easily removed, aesthetic, conserve tooth structure, and provide improved fracture resistance to these compromised teeth but disadvantage is that they may not be able to withstand flexural resistance against core

RPD:Support: resist vertical (occlusion) into tissue or abutment, stability resists (horizontal/torque lack of displacement from accurate seal/seating), retention resist removal away(sticky)Support: abutment occlusal rest and residual ridgeStability: occlusal harmony,reciprocal clasp, proximal plate/guide plane (guide path of insertion should be 1/3 of BL width and 2/3 of GO hieght)reciprocation: guidance planes (during insertion and removal), reciprocal clasp, minor connectormajor connector and minor: cross arch stability and rigidity. distribute stress.denture base: supportretention: retentive claspretainers: provide support and retentionindirect retainer (Canine or PM): rest seat + minor connector: located as far anterior as possible, opposite of fulcrum line, fcn prevent vertical dislodgement of the distal extension base

of RPD, need in kenedy I and II, don’t need in kenedy III, protect soft tissue from major connector . prevents rotation around the fulcrum linedirect retainer: rest seat + minor connector+ clasps (recipricol and retentive)

RPI: mesial rest, I bar, proximal plate Occlusal Rests: min 1-1.5 at marginal ridge and min 0.5-1 mm deeper at apex of triangular fossa, spoon shaped, concave. Must be 1/3 of F/L and 1/2 of width from cusp tip to cuspCingulum rest: inverted U M-D width 2.5, FL depth 2, GO height 1.5 (less torque over butment and more esthetic than incisal)rest with minor connector angle: less than 90 (beading of maxillary cast, for major connector adds rigidity and allows more contact with palatal tissues to stop food)clasp assembly: retentive clasp + reciprocal/stabilizing clasp+ minor connector+ restReciprocal claps: stabilizes (above or at HOC) lingual, touches tooth before or at same tie as retentive clasp. Covers 180 degrees.retention clasp: retention(below HOC terminal 1/3 is wrought wire more flexible contacts gingival 1/3) buccal. At seat should be passive, applying no pressure. Wrougt wire is 0.02 inches (cast clasp is 0.01inches)Survey line: to help find path of insertion, undercuts, and HOC (type I. deepest undercut is in portion of tooth AWAY from edentulous space. Type II. Deepest undercut TWD edentoulous space. Type III. Deepest undercut may be anyways below survery line)Realign when pressing on base and indirect retainer lifts. beading along border of max major: 0.75-1mm deepCorrosion of Nobel metal: chromium (high nobel metal is corrosion/tarnish resistant)most people allergic to: nickel in RPD

Minimum clearance for occlusal rest is 1.5 mm clearance (this is what you check with wax)occlusal rest MINIMUM 2 in center and 1.5 mm minimum on marginal ridge. Must be 1/3 of F/L and ½ of width from cusp tip to cusp concave, spoon shaped, rounded.

Patient with partial interim denture, how is it different: a. estheticsb. retentionc. resistance to occlusal loading Ans C (no rests so vertical support is effected)gonna have retention from clasps and esthetics

If patient has gagger and inoperable palatal torus and lingual has less than 7mm of space to floor:A-PHorshoe(least rigid)Palatal strapFull palate plate Lingual barLabial barLingual plate

When you push on distal extention of lower RPD, and indirect retainer rest comes up, tx?a. Relignb. tell them to use adhesivec. adjust claspsans A (press base and IR to relign)

I-bar, T clasp in RPD, in which direction will it move during function? a) Gingival and mesial b) Gingival and distal c) Occlusal and mesial d) Occlusal and distal

The principal function of an indirect retainer in distal extention RPD is to1. stabilize against lateral movement.2. prevent settling of the major connector. 3. minimize movement of the base away from supporting tissue and minimize movement of the base towards from supporting tissue.and 3

Major connector: rigidity and stability (beaded to depth and width grove of 0.5mm, increases strength and prevents food impaction)

Mandibular bilateral distal extension for long time, when you put pressure on one side, opposite lifts:a. no indirect retention usedb. rests do not fitc. acrylic resin base supportd. Occlusionans (rocking RPD = no IR)

Patient complains that his new bilateral distal extension RPD “feels loose” and abutment tooth is sensitive to percussion issue?A- inadequate indirect retainersB- inadequate seating of dentureC- the retainers are passive on the abutments.D. occlusionAns D

Patient complains that his new bilateral distal extension RPD is rocking. What is problem?A- inadequate indirect retainersB- inadequate seating of dentureC- the retainers are passive on the abutments.D. occlusionAns A

Purpose of major connector

A- stability and rigidityB- stability and retention C- retention and rigidity D- rigidity and estheticA (major connector provides rigidity and cross arch stabilization)

What is combination clasp: type of circumferencial clasp where retentive arm made of wraught wire for flexibility, reciprocal arm is ridged from metal cast, and distal rest

126- - Most common cause of rest breaking?A.Heavy occlusionB. wear by opposing tooth C.inadequate rest seat prepAns C

121- When placing I bar on premolar distal extension, under occlusal forces the i bar movesA-Occlusally and distally B-Occlusally and mesially C-Apical and distal D-Apical and mesialAns D

DISEASE INVOLVED WITH BACTERIA/VIRUS:

Primary bacteria for initiation of caries: Strep. MutansRed Complex Bacteria: P. gingivalis, T. forsythia, T. denticolaOral hairy leukoplakia: EBV (not premalignant)Papilloma, Condyloma Accuminata(reoccurs): HPV 2, 6, 11, 16,18 (highly recurring)HPV assoc with cancer: HPV 16, 18Hecks:HPV 13, 32Koplik’s Spot: measles, rubeolaRamsay Hunt Syndrome: caused by Herpes Zoster. Associated with shingles, facial nervedamage, & loss of hearing in affected site

Patient with a White coating of the tongue that sloughs off leaving a deep red surface with swollen hyperplastic fungiform papillae. Diagnosis: Scarlet fever. Key word fungiform

Scarlet Fever symptoms except: A.FeverB. malaiseC. skin rash D. lymph swelling E. red inflamed tongue F. strawberry gingiva

Ans F (F seen in wegener’s granulomatosis)

EMERGENCY MANAGEMENT:Most common respiratory emergency in dental chair: Hyperventilation related to anxiety/panic Symptoms: Tachycardia, Tachypnea, dizzy, chest pain, fainting, carpopedal spasm,

metabolic alkalosis, hypocapnia Tx: sit up, DO NOT GIVE O2Most common resp after IV anesthesia is: atelectasia (24 hr after), asp pneumo, pulm embolus If asfixating: cyanosis+stridor hiemlich or if not bad x-ray/hospitalMost common dental emergency (90%): Syncope (vagovagal or psychogenic) Symtoms: pale, diaphoresis, nausea, bradycardia, and HYPOTENTION, dialated pupils Tx: check if they are awake, trendelenberg, head tilt/chin lift, O2 administration, place cold

compress on head. If unconscious CAB* (circulation, airway, breath, CPR always 30:2 so 100 compressions, 12/20 breaths)

Acute asthma symptoms: cough**, chest tightness, dyspnea, tachypnea, episodic wheezing Most effective during acute asthmatic attack: sit up, terbutaline/ albuterol (beta-2 agonist)

and O2 Medication for status asmaticus: Aminophylline (bronchodilator), Albuterol

(bronchodilator), corticosteroids (for Long term asthma) Contraindicated drugs in asthma: avoid Aspirin, NSAIDs and narcotics, use mepi w/o

vasoC those on beta-agonists and in theophylline avoid macrolids. Anaphylactic shock symptoms: hives, rash, prurutis, angioedema, stridorFor acute rxn tx: diphenhydramine IVif you hear stridor= laryngeal obstruction always administer O2 firstSever: dose of epinephrine in anaphylactic shock: 1:1000 (0.3 mg IM), call 911Patient Positions:

Syncope: Trendelburge Left lateral decubitus for prego: relieve IVC from baby (15 degree hip up) Upright: Asthma, COPD, postural, crown in mouth Supine: seizureMost common seizure in kids: Febrile tx of seizure: grand mal: phenytoin/ Dilantin (most common type after febrile) petit mal: ethoxamide or valproic acid status epilepticus: IV diazepamMost common heart condition in child: Ventricular septal defectsHypoglycemia symptoms in diabetic: pallor, diaphoresis, tachycardia, hunger, confusion, agitation, coma, hunger, lack of coordinationUnconscious diabetic is treated with: 50% dextrose in IV, 1mg glucagon IMdiabetic and general anesthesia: clear liquids 2 hrs before, light meal 6 hours, heavy meal 8 hours (American society anesthesiologists fasting guidelines) ½ insulin

Angina: chest pain referred pain to left arm, 10 minTx of angina: (ONA): stop, position upright, O2, NTG 0.4mg spray/tablet, reassure, take vitals, NTG if cont pain after 5 min, NTG 3rd dose + chew asprin+911Anti-anginal Drugs: NTG, verapamil (ca ch blocker), proponololMI: SOB, cool skin, tachycardia, diaphoresis, hypotentionTx (MONA): morphine, O2, NTG, asprinangina and MI how to differentiate: duration longer in MI, Pain could be more intense, other symptoms more common in MIMI: thrombosis and arrythmia: defibrillatorLA toxicity: intravascular injection and too much: numbness, biphasic early CVS/CNS stimulation (tachy, HTA, agitation, slurred speech, tinnitus, metallic taste) later CVS/CNS depression (hypoT, bradyC, unconsciousness, seizure, ventricular dysarythmia, coma)Tx: diazepine IVLA allergy: esthers (PABA), methylparaben (preservative)

Patient with chest tightness and ache going to left arm, first step? A- OxygenB- AspirinC- Raise chair from supine to uprightAns. C always in angina: stop tx, position, O2, NTG, reassure, take vitals

How to treat patient with PTSD?A) midazolam every timeB) explain to him/her everything (sort of tell-show-do)Ans A

Dentist applied topical benzocaine on patient mouth. Patient got pale discoloration, cyanosis, chocolate brown blood, what is the reason1. Allergic reaction2. Hypertension3. Methaglobenemiaans. 3 causes of methamoglobulenemia: LA: prilocaine/lidocaine, benzocaine, antihypertensive: Amyl Nitrite, acetaminophen at high doses

You put Pregnant patient in left position To prevent the pressure on 1 fetus2 IVC3 SVC4 bladder Ans 2

77- Patient has prosthetic heart valve, penicillin allergy which you give:

1. 600mg clindamycin 1 hour before 2. 2 mg amoxicillin 1 hour before3. 600 mg clindamycin 1 hour prior 4. No needAns 1 (2g(50mg/kg amoxi, 600 (20mg/kg) clinda)

Patient has facial swelling with 101 fever which antibiotic could you give1. 1 g ampicillin then 500 mg * 4 for 7 days2. 2 g amoxicillin one shoot3. 2g metronidazole then500mg *4 for 7 days4. no needans 1(actyinomycosis is 14 day tx, 10000units )

Patient Blood pressure was 178/109. What is the most likely emergency this patient would have in the dental office?a. Syncopeb. Hypertensive crisis.c. Hyperglycemiad. Hyperventilation.ans b (leading to angina/MI/stroke b/c of aterosclerosis)

patient has uncontrolled HTN. What is the possible emergency situation might arise during dental treatment A- stroke (transient ischemic condition)B- syncopeC- hyperventilation D- shockAns A (for stroke tx is: IV tPA-alteplase)

Patient needs premeditation for what conditions A- heart murmur w/ regurgitation (medium risk)B- replacement of aortic valve (high risk: prosthetic/ surgically constructed heart valve, previous IE)C- cardiac pacemaker (negligible)D- mitral valves prolapse (only with regurg is medium risk w/o is minima; risk)Ans B

patient came for treatment. Patient is anxious prior treatment start. Pt complained about getting sensitivity or pain. During treatment, patient felt tingling in fingers and get unconscious. What happen to the A. MI B. Hyperglycemia C. HyperventilationD. Thyroid storm (fever, agitation, adrenergic effects)E. pheochromo (alpha adrenergic affects like headache, tach, diaph, but episodic and brief)Ans C hyperventilation causes carpopedal spasm (tingling or pain of finger)

Slurred speech where? 1 Transient ischemic attack 2 dementia3 2 more optionsAnswer is 1

