Oral Path



Oral Pathmost closely resembles normal parotid gland histologically – pleomorphic adenoma (meta to bone or lungs; sessile lesion)Needle aspiration from a cyst should be put into: sodium tetraborate decahydrateNatal teeth: at time of birth (common – primary mandibular incisors)Most often natal and neonatal teeth are: primary teeth and should not be extracted unless aspiration is a concern Dental lamina is formed at: 6 weeks of intra-uterine lifeWith the exception of third molars, the crowns of all permanent teeth are completely calcified at the age of: 4-6 yearsFirst permanent molar shows calcification during - 2nd postnatal monthThird permanent molar begins calcification around: 8 – 9 yearsAt birth which teeth are already calcified: all deciduous teeth and all permanent incisors (total 24)Primary ToothCalcification Start DateCentral incisors14 weeks in utero1st molars15 weeks in uteroLateral incisors16 weeks in uteroCanines17 weeks in utero2nd molars18 weeks in utero Permanent ToothCalcification Start Date1st molarsBirth All anterior teeth except maxillary laterals6 months Maxillary laterals12 months1st premolars18 months 2nd premolars24 months 2nd molars30 monthsCalcification of primary teeth in general occurs: during second trimester in uteroIn general, which permanents have begin to calcify when a child is 12 months old: central, lateral, cuspids and first molarComplete mineralization after: 3 monthsPremolar teeth calcify at birth: NoPt has 12 primary teeth & 12 permanent teeth, what the patient’s age? 8.5 yrs. oldApical root closes: 2 ? - 3 ? years after eruptionAt what age does fluorosis of anterior permanent teeth occur? 4-6 moWhat age does fluoride get incorporate into primary dentition: 4 months in uteroIncisors start calcification: 16 weeksFluorosis is the result of excessive systemic fluoride during which stage of toothDevelopment: calcificationDuring which stage of tooth development is the cariostatic effect of fluoride manifested: calcification PDL is from: dental sacTrue about mantle dentin: First formed dentin and has collagen fibres that run perpendicular to DEJRate of formation of dentin: 1mm every 6 monthsBilateral swelling of parotid cannot be caused by: AnorexiaSymptom of actinic cheilitis: loss of vermilion borderWhat is hunter-schreger line: alternating white and dark lines in newly erupted toothOMAs are bening except sarcomaSwallowing difficulty, which nerve: GlossopharyngealSplit papule on lower lip: mucous patchMalignancies most commonly metastatic to jaws: adenocarcinoma of breast, prostate and colon; carcinoma of lung and kidneyCalcification of permanent teeth starts at 3-4 months EXCEPT maxillary lateral incisor at 10-12 months!Primordial cyst (OKC) develops from: developing tooth budPosterior involving ramus: CPAM (cherubism, Pindborg, Amelo, Myxoma)Pindborg/Calcifying epithelial odontogenic tumour: Polyhedral epithelial cells, amyloid, Liesegang ringsAnterior to 6 & 7: CGCG, ABC, SBC, BrownMandibular ridge looks white and beaten up, why? Stratum corneumResidual cyst develops after: tooth extractionMandibular 3rd molars are the last to calcify at: 8-10 yearsRoot completion of primary teeth: 18 monthsAll primary teeth begin calcification IN UTERO and end after 10 monthsComplex odontoma location: posterior mandible (compound: anterior)Hand foot lesion caused by: coxsackieTalon’s cusp is: Dens EvaginatusSigns or symptoms suggest a chronic benign process: sclerotic bony marginsCauses of Verrucous xanthoma? Human papilloma virus (Xanthoma – fatty deposits under skin)Reactive lesions of the gingival tissue reveals bone formation microscopically: peripheral ossifying fibromaEctopic lymphoid tissue would most likely be found in: floor of mouthPrimary teeth formation6 weeks in uteroPermanent teeth formation4 months in uteroDiscoloured teethPorphyriaPurplish-red-brownCystic fibrosisYellowish-brownE fetalisBlue-greenishConditionChromosomePeutz Jegher SyndromeMutation of stk11 gene location on 19Van Der Woude (clefts and lower lip pits)1Cherubism & DI4Marfan (defect in fibrilin)15Osteogenesis imperfecta19Fibrous dysplasia20Cystic fibrosis7Porphyria diagnosis: red urine, sensitivity to sunlight (blisters on sun exposed areas)Kissing lesion: median rhomboid glossitis or long standing candidiasis (lesion on palate same as tongue)Recurrent herpes is confined to: attached gingivaRieger syndrome: delayed sexual development and hypothyroidism, hypodontia, underdeveloped premaxillary area, cleft palate, protruding lower lip.White spongy nevus onset: before puberty; hereditary; bilateralPathological features of radicular/periapical cysts: epithelial lining, fibrous capsule, Rushton bodies and cholesterol cleftsField cancerization: development of multiple mucosal cancers (when patient with oral carcinoma develop additional mouth or throat malignanciesShow the greatest variation in time of calcification: Permanent mandibular PM2BEST the morphology of periodontal ligament fibres: wavyMost strongly implicated in the cause of aphthous stomatitis? Human leukocyte antigensMandibular hypoplasia, short soft palate, anterior open bite, coloboma of the lower eyelid, and malformations of the pinna of the ear are fracture of which of the following diseases? Mandibulofacial dysostosis (Treacher Collins Syndrome – fish/bird face)Dryopthicus = mandibular M1 (6 cusps!)Cementoblastoma: radiolucent rim around radiopaque mass; posterior mandible; teeth are vitalOccult lesion: not easily detected; best way – histology/MRILesions with multinucleated giant cells: aneurysmal bone cyst, CGCG, hyperparathyroidism – brown tumor, paget’s, cherubism, Langerhans cell histiocytosis – ABCC-LPTraumatic cyst is more commonly seen with: florid dysplasiaMost common site of osteofibrosis (cementoma): Mandibular anteriorsHereditary Benign Intraepithelial Dyskeratosis (witkop’s): Like WSN, but in EYES (conjunctiva)Features of Ramsey Hunt Syndrome: Caused by HZ, facial nerve damage (7) and hearing loss on affected side (8)Ganglion in Ramsey hunt: GeniculateMelkersson Rosenthal syndrome = facial paralysis, chelitis granulomatosa and SCROTAL or fissured TONGUETriad of hand-schuler-christian disease includes: lesions of bone, exophthalmos and diabetes insipidusAtrophy of gastric and pharyngeal mucosa, spoon nails (koilonycias) and predisposal to oral carcinoma in postmenopausal females: Plummer Vinson syndromeMenopausal changes are associated with: burning mouth syndromeTx of burning mouth syndrome: capsaicinMetronidazole rarely causes: Steven Johnson syndrome (Disease of skin and mucous membrane, begins like flu-like symptoms, top skin layer dies and sheds off, burning eyes)All associated w/ perio problems except: Stevens Johnson syndromeOther names for Stevens-Johnson syndrome: Toxic epidermal necrolysis or EM majorTrigger for stevens-johnson syndrome: drugsKeratin plug in the middle of the ulceration, lower lip: KeratoacanthomaLesion looks like SSC, but disappears in 16 weeks: keratoacanthoma (skin ca)Stratification specific keratins present in gingival epithelium are: K5 and K14Enamel hypoplasia is seen in: type 1 AITB in the oral cavity: large ulcerHerpes can be diagnosed by: exfoliate cytologyEagle’s syndrome: Stylohyoid ligament calcificationMonomorphic adenoma: Oncocytoma, basal cell adenoma, myoepithelioma, canalicular adenomaMonomorphic adenomaUpper lipBasal cell adenoma & OncocytomaParotidDentin dysplasiaNo CEJ constriction; absent pulp chambersDentinogenesis imperfecta (most common genetic disorder) – rapid attrition of enamelCEJ constriction; scalloped DEJ; obliterated pulp chambers; tulip shaped on x-rayDI 1Associated with OI; pulp space obliteratedDI 2Not associated with OI and only teeth are involvedDI 3Bradywine type – periapical radiolucencies, shell-like appearance & large pulp chambersPrimary canineLonger mesial cusp ridgePermanent canineLonger distal cusp ridgeMost common ectopically erupted toothMaxillary first molarLargest primary toothMandibular second molarLargest permanent toothMaxillary first molarSmallest permanent toothMandibular central incisorSmallest primary toothMandibular lateralLeast likely to be missingCanineMost retained primaryMan first molarMost congenitally missing primary toothMax lateralGreatest occlusal forces are found in: second molar region (because the jaw acts like a class II lever, so the highest force will act on the most posterior region)Tx of ectopic eruption of a permanent maxillary M1: brass wire separating deviceHigh incidence of accessory canals: maxillary second premolarTreacher Collins Syndrome (mandibulofacial dysostosis)Zygoma hypoplasiaCleidocranial dysplasiaClavicleFailure of tubercular impar to retract prior to fusion of lateral halves of tongue result in: median rhomboid glossitisFolate papilla enlargement and atrophy of filiform occurs in: median rhomboid glossitisNeonatal teeth + ulcer on the tongue: Riga fede diseaseHerpes simplex (lipschutz bodies and Tzank smear): Chicken poxDifferentiate between herpes zoster and simplex: fluorescent antibody testTzank cell or acantholytic celllPemphigusTzank testIdentification of herpesHerpes whitlow is caused by: Herpes simplex virusTx of eruption cysts: deroofingSoft tissue variant of dentigerous cyst: eruption cystOral sign of oral mononucleosis: palatal petechia, sore throatPetechiae< 3 mmPurpura> 3 mmLymphadenopathy with swelling but no pain is in: AIDS and mononucleosisJunction between primary and secondary dentin is: resting lineStriations are seen more on a: hypocalcified enamelRing like enamel hypoplasia: erythroblastosis fetalisRH hump: green or blue hue seen in teeth of erythroblastosis fetalisOsteoblast covering the periodontal surface of the alveolar bone constitute a: modified endosteumMucus extravasation phenomenon (mucocele)Lower lip (due to trauma)Mucus retention cyst – Ranula (true retention cyst)Floor of mouth (due to mucous plugs)Tongue innervationAnterior 2/3rdSensory: lingual branch of V3Taste: Chorda tympani branch of facial nervePosterior 1/3rdSensory and taste by glossopharyngeal (9)Posterior mostMotor: hypoglossal (12); except palatoglossus which is supplied by pharyngeal branch of Vagus (10)Non-collagenous protein in the basement membrane: lamininProminent sign of cancer: ANAPLASIA (loss of differentiation)Malignant potential of erosive LP: 17%Onion skin pattern: Garre’s “chronic” osteomyelitis (proliferative periositis) and ewing’s in childrenWhat is ewing’s sarcoma: round cell malignant radiolucency in childrenSoft tissue counterpartLateral periodontal cystGingival cyst of adultCalcifying odontogenic cystCalcifying epithelioma/pilomatrixomaFlorid COD most likely associated with osteomyelitisSalt and pepper type pattern or ghost cell keratinization: calcifying odontogenic cyst (COC) or gorlin cystTriviaCherry blossom – fruit laden branchless tree or mulberrySjogren’sGhost teethRegional odontodysplasiaHair on endThalassemia and sickle cellEnlarged marrow spaceSickle cell anemiaFloating teethEosinophilic granuloma or Langerhans XLeafless treeSialdenosisWhat do you see in histiocytosis X: triad of exophthalmos, lytic bone lesions and diabetes insipidusWhich does not cause scarring of oral mucosa: Erythema multiforme (+ve Nikolsky sign)Positive nikolsky sign: pemphigus vulgaris and erythema multiforme – majorEM – minor is associated with: herpes simplexCoast of Maine like border (café au lait spots) is seen in which pigmented lesion: McCune Albright syndrome (polyostotic fibrous dysplasia)Unique about monostotic fibrous dysplasia: asymptomatic and completely accidental findingOral chancre (primary) resemble: apthousHunter Hurler: disorder that results in buildup of large sugar molecules called GAGs or mucopolysaccharides in lysosomesWhite spot on mandibular molar is due to: early decalcificationWhite spot enamel demineralization: low or uncertain progressSingle white spot lesion on a permanent tooth due to Hypercalcification due to flouride intake Varicose tongue: elderlyGrinspan syndrome: DM + HTN + Lichen PlanusConditions that resemble lichen planus histologically: cinnamon reaction, graft-versus-host disease and lupusPlasma cell gingivitis: swelling of attached gingiva due to an allergen - cinnamonSaw-tooth rete pegs seen in: Lichen PlanusNegative nikolsky: Lichen planusHep C (RNA virus) is associated with: Lichen PlanusT lymphocytes target and destroy what in Lichen: basal keratinocytesHep C (milder than A/B) is associated with: chronic liver disease, hepatocellular carcinoma and the # 1 cause of liver transplantation in USHep with no vaccine: CCivette bodies are found in: Lichen PlanusLichen planus target: T-lymphocytesLoss of rete pegs: pemphigoidRete pegs found in: free gingivafactors does NOT impact the development of xerostomia in an aging population? Chronological ageDentin dysplasia (rootless teeth): both teeth affectedDD type 1 (greater resistance to caries) – radicular – lava flowing around bloulderObliterated or chevron or crescent pulp; PA lesions; short root; both teeth look normal in shape; primary teeth severely affectedDD type 2 - coronalEnlarged pulp or thistle shaped; shell teeth; No PA lesions; pulp stones; primary teeth resemble DI; permanents are normalDI 1primary > permanent, obliterated pulp, short roots, excessive CEJ constrictionDI 2No OI; same as 1DI 3 (only Maryland?): shell teethBrandywine type; pulp exposure, PA lesions; bulbous crown and short rootsPapule: pulipiriHeck’s disease: Cutaneous condition characterized by white to pinkish papules that occur diffusely in the oral cavity, caused by HPV 13 & 32. Also known as focal epithelial hyperplasia.Misused as a biological warfare agent: Q feverPatient with lower complete denture, has pain in mental foramen region. Possible reason: neurofibromaThe Schwann cell is the cell of origin for: neurofibromaIntraoral + skin nodules + macular pigmentation (café au lait): NeurofibromatosisCafe au lait spot seen in: Peutz jeghers syndrome, Albrights syndrome, Neurofibromatosis, Jeffs syndrome. NOT in: Basal cell nevus bifid rib syndrome.Neurofibromatosis (oral findings): enlargement of fungiform papilla and enlargement of mandibular foramenNeurofibroma (benign peripheral nerve tumour)Tongue, buccal mucosa and vestibuleSchwannoma and lymphangioedemaTongueChronic osteomyelitis with proliferative periostitis of the mandible is characterized by marked: periosteal bone formationFirst response of inhalation of mycobacterium: phagocytosis by macrophagesCleft palate, mandibular hypoplasia (retrognathism/small jaw), macroglossia, glossoptosis (posterior displacement of tongue): Pierre Robins Syndrome (bird like face)Chediak Higasi: periodontal problems, neutropenia, recurrent infections, albinism, exfoliation of primary teethCri-du-chat syndrome: 5p-. high pitched cry that sounds like cat. Hypertelorism, heart defect, anterior open bite, enamel hypoplasiaMEN (multiple endocrine neoplasia) syndrome: mucocutaneous oral neuromas, pheochromocytoma and thyroid carcinomaMEN syndrome is nothing but: adrenal over productionMEN 1Pituitary, pancreas, parathyroidMEN 2 (sipple syndrome)Parathyroid, medullary carcinoma of thyroid, pheochromocytomaMEN 3Mucocutaneous neuroma, medullary carcinoma of thyroid, pheochromocytomaHyperpigmentation, which layer of epidermis: Stratum basaleDilaceration (common – max CI) is mostly due to delayed eruptionSeizures are common in which condition: hereditary telangiectasia/trigemino encephalitis angiosis (sturge weber syndrome)Vascular malformation that does not involute: Sturge Weber syndromeHereditary congenital forms of hemangioma: Rendu-Osler-Weber; spider telangiectasiaSturge Weber (encephalotrigeminal angiomatosis)Unilateral portwine stain; vascular disorder of meningesOsler WeberHereditary haemangioma; epistaxisWegner’s granulomatosisVasculitis, granuloma, necrosisPseudoepitheliomatous hyperplasia is seen in granular cell tumour (S-100 positive)Histology of congenital epulis and SCC resemble: granular cell tumour or myoblastomaCondyloma lata and rashes appears in: Secondary syphilis (highly contagious)Copper coloured vesicles on palm and soles: Congenital syphilisIndents on incisal edge with narrowing at mesial and distal: Hutchison’s incisors and mulberry molars (globular enamel)Manifestation of congenital syphilis: Hutchison’s triad (Hutchison’s teeth, interstitial keratitis, 8th nerve deafness), saber shinA patient with syphilis is highly infectious during: secondary stages onlySyphilis resembles: HerpesGranulomas in syphilis are called: Gummas (central necrosis and a plasma cell infiltrate)Asymptomatic stage of syphilis: tertiary (neruo + cardio complications)Condyloma acuminatum (genital warts): HPV 6 & 11HPV oral cancer/ cervical cancer: HPV 16 & 18; 31 & 33Verrucous leukoplakia: HPV 16 & 18HPV is known to cause what in oral cavity: ulcersVerrucous carcinoma best prognosis and most common location: vestibuleCharacteristic of Mikulicz: minor aphthous ulcerPresentation of TB ulcer in mouth: painless and long standingIn area of tension you will find increased: fibroblastic activityType 1 collagenOdontoblastsType 1 & 3 collagenFibroblasts; predominately in pulp Gingival fibres are mainly: Type 1 collagenThe amount of collagen in a tissue can be determined by the content of HYDROXYPROLINESalivary glandsMalignantAcute dermoid carcinoma & Adenoid Cystic carcinomaAggressiveAcinic cell carcinomaMost common malignancy in both minor salivary glands: Adenoid cystic carcinoma (second most common)Most common malignancy in both major and minor salivary glands: Mucoepidermoid (most common)Second most common in major or in children: acinic cell (common in parotid)Swiss cheese or cribriform pattern: adenoid cystic carcinoma (no metastasis) – 2nd most commonFeatures of adenoid cystic carcinoma: perineural invasion but NO upper lip paresthesiaBest prognosis for salivary tumour: Adenoid cystic carcinomaMost common metastasis site for adenoid cystic carcinoma: LungSecond most common in minor: polymorphous low grade adenocarcinomaFacts about mucoepidermoid cyst: hard palate, children, parotidSalivary gland tumor with BEST long-term prognosis: PLGA (polymorphous low grade adenocarcinoma)Cancer with best survival rate: adenocarcinoma (rare, but aggressive)Adenocarcinoma patients are at risk for: hyposalivation, ORN and SCC. Not is bleedingMalignant tumours of salivary glands are mostly associated with: parotidPrognosis of epidermoid carcinoma (SCC) is least favourable in: posterior lateral border of tongueBlue stain is for: AmeloblastomaRed stain is for: AOTAOT is like dentigerous cyst only for: CanineDiff between AOT and dentigerous cyst: radiolucency goes beyond the CEJDental papilla gives dentin and pulpHypodontia; number (supernumerary or anodontia); oligodontiaInitiation or bud stageSize and shape; dilaceration; AI; DI; Enamel hypoplasia; peg lateral; macrodontiaMorpho/histo differentiation – Bell stage – 11 weeksDens invaginatus and taurodontism; tubercle; Odontoma; Fusion; Gemination; Dens in dente; cystCap stage (proliferation) – 9 weeksEnamel dysplasia, enamel hypoplasia, concrescence, enamel pearls, tetracycline staining, fluorisisApposition (maturation) – 14 weeksTaurodontism is associated with: Type 4 AI; down’s; klinefelter’sDens Invaginatus is caused by invagination of inner enamel epithelium Enamel hypoplasiaDefect in maturationEnamel hypocalcificationDefect in matrix formationDens in dente: exaggeration of lingual pit; more in premolars; mongoloid races (Asians, Natives) – maxillary lateral incisorTalon cusp: Dens evaginatus or extra cusp (E, D, P)Enamel pearls occur mostly on: maxillary molarsAnomalies of development are LESS frequent in primary teethHypodontia and multiple retained or supernumerary teeth, frontanella failed to close at birth, frontal bossing, wide nasal bridge are common in: cleidocranial dysplasia (autosomal dominant)Delayed eruption: cleidocranial dysplasia (due to absence of cementum)Patient stopped smoking, but lesion is still present: sub-mucous fibrosisSeen with hyperplastic foliate papilla: lingual tonsil hyperplasiaHyperplastic lingual tonsils may resemble: SCCMultiple