ORAL PATHO

Systemic condition associated with endocarditis & glomerular nephritis: SLEGardener’s syndrome features: unerupted teeth, retained deciduous teeth, impactedpermanent teeth, multiple osteoma + intestinal polypsMechanism of Fetal Alcohol Syndrome: Neural crest apoptosis, mid face discrepancyMost common age Primary Herpetic Gingivostomatitis: Age 1-5Most common inherited: 1:700 Downs Most common abnormality among the following: Cleft lip, then Cleft palate then Dentinogenesis imperfecta, Amelogenesis imperfecta, Dentinal dysplasiaMost common Cleft lip: in male, cleft palate: in femaleMost commonly associated with dysplastic cells/dysplasia: ErythroplakiaMost commonly associated with osteogenesis imperfecta: Dentinogenesis imperfecta Icommon between Crohn’s, Peutz-Jeghers & Gardner’s syndrome: Intestinal polypsGardner’s syndrome AD, rare= familial colorectal polyposis (adenocarcinoma of colon)+ multiple large epidermoid cysts+ 3-6 mandibular osteomas (radioO seen at puberty in angle) +multiple desmoid tumors (fibromatosis)+ prevalence for odontomas, supernumerary teeth, and

impacted teeth + retinal abnormalitys + earl onset pubertyPeutz-Jeghers syndrome: multiple melanotic macules or pigmentation, GI polypsEctodermal dysplasia (x-linked recessive): sparse hair, anodontia (partial/complete), oligodontia, hypodontia, anhidrotic, conical shaped teeth Common features of Cleidocranial dysplasia: Delayed eruption, supernumerary teethPeutz Jeghers syndrome: Pigmentation of face, lips, and oral cavity and intestinal polypsTreacher Choline syndrome (Mandibulofacial dysostosis): relation to ZygomaCleidocranial dysplasia: relation to clavicleBrown tumor (Central giant cell granuloma) is associated with: HyperparathyroidismMost common location of oral cancer in USA: TonguePemphigus vulgaris: Suprabasilar vesicles and acantholysisPemphigoid: Subepidermal and NO acantholysis (hemidesmosomes, BM)Papillon Lefevre Syndrome: Hyperkeratosis of palms & soles of feet, premature tooth loss,PeriodontitisPatient refers to pain during swallowing and moving the head to the affected side dx: Eagle syndrome (take a pano)Crouzon syndrome: Beaten metal appearance of the skull. Hypertelorism (Increased interpupildistance), mid face deficiency, cranial bones fuse too soonSteven Johnson syndrome: Disease of skin & mucous membrane, begins with flue likesymptoms, top skin layer dies & sheds off, burning eyesMcCune Albright syndrome (Polycystic fibrous dysplasia): Cafe Au lait spots, Coast of Maine +polyostotic fibrous dysplasia +hyperPTHrisk of osteosarcoma: McCune Albright, pagetsAssociated with oral melanin pigmentation: PJ, addisons’s disease, McCune Albright, NFM I, smoking/racial/physiological pigmentation, cloroquinone, estrogen, or metastatic malignant melanomaNeurofibromatosis 1: neurofibromas on tongue+Cafe au lait, Liche nodule of Iris, crowes signPlumer Vinson syndrome: atrophy of gastric and pharyngeal mucosa, spoon nails (Koilonycias)(predisposal to oral SCC in postmenopausal females)+ iron deficiencyFrey’s syndrome: Gustatory sweating while eating and crocodile tears (parotidectomy)Melkersson Rosenthal syndrome: Facial paralysis, cheilitis granulomatosis, scrotal tongueSLE Lupus erythematosus affects in: heart, renalBechet’s disease: herpetiform Aphthous ulcerScleroderma: Mona-Lisa face, Widening PDL, limited open, purse sting mouth, deposition of collagen in organs lead organ failure, loss of mandibular ramus.CREST syndrome: Limited Scleroderma, only in lower arms & Legs, sometimes face & throat. Most common location of SCC (most common oral cancer): Posterior lateral border of tongue (intraoral site)Uncontrolled diabetes inhibits osteoblastic activityMost common site of Basal cell carcinoma: Middle third of the faceMultiple myeloma: Bence jones protein, punched out lesion, plasma cell infiltrate, skeletalradiolucency (Bone pain is the 1st sign)Fibrous dysplasia: Ground glass appearanceVerrucous carcinoma (on vestible): Cauliflower, warts caused by HPV 16 & 18 and betel quidProliferative Verukiform Leukoplasia (tongue): poor prognosis, no tx

All of the following are congenital except...a. dentinal dysplasiab. amelogenesis imperfectac. regional odontodysplasiad. ectodermal dysplasiaans C. Regional odontodysplasia/ghost teeth: enamel, dentin and cementum all affected. may be local vascular problem causing teeth to be affected during formationx-ray: almost invisible teeth. Exhibit enlarged pulps, short roots, open apical foramina, thin enamel and dentin. Permanent maxillary ant. Tx: ext

CYSTS AND TUMORS: Most recurrence cyst: KCOT/OKC (associated with Gorlin goltz syndrome)Least recurrence tumor: AOT Adenoid odontogenic tumor or Compound Odontoma s.sOKC is most commonly associated with: Nevoid basal cell CarcinomaNevoid basal cell carcinoma (Gorlin Syndrome): seen multiple OKCs and palmar pitting, planter kerato-cyst, causes cyst in the JawsMost common cyst in oral cavity: Peri-apical (radicular) cystodontoma: more common dontogenic tumorAmeloblastoma: 2nd most common Odontogenic tumorodontogenic myxoma/myxofibroma: most common odontogenic tumor of mesenchymal origin (3rd over all)DD of mandibular posterior: ameloblastoma, KCOT, CGCG, CEOTMost common non-odontogenic cyst: Nasopalatine duct cyst (X-ray: Heart shaped near centralincisor, tx: Enucleation)

26. What condition has multiple osteomas, GI polyps, and Skin cysts A. Peutz-jeghers syndromeB. Gardner syndromeC. Crohn’s disease D. Cleidocranial dysplasia ans B. Gardner’s syndrome AD, rare= familial colorectal polyposis (adenocarcinoma of colon)+ multiple large epidermoid cysts+ 3-6 mandibular osteomas (radioO seen at puberty in angle) +multiple desmoid tumors (fibromatosis)+ prevalence for odontomas, supernumerary teeth, and impacted teeth + retinal abnormalitys + earl onset puberty

Least recurrence tumorA. OKCB. Compound odontomaC. AmeloblastomaAns B (most reccuring is OKC)

Which cyst is not in bone? A- nasolabial

B- Peripheral giant lesionC- AmeloblastomaD- Other optionsAns A

Which would NOT be included in a differential diagnosis of the right mandibular molar radiolucency?A- Keratocystic odontogenic tumor KCOTB- AmeloblastomaC- Periapical (lateral radicular) cystD- Lateral periodontal cyst ans: D (only D is between Mn C and PM)

A newborn girl was delivered via cesarean section due to airway patency concerns. During ultrasound, there was the discovery of a tumor of the oral cavity. On delivery, the pink, compressible tumor of the anterior maxilla was deemed to be a congenital epulis of the newborn. This lesion is composed of cells that are identical to those of the:(1)a traumatic neuroma(2)a schwannoma(3)a granular cell myoblastoma(4)a lipoma3

23-Which of the following has no radiOpacities1 AOT2 fibrous dysplasia3 ameloblastoma4 condensing osteitis Ans 3

Case of young patient, like 14 years old that has swelling on Maxillary canine area, not painful, few months of development, radiolucent image with fleck radiopaque. Diagnose? a. Adematoid odontogenic tumor AOTb. ameloblastomac. Calcifying epithelial odontogenic tumor/pindborg(CEOT in older people and post ramus)d. other ans a. Adematoid odontogenic tumor (AOT): 3-7% of all odontogenic tumors. Benign. Clx: child/ teen, female, slow-growing, asymp unerupted/impacted MX Cx-ray: well-defined unilocular radioL surrounding crown of MX C apically than CEJ (DD: dentigerous cyst) with “snowflake”* calcifications tx: capsulated so enucleation

Ameloblastoma is a most aggressive & most common EPITHELIAL odontogenic tumor. solid, well-defined, multicystic or polycystic (“soap bubble”) lesion, most aggressive kind. TX: requires surgical excision

Ameloblastic Fibroma: compared to ameloblastoma - younger age, slower growth, does not infiltrate. Usually associated w/ impacted teeth

What is the most definite way to distinguish ameloblastoma from KCOT/KOC?a. Smear cytologyb. Reactive light microscopy c. Reflective microscopy (multiple OKC seen in gorlin golz, benign could turn malignant, tends to reccur)

Radiographs reveal a radiolucency where the right third molar usually resides. The mandibular right third molar is not present. Which of the following should NOT be included in a differential diagnosis?1)Odontogenic keratocyst2)Odontogenic myxoma3)Dentigerous cyst4) residual cystAns 3

If mucous glands are seen in the epithelial lining of a dentigerous cyst, this is called:A. anaplasia.B. metaplasia.C. dysplasia.D. neoplasia.E. hyperplasia.Ans B

Which one indicates a Stage III of the oral and oropharyngeal cancer?A.Tumor less than 4 cm B.Metastases in a single ipsilateral node 3 cm or lessC.Metastases in bilateral or contralateral lymph nodesD.Distant metastases presentAns B

following conditions is NOT a possible sequela of a tooth completely impacted in bone? A. Development of a dentigerous cyst around its crown. B. External resorption of the tooth. C. Osteonecrosis of the adjacent bone. D. Development of a benign neoplasm adjacent to its crown

Psuedocyst: Aneurysmal bone cyst, traumatic bone cyst, stafne defect and mucoceleWhat cyst is a true cyst? A- DermoidB- StafneC- DentigerousD- NasolabialAns: B Aneurysmal bone cyst, traumatic bone cyst, stafne defect and mucocele NOT true

Which of the following is most likely to displace the adjacent teeth?- Lateral periodontal cyst- Dentigerous cyst - Periapical cemental dysplasia - Periapical abscessAns A

Baby with nodules on the palatal, what is it?A) Bone nodulesB) Epstein pearlsC) Congenital epulisD) Bohn noduleAns b

Neonate with numerous white nodules on alveolar ridge. What is it?A) Eruption cystB) Bohn’s noduleC) Congenital cyst of newbornans B

Epstein pearls: (keratin-filled cysts on midline raphe, not odonto)Bohn’s nodule (keratin-filled cysts rests of dental lamina odontogenic cysts)congenital cyst/epulis of newborn: granular cell myoblastoma on gingiva

SALIVARY GLAND PATHOLOGYSalivary flow hypofunction: unstimulated less than 0.1mL, and stimulated <0.7mL

Most common tumor OVERALL of salivary gland: Pleomorphic adenoma Most commonly resembles parotid gland, mixed cell type, firm rubbery consistency

Most common tumor of MAJOR salivary parotid: Pleomorphic adenomaMost common tumor overall of MINOR salivary: Pleomorphic adenomaMost common MALIGANANCY of salivary gland: Mucoepidernoid, ACC2nd Most common malignancy of MINOR salivary gland: PLGAAdenoid cystic carcinoma ACC: Perineural invasion seen, cribriform, swiss cheese, highly reccurent, 15 year survival 10% (lethal), palate

Warthin tumor (Papillary Cystadenoma-lymphomatosum) in: 2nd benign parotid, oncocyte+lymphoid stromaPLGA: second most common of minor malignancysialolith found in: Wharton duct (submandibular) need occlusal x-ray to dx

125- perineural invasion is seen in: A.Adenoid cystic carcinoma(malignant palate)B. Acinic cell adenocarcinoma (malignanat in parotid)

C. Mucoepidermoid carcinoma (malignant parotid)Ans A

Bilateral parotid enlargement inA. SilothiasisB. Pleomorphic adenomaC. I can't recall itD. Wharton tumor

Tumors of the salivary glands are:1)uncommon and represent 2-4% of head and neck neoplasms2)common and represent 75-80% of head and neck neoplasms3)uncommon and represent 25-30% of head and neck neoplasms4)common and represent 95-98% of head and neck neoplasmsAns 1

Mixed salivary tumor:1.Adenoid cystic carcinoma2.High grade mucoepidermoid3.PLGA4.Pleomorphic adenomaAns 4

ORAL PATHOLOGY:Found Presence of Supernumerary teeth in: Cleidocranial dysplasiaAnodontia/Oligodontia mostly related to: Ectodermal dysplasia (mostly seen in Alveolar bone)Odontomas mostly associated with: Gardeners syndromeDens invaginates is commonly seen: Max lateralDens-in-dente most common in: MX LIMost common site of osteo-fibrosis (Cementoma): Mandibular AnteriorDiagnosis of OKC: HistologyHypercementosis, most common in PMs in Paget’s disease Discolored of teeth seen: (Porphyria: purplish brown)(Cystic fibrosis: yellowish brown)(Erythroblastic fetalis: blue greenish)Erythroblastosis fetalis: Ring like enamel hypoplasiaBlue sclera is seen in: osteogenesis imperfecta, hypophosphatasiaActinomyces oral manifestation: Lumpy jaw, sulfur granules1st sign of multiple myeloma: Bone pain (“punched out” lesion in X-ray)Osteosarcoma: Sun burst and uniform/symmetrical widening PDL, paresthesia(numbness/tingling)Scleroderma: widening of PDL + microstomia Most common benign tumor in oral cavity: FibromaLesion of alveolar ridge in infant: Bohn’s nodule

Dry socket is a form of Periostitis, Pathophysiology of dry socket: FibrinolysisKeratosis on the oral mucosa and dysplasia are more common in: tongueOral Hairy Leukoplakia: not premalignant, caused by EBVWhen to do biopsy: 15 days afterOsteonecrosis most common with IV drugs: Zolmeda (zoledronic acid) & Aredia (Palmidronate), not with Oral (Fosamax or Boniva)Nikolsky Sign: Pemphigus vulgaris (Acantholysis present) & Erythema multiformeSubepithelial vesicular disease: Pemphigoid & Lichen planusChronic Desquamative gingivitis AKA Cicatrical pemphigoidCauliflower like pebbly appearance: Verrucous carcinoma, Condyloma accuminatum, PapillomaGranular Cell Tumor (skin or mucosal tumor) histologically resembles: Congenital epulis, SCCLesion that resembles to SCC, but disappears in 16 weeks: Kerato-acanthoma (Skin tumor)Most common malignancy found in: Metastatic Ca (Bone), Basal cell ca (skin), SCC/Epidermoid ca (oral cavity) Muco-epidermoid Ca (Salivary gland)Swelling on maxillary lateral incisor area, doesn’t appear on rx. Histology: Pseudostratified squamous epithelium cystic lining. Diagnosis? Nasolabial cystBurning mouth syndrome (in postmenopausal woman) dry sticky bad taste, treatment: Capsaicin is the answerHypercementosis seen in: paget’sFirst symptom of multiple myeloma: **bone painleukemia in children: ALLfeature of fetal alcohol syndrome: cleft lip s.s

Carcinoma of the tongue initially present as: A. nodules on bilateral submandibular region. B. nodule on unilateral submandibular region. C. palpable regional lympnodes; D. Necrotic ulcer on lateral surface of the tongue E. Necrotic ulcer on lateral surface of tongue extends to floor of mouth Ans D

1 Leukaemia gingival enlargement is seen only in dentulous patients. 2 Leukaemia gingival enlargement is seen in chronic leukemia.A) both 1 and 2 correct b) both 1 and 2 incorrect C) 1 is correct and 2 is incorrect D) 1 is incorrect and 2 is correct.ans: C (1 correct, only seen in acute cases, NOT in chronic leukemia)

Which of the following statements are correct?1 Chediak higashi syndrome Is primary neutrophil disorder2 Down syndrome is not a secondary neutrophil disorder3 lazy leukocyte is a primary neutrophil disorder 4 pepillion lefevre syndrome is primary neutrophil disorder 5 inflammatory bowel disease is secondary neutrophil disorder

A - 1,2,3 B - 1,3,5 C - 2,4,5D - 2,3,4Ans B

Pt have pain in one side of face this pain worse when moving his face what is most probably?a. unilateral cavernous sinus thrombosisb. Sinusitisc. Acute periapical AbscessAns B (to tx: give: AB amoxi and nasal decong)

You did exfoliative biopsy and came positive with dysplasic cells what do you do next:Confirm with another exfoliative biopsy Incisional biopsy Excisional biopsy WaitAns B (need to always confirm exfoliative/cytology biopsy, it is an adjunct)

40 year-old man coming regularly to this office since 20 years, every 4-6 months for regular check-up. He has red/blue cyst on lower buccal side filled with mucous. Tx: a.don’t worry - it’s viral infection b.antibioticsc.incision biopsyd.excision biopsy e. cytologyans D

Patient has a large cyst. Appears radiolucent on radiograph. What to do first?a.Aspiration biopsyb. Excisional biopsy.c.Incisional biopsy.d. Antibiotics.Ans A

What is not a characteristic of DI:A. Short roots that breaks easyB. Abnormal lines at the DEJ C. Excessive deposition of dentinans: B. butttt if were talking about DI III then C is wrong, if talking about DI II (most common type) all above are correct b/c absence of scalloping at DEJ makes enamel chip off . check this

213. Case about kid with histopatologic biopsy result of Neuromas. Pick possible disorder:a. Multiple Endocrine Neoplasia IIb

b. GardnerSyndromec. Cohn Syndromeans: MEN multiple endocrine neoplasia IIB (AD): multiple neuromas in lips, tongue, palate + medullary thyroid carcinoma+ pheochromocytoma of adrenal gland

194. Fordyce granules:a. sweat granulesb. ectopic sebaceous granules

Which of the following is seen with hyperplastic (or was it associated with) foliate papilla: A hairy tongueB Lingual tonsil hyperplasiaC median rhomboid glossitisD lymphadenopathy

Hyperplastic lingual tonsils may resemble which of the following? a. Epulis fissuratum.b. Lingual varicosities.c. Squamous cell carcinomad. Median rhomboid glossitis.e. Prominent fungiform papillae. (foliate papillae, not fungiform papillae)

Which of these lesions has the best prognosis?a. squamous cell carcinoma on lower lipb. melanoma on gingivac. adenocarcinoma on hard palate (PLGA)d. other on lateral tongue or floor of the mouthans: adenocarcinoma PLGA

Which of the following has been most strongly implicated in the cause of aphthous stomatitis?A- CytomegalovirusB- Allergy to tomatoesC- Herpes simplex virusD- Staphylococcal organismsE- Human leukocyte antigensAns E

Lesion of basement membrane without acantholysis: 1) Pemphigoid2) pemphigus3) erosion lichen planusAns A

Why is important to rule out okc

a) due to potential for malignancy b) asso with nevoid basal cell carcinoma c) recurrence rate d) infectionA, B , C correct, C most important

What is the first finding in HIV?A. Decrease HbB. Decrease WBCC. Kaposi sarcoma D. B cell lymphomaAns B (leukoplaquia and candida seen before decrease in wbc, cd4 decreases after a while) kaposi seen in AIDs

116. An inherited disorder that presents as micrognathia and retrognathia of the mandible, glossoptosis and cleft palate. Pierre Robin Syndrome

cysts don’t occur in midline: cervical lymphoepithelial/branchial cyst and cystic hygroma coli201- What doesn’t occur in midline? A.Cleft lipB.Lingual thyroidC.torus paltinusD.Nasopalatine duct cystAnswer is A

1- Not need x-ray for diagnosis 1. Hutchinson incisor2. Dens in dent3 concrescence 4 dilecerationAns 1

3- Most common site for sialolithiasis 1 submandibular gland2 sublingual gland3 parotid gland4 minor salivary gland Ans 1. To DX take occlusal Xray

4-Most common duct for sialolithiasis 1 stensen's duct2 bartholin duct3 wharton's duct4 von ebren duct

Ans (3)

14- Which of the following associated with presence of supernumerary teeth1 cleidocranial dysplasia 2 down syndrome3 gardener syndrome4 ectodermal dysplasiaAns 1

15-Oligodontia mostly related to 1 trisomy 212 cleidocranial dysplasia3 ectodermal dysplasiaAns 3

Ectodermal dysplasia seen most in:A- maxillaB- mandibleC- alveolar boneAns C

16-Odontomas mostly associated with 1 neurofibromatosis2 gardener’s syndrome3 albert syndromeAns 2

17- what is the percentage of calcific metamorphosis in population1. 5-18 % 2. 20-35 % 3. 35-49% 4.50-70%Ans 1

Origin of turner incisor? A. Syphilis B. trauma during delivery C. trauma during pregnancy D. trauma and infectionAns. D

41-Which of the following Is Pre Malignant 1 odontoma2 pagets disease3 hairy tongue

Ans 2 (pagets can lead to osteosarcoma)

195. Proliferative verrucous leukoplakia associated to: a. EBVb. papilloma virusc. othersans b

75-Lumpy jaw appearance ( and some more information i can’t recall ) which disease1 actinomycosis2 cherubism3 pagets disease Ans 1

25. Patient came with a burning sensation. It happens mostly while eating food. Clinical examination, red lesion with white border on tongue and patient stated that it always moves around. What is the condition patients have? A. Erythema multiformeB. Erythema migrans C. ErythroplakiaD. Ulcer ans B. migratory, geographic tongue

24. Patient came to visit for checkup. He is currently taking both subepidermal nitroglycerine sublingually 3-4 times daily. Couple of months ago he used to take nitroglycerine weekly. What is the patient health status?A. ASA 1 (healthy)B. ASA 2 (mild, stable)C. ASA 3 (mild, unstable, uncontrolled)D. ASA 4 (Uncontrolled, unstable) Ans D

24- 22 years old girl with fever, malaise, lymphadenopathy, multiple ulcers on tongue, palate with swollen gingiva1 ANUG (anug necrotic ulcerative lesions on interproximal papilla ONLY)2 acute herpetic gingivostomatitis (only on keratinized tissue)3 marginal gingivitis 4 herpangina (on non keratinized tissue)Ans 2

27-Patient girl has Pain when she turn her head to the right and swallow 1 lateral thyroid cyst2 elongated styloid processAns 2

30-Tb oral ulcer present as1 painless ulcer for long duration 2 mostly palateAns 1

Children with Fetal Alcohol Syndrome presents with what sign?a) anecephalyb) Midface deficiencyc) Cleft lipb) Down syndromeans. B

66-dens invaginatus commonly seen in 1 max laterals2 man premolars 3 max canine4 man molarsAns 1

70-How many population have Herpes virus in there bodies 1. 35- 40%2. 50–55%3.80-85 %4.90-95%Ans 3

lingual varicosis associated with 1 hypertension2 gender3 DM4 xerostomia5 ageAns 5 (HTA and age are assoc)

106 - Most common deep fungal disease in USA 1 blastomycosis,2 candidiasis,3 histoplasmosis,4 mucormycosis Ans 3 (most common 2 s.s)

Conditions least likely to have alveolar bone loss in primary dentition

HypophosphatasiaLeukemiaPoor Oral HygieneANS B?

113 - trisomy 21 have all the following except 1 rampant caries2 macroglosia3 short roots4 mandibular protrusion Ans 1

acrylic mostly associated with candidiasis: 1 heat cured2 chemical cured3 light cured and one more optionans 2 (least is heat cure it has less residual monomer, less porous and thus stronger and more colour stable)

82- Most important to determine any disease 1 history and clinical examination2 blood test3 biopsy4 radiographic examinationAns 1

83-Cleft palate / cleft lip mostly associated with which disorders 1 autosomal recessive 2 autosomal dominant 3 Hereditary4. Genetically multifactorial5. X-recesiveans. 4 all of the above

79-Cleft lip is formed in which weeks during pregnancy1. 2-32. 6-93. 10-124. 13-15 Ans 2

ANATOMY

pterygomandibular raphe: junction of buccinators and superior pharyngeal constrictor

Dental Lamina form: 6-7 weeks of uteroTMJ: ginglimoarthrodialrotation/terminal hinge axis of TMJ: lower compartment (first 20mm)Translation/sliding/gliding TMJ: upper compartment (next 30mm) when lat pterygoid simultaneously contract, disc and condyl move down the art eminenceMax mandibular opening: 50-60mmmax mandiublar lateral, max protrusive: 10mmMax mandibular retrusive: 1mm

Facial nerve is most likely to be affected by cut or damage in all except which?A. Internal acoustic meatus (7,8)B. Jugular foramen (9,10,11)C. Stylomastoid foramen (7)D. Parotid gland surgery (7 passes in it so do retro V, superficial temporal A and maxillary A)Ans B

After blodd clot formation what happens to healingIncrease osteoblasticDecrease osteoblasticIncrease osteoclastsDecrease osteoclasts(callus formation then remodeling)

7-From anterior to posterior which order is correct1 Inferior alveolar nerve, Inferior alveolar artery, lingual artery 2 lingual artery , Inferior alveolar nerve , Inferior alveolar artery3 Inferior alveolar artery , Inferior alveolar nerve , lingual artery 4 lingual artery , Inferior alveolar artery , Inferior alveolar nerveAns (1) lingual nerve, ian nerve, ian artery, lingual artery

All are innervated by the Hypoglossal nerve, except?A. HyoglossusB. PalatoglossusC. StyloglossusD. GenioglossusAns B

Which muscle is pierced during IAN block: Buccinator (if medial pt. cause Trismus)

Lymphatic drainage of The tip of tongue drains to: a. submentalb. Deep cervical facialsc. SubmandibularAns A

3) Which of the following anatomical landmark is used as indicator of the posterior border of ramus of mandible in inferior alveolar nerve block: A. Mandibular foramenB. Occlusal plane of mandibular posterior teethC. Pterygomandibular raphe (vertical portion)D. Pterygomandibular raphe (horizontal portion) E. Coronoid notchAns A (if anterior boarder ans E)

28-Muscle to elevated tongue1 styloglossus and palatoglossus 2 genioglossus and styloglossus 3 hyoglossus and palatoglossus 4 hyoglossus and genioglossusAns 1

muscle is most likely to get pierced if IANB is placed MEDIAL to the pterygoman raphe?1 Buccinator and Lateral Pterygoid 2 Buccinator and Medial Pterygoid 3 Buccinator with Superior Constrictor MuscleAns 2 I think SCP and medial pterigoid

Posterior Superior Alveolar artery is a branch of?maxillary from Internal Carotid Arterymaxillary from External Carotid Arteryans B

The anterior loop of IAN can be predicted whe renerve comes: 1 above mental foramen2. anterior to mental foramen3. below mental foramen4.same level with mental foramenans 2

60-lingual artery direct branch from 1 ECA2 maxilary A3 IAN AAns 1

Highest chance of 2 canals in which mandibular teeth? (lowest in MX CI)A. lateralB. canineC. 1pmD. 2pmAns A.