OKCs, bifid ribs, class 3 jaw, mental, hypogonadism, frontal bossing, multiple missing teeth, hypertelorism, calcification of falx cerebri, drosphila: Gorlin Goltz syndrome/Nevoid basal cell carcinomaCancer with good prognosis: Basal CellOKC histologically: columnar, palisading, parakeratin and hyperchromatic cellsFeatures of Gorlin Goltz syndrome: palmar pitting and keratosis, multiple OKC, Hypertelorism of eyes, hypogonadism in male and ovarian tumor in female.Diagnosis only by histology: OKCDisplacement of odontoblastic process? thermalOcular proptosis or hypertelorism (increase in interpupil distance) or mid face def or cranial dysostosis (fuse too soon) + beaten metal is characteristic of + calcified stylohyoid ligaments: Crouzon syndrome – craniofacial dysostosis (Frog-like appearance)Most common mid face fracture: zygomatico-maxillaryHigh arched palate, posterior bilateral crossbite, hypodontia and is a disorder of 1st brachial arch: Crouzan’s diseaseEyes too far apart: Hypertelorism (Gorlin, Down, Crouzon, Apert)Syndrome with proptosis: CrouzonCrouzonCraniosynostosis without syndactylyApertCraniosynostosis with syndactylySmooth surface lesions resulting from flexure of the tooth structure are known as abfraction (due to wear facets)Intact vesicles are seen in: pemphigoidAcantholysis seen in: pemphigusAnother name for chronic desquamative gingivitis? Cicatricial pemphigoidPemphigus (no scarring) – Intra epidermal cleftSuprabasilar or epithelial or subepidermal intraepithelial vesicles and acantholysisPemphigoid (with scarring) and lichen planus– Sub basilar cleftSubepithelial vesicles and no acantholysis; lesion in basement membranePemphigoid - DDeeper (antibodies directed against basement antigens)Pemphigus - SSurface (antibodies directed against desmosomal protein)Immunofluorescence of antibodiesPemphigus (Nikolsky sign positive and acantholysis)FishnetPemphigoid (Nikolsky sign negative and no acantholysis)LinearHistoplasmosis resemble: SCCMost common location of SCC: posterior lateral borders/ventro-lateral of tongueSign of SCC: keratin pearlOther name for SCC: epidermoid carcinomaWhat helps the maxillary incisors in the chewing movement? Lingual concavitySarcoidosis (granulomatosus) commonly involved organ: LungsNon-caseating granuloma: Crohn's, Sarcoidosis and Leprosy (acid-fast)Non-necrotizing granuloma with lot of activated macrophages: SarcoidosisSarcoidosis is similar to: TBLab results in sarcoidosis: significant elevated serum calciumTx of Sarcoidosis (swollen lymph nodes): corticosteroidsStellate granulomas: Cat-scratch diseaseCaseating granulomas with giant cells – langerhan’s: TB (tubercles)Rectal bleeding, recurrent apthous, granulomatous gingivitis: Crohn’s (skip lesions)Example for granulomatous inflammation: Crohn’sOral granulomas, aphthous ulcer, rectal bleeding: Crohn’s diseaseCongenitally missing order: third molar>mandibular second premolar>maxillary lateralMost congenitally missing primary tooth: maxillary lateral incisorNo regeneration after RCT: dentinMacroglossia not found in: hyperthyroidismBrown tumour (CGCG) or multiple giant cell lesions or multilocular radiolucencies are associated with: Hyperparathyroidism (Von Recklinghausen disease of bone)CGCG and PGCG are similar in: microscopic appearanceFacts about CGCG: More in females, anterior mandible and less common than PGCGPGCG is clinically indistinguishable from: pyogenic granulomaIf giant cell lesion is found in bone: Use Bence Jones testTx of CGCG: curettageCause of secondary hyperparathyroidism: renal failureGiant cells are seen in: hyperparathyroidismFeatures of hyperparathyroidism: Hypercalcemia, hypophosphatemia and loss of lamina duraMacroglossia seen in: Down’s syndrome (enlarged adenoids); acromegaly; amyloidosis; hypothyroidismAmyloidosis: complex proteins in which IG light chains are precursorsCrowding of teeth in down’s is: often foundMajority of down’s can have routine work done in officeRare and common in down’s: caries is rare and periodontal is common due to T-cell defectRoots in down’s: short, conicalLife span of down’s: 20-40 yearsCardiac condition common in down’s: mitral valve prolapseIncreased saliva when blood flow to the salivary gland is: enhanced by parasympathetic activityHZ or shingles mimics: tooth painTongueAcromegalyEnlarged Down, geographic, Melkersson Rosenthal syndromeFissured/scrotalPierre RobinsPosterior tongue displacement (glossoptosis)Pellagra (Niacin)Bald tongue of sandwithVit B deficiencyAngular glossitisScarlet feverInflamed fungiform papillae; white coat that sloughsDiseases according to ageFibrous dysplasiaChildrenPaget’s diseaseAdults over 50Aneurysmal bone cyst (aspiration is not needed)TeenagersCapillary HemangiomaNew bornCavernous hemangiomaOld adultsHemangioma from tongue: hamartoma (normal tissue overgrowth)Lesion that does not undergo malignancy and needs to be aspirated before excision: haemangiomaChoristoma: Tissue overgrowth in wrong locationMost common locationsNasopalatine/Incisive canal cyst (most common non-odontogenic): teeth are vital; fluctuant swelling in middle of hard palateBetween maxillary CI – Heart shapedGlobulomaxillary (pear shaped)Between maxillary lateral and canineBrachial cyst (lymphoepithelial cyst)Anterior of SCM; in relation to pharyngeal archOssifying fibroma, PGCGPremolar areaLateral periodontal cyst (tear drop)Mandibular canine and premolarBohn noduleNewborn alveolar ridge gingivaEpstein pearlMidline of palate of new bornDermoid cystMidline tongue and floor of mouth above mylohyoid (doughy) or upper neckThyroglossal duct cystMidline of neckNasopalatine duct cyst VS median palatal cyst: Nasopalatine Duct (Incisive canal) cyst-heart shaped. Location of nasopalatine duct cyst: two maxillary central incisorsTx of nasopalatine cyst: enucleationMost common intraoral site for melanoma: hard palatePigmented lesions in premolars: submucosal melanomaAn 18 year old man complains of tingling in his lower lip. an examination discloses a painless, hard swelling of his mandibular premolar region. the patient first noticed this swelling three weeks ago. radiograph indicate a loss of cortex and a diffuse radiating pattern of trabeculae in the mass. which of the following is the MOST likely diagnosis: ossifying fibromaPulp stones are consistent indicators of: noneNot found in trisomy of 21 (down’s): rampant decayFound in trisomy of 21 (down’s): perio due to P. intermediaKid with down’s is: smiley and kindDown’s syndrome: underdeveloped maxilla (midfacial hypoplasia) and prognathic mandible; short conical roots (NOT – Macrodontia); fissured tongue; missing teethMacrodontia: Hemangioma; pituitary gigantismMicrodontia: pituitary dwarfism; down’s; ectodermal dysplsiaBehaviour true about down’s: affectionateDentition in achondroplasia: normal, but crowded (other features: otitis media, prognathism, small maxilla, crowding, short extremities)Pituitary dwarfism: small mandibleA lesion presented with radiolucency having multiple flecks inside: Adenomatoid odontogenic tumorCannot be on tongue: PGCGHistologically CGCG is similar to: hyperthyroid tumour most associated with resorption at root apex: periapical granulomaPotential sequela of an acute periapical abscess: periapical granulomaTrapezoid mouth, delayed eruption, byzantine arch shaped palate and shovel incisor: ApertApertognathism: anterior open biteExample of Le Fort 3: Apert syndrome (syndactyly & craniosynostosis)Example of Class III: AchondroplasiaEarly calcifications of sutures seen in which syndrome: Apert and CrouzonDecreased ALP and early loss of primary teeth: Hypophosphatasia (systemic disease affecting primary tooth)X-ray of hypophosphatasia: shell like teeth due to incomplete bone mineralizationPericoronal lesion associated with impacted third molar is removed by curettage. Histology will show: OKCEgg shell cracking or crepitus is a feature of: ameloblastoma, OKC, dentigerous cystHistology of OKC: parakeratinized epithelium showing palisading of basal cellsAn infected pulp may cause: dentigerous cystOdontogenic cysts occurs as a result of stimulation and proliferation of the reduced enamel epithelium: dentigerous cystRegional Odontodyaplasia (ghost teeth): involves enamel, dentin and cementum. Teeth are affected to the point they have short roots, open apical foramina and enlarged pulp chambers.Regional Odontodyaplasia is not congenitalUnique about regional odontodysplasia: Only one side or quadrant is affectedShort roots with chevron pulps, periapical radiolucency is indicative of: dentinal dysplasia type 1Very large pulp chambers and open apex: type 2Bacteria that is anaerobic: clostridiumTx of clostridium difficile: MetronidazoleAnti-protozoan and anaerobic drug: MetronidazoleInhibitor of nucleic acid synthesis, is beta-lactamase resistant, has good activity against oral facultative and obligate anaerobes, and has an oral formulation: MetronidazoleTx of clostridium difficile if pregnant or breast feeding: VancomycinDrug for MRSA: Vancomycin (causes red man syndrome)Does not target bacterial enzymes that synthesize protein from the mRNA code: VancomycinHSV causes: cataractsRate of HSV 1 and HSV 2: 60% and 16%Fusion of upper lip is due to: maxillary and medial nasal processes1 less tooth count: fusion and concrescenceGeminationFusionConcrescenceEnamel, dentin, cementum and pulpEnamel, dentin, cementumCementumTooth count is normalTooth count is one less than normal; common in primary teethFusion: dentin and cementumDefective development of epithelial root sheath: No cementumCementum is NOT continuously remodelled like boneInorganic content of cementum: 45%-50%Cellular cementum - mostly on the apical 1/3rd of the root Acellular cementum (first cementum) - mostly on the coronal 2/3rds of the root (thinnest at the CEJ!)Collagen fibers in cementum: sharpey’s (perpendicular) and type 1 (parallel)Oxytalan fibres: immature elastic fibers (also eluanin) that run parallel to root surface in vertical direction and bend to attach to cementumCementum overlaps enamel in how many cases: 60-65%Results in splitting of developing roots: epithelial diaphragm forms too many lateromedial extensionsAbnormal development of first pharyngeal arch cold result in defects in: Zygomatic bones and external earsKoplik spots (they are necrotic ulcers) associated with: Rubeola (measles) – paramyxovirusMumps virus: Paramyxo virus (rubeola)Paramyxovirus – mumps and measlesMeasles causes: deafness in children and orchitis in adultsChronic salivary gland disease is caused by: cytomegalovirusAngle obliterated, ear lobe elevated, 10 years: MumpsIn mumps acute phase, you will see increase in: salivary amylaseMicroscopic suprabasal intraepithelial bullae and acantholysis characterize: pemphigus vulgarisOral hairy leukoplakia infects: B lymphocytesTest to detect oral hairy leukoplakia: monospot test (detects IgM heterophile antibody)Cells most frequently found in granuloma = lymphocytesGustatory sweating while eating and crocodile tears (near cheek area): Auriculo-temporal or Frey's syndrome (CN V)Tx of frey’s syndrome: purified botulinum toxinBotulinum toxin prevents release of: AcetylcholinePigmentation of the face (melanotic macules), freckles on lips and oral cavity (melanin pigmentation) and intestinal polyps (hamartoma): Peutz Jeghers syndromeTx of peutz jeghers: iron supplements Mutation in Peutz Jeghers: LKB1 (codes for serine-threonine kinase)Multiple odontomas (osteomas) occurring in the same patient should arose the possibility of: Gardner’s syndrome and basal cell syndromeWhat is common between Gardner’s syndrome and Peutz jeghers syndrome: intestinal polyps, autosomal dominant, polypsConditions with pigmentation of intraoral mucosa: Addison’s disease, McCune-Albright, PeutzGardner’s: POO (polyps, osteomas, compound odontomas) – unerupted, retained deciduous, impacted permanentsPolyps: GCP (gardner’s, crohn’s, peutz-jeghers)Supernumerary: GDC-S (gardner’s, down’s, sturge weber, cleidocranial)Peutz-Jeghers syndrome: multiple melanotic macules or pigmentation, GI polypsPartial mandibulectomy or maxillectomy is often necessary for: ameloblastoma & odontogenic myxomaMost common odontogenic mesenchymal tumor is myxoma (known to displace roots and cortical expansion)Child 12 year old come with swelling not painful unilocular radiolucent present ramus body region by histological Contain odontogenic epithelium and tissue like dental papilla? Lisegang rings are present in/ islands of squamous-like epithelium that can be misdiagnosed as squamous carcinoma: CEOTCancer with best survival rate: Squamous Cell CaMost common cancer of head and neck: BCCSquamous Cell CarcinomaLower lipMost common siteGoodPosterior lateral border of tongueMost common intraoral siteFairFloor of mouthSecond most common intraoral sitePoorSchwannomaSchwann’s cellsNeurofibromaSchwann’s cells and perineural fibroblastsLeiomyomaSmooth muscleRhabdomyomaSkeletal muscleKaposi Endothelial cellsWarthin’sLymphoid tissueAmyloid is often present in: CEOT (not seen in anterior jaw)CEOT age group is: 40 yearsThe recurrence rate of curretted ameloblastomas can be as high as 90%. Unicystic ameloblastomas have a recurrence rate of about 10%: Both correctPrevalence of torus palatinus: 20% and in womenAmeloblastoma does not occur before: 20 years of agemost definite way to differentiate ameloblastoma, and odontogenic keratocyst? Reactive light microscopyFacts about ameloblastoma: benign but aggressive; expansile but painless; can cross midlineWhich describes ameloblastoma best? Local invasionMultilucency in bone and ramus: ameloblastomaX-ray with radiolucent /radiopaque lesion in the left posterior molar ramus area (11 years old), diagnosis: Ameloblastic fibrodontoma Osteopetrosis (Marble Bone Disease)Pancytopenia is a severe consequence of this diseaseThis condition may be cured by bone marrow transplantation if a suitable donor is availableRadiographically resemble a giant cell tumor. Histologically is consists of a mixture of “giant cell-like” tissue with large venous lakes. Has no effect on periodontal bone lossFrequent complication is secondary osteomyelitisOsteogenesis ImperfectaBlue sclera (also seen in hypophosphatasia)accompanied by dentinogenesis imperfectaGenetically determined imperfection in the structure of Type I collagen underlies the cause of this diseasePaget’s disease (Osteitis deformans) – lion like deformityParamyxovirus infection of osteoclasts is thought to play a causative role in this conditionIncreased serum value of alkaline phosphatase, normal calcium and phosphateIncreased risk of osteogenic sarcoma post radiation (Radiotherapy CI)Pre-malignant (can lead to osteosarcoma)Cause: abundance of osteoblasts and osteoclastsWarm bone“Mosaic” trabeculae (jigsaw puzzle) are seen in this disease“Cotton-wool” radiodense lesions are seen in the middle stage of this diseaseHypercementosis is common (other condition – acromegaly)Reversal lines with a mosaic patternAffects both maxilla and mandible (maxilla 2x more than mandible) Increased alkaline phosphataseHyperparathyroidism; paget’sDecreased alkaline phosphataseHypophosphatasiaCotton-wool: Gardner’s syndrome and Paget’sTx of Paget’s: bisphosphonates and calcitoninFibrous dysplasiapainless enlargement of bone characterized by an ill-defined border and a “ground glass” quality of the affected bone, usually before age 30 or pubertyCan be malignant (high potential)UNILATERALDue to mutation of gene: GNAS1Ground glass: hyperparathyroidism and fibrous dysplasiaCherubismBilateral, multiocular radiolucent lesions of the posterior body and rami of the mandible occurring around age 5 or 6 are characteristic of this diseaseThis disease is seen almost exclusively in the jaws, seldom other bonesHistology of cherubism: Looks like CGCG with perivascular collagen cuffingMost common benign or CT tumor occurring in the oral cavity: FibromaFibroma resembles histologically to: epulis fissuratumEpulis granulomatosum cause: post-extraction socketDysfunction in fibroma: hyperplasiaMost common non-odontogenic tumor: ossifying fibromaBlue sclera: osteogenesis imperfect, marfans syndrome, ehler danlon syndrome, alkaptonuria, fetal ricketsCondyloma acuminata is caused by = Human Papilloma Virus (HPV)HPV should be given before: 18 yearsTraumatic bone cyst (unicameral cyst or hemorrhagic): Only cyst that lacks an epithelial liningGlobulomaxillary cyst: Occurs in a precise anatomical locationPregnant, first trimester, picture of pyogenic granuloma (rasp berry appearance), what to do: wait till second trimesterFastest growing tumour that blanches and bleeds easily: pyogenic granulomaCondition associated with endocarditis and glomerular nephritis: SLETumour common in children: RhabdomyosarcomaMost common site for sialolithiasis: submandibular gland (wharton’s duct) and is UNILATERALTx of sialolithiasis: moist heat or citrus foodTx of chronic sialodochitosis: cannulate the duct and remove gland/stoneWarthin’s tumor (Papillary Cystadenoma Lymphomatosum) most common in: Parotid (bilateral) (War Path - benign)Warthin's tumor has NO what: oral involvement (diffuse neck swelling)Localized neck swelling: Infectious monoDemographics for Warthin’s: Male; >50 yearsPapilla affected in geographic tongue and hairy tongue (AB, H2O2): filiform papillaWhat happens to filiform papillae in hairy tongue: HypertrophyLoss of filiform papilla, which deficiency: Vit BHairy leukoplakia and infectious mono caused by: EBV (burkitt’s lymphoma and nasopharyngeal carcinoma)Best describes an adverse reaction to penicillin: black hairy tongueWhat is the percentage of leukoplakia that turns into cancer: 5-6%A 14-year-old female has gingival tissues that bleed easily on gentle probing. The color of the gingiva ranges from light red to magenta. Probing depths range from 1 - 3mm. Some of the interdental papillae are swollen: ANUG (spirochetes and t.denticola)most closely resembles normal parotid gland histologically: acinic cell carcinomaPatients with Sjogren syndrome are at increased risk for developing: lymphomaA biopsy of the lower lip salivary glands showed replacement of parenchymal tissue by lymphocytes, this finding is an indicative which disease? Sjogren’s Sjogren’s and tongue: has altered taste sensation, but not burning sensation of tongueSialolithiasis can occur in sjogran syndromePatients with sialadenitis caused by sialolith in the duct. It is a large, painful sialolith near the orifice of Wharton’s duct. What procedure do you do for removal? Cannulation & dilationMikulicz disease: Sjogren’s + swelling of parotid and submandibular glandsWhich articular disease most often accompanies Sj?gren’s syndrome: rheumatoid arthritisSjogren’s is associated (most common) with: lymphoma and also RASjogren’s syndrome: dry mouth, dry eyes and parotid enlargementComplication of sjogren’s primary: Keratoconjunctivitis and xeroComplications of sjogren’s secondary: primary + rheumatoid arthritisSjogren’s is not associated with: herpesSjogren’s laboratory test: SS-A/SS-B or ANA – antinuclear antibodySmokeless tobacco has NOT been associated with Nicotine stomatitisA Patient who has been wearing a maxillary denture for 15 years notices multiple, reddened, nodular lesions on his palate. The lesions are soft and painless. The most likely diagnosis is Inflammatory papillary hyperplasiaMuscles inflamed in denture sore mouth: palatoglossus and superior constrictorA 21-year-old male has a painless, compressible and fluctuant, slowly growing enlargement of the anterior midline of the neck. Which of the following is the most likely diagnosis? Thyroglossal duct cystMost common odontogenic tumor: odontomaMost common non-odontogenic tumor: osteosarcoma and metastatic carcinomaMost common epithelial odontogenic tumour: ameloblastomaHistology of ameloblastoma: stellate reticulum in bell stageNon-odontogenic tumour is: osteosarcoma and metastatic carcinomaMost common malignancy found in bone: Metastatic CaFeatures in osteosarcoma: tingling lower lipsOsteosarcoma metastasis to: brain and lungsOsteosarcoma (most common in young people) in x ray: Sun burst and symmetrical widening of PDL & paresthesia.Rubella embryopathy is an example of acquired causes of mental retardationPatechiae like spots on soft palate: Rubella (german measles)have prodromal symptoms which mimic dental pulp pain? HZA 9 year old presents with acute gingival pain of four days duration. There are small, round ulcers on the interproximal gingival and buccal mucosa. Most likely diagnosis is primary herpetic gingivostomatitis (average common age: 1-5)Clinical feature of acute herpetic gingivostomatitis: discrete, spherical vesicles and feverVirus that causes acute herpetic gingivostomatitis is closely related to: chicken poxTx of primary herpetic gingivostomatitis is mostly: palliativeNOT a clinical presentation of oral Candidiasis? Ulcerative patchSteatorrhea, increased pulmonary mucous retention, chronic respiratory infections, and functional disturbance in secretory mechanisms of various glands including elevated sodium chloride in the sweat? Cystic fibrosisDental fact with cystic fibrosis: Decrease in cariesGeneral features of cystic fibrosis: poor growth despite good appetite; malabsorption, bulky stools; steatorrheaA 52-year-old female presents with red, glossy, and swollen gingival. She has denuded and red areas on both buccal mucosae. The lesions have been present for months and vary from time to time in severity. Which of the following represents the most probable diagnosis? Erosive LPHyperplastic palatal tissue (papillomatosis) is best treated by: Supraperiosteal dissection or electrosurserySystemic disease with minor apthous ulcers seen in: crohn’s disease, behcet’s, celiac sprue; major is seen in AIDSAt what viral load of HIV we refer to specialist: 100,000Behcet’s: triple symptoms (apthous ulcers, genital ulcers, conjunctivitis, arthritis & uveitis)Vasculitis is a prominent feature in: Behcet’sIn recurring necrotizing ulcerative gingivitis, which of the following is most associated with exacerbation? Stressful episodesA patient had a mandibular fracture quite some time ago and now has a painful movable tender mass in the old fracture area near the mental foramen: Traumatic neuromahematologic disorder represents a malignancy of plasma cell origin? Multiple myelomaFirst sign of multiple myeloma: bone painOther feature of multiple myeloma: plasma cell infiltrateJoint pain: sickle cell anemia (avoid NSAIDs, barbi and vasoconstrictors)Most common site for multiple myeloma: vertebraABs in multiple myeloma: IgM or M proteinthe most significant finding regarding ectodermal dysplasia? Sparse hair, cannot regulate body temperature – no sweat glands, hypohydrotic, oligodontia and hypodontia, congenital missing teethGenetics of ectodermal dysplasia: sex linked (x-linked) recessive5 year survival rate90%Lip cancer50%oropharyngeal cancer45%Tongue cancer20%oropharyngeal cancer among blacks whose oral hygiene is badOral cancer is 4% of all cancers and 2% of all cancer deaths Highest incidence of oral cancer or least survival: black malesLeast incidence of oral cancer: native americansWhich is the most common location for oral cancer in USA: TongueIncidence of people dying from oral cancer each year: 10% per yearthe rate of oral cancer in the US in the past 5 years is: increasedwhich gene is altered most in oral cancer or cancer translocation: p53Women with cancer have higher survival rates EXCEPT for: lip cancer!Metastatic disease to the oral region is most likely to occur to: posterior mandibleWomen have a lower survival rate of cancer of the lip: trueGlossitis and angular cheilitis are oral manifestations of what type of nutrient deficiency? IronA 14-year-old female has gingival tissues that bleed easily on gentle probing. The color of the gingiva ranges from light red to magenta. Probing depths range from 1 - 3mm. Some of the interdental papillae are swollen. Which of the following represents the most likely diagnosis? ANUGCratered gingiva: ANUGFirst treatment of choice for a patient with uncomplicated ANUG: gentle debridementDiagnosis of ANUG is best made by: clinical signs and symptomsWhat is ulcerative in ANUG: pseudomembrane on marginal gingivaA panoramic radiograph of a 55-year-old female reveals generalized widening of the periodontal ligament space and bilateral resorption of the mandibular angles. What is the most likely diagnosis? Progressive systemic sclerosisWhat is CI in Parkinson’s taking levodopa: epinephrineWhat is CI in multiple sclerosis: LA with epinephrineSymptoms of long-term use of nitrous oxide are similar to: multiple sclerosiswould be included in a differential diagnosis of the palatal pigmentation EXCEPT one lentigo (does not occur in the oral cavity); common in elderlywould be included in a differential diagnosis of the palatal pigmentation: melanotic macule, melanocytic nevus, melanotic neuroectodermal tumourAgenesis is least in caninesDevelopmental anomaly of supernumerary teeth (mostly in anterior maxilla) occurs in which stage of tooth development : InitiationSialolithiasis is common in: Wharton's ductColumnar, palisading, hyperchromatic basal cells: OKCCarcinoma most commonly associated with OKC: Nevoid basal cell carcinomaSyndrome associated with OKC: Gorlin syndrome (same as nevoid BCC)CT lesion that causes pseudoepithelial hyperplasia: GranulomaWhat lesion is localized, not dysplastic, or inflammatory, or metaplastic or reactive: Idiopathic osteosclerosiscancer has good prognosis: cancer of lipKeratosis is dysplastic if it occurs on: Floor of mouthTurner's incisors: Trauma or infection? (most common – maxillary incisors and pms)Why mucous cyst appears blue: Vascular congestion2-year-old child mother complaining that my son doesn't eat anything due to pain he has sore red gums. What is your diagnosis = HerpesProsthodonticsWhich of the following explains why the fovea palatini are not used as landmarks for determining the precise posterior border of maxillary denture base? They are opening of mucous glands that should not be covered by the denture borderLocation of PPS: anterior to fovea palatini and vibrating linemost common reason for a cast crown not to seat on a patient's tooth? Excessive proximal contactThe facial surface of the posterior mandible often presents limiting factors to proper treatment of periodontal defects. Primary among these factors is/are the: external oblique ridgeWhen you wax the RPD on a cast, it is called: refractory castStatic registration of dynamic occlusion is the functionally generated occlusal registration in: indirect gold casting techniqueWhen preparation is wider than a third of inter-cuspal distance for amalgam: use gold castingResin-retained FPD (Maryland) does not have: draw/path of withdrawlA patient with stable posterior occlusion and only missing maxillary incisors you are making a bridge from #6-#11. What do you need to send to the lab? Semi adjustable articulator in MIP with facebow, lateral records, and incisal guideMinimal accepted crown : root ratio: 1:1During the processing of complete dentures, tin foil substitute is painted over the mold surface to prevent the: resin from adhering to moldPressure indicating paste is used at the time of delivery of dentures to: to locate inaccuracies in the tissue surface of the denture baseWhat determine the extension of occlusion: 2/3rd RMPType or margin situated on hard enamel and is a preferred choice whenever possible: supragingivalA rule of thumb in placing the central incisor is: The labial surface of the tooth should be 8-10 mm anterior to the midline of the incisive papillaThe most likely cause of cheilosis in a patient who wears a complete denture and whose medical history is non-contributory is: closed vertical dimensionComplete denture and RPD in same patient, for the wax rim, why would you bevel the anterior part of the wax rim: There is not enough interocclusal space but enough for estheticsMandibular molars should not be placed over the ascending area of mandible because: the occlusal forces over the inclined ramus would dislodge the mandibular dentureImmersion of dry acrylic resin in water overnight causes: no change Best method of removing an old bridge: slide hammerHow do you decrease the width of artificial teeth: deepen the facial line angle proximally and decrease interproximal embrasureOverreduction of which surface can quickly destroy the resistance and retention form of anterior teeth: cingulumThe veneered area must be thick enough for 1.5-2.0mm of porcelain and 0.3mm of metal to provide: rigidityMetal ceramic restoration, the area of porcelain most susceptible to fracture if there is not a passive tilt is the: facial gingivaThe tooth that is most suitable for occlusion on the occlusal table is: mandibular first premolarThe occlusion of a tooth should contact the metal ceramic restoration on: metalA dentist seats a full gold crown on a patients mandibular right second molar. As the patient closes and as the teeth come into initial contact, the patient’s jaw deflects to the right. Before treatment, the patient’s occlusal relationship had been stable. To regain stability, the dentist will adjust the crown. On which incline of which cusp: Inner incline and facial cuspWait time after full mouth extraction for maxillary denture: 16 weeks or 4 monthsNarrow crown is fabricated when: facial ridges are closerFunction of guide plane in RPD: eliminate gross food traps, increase frictional component of minor connectors, lower height of contour on proximal surfaces to allow for better positioning of clasp armsmethods of recording the relationship of mandibular teeth to maxillary teeth: occlusal wax registration; transfer copings, gothic arch transferTo increase the anterior mandibular vestibular depth, the practioner places the mucosa graft directly on the periosteum.Space noticed between the palate and a metal frame (RPD) but fits well on the cast. What’s the reason: distortion of the final impressionReason for occlusal rims to be bevelled: accommodate the tongue and muscles of the floor of the mouthWhen trying porcelain fused-to-metal crown, the dentist observes that the gingival-margin finish-line integrity is excellent, but that the occlusal surface is 1 mm too high. Which of the following is the most probable cause? Incorrectly related castsYou notice a void on occlusal of cast, crown will: fit on die and not on toothIf the 4 maxillary incisors were to be replaced by partial removable denture prosthesis, which of the following would be desirable: contact on Canines on lateral excursionsPier abutment: tooth having edentulous space on both sidesOcclusal morphology determinants: increased overjet, flatter posterior cuspsMarginal ridge is high: retrusive interferenceAs the maxilla resorbs, it becomes: smallerAs the mandible resorbs, it becomes: widerThe anterior maxillary incisors of a middle-aged patient can be given a younger appearance by selective grinding of the enamel. the dentist performs this procedure by: rounding the incisal point anglesChristensen phenomenon: Space that forms in the posterior teeth between jaws during anterior movement of mandible or seen in protrusionTaking an impression of only the prepared tooth and transferring it into the articulator with a plaster index: Functional generated pathway impressionFunction of plaster index: preserve face bow transferShort molar, how to add retention: reduce convergenceWhen finishing the occlusal portion of a posterior composite restoration, the dentist should carefully: avoid altering the centric contact on enamelan examination of the edentulous mouth of an aged patient who has worn maxillary complete dentures for many years against six mandibular anterior teeth would probably show: loss of osseous structure in the anterior maxillary archpatient who have natural dentitions generate the GREATEST amount of occlusal force during: parafunctional movementsrepresents the MOST likely cause of plastic denture teeth being dislodged from the acrylic resin of the denture base: mold was contaminated with wax before processingDisadvantage of metal bases: not easy to reline or rebaseImmediate dentures should be relined after: 8-10 monthsbefore beginning tooth preparation, the dentist should visualize the outline form to: prevent over cutting and overextensionmost common reason for the failure of a casting to seat: proximal contactsPreparing occlusal of lower molar crown should be: Negative likeliness of the opposing toothTo increase the stability of the lower denture: the occlusal plane should be below the tongueResorption in maxillaCentripetalResorption in mandibleCentrifugalResorption of bone takes place in which direction after extraction: downward and inwardWhich muscles cover the (lower) denture: BOPS (Buccinator, Orbicularis oris, Pterygomandibular raphe, Superior constrictor)The lower denture or lingual flange must be parallel to the mylohyoid muscleA patient presents with a restricted floor of the mouth, only 6 mandibular anterior teeth, and diastema between several teeth. major connectors is appropriate for this patient: lingual plate with interruptions in the plate at the diastemaswhen evaluating an extension-base removable partial denture several years after delivery, the dentist should apply loading forces to the base area. if an indirect retainer elevates from its rest seat under these forces, then this indicated the need to: reline the base areaMain function of indirect retainer: prevent dislodgement of distal extension RPD vertically and torque damage to abutment teethFirst step of relining a denture is always: verify the fit of the frameworkCI for relining: Increased VDDentists usually send their cemento-metal restoration cases to dental lab for fabrication. upon receiving the cases, these technicians MOST frequently complain that the: margins have been ill-definedWhy does upper maxillary denture break in midline: alveolar resorptionWhen using semi-adjustable articulator what is the most important translation movement on incisal table: protrusionThe cuspal inclines of the maxillary buccal cusps and the mandibular lingual cusps should be ground if they are in deflective occlusal contact in: working position onlyBeading in RPD for: better adaptation, strength to major connector; prevents food impactionRPD best in a caries prone individual: RPIMain reason of breaking of RPD clasp: work hardeningFace bow is used to record: relation of maxilla to TMJThe Bennett movement exerts its greatest influence in: lateral movementsBennett shift mainly on: lateral movement or working sideBennett angle: angle that is formed by the non-working condyle and the sagittal plane during lateral movementBennet angle: working sideDirection of non-working condyle: down, forward and medialcenter284124Inceram: less aesthetics, good strength, posteriorDicor: more aesthetic, porcelain, anterior maxillaWhen do you make a custom tray for PFM Crown: before preparationWhen you receive a PFM crown from the laboratory, what is the FIRST thing you check: Internal surface or shadeVital tooth with a PFM crown can be checked by a: cold test + rubber damMost common cause of porcelain fracture in PFM crowns is: poor metal designIn PFM, to prevent porcelain fractures, the junction should be: right anglesIn PFM, reduction for metal and porcelain: 0.5 mm for metal and 1.5 mm for porcelainWhile making a crown for erosion of tooth substance, ideal choice of crown is: PFMThe most common cause for a poor esthetic result when preparing an anterior tooth for a porcelain fused to metal crown is: insufficient facial reductionBest method of bite registration for fixed restoration: Lucia jig in CRBite registration on centric relation must be: thin without perforations (thin with perforation in CO)Dependent on patient posture: VDROcclusal grinding is not done coz it alters: VDOWhat do you check during wax try-in: aesthetics, vertical dimension and occlusion. NOT: facebow recordsMost common used face bow in FPD- ArbitraryThe tentative vertical dimension of occlusion is approximately: 12 mmWhen do you check phonetics for a CD/CD? Wax try-inDuring try-in of a complete denture, which phonetics are used: labiodentalWhich sounds do you check during denture try-in: Linguoalveolar (S,Z,Ch,Sh)Mounting patient casts in centric relation (true hinge axis) is most crucial when the treatment plan involves: Tx plan to change the VDO through fixed restorationsNon-working interference: LUBL of mandibular molars (working - BULL)During lateral excursions, opposing cusps contact on the WORKING SIDE (BULL)During lateral excursions, on the balancing side, maxillary lingual cusps (lingual inclines) contact mandibular facial cusps (lingual inclines). LUBLWorking interferences have: 2 contactsNon-working interferences have: 1 contactNon-working are always destructive in nature so a dentist should avoid these contactsCusps that are more prone to crack: lingual of lower molarsQuality of saliva that affects denture from seating: ropy thickMost important factor for retention of full gold crown: Minimal axial taper (3 – 6) Incision made in vestibuloplasty with mucosal graft: supraperiostealWhat is vestibuloplasty: adding soft tissue inter occlusal for better denture fittingThe fenestration technique for mandibular vestibuloplasty is based on the premise that the mucosal attachment will: not cross a fibrous scar bandFenestration technique is done: to increase attached gingivasubmucosal vestibuloplasty: usually done on the maxillary arch to improve denture base area. This procedure is favored because no raw tissue remains to granulate and re-epithelializeVestibuloplasty done on: mandible onlySub-mucosal vestibuloplasty: maxilla onlywait time between extraction and CD insertion: 8 weeks?Max complete denture and mand bilateral RPD, what occlusion: bilateral balanced in lateral excursionsCraddock classification of dentures: mucosa borne, tooth borne, bothSequence of using retraction cord in double cord technique: #00 then #2After using a gingival retraction cord, tissue reacts by recession. Where do you see this the most? BuccalRetraction cord with 8% racemic EPI can produce: systemic actionUnsafe retraction cords have: zinc chlorideSafe retraction cords: EPI, aluminium sulfate and aluminium chloride (15% - Hemodent)Closest speaking space sound or common in vertical dimension or what sound is affected if teeth lack spacing between them: S soundMost important phonetic tests to help evaluate the position of the maxillary anterior teeth at wax try-in are: S soundsWhen testing the arrangement of teeth at the trial insertion of complete dentures, the lower lip should, when pronouncing the letter “F” as in fifty: contact lightly the incisal edges of maxillary incisorsDisto-buccal limit of mandibular denture: masseterDisto-buccal limit of maxillary denture: coronoidMuscle lateral to RMP or mandibular distobuccal flange is determined by: masseterMuscle that interferes with the lingual border of mandibular denture: mylohyoidMuscles that affect the lingual border of a mandibular CD: mylohyoid, genioglossus (lingual frenum area), superior constrictor, palatoglossusArea in mandibular denture that is hard to register: masseteric notchFractures favorable/unfavorable depends on: masseter muscleUpon reducing the external oblique ridge, which muscle can get damaged: masseter or buccinator?the altered cast technique is used to obtain: An anatomic impression of the edentulous ridge and for support (distal extension denture base)Rochette bridge is: perforatedUse of pencil in clinic: draw post dot of CDCD opposing natural teeth. Type of teeth to resist wear: acrylicLower distal RPD should cover: ? or 2/3 of RMPMinimum width of maxillary palatal strap: 8 mm and 1.5 mm thicknessUse of palatal strap: Class 3 & 4 casesCI for palatal strap: distal extensions or missing anterior teeth; not sued with torusMost commonly used maxillary major connector: A-P palatal strapCone technique step: lower functional cusp than upper functional cusp‘s’ ‘ch’ and ‘z’ bring: upper and lower teeth almost closeWhen treatment planning edentulous cases: The decision between a fixed or removable prosthesis depends in part upon arch shapeWhen placing I bar on premolar distal extension , under occlusal forces the i bar moves: apical and mesialPeriodontal damage to abutment teeth of partial denture with distal extension can best be avoided by: maintaining tissue support of the distal extensionBest crown for anterior: PFM with ZirconiaHardest type of ceramic: Zirconia (polycrystalline)Why Zirconia cannot be etched: it does not have matrixZirconia is strong because of: phase transformation under stressesGreatest fracture force: ZirconiaZirconia is cemented with: GILeast fracture force: Leucite and feldspathic porcelainWeakest porcelain: feldspathicWhat forms the glassy matrix and gives the porcelain translucency: feldsparStrongest porcelain: glass – infiltrated aluminaMost damage to an opposing restoration is caused by: tooth-supported RPDWhat is precision attachment: Intracoronal direct retainers. They consist of a male and female portions that are machined and made of metal (key and lock). The female part is soldered to fixed crowns or bridges, and the male part is attached to the denture, and they fit each other preciselySemi-precision attachment: similar to precision, but the male portion is cast into RPDSkirtRetention and resistanceMini-crown prepCollarBracingBevelled shoulder around a capped cuspSkirt preparation in gold inlay is: surface extension of proximal box for secondary retentionMain Disadvantage of gold inlay: deforms under load (since it is high noble gold and softer, may have higher creep)How to remove a gold inlay: Section isthmus and remove in 2 piecesWeakest part of gold inlay (MOD): cement layerImplantsNOT is bad for placing implant: radiopaque lesionsWeakest crown material for implant abutment: aluminiumminimum amount of bone needed between 2 adjacent implants? 