If you cut or damage near the mylohyoid ridge, what will be affected? A. Facial NerveB. Trigeminal nerve C. Hypoglossal nerveD. Glossopharyngeal nerveAns B

PHARMA MECHANISM OF ACTION:MOA of Tetracycline: BacteriostaticMOA of Doxycycline: inhibit 30s ribosome/inhibit collagenous (inhibits MMP-8) longest duration tetracyclineMOA of Montelukast: Inhibition of leukotrienes (Used for Asthma and seasonal allergies)MOA of Ranitidine: Reduce gastric secretionMOA of H-antagonist (Antihistamine): Blocking histamine at the receptorMOA of Ibuprofen: ReversibleMOA of Aspirin: Irreversibly inhibit platelet aggregation, inhibit platelet cyclooxygenase byblocking the formation of Thromboxane A2.MOA of Clopidogrel (Plavix): Alter platelet function, inhibit platelet aggregation irreversibly (Give pt allergic to Aspirin, no ulcer side effect, given to pt with past ulcer history)MOA of Anti-depressant drug:MOA of Warfarin: Inhibit vitamin K reductase resulting in depletion of reduced form of vit K,Decrease K+ needed to synthesize factors II, VII, IX, XMOA of Heparin: Anti-coagulant reversibly to anti-thrombin II & prevent conversion offibrinogen to fibrinMOA of Dicoumarol: Anti-coagulant that inhibits vitamin K reductase & affects K-dependentcoagulation factors (Tx: Coronary Infarct/MI)MOA Benzodiazepines: modulate activity of inhibitory NT (GABA) at the GABAA receptorMOA of Xanax: Increase frequency of chloride channels on GABA receptorMorphine relieves pain by: Acting on opioid mu receptor on neural cell membraneMOA of Anticholinergic: inhibit binding of acetylcholine to muscarinic and nicotinic receptors(found in eyes, secretory glands, nerve endings to smooth muscle cells)MOA of Acetaminophen: Antipyretic effect by acting on centers in hypothalamusMOA of Levodopa: Replenish deficiency of dopamine in patients with Parkinson’sMOA of Reserpine: stabilize the axon terminal membrane preventing release norepinephrine(Used for HTN)MOA of Naloxone: Non-selective and competitive opioid receptor antagonist in case of opioidoverdoseMOA of Clonidine: Centrally acting sympatholytic (alpha adrenoceptor agonist)MOA of Zoloft: Sertraline – Selective serotonin reuptake inhibitorsMOA of Sulfonylurea: Increased insulin production and sensitivity by Beta cells stimulation bybinding to ATP dependent K channel/ Stimulation of pancreatic beta cells to secrete insulin.MOA of Sulfonamides: Inhibit folic acid suynthesisMOA of Bisphosphonate: Inhibit the Osteoclast via apoptosisMOA of Periostat: Inhibit collagenase/protein synthesis

PHARMA CONTRAINDICATION: Acetaminophen is contraindicated with Liver disease (cause hepatotoxicity) and alcoholNitrous Oxide contraindications: 1st trimester only, nasal congestion, COPDAsthmatic pt: Used Acetaminophen (Tylenol), Avoid using Aspirin, can cause Hyperventilation( asthma attack), Macrolides avoided in Asthma (interact with Theophylline)Antihistamine is contraindicated with Erythromycin: TerfenadineEpinephrine (Adrenalin) should NOT be used with tricyclic anti-depressant, hyperthyroidismmax epi given in cardiac pt: 0.04 mg (2 carpules of 1:100,000 and 4 carpule of 1: 200,000)In multiple sclerosis: LA with epi is contraindicatedErythromycin and Tetracycline are prescribed carefully in patients with peptic ulcer because:interact with AntacidsPenicillin is cross allergenic with Cephalosporin because of Beta LactamaseNever give penicillin with tetracycline: due to Antagonists propertyChloramphenicol contraindicated in G6PD, Side effect of chloramphenicol: Aplastic anemiaStrongest glucocorticoids: DexamethasoneBenzodiazepine antagonist: Flumazenil, Opioid antagonist: NaloxoneDetoxification of Morphine addiction: methadoneMixed agonist-antagonist analgesics: pentazosin, nalbuphineUse for sedation on child: (Don’t use Meperidine)Antibiotic for non-odontogenic maxillary sinusitis: Augmentin (Amoxicillin + clavulanic acid)ANUG with lymphadenopathy: Metronidazole (s.s)Med for Trigeminal Neuralgia: Anticonvulsive drug, carbamazepineChild Used Amphetamine med: ADHD (if kid takes, tell him not to take prior dental app)Heparin is contraindicated to pt with taking gingko bilobaAspirin is contraindicated with CoumadinGinseng is contraindicated with Aspirin, Warfarin, NSAIDsGlucocorticoids are contraindicated in DiabetesBenzodiazepines (Diazepam) is contraindicated for pregnant women, myasthenia gravis, acutenarrow glaucoma, COPD, emphysema.cholinergomimetics are contraindicated in: Allergic to Aspirin: Take Acetaminophen, not IbuprofenPregnant Women: Use Acetaminophen, No NSAIDs (causes patent DA)Antibiotic used in gingival cervical fluid for periodontal bacteria: Doxycycline, HIV related oropharyngeal candidiasis: Systemic FluconazoleAntifungal for TROCHES: ClotrimazoleMost common medicine for Grand mal: DilantinEthosuximide is most commonly used: Absence epilepsy (Petit mal)Diazepam for status epilepticusDrugs caused gingival hyperplasia: Phenytoin, nifedipine, cyclosporineMeds cause Xerostomia: Diuretics, CCBs, Antihistamine, antimuscarinics (glycopyrulate/scopolamine)Tx for xerostomia with Sjogren’s syndrome: Cevimeline HCL, pilocarpine (20 mg a day 5q4h)Coronary infarct: Dicumarol (Vit K antagonist)Antidote of Warfarin: Vit KAntidote of Heparin: Protamine sulfateThe most potent & most toxic LA: Dibucaine

Long acting LA with less toxic: BupivacainePain medication for liver toxicity & renal toxicity: OxycodoneTx of Myasthenia gravis: Physostigmine & PyridostigmineTricyclic Antidepressant: Imipramine & amitriptylineBest initial tx for TMJ muscle spasm: NSAIDS + Muscle relaxantTx for Rheumatic arthritis: Adalimumab & infliximab (bind to TNF – alpha receptors)Percocet is class II schedule drug (Oxycodone + Acetaminophen) Motion sickness: Scopolamine, Diphenhydramine (Benadryl)Drug choice for pt with bradycardia: AtropineAsthma: Albuterol (short acting) and theophylline (long acting)Amantadine antiviral drug used for: Influenza A & Parkinson DiseaseEpi to reverse give: Prazosin or chlorpromazineSerotonin syndrome: Tramadol (narcotic pain killer like morphine) + SSRITx of Parkinson disease: Carbidopa + LevodopaPt with sleep apnea, which pain med should give: Ibuprofen/acetaminophenTx of lidocaine induced seizure: DiazepamTx of Depression & Anxiety for Obsessive Compulsive Disorder: SSRIsBest benzodiazepine for pt with liver cirrhosis: LOT (Lorazepam, Oxazepam, Temazepam) due to not metabolized by liver, so safe for to not induce liver failure.Best benzo for IV sedation: MidazolamPt allergic to ester & amides: Use Diphenhydramine (Benadryl)Laryngospasm: Tx with Pure oxygen, if persistent use Succinylcholine, if severe thencricothyroidismMalignant Hyperthermia: tx with DantroleneADHD Kid: Ritalin (methylphenidate hydrochloride)For Hirsutism: EflornithineAdrenal Crisis: Cardiac shock, hypotension, CV collapse, 100mg 0.9% hydrocortisone with saline (if minor qx, pt taking 15mg of prednisone, or 5 mg of albuterol inhaler daily, of ext give 50 day of and 50 after, for multiple ext give 100 day before 100 day after. If taking very high dose of cortisol but only for 3 days not needed, just if its more than 2 weeks of 15 or more or 2 months of 5mg or more)Adrenal insufficiency: caused by prolonged regimen of Corticosteroids, more than 2 yearsThyroid Crisis: Hypertension and Increased HRAnti-anxiety in pregnant women: PromethazineMost common cause of xerostomia: DRUGSTx of xerostomia: pilocarpine Civemeline HCldrug-induced gingival hyperplasia: phenytoin, niphedipine, cyclosporineWhat drug use to reverse meperidine(Demerol) effect? NaloxoneBest drug to reverse effect of Benzodiazepine: Flumazenil (benzodiazepine antagonist)142- day 2, antibiotics for ANUG? metro (s.s)143- day2: all true for transient ischemic attach except; give nitroglycerin146 - antibiotics that is safe for renal hemodialysis: I put clindamycin 147- antibiotics for mycoplasma: erythromycin, clarithro, tetra150- patient allergic to ampicillin what to give him: azithromycin 500 mg/ clinda

163- aspirin 12 mg/ml in plasma concentration how ml after three half lives? Answer: is 1.512–> 6 —>3 —>1.5

PHARMACOLOGY

Best drug to reverse effect of Midazolam (Versed): Flumazenil198. Glucocorticoides medication can cause : cushing syndrome (thining of skin (strae), moon facies, adrenal crisis in Ux, central adipose, muscle thinning, infections, immunosupression)opioid causes all except? a.resp depression, b. pinpoint pupils, c. peripheral pain, d. somnolence ans cthe metabolites of codeine are: morphine and hydrocodone metabolites of morphine: hydromorphone, normorphoneaction of ranitidine? inhibit gastric acidityquestion about betel quil ..s.s

13. Antibiotic Prophylaxis for: a) Mitral valve with regurgitationb) Implanted cardio stentc) Valve replacementd) Pace makerans C231. Test to do for patient taking Coumandin a. PT/INR (test for people taking heparin? PTT)

RQ- 1 dose of aspirin can cause bleeding up to:A- 4 hoursB- 10 hoursC- 1 weekD- 1 monthAns C

Warfarin mOA: Warfarin binds to vitamin K epoxide reductase complex subunit 1 and irreversibly inhibits the enzyme thereby stopping the recycling of vitamin Kwarfarin: teratogen nitroglycerin side effects (vasodilation/ SE headache syncope tachy methemoglobulenemia : causes chocolate blood and cyanosis of lips)assoc with methamoglobulenemia: Benzocaine, Chloroquine, Ciprofloxacin, Dapsone, Flutamide, Isosorbide dinitrate, Metoclopramide, Naphthalene, Nitrofurantoin, Nitroglycerin, Nitric oxide, Phenazopyridine, Phenelzine, Phenobarbital, Prilocaine, Primaquine, Quinine sulfate, Sulfonamides, Trimethoprim172- patient child use amphetamine what he have : ADHDPatient use Anticonvulsants drug what he have: Trigminal neuralgia

.Which medication to control excess of saliva on an IV patient with ketamine administration: Glycopyrrolate200. Which of those medications doesn't match with the disease?

a. Ganciclovir.... CMVb. Zidovudine with chickenpox c. Adamantine with influenza Aans b. for HIV

10- NSAID therapeutic effect1 reducing the production of prostaglandins 2 Cox inhibitors3 increase the production of prostaglandinsAns 2

42 -pseudomembranous colitis caused by clindamycin is 1 overgrowth of C. diff2 treated by IV metronidazolAns both are true. C.diff treated with metro and vanco

The platelet-aggregation blocking effect of aspirin is reversed only by the:A. NaHCO3 (asprin toxicity)B. Vit. K (warfarin)C. Protamine (heparin)D. Platelets (asprin)E. Hemodialysis (everything)ans D

Pt with myasthenia gravis, which antibiotics can you give: ErythroClarithroImepenemPenicillinAns: D

Treatment of glaucoma:PilocarpineBetaxololLatanoprostBimatoprostbrimodineAll of the aboveAns: all of above (diazepam is contraindicated, same with any muscarinic blockers)

13-The drug-receptor activity of naloxone is best characterized by which of the following pairs1 High affinity, No intrinsic activity 2 Low affinity, High intrinsic activity

3 No affinity, High intrinsic activity4 No affinity, Low intrinsic activity5 High affinity, High intrinsic activityAns 1

Burning mouth syndrome treatment: Capsaicin or antidepresantsanti tartar in tooth paste: tetrasodium pyrophosphatedesensitizing: potassium nitrite antiplaque: tricoslan

63- ginseng contraindicated with 1 Aspirin2 Penicillin3 ClindamycineAns 1 73- Antidepressant drugs mode of action1 blockage of amine reuptake2 Selective serotonin reuptake inhibitorsBoth are correct depending on what were talking about SNRI, SSRI, MAOI

74-patient has signs of opioid toxicity what u should give 1 aspirin2NaloxoneAns 2

92 - How many cartridge of LA 2% lidocaine u can give to child 45 lbs 1. 12. 3 3. 6 4. 9Ans 2 (3 cartridge )

Fastest acting LA?A - lidocaineB- ArticaineAns. B

119- Angioneurotic oedema is mostly occurs with which of the following LA A.ArticaineB.LignocaineC.prilocaineD.mepivecaine E.BupivecaineAns A

Most potent LA? Bupivacainecause of methemoglobinemia: prilocaine, lidocaine, bupivacaine, topical benzocainse** (tx: IV methelyne blue)toxicity of LA: IV injection or too much (biphasic response. Initially: tachy, HTA, confusion, tinnitus, metallic taste. Later: tremor, halluc, hypotention, brachC, seizure, resp/CV arrest)

NITROUS (blue cylinder)Nitrous oxide edverse effects: nausea (diffusion hypoxia)Contraindication of nitrous: 1st trimester prego (give promethazine), COPD, nasal congestion, collapsed lung, very nervous child, resp infectionIf nitrous abused:oxidizes the cobalt in vitamin B12, resulting in the inhibition of methionine synthase, can lead to peripheral neuropathymajor advantage of using nitrous oxide? Nitrous Disadvantage: vomiting, lack of potencyThe correct total liter flow of nitrous oxide-oxygen is determined by the amount necessary to keep the reservoir bag: 1/3 to 2/3 full.Nitrous oxide Total flow rate: 4-6 L per minFirst sensation from N2O: tingling of fingersDevice used in evaluation of N20? Pulse oximeterthe least person to get exposed from toxic effect of nitrous oxide? Patient (most staff)max nitrous given to children: 50%max nitrous given to adults: 70% (stop switch)

All of the following can be used in dental phobia except: .Nitrous oxide Anti anxiety oral med Sedatives drugsPositive reinforcement Tell show do techniqueRelaxationAns TSD (not nitrous for phobic pts) s.s

A 26-month old child w/ 12 carious teeth. How to treat? a. General Anesthesia b. Oral sedation c. Nitrous oxide d. local anesthesiaAns A

What true with concious sedation: 1.Patient should keep eyes open 2.Patient shouldn't fall a sleep 3.Patient should have defensive response 4.Patient should have verbal communication completely or all the time

fail-safe mechanism on an analgesia machine for nitrous oxide and oxygen prevents the delivery of nitrous oxide greater thanA- 20 percentB- 50 percentC- 70 percentD- 90 percentAns C

25 yo female breast feeding 12m old child and currently pregnant, which sedative ?• Halcion• Promethazine• Nitrous• Diazepam• Phenobarbital

A patient with mild sedative what do u expect regarding his response? Can not verbally communicateMaintain heart functionDoesn’t respond to touchLoss all normal protective response ans B

A patient with mild sedative what do u expect regarding his response? Can maintain his airway independentlyCan’t maintain his airy Can’t communicate verbally Ans AStage 1 of geudels stages of general anesthesia (amnesia and analgesia) is conscious sedation *best way to monitod is verbal response* (3 signs to indicate correct level of sedation reached verrills sign, slurring speech, burring vision)

ORAL SURGERY: Minimum platelet count for oral surgery: 50,000 (normal 150k-400k) Most common facial fracture nasal bone fracture, 2nd most mandibular fracture Mandibular fracture: most common condyle, angle, then body Most common mid face fracture: Zygomatico-maxillary Alveolar fracture, closed reduction: semi-rigid MMF/IMF splint for 4-6 weeks unless

(have callus formation unlike with rigid internal fixation RIF, no callous)a. condyle fracture: open/close reduction + IMF max 2 weeks or get ankylosis

after BSSO have internal fixation, but use occlusal splint for is 4-6 weeks Paresthesia in lower lip: Angle of mandibular fracture, after EXT, malignancy Lefort I fracture Guerin Sign (transverse maxillar): crepitus and ecchyosis in buccal

mucosa and greater palatine vessels region, (Lower midface, floating palate), open bite Lefort II fracture (pyramidal): periorbital edema, paresthesia of infraorbital nerve,

Subconjunctival hemorrhage

Lefort III fracture (naso-ethmoido-frontal complex, cranio-facial): same as above+ Subconjunctival hemorrhage+ Rhinorrhea ([CSF] leak into nasal cavity)

zygomatico-maxilary: flattening on cheek bones, same as above + May have limited mouth opening if interfere with coronoid process

blow out fracture “orbital fracture”: results in diplopia, eye looks down Bilateral Sagittal Split Osteotomy (BSSO): correct malocclusion of mandible, mandibular

retraction, mandibular augmentation or asymmetry. Worse complication: IAN paresthesia neurosensory loss (mostly to pull fwd but also back)*condyle not movesvertical ramus: specifically to put back**

Distraction Osteogenesis (DO): done in ant mandible, lengthen only not widen. Vs. BSSO DO done in young age, growth seen after, less nerve damage b/c 1mm activation per day, less time, less relapse, but more discomfort and more follow up

Correct bimaxillary Class III: Le Fort I + BSSO Worst place to do graft: Canine eminence, interdental Submandibular drain into what space: Deep cervical lymph nodes OS instruments: Forceps and elevators:

a. Maxillary: i. # 150: universal maxillay

ii. #286: max root tipsiii. #65: Bayonet: max rootsiv. #88: L/R molars, cowhorn

b. Mandibular i. 151: ant mandible, A: PM

ii. cryer elevator: Mand rootiii. #23: L/R molars, cownhorniv. #23 and 222 molars

c. #65 forceps, usually used for removing root tip d. Elevator acts as: Levers, engage below Alveolar crest

One side tissue suture: Interrupted (immobilize the flap, 2-3mm apart, 2-3 from free edge, from movable to non-movable, disadvantage takes more time)

a. Only do continuous on vermillion border Most to Least Frequent Impacted teeth: Mn M3, Mx M3, Mx C Easiest to extract Mn M3: Mesio-ang, horizontal, vertical, Disto-ang(opposite for MX)

a. Ideal time to remove when M3 root is 2/3 formed During extraction, which direction tooth should luxate: Child: Palatally, Adult: Buccally Most sever complication EXT: fracture of tuberosity (maxilla), IAN injury (mandible)

a. Tuberosity: fully ext, smooth boone, if attached mobilize w suture Most common complication of EXT: Bleeding (maxilla), infection, Trismus, *dry socket

(mandible), root fracture (during qx) Causes of Alveolar Osteitis (Dry Socket) cause: Active dislodgement of blood clot

(Fibrinolysis of the Clot, usually around day 3) smokers/oral contraceptivea. Symptom: trobbing pain, fetid odur, bad tasteb. Tx: Irrigation with Sterile solution & Medicinal/Sedative dressing every 48 hr, to

control pain: Analgesics. NO ANTIBIOTICS NEEDED, NO curettage EXT M3 and root displacement Mx: infratemporal space, Mn: submandibular space

Caudwell Luc Technique: removal of root tip from Max sinus, incision over canine fossa, we souldnt do it tho only oral surgeron

Biggest risk with EXT of a lone single (ankylosed) remaining MX M: Fracturing tuberosity/fracturing ramus

What order do you extract upper posterior molars & why? Order of extraction of teeth in maxillary molars: M3, M2,M1 to prevent fracture of tuberosity (max before mandible and most posterior teeth first)

Non-rigid splint is recommended for Subluxation, Luxation, Avulsion to avoid Ankylosis MADS blood supply to TMJ: maxillary, ascending, deep auricular, superficial temporal TMJ surgery there is risk of damage to: facial N Freys syndrome: auriculotemporal N damage (gustatory sweating, after parotidectomy) Type of X-rays to see Fractures:

a. Pano: best for mandible fractureb. Reverse towne: for condyle fracturec. SMV: zygomatic fractured. Water’s: for maxillary sinuse. CT: facial best of all***f. Sympisis: AP/ occlusal (symphysis closes at 6-9 months)

primary consequence of trauma to jaw in kids: retards growth and asymmetry (key signs are occlusal discrepancy)

lefort I surgery: maxillary sinus, nasal widening A 40 years old patient bilateral posterior crossbite. Tx? Surgery: Maxillary ostectomy

a. Cannot do rapid palatal expansion, this is only in child Infection of Mx CI/C: canine space, MX PM: max sinus, MX M2: buccal space MX3: infra Infection of Mn I: mental, Mn M3: submandibular or submassateric risk of infections in the face region? Anterior triangle cavernous thrombosis, veins with no

valves. (danger triangle from ophthalmic vein or facial) cavernous sinus thrombosis if canine space or deep temporal space is infected

for it to go to mediastinum: retropharyngeal

A displaced fracture of the mandible courses from the angle to the third molar. This fracture is potentially difficult to treat with a closed reduction because ofA- Injury to the neurovascular bundleB- Malocclusion secondary to the injuryC- Compromise of the blood supply to the mandibleD- Distraction of the fracture segments by muscle pullAns D (unfavourable fracture)

Fracture of which part of the face would compromise pt’s respiration?A) Fracture through the body of mandibular (bilateral)B) Fracture to condylec) Fracture to angle of mandbilateral mandible fractures may result in posterior displacement of the tongue resulting in airway obstruction.

ecchymosis in Floor of mouth after trauma:

a. Bilateral fracture of mandb. Ranulac. Body of mandible Ans 3. Coleman’s sign (guerlin sign for Lefort I)

Patient right eye is drooping, loss of sensation......what the possible area is fractured?A. Infra-orbital border of eyeB. Maxillary process of sphenoid boneC. Lateral border of maxillary sinusAns A: blow out fracture”

After, qx a mesial root tip on a molar extraction breaks, what’s the first thing you do? A. get hemostasis and visualize the root B. take an x-rayC. pick at it with root pickD. surgical retrievalans. A

Patient came to the office with Oro-antral fistula 6mm, 1 week after extraction. Treatment: buccal flap (if communicate at time of surgery less than 2 nothing, if between 2-6: suture, if more than 6 flap)

proper placement of a lower universal extraction forceps for the removal of tooth 4.6 involves placing the beaks of the forcepsA. as far apically on the tooth root as possible and applying apical pressure during luxation.B. on the lingual and buccal enamel of the crown and applying apical pressure during luxation.C. at the cementoenamel junction of the tooth and gently pulling upward during luxation.D. as far apically on the tooth root as possible and gently pulling upward during luxation.E. at the cementoenamel junction of the tooth and applying a rotational force during luxation.Ans A

Why smoking increases the rate of dry socket?A) reduced capillaries permeability B) reduced healing C) vasoconstrictive effect on blood vessels D) allAns C and B

Patient wants an implant, what the best INR level dentist should consider? INR procedures:EXT normal pt: 3.5INR pre-op (<2.5)o Aspirin: <100 mg/day: no changeo Aspirin: >100 mg/day: stop 5-7 days prior to surgeryo Plavix (Clopidogrel): talk to doct

o Coumadin (INR <2.5): no changeo Coumadin (2.5-4): physician consult, stop 2 days pre-opo Coumadin (4<INR): physician consult, stop 2-5 days pre-op, and check

A healthy person has an ANC between 2,500 and 6,000. ANC of <1000 no tX

Which local infiltration you give for maxillary premolar A. Endosseous Local Infiltration B. Paralingamental C. Transligamental D. SupraligamentalAns C (another name if innjected into PDL)

Amide anesthesia synthesize in plasma:a. Articaine-septocaine b. Azitromicynec. PrilocaineAns A