3 mmDistance between implant and tooth: 1.5 mmIdeal depth of bone for an implant: 8 mmMinimum bone around implant: 1 mmImplant 4mm in width, labio-facial bone needs to be: 6 mmDistance from IA canal or maxillary sinus and implant should be: 2 mmDistance from vital structures like mental foramen: 5 mmHow much bone loss around an implant is a failure: more than 0.2 mmWhat causes the least buccal-lingual resistance to lateral forces: one 4 mm diameter implantImplant diameter is 3.75 mm. What is the minimum labiolingual distance required: 5.75 mmThe major mechanisms for the destruction of osseointegration of implants are: similar to natural teethAbsolute CI for implant: bisphosphonate therapyAfter implant placement, an edentulous patient should: avoid wearing anything for 2 weeksDiff between 1 stage and 2 stage: (1 stage) immediate loading vs (2 stage) traditional wayImplant retained fixed prosthesis, doctor took radiograph and it showed 2 out of 3 implants seat positively with good margin. What should doctor do after? Section and indexA FPD will be supported by both an osseointegrated implant and natural teeth. Most serious potential problem is: implant and natural teeth have different mobilityWhere do you put occlusal rests for implant supported RPD? NONEWhen not to immediately load an implant: bone grafting with GTR: bone grafting with GTRIf implant is placed too labially: change abutment angulation When selecting an implant: There should be at least 1 mm of bone lingual and buccal of implant for survivalMajor advantage/indication of a screw crown is: when there’s small interarch space (< 5mmWhat causes the least buccal-lingual resistance to lateral forces: two 5 mm diameter splinted implantsAt the time of delivery of an implant supported prosthesis, only 2 of the 3 implants seat: separate the prosthesis and re-index itWhat is the temperature limit before bone dies in implant procedure? 47?C for 1-5 minutesMinimum implant length recommended is 10 mmScrew should be tightened: 50%-70% of yield strengthSleeping implant: Implant in wrong position, cover it with soft tissueWhat determines implant height in an overdenture? Gingival heighta major advantage to patient treatment with osseointegrated dental implants is a change in the pattern of edentulous ridge resorption, which of the following is believed to be the reason for a more physiologic loading of the bone: endosteal loadingImplant 1mm bone loss after a year of placement: normal boneImplant position in relation to adjacent tooth: 2-3 mm apical/below CEJIn an appointment for the impression of implant what do you do first: put the coping firstINR safe for implant: 2.5INR safe for extraction for patient on warfarin or invasive procedures: 2 – 2.5INR safe for extraction for patient with prosthetic heart valve: 3-4Normal INR: 0.7 – 1.2INR determines: Prothrombin TimeINR < 3: impactions and multiple extractionsINR < 4: simple extractionsINR pathway: extrinsicaPTT is for: heparinHow long do we have to wait before placing an implant in a previously failed implant site? 4-6 monthsAge is not a CI for implant treatmentPatient was prescribed Coumadin (INR), why?: MIGap between the abutment and the implant: microgapAbutment is always: coronal to boneIf you use distilled water while doing implant surgery. What can happen: cell necrosisINR is used to determine: prothrombin activityA patient who takes dicumarol (anti-coagulant) is probably being treated for: angina pectoris/MI/coronary infarct Most useful in treating or preventing angina pectoris: PropranololOther used in treating or preventing angina pectoris: Isosorbide dinitrate and Pentaerythritol tetranitrateCT fibers around implants: parallel and non-crossingBest bone for implants: D2Type of bone in lower anterior: D1you are considering the placement of an upper and lower important retained complete denture. How many implants will you place in the anterior region: maxillary four and mandibular twoUse of ultrasonics is CIPlatform switching: Reduction of the diameter of the prosthetic component in order to displace the inflammatory infiltrate more horizontally and prevent bone loss; matching a smaller diameter abutment with a wider diameter implant.Overload: forces that take out the post from the implant (lateral or bending forces or parafunctional forces)Implant CI: cleft palate; bruxism; bisphosphonate therapy; tobacco – relativeImplant internal component helps with what? Prevents rotation of abutmentLoadingImmediate loadingSame day – 1 weekEarly loading1 week – 2 monthsConventional loadingAfter 2-3 monthsWhat is the problem with preloading a screw implant: High loading can lead to implant creep; low loading can make it looseLigament most likely to cause an implant to fail: Transseptal (maintains integrity of dental arches)Fiber groups not attached to alveolar bone or which inserts in two adjacent teeth: transseptalWhat causes rotation of a tooth after ortho therapy? Transseptal fibersImplant success rate at 5 years: 85% or 95%?Implant success rate at 10 years: 80%Implant success is not affected by: agetwo implants to support denture: implant gives retention and tissue gives supportBone grafting: works best to augment ridge widthGingival grafts should be performed: prior to fabricating the final restorationProvisional restorations should not: rest on bone grafts or newly placed implantsImplants are most often made of: TitaniumAbutments for implant-level impressions are: selected in labAbutments for abutment-level impressions are: selected in mouth Types of implantsSubmerged2 stageMicro gapsNear bone levelTransmucosal1 stageNo micro gapsAbove bone levelTransfer-type impression copings: remain on the implant when the impression is removed; advantageous for posterior segmentsPick-up type (open tray) impression copings: requires a hole in impression tray; remain in the impression when removed; more accurate; don’t have to put coping back into impression; impression material not deformedClosed tray: transfer easier, better for shorter interarch distance, not suitable for deep implants, don’t work for non-parallel implantsWhat will you do when implant is inclined too buccally and you don’t want the screw to be seen on the buccal surface of crown? Angled abutment and cement or custom abutmentTissue around implant: parallel with cuff likeWhen getting crown for implant, what occlusal scheme is preferred? metal occlusal is preferredAdvantages of open tray impression: reduce effect of implant angulationDuring stage II (uncovering) of a 2-stage implant, the healing abutment should be placed: 1-2 mm “taller” than the tissue, out of occlusion, designed to shape or mold the tissue and radiographically confirmed as seatedPick-up impression may be used with: divergent implantsAbutments for implant level impressions: can be selected in laboratoryAn implant level impression means that: the impression recorded the actual abutment attached to the implantSubmerged implants: abutments are exposed in the oral cavityNon-submerged implants: implant is exposed and is a 1 stage processTo verify that abutments and crowns are engaging external connection systems: A combination of clinical and radiographic checks are recommendedMorse taper: cone-in-socket type of abutment to implant connectionFor crowns in the esthetic zone, soft tissue support: Can be created in the abutment and the crownImmediate loading is: placement of restoration at the time of implant placementDistal cantilevers on implant prostheses are: to be avoided whenever possible and limited to short spansMost bad thing in cantilever bridge: rotation forceCantilever bridges are not good in the long term BECAUSE periodontal forces are best along the long axes of tooth: statement and reason are correct and relatedWorst cantilever bridge: over central pontic and lateral abutment.Implant indexing is: method of impression-taking at the time of surgical placementPassive fit is: the placement of a bridge without resistanceImplant analog: A replica of the entire implant, not intended for human implantation; part that goes into impression before pouring the cast.Testing if screws can turn without resistance until the last quarter turn is: Useful for verifying proper fit in multi-unit restorationsAfter delivery of a screw-retained bridge: It is recommended to block the screw access hole with a temporary materialWhen using a two-stage implant, radiographic bone level is expected to be: at the level of the first threadImplant home care aid: superfloss or yarn ONLYOral hygiene instructions for implants: should include specific wrap-around techniquesIf a patient has removable dentures, what generally needs to be done at yearly visits? A change of female attachmentsWhen observing a routine radiograph for an implant patient, you see a horizontal dark line between the implant and what seems to be the abutment. This is probably is a sign of component looseningAt a maintenance visit, an implant-retained bar is found to be mobile at one extremity. Step to be taken: verify that the screw is loose and place a new oneAdvantage of screw retained prosthesis: ease of retrievalLoose screw should be: replacedAdvantage of cemented prosthesis: ease of fabricationConnecting implants and teeth: should be avoided whenever possibleRough surface of implants is desirable for: improved osseointegrationOsseointegration means 40-70% bone-implant contactThe first event leading to osseointegration that occurs after implant placement is: formation of blood clotTrue osseointegrated implants: Only endosseous (root & blade) and transosseousMost commonly used implants today: EndostealFirst phase of osseointegration: direct contact between woven bone and implant in one weekHistological definition of osseointegration: direct connection between living bone and load-bearing at light microscopic levelAt what appointment do you first check osseointegration: Second stage of surgery (placement of healing cap)What is most important for osteointegration in implant procedures: How well the surgical procedure is managedMajor mechanisms for the destruction of Osseointegration are: similar to those of natural teethHow does titanium of an implant help in Osseointegration: Forms titanium oxide layerSimilarity between bone and implant: vascular bundle below boneExcessive force on implant crowns results in: fatigue of implant components, leading to fracturePreload is: Tension placed by screws to protect implant components from displacing forces or keeps the screw threads tightly secured to the mating counterpart of the screw and holds the parts together by producing clamping forcesSettling effect: embedment relaxation (reduces preload)Lateral forces are well tolerated: loading is done off-axisImplant survival: refers to presence in the mouth after a period of timePeri-implantitis: inflammation of peri-implant tissues leading to bone lossReason for peri-implantitis: excess cement, poor hygiene and occlusal forcesPlaque and calculus: accumulate on implants similarly to teethConnective tissue fibers around the implant neck are: parallel to implant surfaceDisadvantage of cemented implant: inflammation due to cement flow into sulcusImplant recall visit for hygiene is every: 3 monthsMinimum amount of space required for 4 mm implant is 7 mm (4+1.5+1.5)Minimum width of bone to place an implant is 7mmThe minimum required bony buccolingual ridge width in millimetres for placement of 4.0 mm root form implants is 6 mmEsthetics of a maxillary central anterior implant replacement is determined by: Emergence profileIf implant and bridge are done with natural tooth, what is the complication: there is a lot of force on crown of implant and cause fracturePlatform of implant from adjacent CEJ: 2-3 mm for emergency profileThe minimum interarch space for a fixed implant-supported (FPD) prosthesis is: 7 mmThe minimum interarch space for a removable implant-supported (RPD) prosthesis is: 12 mmHow do you measure interarch distance: mesial of 6 to the other 6Ridge mapping measures: soft tissue thickness clinically to deduce bone widthMinimum amount of bone height required for dental implant: 10 mmMost popular implant: root formImplant of choice in very atrophic mandible: trans-osseousBone resorption after 1 year in implant: 1 mmMost bone loss associated with dental implants occurs at: 0 – 1 yearBony resorption from implant is considered successful of you have: 0.1mm of resorption per yearWorst patient to place implants: adolescentLingual incline of buccal mandibular cusp which interference: Non-workingTemplate for implant control except: Size of implantRadiographic templates are used to visualize diagnostic teethA scannographic template is: An aide for visualizing diagnostic teeth on a computed tomography imageCommon complication with implants: Abutment screw becomes looseWhat is important in single implant tooth replacement? Broad contact with neighbouring teethBest prognosis for implant: anterior mandible (densest bone)Best location for bone graft: posterior mandibleWorst prognosis for implant: posterior maxillaMost harmful force to single implant: horizontal/lateralBest can tolerate: verticalWhat doesn’t affect implant treatment planning? Smoking history, but failure rate are higher among smokersCombination (Kelly’s) syndrome can be improved with: implants in posterior mandible (specific pattern of bone resorption in anterior edentulous maxilla cause by wearing a CD opposing natural anterior teeth)Kelly’s syndrome show: maxillary ridge resorption; atrophy of premaxilla; hypertrophy of tuberosity; flabby tissue (papillary hyperplasia), enlarged tuberosities, extrusion of lower anterior teeth. NOT is increased VDOPurpose of HEX in implants: Anti-rotationInternal HEX: anti-rotation and deeper within the body compared to external HEXInternal HEXNot mechanically better but is supposed to resist loosening better; more surface area and more rotational stability; best in aesthetic areas1.9 mmExternal HEXAllows micromotion, less rigid, anti-rotation0.7 mmMicromotion limit during healing phase of implant is: 150 micronsRecommended number of implants for completely edentulous patients: Maxilla 6 and mandibular 4When do you check an implant for osseointegration? Before abutment placementIn patients with this disorder, implants are CI: body dismorphic disorderImplant and bone interface: Hemidesmosomes (also gingiva to enamel)Sign of lose implant: mobilityYou do probing around the implants and what should be the normal width: 3 mmImplant indicationsEdentulous atrophic mandibleIf adjacent teeth don’t require any restorationsImplant contraindicationsSmoker and alcoholicsMaxillo-facial deformities (C/P)Systemic diseases (diabetes)Steroids Radiation treatmentImplant CIsSupport for Kennedy class 3 with modification one comes from: occlusal restIn a class I occlusion, which cusp of which permanent tooth moves between the mesiolingual and distolingual cusps of the mandibular second molar in a working side movement: mesiolingual cusp of maxillary second molarA surgical template for an immediate maxillary CD is used to: indicate areas that require additional hard or soft tissue removalUse of surgical template or guide: For angulation of bur for implant placementAt the try-in appointment, an all metallic crown has an open margin. The most likely cause is: undercontour of the provisional restoration interproximallyPonticA pontic should not exert pressure on the ridgeA conical pontic replacing a mandibular first molar should be designed so that: it has open gingival embrasuresPontic of a FPD must be no less than 3 mm occlusogingivallyBest for a knife edge residual ridge where aesthetics is not a major concern: conicalPontic replacing a mandibular first molar should be designed so that it has open gingival embrasures and its gingival surface is convex in all directionsIn children: ovate (sanitary substitute for saddle-ridge-lap) is for anterior and hygiene/sanitary is for posteriors (gap is 2 mm)Unhygienic pontic or difficult to clean because of tissue contact: saddle (ridge lap) – concave – NOT USEDMost popular type of pontic: ridge lapHygienic pontic: egg/bullet shaped – convex; POSTERIOR teeth only (poor aesthetics – no probs)Modified ridge lap: esthetic zone, minimal contactDeflection of Pontic occlusogingival: directly related to cubic pontic lengthPosterior pontic, how should it be: MD convexPontic in an esthetic area: modified ridge lap (minimal contact without blanching)Pontic that is only all-metal: sanitaryPontic requiring surgical preparation: ovateSanitaryPosterior mandibleSaddle ridge-lapDON’T USEConical Molars without esthetics Modified ridge-lapHigh aesthetic requirementOvateVery high aesthetic requirementThe coefficient of thermal expansion of the metal relative to the porcelain for constructing a ceramometal crown should be: slightly moreThe coefficient of thermal expansion of composite resins is: greater than that of enamelHighest linear coefficient of expansion: composite resinCETEAcrylic90Composite resin25 - 60Amalgam25Enamel11.4Dentin8Porcelain4A vital canine is to be sued as the anterior abutment of a four unit fixed PD and it has 2 mm remaining coronal tooth structure. Most acceptable would be: pin retained composite resin core build-upClass 4 composite filling is ok but color is too light, what do you do? Composite tentThe portion of an artificial tooth that is found only in porcelain anterior teeth is: pinGingival margin of the preparation for a full crown on a posterior tooth, that satisfies the requirements for retention and resistance should be placed: supragingivallyThe condylar inclination as set on the articulator from a protrusive records is: a mechanical equivalent of the actual condylar slopeA protrusive jaw relation record is made in order to set the: horizontal condylar inclination of the articulatorIn protrusive condylar movement, interferences can occur between which posterior cusp inclines: DUML (distal inclines of maxilla and mesial inclines of mandible). Opposite in retrusive condylar movements.DUML for protrusionMUBL for retrusionWhen adjusting the condylar guidance for protrusive relationship, the incisal guide pin: should be raised out of contact with the incisal guide tableHow much undercut area a clasp arm should engage: pre-determined amount of undercutpatient who have natural