Surgical guide for all except:SizeAngulationLocationNumber of implantsAns D. number of implants will be given by CBCT or space available

After extraction of 8 what is the percentage of alveolar bone resorption? 1.10%2.40%3.80%4.100%ans 40Resorption of bone takes place in which direction after extraction? Max: up and inMandible: down and out (s.s)

31- In genioplasty surgery there is risk of damage to , in retromolar flap lingual N1 facial nerve2 lingual nerve3 mental nerve4 hypoglossal nerve Ans 3

Greatest risk to injure IA nerve on extraction of 3rd molars:Lack of visualization of end of roots

Root tips sit on top of mandibular canalHorizontal impactionans3

What could be least possible in differential diagnosis of unilateral pain over TMJ, headache , restricted mouth opening, 3 weeks after wisdom tooth extraction:1-TMD2-Neoplasm in mandibular molar region3-Cellulitis4-Infection of extracted socket5-Hemicranial headacAns 2

The most appropriate time to remove a supernumerary tooth that is disturbing the eruption of a permanent tooth isas soon as possible. (through palatal flap)after ⅔ to ¾ of the permanent root has formed. after the apex of the permanent root has completely formed. after the crown appears calcified radiographically.Ans A

how to make incision to remove mandibular tori? Intrasulcular incision if there’s teeth and least one tooth after for better accessibility, and if edentulous on alv ridge NO vertical releases needed (envelope)

In removing a torus palatinus, the practitioner inadvertently removed the midportion of the palatine process of the maxilla. One would expect to seeA- The nasolacrimal ductB- The inferior nasal conchaC- An opening into the nasal cavityD- An opening into the maxillary antrumAnd C (indicated in chronic irritation, denture, speech interference, place palatal stent to prevent hematoma formation and to support flap. Double Y flap is required for palatal torus)

A stent for palatal flap for what?A- Preserve flap displacementB- To eat patient normal food after surgeryC- To improve the nutrition of the flapD- Prevent the flap from thermal injuryAns A

In which of the following mandibular fracture cases should the intermaxillary fixation be released earliest?A- A high condylar fractureB- A fracture through the site of an impacted third molar C- An angle fracture and contralateral parasymphyseal fracture

D- A jaw in which the treatment has been delayed by the management of other injuriesAns A (muscles that up fractured segment up in condylar fracture are sling muscles and temporalis meanwhile lateral pterygoid of contralateral moves TWDS side of facture +contralateral open bite)

Lefot 1 include which of the following 1 Max sinus 2 orbit 3 zygomatic process Ans 1

Recurrent ranula treatment? 1. Marsupialization2. Flap surgery3. Removal of the ranula and part of sublingual glandans 3

after man 3rd molar extraction what may happen 1 parasthesia, trismus, infection 2. paresthesia, fracture, infection3 parasthesia, bone fracture, alveolar ostitis 4 bleeding, fracture, trismus Ans 1 (bleeding, infection, dry socket, Trismus)

Damage to the lingual nerve following a mandibular third molar extraction isA. preventable in most cases. B. not likely to recoverC. more frequent than damage to the inferior alveolar nerveD. too rare to inform the patient during consentAns A (never sever section the tooth completely and never do trough in lingual corex)

You extracted a tooth and gave penicillin. Next day pt has high fever, and dysphagia. What do you do? A)Add another drug2) change the antibiotics3) refer to OMFSAns: pt has Ludwig angina (submandibular, submental and sublingual spaces bilaterally) refer to OMFS for I&D

not involved in Ludwig's angina? 1 Sublingual space 2 Submandibular space 3 Retropharyngeal space 4 Submental space ans 3

Immediate Alveolar osteitis treatment: a. Chlorhexidine rinse at homeb. Irrigation on the area and sedative dressing c. Antibioticsd. Curetaje of alveolus ans B

Which of the following is the most likely cause of ankylosis of the TMJA- NeoplasmB- Rheumatoid arthritisC- Traumatic injuryD- Developmental abnormality ANS: C cause is trauma, most common complication of RA is ankylosis bilaterally

What do you use to evaluate a TMJ disc?CT Scan.PAMRI (Answer). (radiowaves)Antero-Posterior.

A patient has a skeletal deformity with a Class III malocclusion. This deformity is the result of a maxillary deficiency. The tx of choise is: A. orthodontics.B. surgical repositioning of the maxilla.C. anterior maxillary osteotomy.D. posterior maxillary osteotomy.E. surgical repositioning of the mandible.Ans B but if before age can do reverse pull head gear

What true with concious sedation: 1.Patient should keep eyes open 2.Patient shouldn't fall a sleep 3.Patient should have defensive response 4.Patient should have verbal communication completely or all the timeans 4

BISPHOSPHONATES:Oral bisphosphonates: Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel)IV: Pamidronate (Aredia), Zoledronic Acid (Reclast), Ibandronate (Boniva)MOA bisphosphonates: inhibit osteoclasts via apoptosisBisphosphonates indications: osteoporosis, bone metastasis, pagets, multiple myeloma or cancer metastasisRisk of BRONJ oral is increased as duration of oral bisphosphonate therapy exceeds: 3 yearsRisk of BRONJ for IV: 2 monthsif taking longer than 3 years with cortico: A 3 month drug holiday. surgeries and dental

implant placement should be avoided, and endo treatment should be considered before extractions osteoporosis bisphosphonates usually given usually orallybisphosphonate IV for 2 years absolute contraindication: for implant, EXT, orthobisphos half life of 10 years or longer

Biophosphonate1) are generally given in IV formulation for osteoporosis 2) have half life of 10 years or longer 3) at lest 12 weeks of exposure is one of the diagnostic criteria for BRONJ.Ans (for dx criteria of BRONJ: 8 weeks/2 months atleast)

pt needs full mouth EXT for denture, taking zaldendronate, how to treat?a) Do full mouth ext b) Ext questionable teethc) Refer to specialist? maybed) RCT and de-coronateAns: D (never EXT, maybe specialist)

Patient has BRONJ and bone is exposed, what is treatment? A) hyperbaric oxygenB) sc/rp C) chlorhexidine rinse and oral antibiotics D) allAns: C but depends on the stage Stage 0: no txstage 1: asym exposed necrotic bone tx: CLXstage 2: sympt exposed bone with soft tissue infection tx: CLX, antibiotics Stage 3: sym exposed bone, and fracture tx: CLX, antibiotics, debridement

Osteoradionecrosis and BRONJ:A. have identical pathophysiologyB. demonstrate similar clinical presentation.C. occur more frequently in the maxillaD. can be prevented by hyperbaric oxygen therapyans B

OSTEORADIONECROSIS

Osteoradionecrosis is above: 60+grays, ORN occurs in mandiblecause of ORN: hypocellularity, hypoxia, hypovascularity.Osteoradionecrosis pt indicated in EXT: Use Hyperbaric O2 for angiogenesis but prefered tx is Endo and decrown too

What is the first sign of damage after acute irradiationa- death

b-erythemac-hair lossAns B

Treatment of Osteoradionecrosis: A. Antibiotic coverage B. Conservative treatment including antibiotic coverage and resection of jaw segment. C. Conservative treatment with sequestrectomyans B

Osteoradionecrosis is mostly related to A. seen in maxillaB. seen in mandibleC. related to bisphosphonate useD. happens when radiation is 42.5GyAns B

A patient received radiation therapy and requires extraction, treatment be? A)extraction with alveoloplasty and suturesB)extraction with alveoloplasty of basal bone and sutureC) pre-extraction and post-extraction hyperbaric oxygenD) no extractionans C

IMPLANT

need 8mm of bone height in mand, in maxilla (need 10mm in length of implant)use CBCT for implant placement not pano (orthopantogram)

Implants- implant: 3mm, tooth-implant: 1.5 IAN- implant 2mm from IAN, implant-mental foramen 5mm Implant max sinus: 1mm high torque, low speed (max torque applied 35Ncm and max rmp of hand piece:15 rpm) irrigation: with saline** countersink implant: flaring or enlarging the coronal end of the osteotomy implant/ficture level impression: the impression coping/post attached to the implant abutment level: coping attached to abutment During the first stage of implant surgery: the implant fixture is placed into the bone, and a

cover screw is inserted. after healing, 2nd stage: is put healing abutment and test torque implant.

Healing period: Maxilla: 5- to 6-month Mandible: 3- to 4-month healing period In single-stage procedure: the implant healing abutment would be placed immediately, and

no cover screw would be utilized. Larger diameter implants offer greater surface area for osseointegration, thus provide

greater implant stability than height

Placement of an endosseous implant after grafted alveolar cleft should occur after a 4-month consolidation period.

In a 15 year old pateint, #8/9 fell out, can put implant b/c at age 12 vertical growth of maxillary bone complete.

If infection at EXT site must wait 1.5 months prior to implant placement If heat above 47 degrees, primary stability osteointegration fails Preload implant is comparable to: torque Biting load of denture comp to real teeth is 1/6 or 1/5 (less) implant analog definition: replica of entire dental implant, not intended for implantation

rather used in lab to fabricate abutment in lab, to pout cast with worst force to implants: horizontal Best anchorage for primary stability: D1 because its cortical Better vascularity and good primary anchorage: D2

a. Best bone for osteointegration? type 2 (D2) Best prognosis for implant?Anterior mandible (has D1 and D2) Worst prognosis for implant: post maxilla (D4 bone) function of internal connection between implant and abutment? Antirotation (internal hex

better, external hex unscrews) most common sign of failure: mobility max taper for o ring: 15

Minimum distance between 2 implants 1 .1mm2. 2mm3. 3mm4. 4mmAns 3

How much minimum buccolingual bone thickness needed for 4 mm implant 1. 5mm2. 7 mm3. 9mm 4. 11mm(There was no 6 mm option) Ans 2

How much distance from inferior alveolar canal and implant should be1. 1mm2. 2mm3. 3mm4. 4mmAns 2 (from mental 5mm)

55- How much distance from maxillary sinus and implant should be1. 1mm2. 2mm3. 3mm

4. 4mmans. 1 (from buccal/lingual plate, inf border, max sinus, nasal cavity) from natural tooth 1.5 (always add bone graft to sinus floor not to ridge)

Main reasons implants fail to integrate: A. premature loadingB. apical migration of junctional epitheliumC. overheating during placementD. loose fitting implantsE. smoker, alcoholF. radiationG. all of the above ans 7 all of the above

Why you put implants instead of tissue born RPD in lower arch which is opposite upper natural dentation1 to distribute the force2 to decrease bone loss3 to increase supportAns 2

two implants to support denture1. implant gives both support and retention 2.implant gives support, tissue gives retention 3 implant gives retention, tissue support4 implant gives retention tissue retentionAns 3 (4 implant min for maxilla, 2 for mandible)

Platform switching 1) typically refers to larger diameter implant and smaller diameter abutment2) requires less bone remodelling post abutment placement3) decreases risk of screw looseningAns A and B are correct

236. Where should you put implant platform in esthetic area? 1. At level of alveolar crest2. below opposing tooth gingiva3. 1mm subgingival to adjacent teeth CEJ4. 1-2mm above ans 3 (should be 2-3 mm below CEJ of adj tooth)

Cervical position while placing an implant, how should the implant be placed in relation to adjacent CEJ? I chose 2-3 mm apical the adjacent CEJ

most common reason why implant fail? A. Lack of primary stability

over heatingb. smokingc. qx errord. Does not osteointegrateans D (90% 10 year success rate of implants)

A fixed dental prosthesis that uses an osseointegrated implant as one abutment and a natural tooth as the other abutment is likely to fail due to which of the following?(1)There is difficulty attaining proper esthetics.(2)Obtaining a favorable path of insertion will be difficult.(3)The implant and the natural tooth will exhibit different mobility.Ans 3

Cervical position while placing an implant, how should the implant be placed in relation to adjacent CEJ: 2-3 mm apical the adjacent CEJ

When osseointegration occurs, which of the following best describes the implant–bone interface at the level of light microscopy following osseointegration?A. Epithelial attachmentB. Direct contactC. Connective tissue insertionD. Cellular attachmentans B. direct

in implant preparation, which of the following can be used? A) hydroxyapatite irrigation b) High-Speed Hand Piece c) Low torque Drill d) Saline Coolantans D

least likely to cause problems in OH:1) Open contact2) Overhanging restauration3) Ruematoid arthritis 4) Subgingival calculus

MOST COMMON IN TEETH/BONE

Most common impacted tooth: Mn 3, Mx M3, Mx C Most common congenital missing teeth: M3, MN PM2, MX LI (in primary LI)Most common occlusion in primary teeth: Edge to EdgeMost likely crowded out of mandibular arch: MN PM 2, from retention of primary Mn M2Most likely crowded/blocked out of maxillary arch: MX CMost common reason of maxillary tori removal: Prosthetic treatment (23% and woman)Most common permanent tooth have caries: MN M1 Least common: Mand incisorsMost common complication of extraction: Root fracture

Caries in radiotherapy patient mostly in: Cervical

Most common impacted tooth from the following1 max canine2 man 1st premolar 3 max lateral4 man canineAns 1

Most common congenital missing from the following1 max lateral2 man canine3 max premolars 4 max canineAns 1

RADIOLOGY Collimation: Control size & shape of X-ray beam, reduce area of exposure (reduce volume

of irradiated tissues), reduce amount of scatter radiation by 60%, Reduce x-ray beam size/diameter. Rectangular preferred * cant be bigger than 2.75 inches of pt face

a. Rectangular preferred: (lead) Filtration(aluminum): selectively absorbs low energy, high wavelength x-ray/energy

photons. (total filtration cant be more than 2.5 mm) Penumbra: the fuzzy, unclear area that surrounds a radiographic image

a. Larger Penumbra: Decreased CONTRAST, Decreased SHARPNESSb. Less Penumbra: Increased CONTRAST, Increased SHARPNESS

Sharpness Influenced by: Focal spot size, Film composition, Movement Reduce/Prevent Penumbra: Reduce Object-Film distance (X-ray should be parallel to long

axis of tooth and as close as possible), decrease Spot-Object distance (use 8 in PID), No MOVEMENT

Best revealing issue for prediction about Ossification: Hand wrist radiograph sinus/orbital rim: Waters (If waters is not option, then CT scan)

a. Mid facial fracture: Waters Zygomatic arch/Zygomatic fracture: SMV (Submentovertex) Mandibular fracture: Panoramic Condylar fracture: Reverse Towne Mandibular symphysis fracture, sialolithiasis in Wharton’s ducts: Occlusal

a. Mandibular Symphysis Fracture: Antero-posterior or pano Fracture of Angle, body, and ramus: Lateral oblique Errors in angulation:

a. Vertical: x-ray needs to be perpendicular to film & object (if too much angulation= foreshortening. too little angulation=elongation*elong more common) usually 8-10 degrees is needed (5-10 degrees)

b. Horizontal angulation causes distortion of image: Overlap, superimposition contactsc. Central ray not in middle: cone cut

Pano: If chin is down (steeper smile): max anterior teeth elongated & narrow, mandibular anterior teeth appear foreshortened & widen

a. If chin is to high (frown line): Max anteriors appear frowned foreshortened & widen Mand anteriors elongated & narrow (Reverse smile line/ positive occlusal plane AKA

PID length changed from 16 to 8 inch: beam 4 times intense PID length changed from 8 to 16 inch: beam 1/4 times intense Kvp: beam quality, ability for the beam to penetrate tissues, energy (quality & quantity),

Only Kvp and Filtration affect Contrast. mA: A beam radiation quantity, density & patient dose (quantity) to Increased contract and density in X-ray: increase Kvp, mA, exposure time, reduce obj-film Max permissible dose of radiation in a year:

a. Occupational: 5 rem/yearor 0.05sv/yearb. Dental professional: 5 rem/year, 50 msv/year, 4 msv/month, 0.8 msv/weekc. Non occlpational/prego assitant: 0.1 rem/year, 0.0001 sv/year

Radio-sensitive: Immature blood cells esp lymphocytes /bone marrow, Reproductive (#1), Intestine, Mucous Membrane

Radio-resistant: Muscles (#1), Nerves, heart, mature bone, salivary glands First thing that will happen after high dose of radiation? Erythema Horizontal fracture: Multiple vertical angulated radiographs (PA)

MRI which type of radiation 1 electromagnetic radiowaves2 ionizing radiation (UV, x-ray, gamma ray, light waves)Ans 1

Most readiosensitive to x-ray: Bone, muscle , Nerve or thyroid (mucous membrane)

When a radiographic examination is warranted for a 10 year old child, the most effective way to decrease radiation exposure is toA. use a thyroid collar and lead apron. B. apply a radiation protection badge. C. use high speed film (EKTA F-type is the best)D. decrease the kilovoltage to 50kVp. E. take a panoramic film onlyAns C primarily (ways to reduce pt radiation, speed films, lead apron, increase filtration, lead diaphragm in con, rectangular collimator, inc source fim distance, intensifying screens (used in pano and ceph) so if all of the above option, pick that

1 pano=2 bitewings

Sinus appears inferior to the roots of molars, which radiographic technique used?A- Periapical parallelB- Bisecting bitewingC- Parallel bitewingD- Periapical bisectingAns D

A higher kilovoltage produces x-rays with:A Greater energy levels B More penetrating ability C Shorter wavelengths D Increase in densityE AllAns: E. All. higher kilovoltage (higher kVp produces higher contrast scale too so more greys)

68-Why to wash film by water in the last step in processingprocessing: to remove excess chemicalspurpose of processing: gain latent image developer: turns all exposed areas to black metallic silver, last step restrainer: removing unexposed silver halide crystals to reduce fogfixing: stops developing.last step hardener: hardens gelatin, shortens drying time, protect filmfixing always twice as long as developingAns: 1

102 during panorama x ray Patient was moved for 1 sec what will happen1 horizontal distortion2 vertical distortions in the inferior border of mandible in this area when he moved 3 blurred all the film4 no thing5. the film was reversed (placed backwards) during exposure (will get herringbone effect)Ans: 3 if patient/cone moves during exposure its blurry, vertical distortion will happen if vertical angulation changes, horizontal distortation if head moves left/right

117- if you compare the radiation dose of the person working in a nuclear power plant and that of the dental assistant or whoever takes the x-Rey in the dental office, how much will the dosage of that person be?A. 1\10 of the nuclear workerb. 10 times of the nuclear worker C. 5 times of the nuclear worker D. 1\5 times of the nuclear workerAns A

In health, the crest of the alveolar bone, as seen in a radiograph, is situated 1~to~2mm apical to the CEJ. Radiographically, the normal alveolar crest should parallel an imaginary line drawn between the cemento-enamel junction of adjacent teeth. Both statements are true

What cannot be seen with a PA radiograph?A. Pterygoid hamulusB. coronoid notch/mandibular formaneC. mental foramenD. mandibular Canal

E. coronoid processAns B (notch cant be seen, cornoid process can be seen)

Filtration is used in dental x-ray machines to remove A- Scatter radiation photonsB- High energy electronsC- Long wavelength photonsD- Low energy electrons Ans C (Filtration is a mechanism where the low quality, long wavelength X-rays)

Crown - root ratio and residual support can best be test: A. Bite Wings film B. Panoramic C. PA film bisecting angle technique (bisecting angle reduces exposure time b/c use of short cone, but distorted)D. PA paralleling technique(paralleling technique shows less distortion, increase exposure time b/c long cone used)ans D

cephalometric doesn't show:a.ethmoid sinus b.sphenoid sinus c.maxillary sinus d.frontal sinusAns A (use ruler as magnification)

Identify Q: ear lobe, M:Coronoid process, O: stylohyoid (s.s)? N: angle, H: gosht image of contralateral mandible. K: dorsum of tongue. F: embrasure spot/black triangle Hyoid bone zygomatic process. Maxillary sinus, Identify the u shape in x ray: zygomatic process (u above 1st Mx M1)

DISEASE IN RADIOLOGY:

Soap bubble/step ladder appearance: Odontogenic myxomaSoap/honey: ameloblastomaHoney combed appearance: aneurysmal bone cystScoop out radioL: histiocytosis x/langerhansCotton wool appearance: Paget’s diseaseScalloped in Mn PM: traumatic bone cystGround glass appearance: Fibrous dysplasia (McCune with map of maine cafe au lait +hyperPTH+fibrous dyspl)Sunburst appearance: OsteosarcomaSwish cheese appearance histology: Adenoid cystic carcinomaGhost teeth: regional odontodysplasiaGhost cells: Calcifying odontogenic cyst/gorlin cystRadiolucency like dentigerous w snowflake around Mx C: Adenoid odontogenic tumor AOTRadiolucency around crown: Dentigerous cystRadiolucency with driven snow calcification: CEOT/pindborgAsymptomatic radiolucencies and transform radiopacities: Cemento-osseous dysplasiaSequestered bone seen in Xray: Osteomyelitis

Multiple myeloma: punched out radiolucency

PEDIATRICDental lamina forms at 6w but teeth begin to calcify 2nd trimesterDuring initiation: supernumerary (most in Mx anterior mesioense), agenesis (least Mx canine)During cap stage (proliferation): fusion (in primary, 2 Root, tooth count 1 less), germination (1Root normal tooth count), odontoma, dense in den (permanent MX LI), cystduring bell histo : AI, DI bell morpho: peg lateral, macrodoncia, taurodontism, concrescene, dens evaginatusDuring apposition: enamel hypoplasia, pearls, concresenceDuring maturation and Calcification/mineralization: Fluorosis(enamel), tetracyclin(dentin)thickness of coronal dentin in primary teeth, compared with permanent teeth: ½thickness of coronal enamel in primary teeth, compared with permanent teeth: s.s…Most common class for pedo: flush terminal (will turn to edge to egde or class I)If distal terminal: most likely class IIIf mesial terminal: most likely (class I or III)after tx of child, most common: traumatic lip injurythe difference between the dimensions of primary C&D&E and permanent canine+ first and second premolars? leeway space (mandibular 5mm, maxillary 3mm)the most critical primary tooth to be lost? 2nd molar which type of growth menarche related to? skeletal or dental or .. cant remember other options .. i picked skeletal s.s???Most common cause of sealant failure: moisture Sealant retention: micromechanicalCommon reason amalgam fails: inadeqeuate depthHow many permanent teeth does a 9 year old have in the mouth. 9-12 Child LA dose= Child'sweight (lb)/150(lb) x Adult dose.APF percentage – 1.23%HHS recommends fl- level to be at 0.7mg/L but EPA: max 4mg/L (usually b/w 0.7-1.2)Lethal dose fluoride in adult: 2.5-10g (4-5g)Lethal dose fluoride child: 5 mg/kg (500mg)Fl community (74%)If indicated, minimum age to prescribe fluoride: 6months until 16 years

When determining the appropriate dose of systemic fluoride supplement for a child, it is MOST important for the dentist to consider which of the following

a. The fluoride content of the drinking waterb. the child’s diet and caries activityc. the child age and the fluoride content of the drinking waterd. the child’s weight and the fluoride content of the drinking water.Ans c

What is the optimal average amount of fluoride, in ppm, for public drinking water of most communities?A- 0.5B- 0.7C- 1.0D- 1.5Ans B ( 74% of communities are flurodated)

The optimal concentration of fluoride for community, water depends upon:A) the proportion of residents who are children.B) temperature of the air.C) caries rate of the total population. Ans B cold climate: 1.2 ppm, warmer climate: 0.7 ppm

RQ Recent tests have shown that out of the following one is the most effective:A. Apf 1.23% for 25 secs B. Fluoride mouthwashC. Sodium fluoride gel tray for 1 min D. Fluoride varnishAns D

What is the difference between treating an odontogenic infection in children and adult?Children more bleeding tendencyChildren more at risk for leukocytopeniaMore likely to dehydrate

For incipient caries what do you recommend?-varnish (25% lowered)-silver amide fluoride-compositeAns A (if sealant there better 70% lowered caries risk)

Child has history of generalized growth failure (“failure to thrive”) during first 6 months of life, following dental sequelae: A Enamel hypoplasia B retrusive mandibleC retrusive midfaceD small permanent teethans A (Crown calcification of permanent teeth begins at birth (first molar) and between 3-12 months for the anterior teeth.)

129- Most common location for caries in a 4 year old child? a. Distal of mandibular m2b. Mesial of mandibular m1 c. Distal of mandibular m1d. Distal of mandibular canine Ans C (distal of primary MN M1 and mesial of MN M2)

In attempting to correct a single tooth anterior crossbite with a removable appliance, Which of the following is the most important for the dentist to consider?A- Making periodic adjustmentsB- Incorporating maximum retentionC- Patient’s overbiteD- Making sure there is adequate space(fixed appliance with finger spring appliance do it ASAP during mixed dentition)

Superficial decalcification and staining are evident in the buccal groove of a mandibular molar. Which of the following is the treatment of choice?A. Oral prophylaxis at 3-month intervals b. Daily irrigation with pressurized waterC. Complete elimination of the area by preparation and restorationD. Enameloplasty, limited to the superficial depth of the decalcified enamelAns D

permanent tooth bud is accidentally extracted while removing a primary molar, a. Immediately placed back on the crypt, b. throw it away and inform the parents c. othersAns A

5. What to make sure to do in Pedo anesthesia?a. aspirate and administer anesthetic slowelyb. administer only one cartridge c. othersans A (limit of lido 4.4mg/kg)

if you give 1 carpule and kid starts feeling agitates: Intravenous adminAllergic to anestheticAllergic to epinephrineANS a

Which of the following accounts for the main cause of failure of replanted teeth?A. AnkylosisB. InfectionC. Pulpal necrosis

D. internal resorptionE. external resorption or inflamm sameAns E

What determines the level of a class II gingival seat on primary tooth?1.Based on the Contact of the adjacent tooth2.axial depth3.Gingival papillae4.Marginal gingivaans could be a or 2?