dentitions generate the GREATEST amount of occlusal force during: parafunctional movementsRetentive clasp is located in: gingival third or in an undercutReciprocal clasp is located in: middle thirdMain disadvantage of an infrabulge retainer: too flexible for effective bracingAdvantage of infrabulge retainer: more retention, less distortion/caries riskMost important property of a clasp is: elongationThe undercut for Cobalt Chrome’s retentive arm clasp is: 0.25 mmFlexibility of clasp arm does not depend on: depth of undercutCombination clasp:Used when undercut is mesial to base of dentureRetentive arm is made of wrought metal (platinum-gold-palladium alloy or chrome-cobalt alloy), which makes it more flexibleReciprocal arm is made of cast metal, which makes it rigid or strong (less flexible)The retentive terminal reaches the undercut from above the HOCEach clasp should encircle more than 180 degreesMost suitable to use on a tilted molar for partial denture: ring claspIf axial wall is less: give circumferential shoulderWrought wire clasp should have at least: 6% elongationa wrought (cold-worked) metal is BETTER than cast metal: flexible, greater tensile strengthHow wrought loses its elasticity: over adjustmentOcclusal reduction of porcelain crown: same as occlusal anatomyIn developing a canine-protected articulation where the anterior vertical overlap is determined to be less than 2 mm, the posterior cusp height should be kept shallow because the buccal cusps of the posterior teeth will have to assist in protrusive disocclusion. Statement is correct, but reason is NOTBuccal cusps of posterior teeth do NOT assist in: protrusive disclusion!Excessive vertical dimension of occlusion may result in: trauma to underlying supporting tissuesCorrect order to prepare RPD: Prepare guiding planes, Height of contours (Carbon marker), Retentive contours (Block out undercuts), Prepare RestsWhy have guiding plane: better clasp retentionThe higher modulus of elasticity of a chromium-cobalt-nickel alloy compare to a type IV gold alloy, means that chromium-cobalt-nickel partial denture clasps will require: shallow undercutIn the edentulous patient, the coronoid process will likely: limit the thickness of the maxillary buccal denture flangeImplant failure is due to: occlusal trauma and surgical errorTitanium and Titanium alloys are used for manufacturing root form implants because the oxide layer makes the surface: passiveOcclusion in which all the posterior teeth disarticulate during right excursive movement: mutually protectedThe auxiliary occlusal rest on teeth for partial denture should be placed: away from fulcrum lineIn implant supported RPD, where to put occlusal rest: NoneMinimal thickness of occlusal rest is: 1.5mmMinimum clearance for occlusal rest: 2 mmCause of fracture of occlusal rest is: shallow preparation in marginal ridgePorcelain denture teeth are fabricated with: pins for retention (anterior teeth) and diatorics (posterior teeth)Deepest part of rest: occlusal (2 mm)Function of rest: supportCommon cause of rest breaking: inadequate rest seat preparationWhy is a lingual rest better than a cingulum rest: Lingual rest exerts less leverage against the tooth The classification of the soft plate throat form is important to note prior to making impression for several reasons. The most notable is: selection of the stock edentulous trayKennedyKennedy’s Class III gets support from: occlusal rest (tooth supported)Kennedy’s Class IV is: tooth supportedIndirect retainers most needed in: Kennedy class I and IIOcclusal rest used in Kennedy class I: mesial restDistal extension PD: Kennedy class IUpper denture with palatal strap, which acts as indirect retainer: Class IIIRetention is a problem in: Kennedy Class I because it is tissue retainedHow to enhance color of porcelain in PFM? Internal glazingNatural glazing of porcelain: heated rapidly for 10-15 minutes and maintained at that temperature for 5 minutes before it’s cooled. Natural glaze is better and more permanent than over/applied glaze!Porcelain overglaze (or applied glaze): ceramic powders that can be added to the porcelain before firing. It's non-porous but can be eroded, leaving a rough porous surfaceStrength of porcelain decreases due to: over firing, entrapped air bubbles, and sudden cooling What causes porcelain to break off from the PFM: metal contaminationRough surface of porcelain/porosity is a result of: lack of compressionA patient has a high caries index, short crowns and minimum horizontal overlap. What restoration will you place: PFMThe primary reasons for obtaining the most extensive area coverage for a mandibular complete denture are: to increase the capacity of underlying structures to withstand stress due to biting forces & to increase the effectiveness of the peripheral sealMost important for retention: peripheral sealThe physiologic rest position is important in complete denture construction because it: Provides a guide to the vertical dimension of occlusionPat has a temporary hypersalivation after wearing a denture. What is the reason: reflex action on stimulation of parasympatheticPatient complains that CD falls off when speaking, what could it be: overextendedPatient yawns and denture falls off, what's the problem: Overextended buccal flange (interferes with the coronoid process)Overextension of a mandibular denture base in the distofacial area will cause dislodgement of the denture during function as the result of the action of the: buccinatorThe distal portion of a mandibular denture base should include: Retromolar pad completelyMaximum support in distal extension RPD gained through: proper tissue support by denture baseDenture base least important in terms of: rigidityBorder moulding the custom tray is best achieved with placing the stick compounding areas of primary stress bearing areas firstYou’re doing border moulding of the buccal posterior mandibular area, near the masseter, what movements do you ask the patient to do? Closing mandible against pressureMost difficult part for border moulding: anterior mucobuccal foldMost important factor for maxillary retention (complete dentures) is: mucobuccal foldHardest record (impression) to take: Protrusive record (made for horizontal condylar guidance)Protrusive record is made of: anterior and inferior condylar pathHardest area to take impression of (in CD): retromylohyoid for the mandible, and anterior flange for the maxillaRetromylohyoid area is limited posteriorly by action of palatoglossus and inferiorly by superior constrictor muscleWhich muscle should be relieved while recording the buccal flange of the mandibular arch: triangularisMain purpose of buccal flange of Mx denture: StabilityThe face-bow is used to record: relation of maxilla to TMJThe Frankfort plane is parallel with: Ala-tragus planeThe upper and lower anterior teeth are best arranged with: 0 mm vertical overlap.The amount of jaw separation when the teeth or occlusion rims are in contact in centric occlusion is defined as: occlusal vertical dimensionCusp to fossa relation: centric occlusion coincide with centric relationThe jaw relationship most frequently used in the actual design of restorations is: acquired centric occlusionTripod marking in surveyor is used to: re-orient the cast on surveyorFirst step to design partial denture is: surveyingAttrition in elderly ppl doesn’t cause loss of contact due to: deposition of bone around fundusIn determining the replacement of missing anteriors with ridge lap design or with incorporation of labial flange, what factor is most important: high lip lineFree way space: 2-4 mm in edentulousWhat determines the limits of the inferior border of the lingual component of an RPD: elevation of anterior floor of the mouthTaking impression with elastomers for maxillary fixed bridge using custom tray, the special tray should be: having space of 3 mmClinical symptoms of mental nerve compression by the denture borders? Lower lip & chin numbnessWhat is the advantage of acrylic resin over Cr-Co: ease of adding teethPPSThe posterior palatal seal for a maxillary denture: helps to compensate for the lack of adaptation caused by shrinkage of acrylic & will vary in outline and depth according to the palatal form encounteredindication for removal of a maxillary torus to fabrication of a maxillary denture? Interferes with posterior palatal sealDistal extent of hard palate: anterior outline of posterior palatal sealLocation of posterior palatal seal: vibrating line (between hamular notches, 2 mm anterior to fovea palatini)Posterior outlineformed by the “ah” line or “vibrating line”: close to the fovea palatini, in between the hamular notchesAnterior outlineDistal extent of hard palateLocation of posterior palatal border: fovea palatini (not vibrating line)Purpose of PPS: compensate for shrinkageContraindication of (enamel shell) restorations: edge to edge biteThe stock tray selected for the primary impression is best described as: slightly oversizedLimiting structures related to the mandibular denture include: labial frenum, masseter muscle and mylohyoid muscleFor a porcelain fused to metal restoration, the metal surface: must develop an oxide for chemical bondingThe most ideal soft palate form for denture retention is: Class IAn interocclusal distance or rest space: allows room for chewing, swallowing and speakingOne important objective of the final (secondary) impression is to: Record the detail of the denture bearing area in an unstrained and undistorted stateRPDMajor connector function: Unification, Stress distribution, rigidity, and stability (cross-arch stabilization)To increase rigidity of a major (materials): chrome-cobalt, cast & ? roundTo increase rigidity of a major: corrugate linguo-plate or rugae areasRequirement of a major: should not enter undercut areas; avoid terminating on free gingival margin; hard tissues such as mid-palatal suture or mandibular toriMinor connector function: retention and stabilityFunction of rest: provides vertical supportRetentionVertical dislodgementStabilityHorizontalSupportVertical seating forcesRest has to form acute angles with: minor connectorsWhen using a non-rigid connector, the path of insertion of the key into the keyway should be parallel to: the path of insertion of the retainer NOT holding the keywayNon-rigid connector is limited to: short span bridges replacing 1 tooth; key and keyway that connects one piece of a prosthesis to anotherNon-rigid connector in a FPD is indicated when: forces in different directions would cause a pier abutment to act as a fulcrumWhen utilizing a non-rigid connector when there is a pier abutment, the KEYWAY should be placed: distal of the pier abutmentMajor connector for palatal torus: horse shoeWhich would provide a greater increase in the strength of a rigid connector? Double the occluso-gingival widthOther names for anterior palatal plate: U shaped or horse shoe (poor design; too flexible)Foremost function of reciprocating arm is: stabilizationPrimary support for both mandibular (buccal shelf) and maxillary CD: alveolar ridgeDental clicking: Increased VDO (whistling: decreased VDO)Porcelain teeth can cause: clickingDull thud: Self reducing subluxationDecrease in VDO = increase in freeway spaceMeasure VDO: Let patient pronounce letter F to measure rest positionMandibular freeway space: 3-4 mmMaxillary freeway space: 2-2.5 mmMandibular leeway space: 6.2 mmMaxillary leeway space: 2.6 mmClosure of leeway space results in: late mesial shift of the permanent first molarWhat is leeway space: difference in the MD width of primary molars and canine with permanent canines and premolarsWhat makes space for mandibular incisor teeth when they erupt? Primate spaceWhat doesn’t affect implant treatment planning? AgeDrug with good first pass effect? Low bioavailability (drug available in blood/plasma)Cheek biting occurs due to = insufficient HORIZONTAL overlap in molarsnew completed denture and the patient complains of cheek bite, what will you do: grind buccal of lower teethWhich aspect most commonly needs convincing for the pt with new CD: mandibular denture retentionTongue biting occurs due to = excessive HORIZONTAL overlap in molarsocclusal disharmony in newly inserted complete dentures MOST frequently results from: errors in registering jaw relationsA patient has only the mandibular anterior teeth remaining. The treatment plan calls for a maxillary complete denture and mandibular removable partial denture. Desirable in the occlusal scheme? Bilateral balanced contact during excursive movementsThe incisal guide table is designed to protect the function and arrangement of anterior teethWhat is the most difficult to achieve with max denture and opposing natural teeth? Bilateral balanced occlusionLingualized occlusion is a modification of: balanced occlusionHow to maintain balanced occlusion when there is excessive incisal overlap: decrease condylar inclinationIf incisal guidance is low: increase condylar guidanceOn the articulator, the incisal guidance is the: mechanical equivalent of horizontal and vertical overlapA balanced occlusion can most frequently be established with a: mandibular RPD against CDContacts in Balanced OcclusionCusp-to-fossa contact in centric occlusionIdeal Class 1During lateral excursions, OPPOSING cuspsContact with WORKING SIDE. (BULL)During lateral excursion, on the BALANCING SIDEMaxillary lingual cusps (lingual inclines) contact Mandibular facial cusps (lingual inclines). (LUBL)In unilateral balanced occlusion, contact between mandibular buccal cusps and maxillary buccal cusps (or lingual and palatal) will most likely occur in: laterotrusive movementsBalanced occlusion requires that maxillary lingual cusps of posterior teeth on non-working side contact lingual incline of facial cusps of mandibular posterior teeth on working sideWhat’s advantage of using arcon over non-arcon articulators? gives more similarity to mandibular movementsWhich articulator is capable of duplicating the border mandibular movements of a patient: arcon-typeArcon articulator is associated with centric relation. Like a human mouth, more accurate. Used for FPDPure rotation of the condyle (terminal hinge position) is possible when the mandible is in: centric relationPurpose of facebow is to set the maxillary arch to: terminal hinge axisMandible to skull relationship is: centric relationWhich articulator is used to mount a cast (for changing VDO for e.g.): ArconNon-arcon: condyles are in the lower compartment; used for dentures; upper and lower compartments are rigidly attached. Semi-adjustable and uses a facebowMinimum requirement to set the left condylar inclination and the left side shift on an ARCON articulator: right lateral excursive record (explanation: the jaw movement during the right lateral excursive movements allows for the left side shifting to occur, and vice versa)Balanced centric occlusion seen in RPD and CDBalanced eccentric occlusion: must in CD, but not in RPDAll post teeth disocclude while eccentric movement. Which cusp u won’t grind: Max lingualLabial/lingual bar major connector has to be at least: 3 or 4 mm below gingival marginLingual plate: Lingual bar with extension over cingula of anterior teeth; use when bar cannot be usedSituations when impingement from lingual bar happens: high floor of mouth; prominent lingual frenum, lingual toriAdvantage of lingual plate: easier to add denture toothExamples of continuous bar retainer: Kennedy bar; Double lingual barWhat is a continuous bar retainer: lingual bar with secondary bar above cingula which acts as indirect retainerMaxillary major connector should be at least: 6 mm below gingival marginThe maxillary case partial denture major connector design with the greatest potential to cause speech problems is: thick narrow major connectorMaxillary cast partial denture major connector design with the greatest potential to cause speech problems: thick narrow major connectorFull palatal plate: choice in long distal extension cases; 6 or less anterior teeth remain; abutments are periodontally involved; flabby tissueMinimum thickness of a connector is: 3 mmMargin discolouration of veneerdayAmineweekMicroleakage or porcelain breaksmonthMicrocrack or resin wears offHow to clean implants: Non-metal based scalers; proxibrushMetal framework wax-up is done on what cast: final castWax with lowest melting point: Paraffinmodel cement commonly known as sticky waxType A wax (hard); type C wax (soft)Stress bearing in maxillaPrimaryRidgesecondaryTuberosity and rugaeStress bearing in mandiblePrimaryBuccal shelfSecondaryAnterior lingual borderAn exaggerated curve of the occlusal plane and loss of the image clarity of the roots of the anterior teeth is indicative of a panoramic positioning errorFunction of compensating curve: provide balanced occlusionIf posterior teeth separates in try in in protrusive excursion, increase: compensating curve.Pressure on the mid-palatine suture will improve: neither denture retention not denture stabilityClicking of the dentures during speech most often indicates: insufficient interocclusal spaceDenture teeth (always use plastic teeth! Even if opposite teeth are PFM crowns. Ceramic teeth in dentures will resorb the ridge much faster)Immediate dentureMonoplane plasticPermanent dentureAnatomicMonoplane occlusion: No curve of speeA crossbite relationship of the posterior teeth is an indication for: monoplane concept of occlusionTooth set in 20 degree for balanced occlusion, but adjusted to 45 degree what is need to corrected for balanced occlusion: compensatory curvePurpose of leveling curve of spee: to correct deep bite (serial extraction CI)Maxillary and mandibular arches have curvatures in: sagittal and frontal planesCurve of WilsonMedio-lateral U-shaped curve of upper and lower posterior teethCurve of SpeeA-P curvature of mandibular occlusal planeCompensating curveUnder dentist’s control. Helps provide a balanced occlusionInverted curve of speePatient chin too highExaggerated curve of speePatient chin too low; deep biteCurve of spee: beginning at the tip of the lower cuspid and following the buccal cusps of the posterior teeth. Naturally occurring phenomenon in the human dentition. This normal occlusal curvature is required for an efficient masticatory system. Part of a circle with a 4-inch radius. Has a biomechanical function during food processing by increasing the crush/shear ratio between the posterior teeth and the efficiency of occlusal forces during mastication.A patient has received a new mandibular removable dental prosthesis. Soon afterward, the throat of this patient becomes sore. Which of the following has probably caused this soreness? An overextension of the distolingual flangeIn arranging the patient’s maxillary anterior teeth, the dentist should create a pleasant, natural-looking smile line. This can be done by contouring the incisal edge to follow the lower lip when smilingExaggerated smile line or v smileChin tipped down (maxillary anterior teeth will appear elongated and mandibular teeth will appear foreshortened)Reverse smile lineChin too up/forwardpathogenic microbiota is most likely associated with a failing implant? Gram negative anaerobic rodsmost common organism in chronic periodontitis: anaerobic gram negativeReductionsFor the porcelain veneer preparation, the standard amount of tooth reduction in the middle one third of the facial surface is 0.5mm; gingival 1/3rd – 0.3 mmHow much the reduction from incisal edge in veneer: 1.5 mmIncisal edge of anterior PFM is opaque because: improper second plane of reductionWhat not to do in veneer: etch enamel with hydrofluoric acid (only etch internal surface of veneer)Female with protruded teeth, what makes it worse: veneerAverage life span of resin composite veneer: 4 yearsHow much do you take off for a facial veneer? incisal - 0.7 mm, labial - 0.5 mm. cervical - 0.3 mmOptimal reduction for buccal cusp or incisal in PFM: 1.5 mmPFM buccal margin depth is 1.5 mmThe optimum depth for the facial reduction of a metal ceramic preparation is 1.5 mmGingival third of PFM is very translucent, cause: inadequate reductionOptimal incisal reduction for a metal ceramic crown: 2 mmIncisal reduction for porcelain crown: 2 mmThe cups to be restored with dental amalgam should be reduced by: 2 mm while forming flattened surfaceShoeing cusp is a form of RESISTANCEWhat is "head lightning": opaque layer showing through the crown caused by improper tooth prepAmalgamWorking cusp2.5 – 3.0 mmNon working cusp2.0 mmCast Gold/Full metalWorking cusp1.5 mmNon working cusp1.0 mmCeramicWorking cusp1.5 – 2.0 mmNon working cusp1.5 – 2.0 mmVeneer looking opaque: veneer under preppedUsed to cement a veneer or porcelain: light cured resin cementMaxillary incisor chip off: VeneerHardest thing in doing veneers? CementingDentist after finishing preparation for full veneered crown but a groove on buccal surface as a final step, why: indication for seating of crownUsed to cement ceramic onlay: resin cementFunctional cusp bevel: To prevent fracture of the cusp and for proper casting/fabrication of the crown; structural durability/integrityoutcome of not giving a functional cusp bevel: decrease in thickness of restorationGingival bevels is needed for: onlay preparation and amalgam prepsWhy gingival bevel in class 2 preparations: remove unsupported enamel margins and as resistance form against #Gingival bevel can be placed with: sharp fluted instrument; GMT and thin diamond burGingival bevel cannot be placed with: enamel hatchetWe bevel the edge of gold for: better adaptationOnlay axial walls: divergentWhich is the only surface not beveled for an onlay? PulpalSupporting cusps are rounded and flatNon-supporting cusps (guiding) are sharperDeterminants of occlusion: TMJ, muscles, teeth (occlusion)Determinants for restoring a complete and functional occlusion: overbite, articular eminence, bennet movement, position of tooth in the archAn occlusion that is free of interferences to smooth gliding movements of the mandible with absence of pathology: Functional occlusionAnterior determinant of occlusion is the: horizontal and vertical overlap of anterior teeth1. Value (reflection of amount of light or intensity) – lightness or darknessMost important; B & W; brightness; ranges from 0 (black) to 100 (white)2. Chroma (concentration dependent) – saturation or puritySaturation (intensity/strength)3. Hue (wavelength of color)Least important; choose FIRST Order: HCV (hue, chroma, value)If the crown is unaesthetic, it is due to: valueIntensity of x-ray is dependent on: mA, kV, exposure time and distance! Staining a porcelain restoration or using complimentary colours: Decreases the value and increase huerubber dam gives a black background appearance, affecting the Shade selection (everything looks whiter than is actually)What didn’t cause the unaesthetic opacity of crown? shade selectionDentist can most easily change: ChromaDentist can’t change: Hue (measured in the 100th)Yellow and pink/purple are used for: HueOrange increases: ChromaJugaadYellow stainIncrease chroma in yellow hueOrange stainIncrease chroma in yellow red huePink purpleYellow redWhen you add a different color to a resin, you increase what? ChromaIdentified on a photograph: chromaOrange stain: alter hueTo minimize fovial fatigue when making shade selection on a patient, the dentist should use an: observation time of 5 seconds or lessWhat does staining do for ceramics: decreases value and alters chromaWhat does orange colour do to porcelain: darken porcelain and decrease valueHow to reduce value: add complementary colour from color wheelWhat can’t be changed with addition of stain: Increase in valueCritical for shade selection: value (because it cannot be altered)Which one can human eye see: ValueDecreases with time and stains: valueColor choice for cervical third for full coverage: highest chromaShade guide is to detect: valuedifficult to accomplish with extrinsic characterization of metal ceramic restorations: increase valueChanges with age: increase chroma, decrease value, no change in hueLarge composite and acceptable appearance what to do: tintDentin and CFO: opaqueness, flourescence and chromaVita shade A1: higher value than A4refers to a decreased occlusal vertical dimension: Occluding vertical dimension that results in an excessive interocclusal clearance when the mandible is in rest positionThe difference between a 330 carbide bur and 245 carbide bur is: head of a 245 bur is longer (3mm) than the head of a 330 bur (1.5mm)Diameter of 245 bur (pear shaped): 0.8 mmBur used for amalgam class II: 245Proper pulpal floor depth using 245: 3 mmWhat sterilization ruins a carbide bur? Heat sterilizationCarbide but cuts: smooth Use of burs245 (used for kids)Occlusal/cavity preparation701Interproximal and axial wall232 and 257Amalgam cutting169InlaySpeedHigh speed200,000Slow speed20-30 KEndo800function of occlusal (night) guards: redistribute forces on teethexplains why proper contouring of the axial surface of complete cast restorations is extremely important: effect on gingival tissue healthPatients receiving cast restorations have to be recalled (at least) every: 6 monthsrarely a symptom of combination (kerr’s) syndrome: increased occlusal vertical dimensionFinish linesmost accurately describes the finish line and margin of crown: finish line should be placed in hard dentin when it is possibleLeast important factor to increase retention in crown: utilizing shoulder finish lineFinish line that does not improve retention: shoulderFinish line for all ceramic crown is: shoulderFinishing margin for full GOLD restorations: chamfer and feather edgeAll ceramic: shoulderIdeally, what type of margin should be prepared on a cavity before placing a ChemFil restoration: Butt jointMetal: chamferPFM: lingual chamfer; shoulder buccalBur for chamfer: round end taperedSSC, cast gold: feather edgeButt jointPoorest type of finish lineAcute edgeBest finish lineFeather edgeBest finish line, but least marginal strengthChamferPreferred on GOLDReverse 3/4th crown preservesLingual areaStandard 3/4th crown preservesBuccal area (most common partial veneer)What is 7/8th crown3/4th crown whose vertical DB margin is positioned mesial to middle of buccal surfacePath of insertion anterior ? crownShould be parallel to the incisal ?-2/3 of labial toothSeven eight crown or three forth crown serves as an excellent abutment for: bridge, as it covers both the proximal surfaces.Retainer provides more retention in anterior bridge work: 3/4th partial veneer crownBone to implant contact enhanced by: Functional loadingHealing phase is completed in 3 months (BIC is not 100%)A posterior tooth under a heavy occlusal load has cusps undermined with caries. The restorative material of choice would be: Cast goldFor an amalgam restoration of weakened cusp you should: reduce cusp by 2 mm on a flat base for more resistanceThe physical property of cast gold allowing for its excellent burnishing is: MOEAxial walls on a MOD cavity for a cast gold onlay or inlay should: converge from the gingival walls to pulpal wallsAxial walls diverge and facial/lingual walls converge for: amalgamDuring clinical evaluation of a complete crown on a mandibular right first molar, a premature contact causes the mandible to deviate to the patient’s left. One would expect to see the interfering contact marked on which surfaces of the crown? Buccal inclinesCommon cause of denture gagging EXCEPT one. Inadequate posterior palatal seal; Excessive vertical dimension; Bulkiness of denture Which is the EXCEPTION? Excessive anterior guidanceTx of gagging patient: gradual desensitizationGagging is a problem with some patients, it can usually be prevented by: having the patient breathe through noseAnterior guidance should be AVOIDED in: complete denturesinterference during working movements for a posterior complete crown restoration? the buccal inclines of mandibular teeth contact the lingual inclines of maxillary teethAn articulating paper mark on the lingual incline of the buccal cusp of the mandibular molar represents which type of interference: non-workingThe maxillary and mandibular definitive casts have been articulated. The maxillary cast was mounted without a face-bow transfer. If the dentist were to increase the occlusal vertical dimension by 4 mm, it would be necessary to obtain a new centric relation recordMethods to prevent overheating of the bone implant site preparation include: low speed high torque handpiece and sharp bursIn implant preparation, what can be used: hydroxyapatite irrigationIn implant preparation, what cannot be used: air coolantPreload of implant is comparable to what force: compressiveTorque in all directions: Rectangular arch wireWhich action represents the most effective means of preventing caries on overdenture roots? Coverage of roots with cast copingsIn selection of maxillary teeth for overdenture abutments, the ideal location is: maxillary central incisors, lateral or canine. For mandible, canines and premolarsBy encircling an abutment tooth 180 degrees, a removable partial denture clasp assembly serves to: prevent tooth movement away from the claspinterference during working movements for a posterior complete crown restoration? The buccal inclines of mandibular teeth contact the lingual inclines of maxillary teethPatient has skeletal class 2, but dentoalveolar is class 3, he has dental compensation. What movement would you do pre operation = Upper LABIAL and lower LINGUAL (ULa-LLi)A wear facet is seen on the mesio-buccal incline of the mesio-buccal cusp of a mandibular first molar complete metal crown. This facet clould have been formed during which jaw movements? Protrusive or workingThe margin of a preparation for casting should not be placed in wear facet. It can be placed in a lingual bevel, marginal ridge, or gingival sulcus2 designs in tooth preparation can be used with all-ceramic crowns? Butt-joint shoulder or chamferFunction of the key way in post preparation: Anti-rotational feature. To limit movement or resist removal (Dentin)Function of post: provide retention for a coreAfter implant placement, an edentulous patient should: immediately have healing abutments placed over the implantsN2O is contraindicated in patients with: mild-moderate asthmaThe microabrasion technique involves: HCL + Pumice (used for fluorosis)RadiologyDentist try to take an x-ray PA of mandible, but because of interference in the moth can’t take it, what kind of extra-oral x-ray can be taken? Oblique mandibleMost commonly used digital image receptor: charge coupled device (CCD); CMOS is newestTrue regarding the long-cone paralleling technique is accurate: minimizes distortion of tooth dimensionOn x-ray looks single: sella turcicaEffective Dose: used to estimate risk in humansInverted Y is formed by: floor of nasal fossa and maxillary sinus borderY axis in a ceph is form by joining sella turcica to gnathionDisadvantages of the CCD sensors over film include: poor resolution, cost & thick sensorsExamples of non-particulate radiation include: x-rays and gamma raysExamples of particulate (move at high velocity) include: alpha, beta and electronsLong wave length: micro and radio (longest)What is CID: similar to CCD but does not connect to a screen (image shows on camera)Structures cannot be seen on a PA radiograph: mandibular foramen and coronoid notchSource of x-ray or electrons: cathodeTo obtain the most geometrically accurate image: film should be parallel to object; central ray should be perpendicular to filmAnatomy not observed on x-ray: buccal curvature of rootsCysts associated with vital teeth: globulomaxillary cyst, traumatic bone cyst, OKC, CGCGelectrons carry energy from the cathode to the anode. MOST of this energy converted in the target into: heatTherm-ionic emission of x-ray comes from – filament (Emission of electrons from heated cathode)“Y” – floor of nasal cavity and border of maxillary sinusInitial interaction leading to the production of characteristic radiation: Cathode electron ejects an electron of a target atom out of it's orbitFor a periodontal disease examination which of the following x-rays is best used: periapicalThe “indirect effects” of radiation in biological systems are due to: radiolysis of water moleculesMost biological damage from ionizing radiation involves: indirect effects, mediated by free radical formationRadiation that is bactericidal: IonizingExamples of ionizing radiation: gamma, x-ray and UV What factor is more important when considering the biologic effects of radiation: acute exposureMost mitotically active cells and most radiosensitive: basal epithelial cellsGhost images of non-midline structures appear on: opposite side of real and higherIf the frequency of an x-ray photon is increased: energy of photon is increasedMucocele is radiopaqueX-ray beam is: polychromatic (because potential across the tube changes constantly as the AC (alternating current) voltage varies)Effects of radiation are: additiveRadiation induced thyroid cancer is: somaticAll developmental cysts are radiolucent except: NasoalveolarBest radiograph for mandibles symphysis fracture: AP or CTBest radiograph for angle, body and ramus: lateral obliqueWhich radiographic assessment is best for assessing small volumetric changes in alveolar bone density: Subtraction radiographyPrinciples of projection geometry is violated when using the paralleling technique for taking intraoral films: short object-film distanceCrown-root ratio and residual bone support can best be seen radiographically in a: periapical film – paralleling techniqueOn a radiograph, the facial root of a maxillary first premolar would appear distal to the lingual root if the: X-ray head was angled from a mesial position relative to the premolarPhleboliths: onion rings/donut; multipleTonsillolithsX-ray sizesLargest intraoral film is: 4 and standard is: 2Size 1 film would most likely be used for: incisors and cuspidsSize 0 for childrenSize 2 for adult posteriorsHighest source of radiation in the USA: Radon (56%) followed by medical (15%), Nuclear (11%)which type of radiation is constantly in effect or from nature: Inhaled radon radiationMajor contributor to background radiation exposure: RadonIrradiation cause saliva to have lower: sodium contentTo confirm horizontal fracture: Multiple vertical angulated radiographsMajor biologic damage of radiation is mainly due to: radiolysis of water moleculesGamma rays are the rays with: high intensityWhich caries zone of enamel appears on x-ray: bodyOther name for Stafne bone cyst: ectopic salivary gland dysplasiaReplenish the developer and fixer daily and replace them monthlyThe primary function of developer is to: reduce crystals of silver halide to solid silver grains or irradiated silver bromide to silver metalFunction of fixer: remove unexposed silver halide crystals or non-irradiated silver bromideUsed to suspend silver halide crystals, but not radiosensitive: GelatinComponent of fixer: sodium thiosulfateThe radiolucent portions of the images on a processed dental x-ray film are made up of: microscopic grains of metallic silverSingle most effective method of reducing patient somatic exposure when taking a radiograph is to use: speed e-film or rectangular PID or long rectangular coneTo limit magnification we need: Long PID (target to receptor distance) and short object – receptor distanceUnit for measuring x-ray ionization of air is: roentgenWhat is cataract: UV effect on eyeDeterministic effect (cause and effect relationship)Dose dependent, increases with increase in dose; time and typeXerostomia, cataract, oral mucositisStochastic effectIt is not dose dependent any amount will cause effect; long-term effect from low level chronic exposureThyroid cancer and heritable effectsDose equivalent (effects on tissues)Sievert/REM1 SV = 100 REMAbsorbed doseGRAY/Rad1 Gy = 100 radsExposureRoentgenAbsorbed doseGy - grayEffective dose (estimate risk in humans)Sv - sievertRadioactivity (decay rate of radioactive materialBq4 Gy at 2 meters, at 1 meter it will be → 16 Gy (if you double the distance, the radiation will be 1/4th)Max radiation dose per year50 msv or 5 remPer month4 msvPer week1 msvOrder: In what order the 3 canals of molar will appear if your x-ray is coming from mesialMandibular: ML MB DMaxilla: Palatal, MB2, MB1, DBSign of malignancy in radiographs: cortical bone ruptureAnterior nasal spine is related to maxilla and posterior nasal spine is related to palateReversal occlusal plane can be seen in a given pano: chin tilted too much upShape of pterygopalatine/pterygomaxillary fissure: tear dropDescribe x-rays: high frequency, short wavelength and high energy electro magnetic wavesComphoton: Increase wavelengthGrid in x-ray: reduce scattered and increase contrastMost powerful and outermost electron shell: NInnermost shell and highest electron binding energy: KElectron shell with highest energy: outermost shell (valence electron)Opacity seen from angle of mandible and traversing through molar apices: external oblique ridgeAreas of rarefaction are evident on x-ray when: cortical bone has been erodedHow is alpha radiation produced: when an alpha particle (heaviest and high energy) is expelled from unstable nucleiRadiation that is not electromagnetic: alpha and betaElectromagnetic Radiation includes: microwaves, x-radiation, visible light, and gamma radiationNon-particulate radiation: x-rays and gammaPID length changed from 8 inch to 16 inch, so the resultant beam is ? as intense.PID length changed from 16 inch to 8 inch, so the resultant beam is 4 times intenseDouble (2r) PID/cone length = Increase exposure time 4 timesTriple (3r) PID/cone length = Increase exposure time 9 timesIf you double the distance of the x-ray cone: radiation decreases by 4XIf the source to film distance is changed from 8” to 24” the intensity of the beam becomes: 1/9 as intenseAccording to the inverse square law, if we change from an 8” to a 16” cone, the intensity of the beam will be decreased to 1/4th the original intensitywhat is the problem if you want to perform apically repositioned flap surgery in the mandibular second and third molar areas: external oblique ridgedirectly image the TMJ disc: MRI (radiowaves; gamma and magnetic)The amount of radiation on a panoramic RX is compared to: 4 bitewings (D speed)When should the 1st panoramic and/or FMX be taken? When the first permanent 6 eruptVertical angulation in bitewings should be: +8 and +10 degreesMost precise radiograph technique: CT8-bit digital image would have: 256 shades of greyCBCT uses: less radiation than conventional CT and also less accurateObject away from focal spot: OPGHounsfield numbers are: arbitrary numbers set for tissue density on CT templateUsing oil in x-ray will: dissipate heat/cools off the anodeDental x-ray machine tube is surrounded by: OilIf 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? 1\10 of the nuclear workerA patient’s mandibular canal is positioned lingually to her mandibular third molar. In what direction would the canal appear to move on a radiograph, if the X-ray tube were moved inferiorly (i.e., if the x-ray beam were pointing superiorly)? ApicallyAt 90 kVp and 15mA at a BID distance of inches, the exposure time for a film is 0.5 seconds. In the same situation, which of the following should represent the exposure time at 16 inches? 2.0 seconds (0.5*4)A patient’s molar palatal canal is positioned mesial to her mesiobuccal root. In what direction would the palatal canal appear to move on a radiograph, if the X-ray tube were moved mesial: mesiallyA 16-year-old patient has a long history of mild pain in the area of the mandibular left first molar. Radiographs reveal deep caries in the tooth with an irregular radiopaque lesion apical to the mesial root. Which of the following represents the most likely diagnosis? Condensing osteitisDuring pan, patient was moved for 1 second, what will happen: vertical distortion in the inferior border of mandibleMagnification of PA: 5-6 timesMagnification of ceph: 7-8%Acceptable magnification of x-ray: 3 – 5%Resolution in pan or distortion: 22-36 (25%)Magnification error of 13-28% is: normalHow much SV radiation dosage is acceptable: 0.05Extractions are typically performed __________ weeks before starting radiotherapy: 3 purpose of the radiographic penny test? Proper safe-lighting conditionsWhy wash film with water in the last step in processing: to remove chemicalsRadiographic contrast can be directly affected by altering: kilovoltageIncrease the voltage of radiation, the rays will have: short wavelength and high energyIf the tube voltage is increased: number of electrons in the tube is increasedThe “high voltage” circuit of the x-ray tube: accelerates electrons across the x-ray tubeDiagnostic radiology is based on which of the following interactions of X-radiation with matter? Photoelectric effectPhotoelectric effect: The interaction in which an x-ray photon gives up all its energy in ejecting an inner orbital electron, thus removing the photon from the beamAt atomic level X ray photos loose energy by: Crompton and photoelectric processPhotoelectric absorption: when a photon collides with a bound electronPhoto electric reaction is highest for: EnamelTissue most sensitive to radiation: hemopoietic – immature blood cells, lymphoid cells, intestine, mucous membrane, prostate gland, reproductive cells (1st). thyroid>reproductive>skin> mature bone/teeth>nerves>muscle (least)Most radio resistant: skeletal muscleRadio responsive: myeloblastic cellsPrimary cause of radiation is damage by: IonizationIn damage by x-ray: mandible is more susceptible than maxillaX-ray prescription: Individualized, as neededIf the distance is double, the intensity will be: quarter (Intensity = 1/D2)Mental foramen is: below second premolarIncreasing mA setting of an x-ray unit raises: number of photons generatedRadiographic feature of sickle cell anaemia: step ladder trabeculationCaries in radio therapy patients: cervicalFirst sign of damage after acute irradiation: erythemaBest to view maxillary sinus or orbital rims or mid facial #: water’s (W-M) (CT if water’s is not in the options)The maxillary sinus appears to be lower around the roots of the maxillary teeth in the following techniques: bisecting angleBisectingParallel - PreferredFilm close to the teeth as possibleFilm parallel with the long axis Central ray PERPENDICULAR to “BISECTOR” imaginary line BISECTING the angle between the teeth and the “film”Central ray is place PERPENDICULAR to both the long axis of the tooth and “film”.A dentist is using the bisecting technique to take an x-ray. He stands 8 inches away. If he decides to use the paralleling technique, and stands 16 inches away (2X the distance) how will the exposure time differ: stay the same (exposure time in paralleling technique is TWICE as much! so if you double the distance, you decrease exposure time by ?, which will result in the SAME exposure time)Condylar fracture: reverse tomePortion of orbit seen in OPG: lateralView for zygomatic fracture: SMV (jug handle view)View for zygomatic arch: panoRoot of zygoma interfere with: extraction of maxillary first molarThe radiopaque structure overlying the buccal roots: zygomaDiagnosis of # of maxilla: Anteroposterior radiograph of skullBest revealing issue for prediction about ossification or used to detect growth spurts: Hand wrist radiograph (not useful if growth stopped)Mesiodens seen in: occlusal view or horizontal PAA 3 year old has been diagnosed with an inverted mesiodens. What is the most appropriate time to extract the mesiodens? Just prior to eruption of maxillary central incisorsSource/object distance for lateral ceph. = 5 feetDistance btw film and midsagittal plan in cephalometry? 6 feetCeph doesn’t show: ethmoid sinusWhich cyst is not in bone (extra osseous): Nasolabial (appears as soft tissue bulge on upper lip or long standing at the ala of the nose or swelling in the floor of the nostril and beneath the upper lip)Cyst not seen radiographically: nasolabial cyst (pseudo stratified squamous lining)Lining of nasolabial cyst (maxillary lateral incisor area): pseudostratified squamousMRITMJ disc (soft tissues) and parotid; maxillary sinusAnatomyCTCBCTImplant and endo (hard tissues); vertical resorptionMRI with dyeSialolithOcclusal and CTSialolithKvp (ability for the beam to penetrate tissues)Controls energy or radiographic density - # (quality & quantity – velocity - contrast)mANumber of photons/electrons from cathode – quantity; density & patient doseKvpTotal number of photons increases & mean-max energy increasesmATotal number of photons increases & mean-max energy NO CHANGEBeam qualityMean energyBeam intensityNumber of photonsTube filamentControls number of electrons emitted and regulates temperature of filamentTube currentControls number of photons generated – intensity of beam, but not beam energySetting for thick heavy bone or greater penetration: increase kvp and low mAPrimary factor in controlling the density without affecting contrast: mATo increase density in x-ray, what has to be done: increase kvp, ma, timeQuality of x-rays increased by: increasing kvp or using flitrationHow to increase radiographic density: Increase mA, kvp, exposure time and decrease distance between focal spot and filmHigher kvp: more densityNo contrast: increase kvpContrast is only affected by: Kvp and filtrationKvp most suitable for dental radiographs: 60-80 (~ 70)To darken an x-ray: increase mATo lighten an x-ray: decrease mAIf you double mA (or kV) you double the: intensityOne geometric factor that will reduce the sharpness of the radiograph image is: short source to object distanceSkin exposure with an intraoral radiograph is: 125 mSvMost image clarity loss is due to: Compton scatterBremsstrahlung radiation results from: electronics interacting with nucleiFactors influencing mean energy: kilovoltage and amount of filtrationFactors influencing x-ray beam: kilovoltage, mA and exposure timeCharacteristic radiationHappens only at kvp higher than 70 (when the high speed electrons dislodges an inner-shell electron from the tungsten atom and causes ionization)General radiationBraking or bremsstrahlung radiation (when high speed electrons hit the tungsten nuclei at the target, causing a sudden stop, which is 70% of x-ray energy)Compton scatter62% of the scatter that occurs (an x ray photon dislodges an inner shell electron and gives it its energy)Coherent or unmodified scatterLow energy photon interacts with an outer shell electron (the exact opposite); accounts for 8% of interactionsBremmstrahlung RadiationProduced when cathode electrons are decelerated by their attraction to the nucleus of target atoms; heterogeneous in natureHigher kvpLong scale contrastLower contrastLower kvpShort scale contrastHigh contrastPID size increasesLower magnificationPID size decreasesHigher magnificationRadiographic errorsFilm is too lightUnderexposed, low mA, low kVP, incorrect focal-film distance, or cone too far from the patient's face, or film is placed backwardsDark filmsToo long in solution, too high kvp and mA; warm developerFilm fogImproper lightning or scatter radiation; increased film densityFoggy filmOutdated material or improper storageHerringbone patternreversed film, causing a light imageStatic electricityBlack branching linesTeeth too wide on panoramicanterior to focal troughVertical angulation - IncreasedshortenVertical angulation - decreasedelongationFlat angulationElongated image (90 to object)Steep angulationForeshortened image (90 to film)Vertical linePatient movesLonger film exposureLight filmExhausted developerLighter picturePano with short upper rootsPatient did not put tongue on the top of their mouthCentral ray perpendicular to object, but not filmelongationCentral ray perpendicular to film, but not objectforeshorteningPano ?Head too lowPano ?Head too highPano with spine superimposed over ramus area and narrowing/blurring of anterior teethPatient’s head positioned too far forwardPano with widening of anterior teeth; ghosting of mandible; blurring of turbinates across the sinus; unsharp imagesPatient’s head positioned too far backwardPatient twisting – one half elongated; one half squeezedIn panoramic radiography, the focal trough is the: zone of sharpnessThe angulation of the target in an x-ray tube affects film quality because: Effective focal spot is increased, and image magnification decreasesThe two major purposes of the developing solutions are to: soften emulsion, develop silver halide crystals exposed to radiationReverse film: lead foil comes frontHead/chin too low: steeper smileHead/chin too high: frown line (reverse smile line)Increasing the object-to-film distance will have what effect on image quality: decreased sharpnessDecreased source-to-film distance: decreased sharpnessPenumbra: Fuzzy unclear area that surrounds a radiographic image is called as penumbra or area around umbra is called penumbra or partial shadowUmbra: area on the film that represents the image of a tooth or complete shadowHow to reduce penumbra: decrease object/film distance or increase source to object/film distance or use small focal spot or no movementLarge penumbra is due to: decreased contrast and sharpnessFocal spot and sharpness relation: inverseThe size of the x-ray tube focal spot influences radiographic: resolution What’s described by lack of sharpness and unclear borders of objects in the film? PenumbraHigh risk caries patient when you take x-ray: 6 monthsEarliest radiographic sign of traumatic occlusion is: widening of PDLSign of traumatic occlusion: wear facetsExcessive wear facets is an indication of: disharmony between centric relation and occlusionWear facets in primary are normal, not traumaThe technique to image the lingual opacity was an occlusal radiographincluded in a differential diagnosis of the right mandibular radiolucency? OKC, ameloblastoma, lateral periodontal cystmost similar to lateral periodontal cyst: dentigerous cystRarest cyst: lateral periodontal cystMost likely to displace adjacent teeth: Dentigerous cystMost common developmental cyst: dentigerous cystDentigerous always associated with a: tooth. If not, could be: OKC, myxoma, residual, ameloHistology of dentigerous cyst: non-ker stratified squamous epitheliumWhich cyst has highest transformation to ameloblastoma: dentigerousbest diagnostic methods for lateral periodontal cyst: x- raycharacteristic is most frequently associated with osteoradionecrosis? Mandibular locationosteoradionecrosis is due to: suppression of vascular blood supplyosteoradionecrosis happens above: 4-5 GY of radiation therapyMaximum Permissible Dosage (MPD)Non-occupational permissible dose of radiation in a year0.001 sv or 0.1 rem or 5 msvOccupational permissible dose of radiation in a year0.05 sv or 50 msv or 5 REM or 5000 mrem/year or 0.1/weekDental professional50 msv/year, 5 rem/year, 4 msv/month, 1msv/weekOccupational permissible dose + pregnant0.001 svMaximum radiation dose50 m Sv per year/whole bodyDental x-ray technicians receive: 0.2 mSv annually (0.4 % of allowable limit)Annual average exposure in the USA: 6.2 mSvNuclear plant worker vs. dental assistant for radiation dose: 1/5th of nuclear workerused primarily as filter material in a dental X-ray machine? Aluminium (to filter useless long wavelength rays; preferentially absorb low energy photons)Types of aluminium filters: 1.5 mm for kvp < 70 and 2.5 mm if kvp > 70Man-made radiationDental x-ray0.26%CT47%X-ray tubing made of or cathode: tungsten; anode made of copperAlumsAlum discs Filter long wavesAlumIn gingival retraction cords in hypertensive patientsAlum oxideFiring of porcelainAlum thiosulfateFixing agentAnode is made of: molybdenumWays to reduce radiation: double emulsion, intensifying screens, digital imaging, f-films, rectangular PID (reduces the most), grid, duplicating filmWhich converts electrons into x-rays: positive anode focal spotVoltage: force that causes electrons to move (- to +)Emulsion layer contains: silver halide grains in gelatin (mainly silver bromide in gelatin)Target in x-ray (x-ray generation): tungstenThe steeper the slope of the curve: the greater the contrast of the filmused to visualize the integrity of the zygomatic arches? CT scan29 year old with a H/O painful right neck swelling just prior to meals. Following a clinical examination, what test is recommended: CT scanDuring an extraction under sedation, the patient aspirates the crown of the tooth. Where would the crown most likely appear on a chest x-ray: right bronchusCervical caries can be secondary to the effect of radiation on salivary glandMost danger to operator on an x-ray room comes from: Scatter from patient's faceQUESTION: What characterizes secondary radiation? coming off the matterHigh risk to get retinal damage from dental staff: light used in polymerization of photo-activated materialsMost likely cause of the V-shaped radiolucency between the roots of the teeth 2 and 4 would be: maxillary sinusRectangular collimation: Restricts the dimensions of the x-ray beam or reduce the size & shape of x-ray (60-70%); reduce scatter by 60%; reduce area of exposureCircular collimation2.75 inches (7 cm)Rectangular collimationLarger than the filmIt is important that the film base be: flexibleRectangular collimation is recommended because it: decreases patient doseBy changing conventional to digital radiology there is almost reduction of: 70%Material used for x-ray filtration and collimation: LeadHow much less radiation do you get from using digital versus D speed film? 50%By what % do you decrease radiation when you use a square collimator vs. rectangular: 80%How much radiation is reduced when you use a circular vs rectangular collimator? 48-60 %Collimation does not: reduce operator exposure or decrease the average energy of x-raysCollimation and using a rectangular PID: greatest decrease of radiation to the patientCollimation diameter: 7 cmCollimation: Diverging x-ray photons are restricted to a useful beam sizeCollimation: Size and shapeCollimation does not: increase penetrabilityCollimation blocksScattered radiationFiltration blocksLow energy radiationX-ray tube is made of: cast steelX-ray collimated no more than: 2.75Total filtration: 2.5Filtration : Reduces intensity of electron beamInherentGlass envelope and oil around x-ray tube to cool the tubeAddedAluminiumTotalInherent + AddedEkta filmMost effective way to reduce exposure time, patient radiation and scatter radiationIntensifying screensExtra-oral x-raysCause of scatter radiation: higher Kvp and close ended PIDRare earth elements are used in: Intensifying screensParts of x-rayFilament (thermionic emission)Produces electrons - cathodeTargetProduces x-ray photons - anodeHouses the filamentMolybdenum cupGlass housingHouses the ENTIRE TUBELocation of copper sleeveCathodeHalf-value layerIndicator of quality of x ray beamHigher the half-value layerThicker the aluminiumDigital sensors are made of: europiumFunction of copper stem: dissipate heat/reduce the risk of target meltingFunction of molybdenum cup: part of cathode, focuses electrons into a narrow beamWhich condition would delay a dentist's decision to take full mouth x-rays: pregnancyDamage to biological systems from ionizing radiation is due primarily to radiolysis of water moleculesFiltration is used in dental x-ray machines to remove long wavelength and low energy photonsOptical density Enamel0.4Dentin1Soft tissue0.2Oral SurgeryA 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 of: Distraction of the fracture segments by muscle pullThe best time perform oral surgery on a patient receiving dialysis 3 times per week is: 1 day after dialysisWhat area of the mouth produce ear pain: mandibular molarsMandible angle fracture: lip paresthesiaChild has mandibular trauma, what do they have later? Midline facial asymmetryCollagen is a protein that has: high fluid turnover rateDry socket is a form of: periostitisWhich fluid is given IV after maxillofacial trauma: Ringer's lactate (also used in arthrocentesis)If genial tubercle is removed: flaccid tongueMost common complication of GA: Atelectasis (1-24 hrs)Most common cause of fever in GA: Atelectasis and pneumonitis or tosisMyringotomy: surgical procedure in which a tiny incision is made in the eardrum to release build-up of fluidVRF common in: lower 7Most common facial #: nose boneHow long do you splint a closed fracture for (i.e. mandible fracture): 6 weeksStandard length of IMF is 4-6 weeksIn which direction do you luxate disto-angular maxillary 3rd: DistobuccalChildren: luxate more palatal and adults more buccallyIn an upright position, blood from medial cantus, lateral nose and upper lip drains into? Inferiorly to facial veinPositive aspiration is directly correlated to: needle gaugeThe primary reason for designing a surgical flap with a wide flap base is: maintain an adequate blood supply to reflected tissueNon-rigid splint is recommended for subluxation, luxation and avulsion PrimarySecondaryCanineTemporalInfratemporalMassetricBuccalPterygo-mandibularSubmentalLateral pharyngealSubmandibularRetropharyngealSublingualPre-vertebral Retained rootsRetained roots in mandibular anteriorCauses resorptionRetained roots of maxillary anteriorOverdentureRetained roots of 22 and 27 (canines)RetentionThe most frequent respiratory complications following oral and maxillofacial surgery are:In smokerspulmonary atelectasisPatient right lungaspiration pneumoniaNon-ambulatory patientpulmonary embolusFractured mandible is appropriate to keep it stable for after closed reduction: 6 weeksDry socket after tooth extraction in diabetic patient is caused due to: atherosclerosisOsteoctomy: removal of supporting boneThe first molars are extracted in both arches, you will notice: more resorption on lingual side of mandibular molarsFollowing extraction of maxillary molars: more bone lost on palatal than buccalDuring extraction of MAX 3rd molar, root can go into which space? InfratemporalSuture stay longest in oral cavity: silk (allows bacteria to enter)Best suture material is best for a deep cut involving periosteum: 3:0 chromic gutIntra-oral sutures: 3/0, 4/0Extra-oral sutures: 6/0Sutures used in severely retarded child with trauma to the tongue: chromic gutDon’t use resorbable sutures in: Pts on blood thinnersChromic gut resolved after: 9-14 daysPlain gut or chromic gut are never used for: suturing surface of skinResorbable sutures (silk and cotton) can be an etiology for: granulomatous inflammationResorbable sutures avoided on skin because: inflammationDrainage of an acute abscess will need antibiotic as wellExample of class 2 lever: tooth extractionElevator in oral surgery acts as what type of machine: LeverElevator can be used to advantage when: interdental bone is used as fulcrumSurgical stent: used for locating areas of residual ridge that needs reductionRadiographic stent: identifies implantsMost common root fracture during extraction: maxillary PM1Sequence of extraction in maxilla to protect maxillary tuberosity: second molar, first molar and then premolarsFractures in children mostly cause: movement towards one sideCorrect extraction sequence: molars leaving 6, anteriors leaving canine, 6, canineAmeloblastoma managementSolid typeEn blocUnicystic typeenucleationYou notice a red area on the palatal of the tooth which was extracted on the previous day. The area is covered with white slough and is at site of the needle injection. Which is it most likely: necrosis due to VCan extra oral incision for a submandibular space abscess passes through: skin, superficial fascia, platysma, deep cervical fasciaDistractive osteogenesis advantage over BSSO: large movementsBiggest disadvantage of BSSO: paraesthesia or neurological disturbancesMandibular setbackVertical oblique Mandibular advancement (Tx of Class II)Sagittal split techniqueDuring which surgery do you have most chance of paresthesia of lip & tongue: BSSOCorrection of class III: Le Fort 1 with BSSOHow is suturing best done: from movable to fixedThere is an incision on the corner of lip, where do you put suture: Movable to fixed tissueWhat does an interrupted suture accomplished: immobilize the flapWhich type of suture is indicated in an immediate denture case to promote the best wound healing for the alveolar