All of these reasons are why you keep mand 2molar in mouth that’s ankylosed as long as possible except:A Mesialization of per 1mB Distalization of pm1C Supraeruption of opposing toothD Maintain bone widthAns B

The late mesial shift of a permanent first molar primarily the result of closure of:A. CanineB) Leeway (occurs when you loose E)C) PrimateD. ExtractionAns B (early mesial shift is when permanent M1 erupts because of primate space)

45- 4 years child Primary central intruded 5 mm what to do 1 ortho pull2 surgical extract3 let re eruptAns 3 (if specifically says its touching tooth bud, then EXT according to DD)

A 6 year old patient has an intrusive injury to tooth 5.2 All of the following are possible sequelae to the permanent successor EXCEPTA. enamel hypoplasia. B. root dilaceration. C. delayed eruption.D. ectopic eruptionAns A because by age 6 Cr formation already formed.

3 years old comes to have what do you see:A. Plaque and pellicleB. NothingC. BacteriaD. Nasthmiyh

Ans D

The permanent first molars of a 7 year old patient have pronounced, deep occlusal fissures that are stained. Bite-wing radiographs show a normal dentino-enamel junction. The most appropriate treatment isA. conservative amalgam restorations. B. glass-ionomer restorations. C. application of pit and fissure sealants. D. topical fluoride application. E. observationans C

Among the following which is the best material to obturate the primary tooth in pulpectomy?A. Caoh2B. ZoeAns. Primary B ZOE so that it reabsorbs (A if permanent for apixification)

132- A radiograph of a 4-year-old child reveals no evidence of calcification of mandibular second premolars. This means that1. these teeth may develop later.2. the child will probably never develop second premolars.3. it is too early in life to make any final predictions concerning the development of any permanent teeth4. extraction of primary second molars should be performed to allow the permanent first molars to drift forward.Ans 1

Five hours ago, a 12-year-old boy fell and fractured his maxillary right central incisor atthe level of the gingival tissue. The exposed pulp is vital. For this tooth, tx:A. Pulp capB. ExtractionC. PulpotomyD) complete root-canal treatmentE. Pulpectomy and placement of calcium hydroxideans D

The success of a pulpotomy for a primary molar depends primarily upon:A vital root pulpB. the patient's age.C the amount of root resorption:D. the absence of internal root resorption.

14 yo has a good oral hygiene, lives in community fluoridated area. For prevention of future caries what should be instructed:A better oral hygiene

B placing sealants in all 4 1st molars, C fluoride gel placement by pt daily, D fluoride rinse daily after brushing.ans: D (fl- until 16yr most effect, sealant from 6-12.5)

14 yo she has a little brown discoloration in her mandibular 1st molar occlusal pit and fissure, with an explorer catching on it, you should:A place sealant over B preventive resin restoration C amalgam,D no treatment at this time.Ans: B (if she was 12, I would put A)

the MOST crucial element in sealant retention is: a. depth of fissures b. number of pits c. moisture control during placement d. type of sealant (light cure vs self cure) e. length of curing timeAns C

Q. Which of the following shows 200% of its adult growth by age 9-10 years?A. Lymphoid B. GeneralC. GenitalD. NeuralAns A

9.5 year old child has a white spot on the facial surface of permanent maxillary central incisor. Condition is due to: 1. hypocalcificaion secondary to trauma to primary dentition 2. Hypoplastic defect secondary to systemic infection at 6-12 mnth of age 3. disturbance during morphodiferentiation stage of tooth development4. hypercalcified enamel secondary to increased ca uptake into tooth at 6-12 month of age ans 1

84- 11 years old child with buccal erupted canine what to expected to see 1 gingival Recession2 anterior deep biteAns 1

The radiographs of a 9 year old with tooth 1.1 completely erupted and tooth 2.1 unerupted reveal a palatally located mesiodens. The most appropriate management is toA. monitor the eruption of 2.1 for another year. B. uncover the mesiodens, wait for eruption and then extract it. C. extract the mesiodens and allow passive eruption of 2.1.

D. extract the mesiodens and orthodontically extrude 2.1Ans C (remove mesiodense with a palatal flap)

to test newly erupted tooth: cold?

Case with pulpal necrosis after trauma on completed root formation tooth, treatment to doa. Apexificationb. Apexogenisisc. pulpotomyd. Pulpectomy(thisone)

80. Same question above but with incomplete root formation? Apexification

ORTHODONTICS

1. space for eruption of MN molars is due to: resorption of ant border of ramus2. Epiphyseal plates? Synchondrosis3. 191 which class: class 2 div 1 (me, kan is 2.2)4. Temporary anchorage device (mini implants in ortho) can be transosteally,

subperiosteally, or endosteally in intraalveolar or extraalveolar. Use: to move teeth then removed after tx complete

Orthodontic uprighting of a mandibular second molar that has tipped mesially into the space of a missing mandibular first molar in an otherwise intact dentition may result inA. decreased overbite B. intrusion of the mandibular second molarC. extrusion of the mandibular second premolarD. initial mobility of the mandibular second molarE. development of posterior crossbiteAns A

What happens if there is premature exfoliation of mandibular primary canine?a. need space maintainerb. shift of midline to affect sidec. mandibular incisors move distally and linguallyd. decrease in arch lengthans. B (tuft) but if ALL of the above, go with that (because needs lingual arch, C is correct from dentin and decrease in arch length too)

pt with maxillary arch constriction of 3mm and a posterior cross bite. What will you see? A. Normal midlineB. Midline shift towards the unaffected sideC. Midline shift toward the affected sideans. C (midline shifts twds affected side but functional shift away from affected side)

Vertical bone loss in ortho T/F

Heavy force, pulling with large movementLight force, pulling with large movementHeavy force, pulling with small movementAns C

What happens with inter-canine distance after mixed dentitiona. increasedb. decreasedc. stable, no changeAns.C increases during mixed dentition then stabilizes)

Orthodontic correction of a maxillary midline diastema is most appropriate in a/anA. 8 year old patient without a thumb sucking habit. B. 14 year old patient without a thumb sucking habit. C. 8 year old patient with a thumb sucking habit. D. 14 year old patient with a thumb sucking habitans B (correct diasthemas only when canines are out)

When do you do serial extractions? A. For space deficiency in maxilar anterior regionB. For space deficiency in max posterior region C. For space deficiency in mand anterior regionD. For space deficiency in mandíbular posterior regionAnd. C (I thnk A and C)Serial extraction required: For sever arch length descripancy (more than 10mm in Bolton analysis) in mixed dentition. Done in both Mandibular symphysis fuse/closed: 6-9 months

Serial extractionA. involves the 4 permanent first premolars. B. is the treatment for Class II skeletal malocclusions with severe space shortage. C. is commenced with bilateral expansion of the arches. D. is best suited to Class I dental and skeletal malocclusions with minimal space shortage. E. requires leeway space maintenance

The space for the eruption of permanent mandibular second and third molars is created by the:A. apposition of the alveolar process.B. apposition at the anterior border of the ramus. C. resorption at the anterior border of the ramus.Ans C

When a simple tipping force is applied to the crown of a single-rooted tooth, the center of rotation is locatedA. at the apexB. at the cervical lineC. within the apical half of the rootD. within the cervical one third of the root.

Ans yuri says D (group says C) check

The Frankel functional regulator appliance performs all of the following EXCEPTA. increasing vertical dimension. B. repositioning the mandible forward. C. retraction of the maxillary molars. D. expansion of the dental archesANS A (asked yuri, check learn understand)

46- In forced excursion of central incisors u pull it: 1. 1mm in 1 week2. 2mm in 1 week3. 1mm in 1 month4. 2 mm in 1 month Ans 1

76-Which is hardest to maintain space missing primary 1 max 1st molar in 7 years2 man 1st molar in 6 years3 man 2nd molar in 5 yearsAns 3

109 - scaring from the electrical burn, never treated and it is in the corner of the mouth, what will happen? A. arch length discrepancy B. impacted tooth C. decrease VDO D. labial inclination of teethAns C.

The advantage of external split over internal?RigidityDurabilityConservative to the tooth

Patient wants an implant on space between teeth but not sufficient enough space for implant. Dentist provided coil spring to create space. What type of movement a) intermittent forceb) continuous forcec) interrupted forceAns B

33 years old Male Fat Patient had septal deviation suffer from sleep apnea, which one of the following is NOT related to sleep apnea1. Patient gender2. Patient age

3. obesity4. Septal deviationans. 2

Class III patient: which of the following is not helpful in establishing whether pt has retrognathic maxilla or prognathic mandible? A. photographs B. study models C. ceph analysis D. clinical examinationAns. B (don’t show relation of jaws, just dento alveolar)

Which of the following is NOT true regarding orthodontic tooth movement?A- Blood flow within the PDL is altered after force applicationB- Pulpal tissue activates a neural responseC- Chemical changes in the compressed PDL stimulate cellular differentiationD- Oxygen tension is increased in some areas of the PDL and decreased in other areas.ANS: B

An 8-year-old patient has a permanent maxillary first molar extracted because of caries. The best approach to prevent malocclusion is to:1. place a space maintainer. 2. wait for the second molar to erupt and drift mesially into the space.3. extract the mandibular first molar to equalize the tooth-size ratio.4. extract the contralateral maxillary first molar to maintain arch.symmetry

185- diagnosis : reticular Lichen planus

186 – diagnosis : Florid cemento osseous dysplasia

187- Diagnosis antral pseudo cyst

MALIGNANCY of jaw will make: 1) Tooth displace2) Root resorption3) Cortical expantion4) Cortical destruction

Informed consent can have all of the following EXCEPT: A) Informed consent mustbe presented in advance of the treatment. B) Informed consent must contain treatment options.

C) Informed consent must be in written form. D) Informed consent must contain risks and benefits of the treatment

analysis of a study is ina. methodb. discussionc. conclusion

DAY 2:

https://www.aapd.org/media/Policies_Guidelines/BP_CariesRiskAssessment.pdf

cephalometric analysis: to check profile must use soft tissue (point Sb-subnasale and Pog’)rule is for magnification and ethmoid sinus is only one that cannot be seen (frontal, maxillary and sphenoid are identifiable)

For LAP: give metronidazole. For endo: pen V, amoxi, augmentin, clinda, metro, clarithro, azithro, doxy but lots of resistance (not ceph, not erythro, no Cipro and def NOT mino)

Smoking pt: pharma: Buspirone or Chantix

If pt is taking antibiotics and needs prophylaxis, we give them from another category

In which cases do we treat with conscious? In which with NO2 and in which with tell show do?

Bad taste of drugs? a)Xanax; b)aspirin c)fosamax d)some beta-blockerMeds cause Bad taste: Metronidazole, Chantix, Carbamazepine, ACE inhibitors, clarithromycin

When to premedicate:extractions, periodontal procedures. (surgery, SRP, probing, and recall maintenance), implant placements of avulsed teeth, endodontic (RCT) instrumentation of surgery ONLY past the apex, subgingival placement of antibiotic fibers/strips, initial placement of orthodontic bands (not brackets), intraligamentary local anesthetic injections, prophylactic cleaning of teeth or implants where bleeding is anticipated. Sulcular (PDL) injection (because bacteria filled sulcus can cause bacteremia)

NOT to premedicate:Restorative Dentistry: with or without a retraction cord, local anesthetic injections (non- intraligamentary), intra-canal RCT, post and core placement, placing rubber dams, post-operative suture removal, placement of RPD and orthodontic appliances, impressions, fluoride treatments, radiographs, or shedding of primary teeth.

ASAhttps://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system

Bacteria causing SABE: alpha hemolytic, viridans streptococcal organisms, including Streptococcus mutans, S. mitor, S. salivarius, and S. sanguis.

Absolute Implant Contraindications: recent MI or CVA, valvular prosthesis surgery, immunosuppression, hemostatic issues that impair normal healing cascade, active malignancy treatment, drug abuse, psychiatric illness and IV bisphosphonates.Relative Implant Contraindications: osteoporosis, smoking, uncontrolled diabetes, alcoholism, + interlukin-1 genotype, HIV positive, cardiovascular disease, hypothyroidism, post-irradiated mandible or maxilla, and poor oral hygiene. girls before 15, boys before 18