ridge: interruptedMost effectively aid the patient during the first 24 hours of wearing immediate dentures: maintain a liquid diet and do not remove the dentures until the return visit in 24 hoursWhat kind of suture do you use if you are only removing tissue on one side of tooth: InterruptedIf there is a 2 cm laceration on lip, what type of suture do you do? ContinuousSurgical stent is required for: immediate dentureLip sutures are done from: inside to outsideMuscle involved in torticollis is: sternocleido mastoidConditioning of roots after resection: citric acidRisdon or submandibular approach: best to expose neck of condyle and ramus Mandibular LA during trismus: Vazirani-AkinosiCorrect position of needle tip for the administration of LA for IANB: superior to mandibular foramenThe point of needle insertion for IANB in relation to pterygomandibular raphe is: outer to pterygomandibular rapheAfter IAN block, patient has facial paralysis. Which ligament: Sphenomandibular ligamentWhile giving IAN block, if it caused paralysis of facial nerve, where did u inject: Too far posteriorlyImmediately following a posterior superior alveolar block injection, the patient's face becomes quickly and visibly swollen, the immediate treatment should be to: Use pressure followed by cold packs over swellingInto which space is local anesthesia solution deposited during an inferior alveolar nerve block: Pterygomandibular spaceFor a successful IANB, lip paraesthesia should be within: 90 secondsLateral pterygoid forms roof of: pterygomandibular spaceWhen draining purulent exudate from an abscess of the pterygomandibular space using an intraoral approach, which muscle is involved: buccinator muscleRaphe is between: superior constrictor and buccinatorIf the hamular notch hits the retromolar pad, what do you do?reduce the maxillary tuberosityanterior undercutDo nothinganterior undercut + max. tuberosityReduce bothPendulous tuberosityOsseous contouringWhich muscle separates two potential infection spaces from a maxillary second molar: buccinatorThis particular muscle because of the direction of its fibers can get covered by the denture base: buccinator The buccal shelf of the mandible makes a good support area for the mandibular denture. One of the reasons it may be used is because of the alignment of the fibers of the buccinator muscle: anteroposteriorly Raphe extends from: pterygoid hamulus to lingulaIANB failed, what could have been freezed: mylohyoidClicking during mouth opening: displacement of disc from anterior position to being back on the condyleTx of clicking: arthroplastyWhat is clicking: internal derangement with reductionTx of recurrent dislocation: articular eminectomy + capsular plication or interpositional arthroplastyIn condylar dislocation the disc moves anterio medialA patient has pain over the left pre-auricular area, this patient can open approximately 45 mm and has a “pop-and-click” in the joint area. The MOST likely diagnosis is: internal derangement with reductionclassic sign or symptom of an anterior displaced disc with reduction: reciprocal clickMandible deviates towards side of injury in: lateral pterygoid injury and ankylosisWhat causes deviation of mandible on opening to the unaffected side: condylar hyperplasiaWhat causes deviation of mandible on opening to the affected side: condylar hypoplasia and fractureIf a laceration occurs in the vermillion border: first suture should be placed at the mucocutaneous junctionIf you get punched in right side, the left condyle will break: trueNeedlesRed25Yellow27Blue30How to reduce a dislocated mandible: downward backwardMandibular nerve / V3 exits skull via: foramen ovaleMaxillary nerve exists through: foramen rotundumIf you delay treatment of temporal arteritis, outcome: vision losswide frenum surgery: V-Y plastynarrow frenum surgery: diamond or z-plastyZ-plasty technique used in modifying a labial frenum is considered to be superior to the diamond technique: it decreases the effects of scar contractureMuscle in maxillary frenumorbicularis oris, elevator angular orisMuscle in mandibular frenumtraingularis\depressor anguli oris, buccinatorMost critical in a flap: designAvoid vertical incisions in: lingual and palatalIn genioplasty surgery there is risk of damage to: mental nerve and mentalisThe mental nerve innervates the soft tissue of mandibular premolars and canine, but it is not sufficient for the tooth itself.When doing flap surgery on mandible, what structure do you watch for? Mental nerveBest prognosis with surgery for genioplasty: inferior border osteotomyFlaring or enlarging the coronal end of the osteotomy: countersinkingTapping osteotomy: creating groove on the inside of the osteotomyTapping: threading the osteoctomy wall in implantsMOST common postoperative problem associated with mandibular sagittal-split osteotomies: neurosensory disturbancesThe osteotomy cut for vertical ramus osteotomy procedure is incorrectly high what is the next step? Make inverted L osteotomy Least invasive surgical treatment for TMJ complaint: arthroscopy OsteotomyVertical body osteotomySet mandible back to correct class 3 and extracting mandibular premolars bilaterallyVertical ramus osteotomySet mandible back to correct class 3Step osteotomyFor mandibular class 2, class 3, asymmetry and apertognathia (open bite)Adson’sHold soft tissue which will not be removed from the bodyEllisHas sharp teeth, used to hold or grasp heavy tissueVertical incision is done: either mesial or distalIncision for removing lingual tori: crevicular in the gingival sulcus and embrasure areaExternal crevicular incision ends on: boneWhat incision for mandibular tori: envelope without vertical releasing incisionsFlap for extrusion of canine: envelope flapMost common incision by oral surgeon: envelopePartial flap does not involve: boneA stent for palatal flap for what: preserve from displacementMost commonly used incision: envelopPseudoanodontia is synonymous with: impaction of teethDifficult mandibular impactions: disto-angularDifficult maxillary impactions: mesio-angularVertical impaction is easy than horizontal in maxilla and vertical is hard in mandiblebullet injury is: compoundAfter mandibular 3rd molar extraction what may happen: paraesthesia, trismus & infectionWhen performing I & D of an acute peri radicular abscess, the incision should: allow for blunt dissection of underlying tissueDisplaced muscle in a subcondylar fracture of the mandible: lateral pterygoid (depressor of mandible or translate the mandible)Muscle that retrudes the mandible: temporalisChemical cauterization in odontogenic keratocyst is done by: Carnoy’s solutionTrismus due to damage: medial pterygoidLateral to medial pterygoid: IANSpace involved in trismus: sub massetericLudwing’s angina does not involve: Retropharyngeal or parapharyngeal (only subs)Complication of ludwig’s: edema of glottis (elevation of tongue)Obstruction seen in Ludwig’s: laryngeal obstructionLudwig vs cellulitis: Ludwig is bilateralSpace not involved in Ludwig’s: retropharyngealIf you have an infection in the lateral pharyngeal space, what muscle is involved? Medial pterygoidWhich muscle separates 2 potential infection spaces from a maxillary 2nd molar? BuccinatorThe most important anticoagulant effect of heparin is to interfere with the conversion of: fibrinogen to fibrin (PTT test)Heparin effects: thromboplastin formationHeparin potentiates the action of: antithrombinAntithrombin inhibits factors: 2, 9, 10The drug contraindicated in patient taking gingko biloba: HeparinUse of gingko biloba: improves memoryNatural herbs that are also anticoagulants: Ginseng, Gingko (ginko biloba), Garlic and ChamomileAspirin burn is a type of necrosis (sloughing of necrotic epithelium)Types of nerve injuriesNeuropraxiaOnly epineurium, intact axon & sheath (LEAST severe); RARENeurotemesisMost severe nerve injuryTypes of fixationsRigidPlates, screws and pinsPrimary bone healing without callusSemi-rigidMini-plates and wiresAreas of primary and secondary bone formationNon-rigidIMFSecondary bone healing with callusCranial distortion is possible because of: fontanellesFirst indication of cavernous sinus thrombosis is: periorbital edema – soft tissue abscess in upper lip or blurry vision (not blindness)Pathognomonic sign of CST? Head achesAnterior face infections or upper lip: Cavernous sinus involvementAn infection in the area of (upper lip) is dangerous because: the veins don’t have valvesCommon cause of death under GA: mismanagement of airwayPrimarily responsible for moving the mandible to a lateral position and translating condyles: lateral pterygoidMuscles that close the mouth: masseter, medial pterygoid, temporalisAll MOM are supplied by anterior division of mandibular nerve except: medial pterygoidMuscles that OPEN the mouth: lateral pterygoid, anterior digastric, omohyoidMuscle not attached to ramus: lateral pterygoidLateral pterygoid attached posteriorly to: discwhat muscle of mastication is involved when an interference occurs in a centric relation? Lateral pterygoidsLumpy jaw: actinomycosis (many fistulas)Tx of actinomycosis: 10 million IV penicillin for 10-14 days followed by oral ABA deflection of mandible towards right upon opening may be due to: ankylosis of right TMJPart of face nerve affected during TMJ surgery: temporalTMJ surgery which branch of FACIAL nerve is damaged most commonly: temporalWhen a patient bites on a hard object on the left mandibular molar, the interarticular pressure of the RIGHT TMJ is: decreasedDelayed side effect of corticosteriod treatment of TMJ: Blurred visionWhich way is the articular disc most displaced? Anterior-mediallyDislocation of condyle causes mandible to: deviates oppositeWhere do the condyles go in CR? Antero-superior-medialMuscles elevating the jaw: masseter, temporal, medial pterygoid and SUPERIOR belly of lateral pterygoidFunctional part in TMJCondyle and articular eminenceNon-functional partGlenoid fossaSlidingTranslation (articular fossa & disc)UpperHingeRotation (condyle & articulating disk)lowerPart of the TMJ that purely rotates: articular eminence of condyleArterial supply of TMJ: middle meningeal from maxillary, ascending pharyngeal, deep auricular and superficial temporalTMJ ligamentPrevents displacement of condyleMain stabilizing ligamentCollateral/discal ligamentRestricts movement of disc away from condyleThey do NOT stretchASA has more profound effect on bleeding than ibuprofen because ASA: binds irreversibly to platelet cyclooxygenaseAfter treatment with acetylsalicylic acid is stopped, cyclooxygenase activity recovers as a function of platelet turnover in about: 4-7 daysAB for a patient with Type 1 diabetes, acute periradicular abscess, facial swelling and fever: Pen VK plus metroTetracycline slows the effect of which AB: Pen VKSafe for pregnant: Pen VKWhat antibiotic is used for endo, pulpal involvement? PEN VKEmpirical drug of choice for the treatment of an uncomplicated odontogenic infection is: Pen V (narrow spectrum beta lactum)Pharmacological profile of Pen V: most facultative gram positive cocci and most gram negative anaerobesApproximate elimination half-time for penicillin V: 0.5 hoursMicroorganisms responsible for odontogenic infections (pulpal, periodontal, pericoronal) are primarily: gram-positive facultative and gram-negative anaerobes Applicable for Pen V: destroyed in the acidic environment of stomachEmpirical drug of choice for the treatment of an SEVERE odontogenic infection is: ClindaBacteria generating resistance to macrolides, also generate resistance to: ClindaWhen treating an uncomplicated odontogenic infection with penicillin V and significant improvement is not noted within 48 to 72 hours, the empirical addition of ____________ is reasonable: MetroStage of tooth development does tetracycline discoloration occur: mineralizationA 5 year old is given tetracycline, which tooth is affected: Canines, premolars and second molarsTetracyclines should not be given with: anticoagulants and oral contraceptivesLymphatic spread from carcinoma on tip of the tongue would involve which nodes: submentalThe most common node involved in metastases: Submental nodeDuring extraction of an impacted 38, lingual nerve is damaged. You will notice: loss of taste from anterior 2/3 on left side of tongue; decreased salivary output from left sublingual gland/submandibular gland; numbness of the left sublingual mucosa. NOT is deviation of tongue to the left on protrusionMuscles of tonguegenioglossusProtrudeshyoglossusDepressespalatoglossusElevatesstyloglossusRetractsMylohyoid ridge correction: damage to lingual nerveMost common mid-face fracture: ZygomaticomaxillarySubconjunctival haemorrhage: zygomaticomaxillary fractureZygomatico-complex fracture also known as: Tri-pod #Stridor – crowing sound (high pitched sound) is diagnostic for laryngospasm (blockage of upper respiratory tract)Fracture on the orbit of the left eyes which border of the maxillary sinus will it effect? SuperiorBlow to lower orbit, eye movement is limited to: upperPt had fracture and numbness on side on nose cheeks...fracture site? Floor of orbitAnaesthesia stages:AnalgesiaConsciousDelirium – excitement Want to pass this stage quicklySurgical anaesthesia – loss of reflexes and muscle controlDeep sedationMedullary or respiratory paralysisDeadMore insoluble/more lipid soluble the agent, the faster the onset/offsetRate of induction during anaesthesia is not affected by: Hb content of bloodHalogenated hydrocarbon can cause: liver damageIn GA, what doesn’t influence induction: HbWhile conscious sedation: verbal response must be present and eyes openDisadvantages of conscious sedation: prolonged latent period, erratic and incomplete absorption of drugs from the GIT, inability to titrate, prolonged duration of action.Following the administration of a local anesthetic, most patients can be maintainedin conscious sedation at: 20-40% nitrous oxidemost likely suggest a non-odontogenic toothache: LA does not eliminate painIf there is insufficient space between the maxillary tuberosity and the retromolar pad, then the dentist should surgically reduce the occlusal aspect of the tuberositymost likely cause of ankylosis of the temporomandibular joint: traumatic injuryPain associated with TMD is caused by: muscle hyperactivityPatient presents with acute TMD symptoms, what’s the right order of treatment? Splint, if symptom free, occlusal reductionA fail-safe mechanism on an analgesia machine for nitrous oxide and oxygen prevents the delivery of nitrous oxide greater than 70%Max nitrous oxide for a child: 50%Nitrous oxide inhibits: Vit B-12 dependent methionine synthaseNitrous oxide minimum age: 4 yearsNitrous oxide compared to air: 1.5X heavierProlonged exposure to nitrous oxide causes: bone marrow suppressionIf patient does not have 100% oxygen after nitrous oxide? Diffusion hypoxiaNitrous oxide is not given to: psychotic patients and COPDMax nitrous oxide in kids: 30% (4-6 L/min flow)Nitrous limits on children for operative procedures: Increments of 10% up to 30%Reversal of nitrous oxide and oxygen analgesia (to prevent diffusion hypoxia) can be done with at least: 3 minutes of 100% oxygenNitrous oxide is metabolized at which rate: 0.004%Not CI for nitrous oxide: sickle cell anemiaNitrous oxide in children: 50/50Device used in evaluation of N20: pulse oximeterAbuse of nitrous oxide results in: peripheral neuropathyNO on pain: helps patients regulate threshold to painFirst sign/ start of nitrous oxide sedation is signalled by: tingling of handsToxic impurity that can be found in nitrous oxide gas is: nitric oxidePatient complains of nausea while administering nitrous oxide, what to do? Turn offEarliest sign of nitrous oxide sedation: light headednessDoes nitrous oxide causes muscle relaxation: NO! nitrous oxide has minimal cardiovascular effects and NO skeletal muscle relaxation effects!A patient was administered a flow rate of 4 litres of oxygen and 2 litres of nitrous oxide. What percentage of nitrous oxide did the patient inhale: 33%Nitrous oxide sedation should be postponed in pt. with: Sinusitis, GI obstructions, Middle ear disturbances and NauseaNitrous oxide irrational numbing is a sign that the patient is: entering stage II of anesthesiaNOT an advantage of the connective tissue graft procedure: Requirement of two surgical sitesTx of ranula: marsupializationTx of recurrent ranula: surgical sub-lingual gland removalRanula (rubbery) is due to: traumaBest allograft (from one human to another – same species): FDBA CadaverAn allograft is from: freeze-dried human bone graftDemineralized freeze bone works because it has: BMPHormone used for bone graft: BMP (bone morphogenic protein)Worst place to do graft: canine eminence, interdentalWhich graft is usually used for alveolar ridge augmentation: Hydroxyapatite (alloplastic)Bioactive glass or perio glass is an example of: alloplastIsogenic bone grafting: bone marrow transplant to treat leukemia.Types of allograftsFresh frozenrarely used because of transmission of diseaseFreeze dried (eventually replaced by host bone)osteoconductive potential onlyDemineralized freeze driedOsteoconductive and inductive; lacks strengthDecalcified freeze driedOsteogenic or allogenic potentialOsteoconduction: provides a framework for existing progenitor cells (from underlying bone) to migrate and form boneOsteoinduction: produces the cells necessary to form bone (eg: allograph & autograph)Bone morphogenic protein: OsteoinductiveGreatest osteoinductive potential: hip marrowWhat characterizes freeze dried bone allografts: eventually replaced by host boneFreeze dried bone allografts are decalcified because: calcium may block bone morphogenic proteinLarge bone graft from: IliumMost common side effect of autogenous bone graft: root resorptionGraft from a pig or different species is considered: xenograftDisadvantage of autograft or connective tissue graft: two surgeriesDisadvantage of cancellous autograft: lack of strengthThe type of bone present in the inter radicular area is: CancellousWhat graft is best for sinus lift? Autogenous and alloplasticMost common graft sites for autogenous bone are: anterior cortex of symphysis, lateral cortex of ramus and external oblique ridge, iliac crest, and ribFor big osseous defect in mandible which graft is the best: autograftMost predictable graft and most useful in large mandibular areas: autograftBest osseous regeneration or most osteogenic: autograft or hemopoietic bone graft or allograftLeast osteogenic potential: cortical bonehigher osteogenic potential: DFDBAOstectomy: tooth-supporting boneOsteoplasty: non-supporting boneWidow’s peaks: peaks of bone left after ostectomy that must be removed (otherwise might cause pockets!)Open bite more than 8 mm, what you’ll do? Le Fort 1 osteotomyLe Fort 1 fracture include: maxillary sinusThe procedure of choice for vertical maxillary excess is: Le Fort I osteotomyTreatment of midface deficiency: Le Fort 3Nerve involved in Le Fort 2: infraorbitalRadiology for Le Forts: CT scanA patient experiences numbness of the left upper lip, cheek, and the left side of the nose following a fracture of his midface. This symptom follows a fracture through the: Infraorbital rimLF 1LF 2 – pyramidal #; separation and mobility of midfaceLF 3 – Cranio functional dysfunction or craniofacial separationBrings the lower midface forward, from the level of the upper teeth, to just above the nostrilsAnterior open bite; gagging on posterior teeth; separation of the maxilla, attached nasal complex from the orbital and zygomatic fracturesBrings the entire midface forward, from upper teeth to just above cheek bonesGuerin’s sign (ecchymosis from greater palatine vessels)Zygomatic #Battle’s sign (ecchymosis behind the ear/basilar fracture in mastoid region)Moon faceRaccoon or sunken eyes and panda faceFloating palate/disturbed occlusionParaesthesia of cheeks# of cranial base from nasoethmoidal complex, zygomas and maxillaCSF – rhinorrheaBilateral periorbital ecchymosis/hematomaPalpable crepitation in upper buccal sulcusCracked pot soundSinus communicationIf < 2mmNo tx< 7mm (2 – 6)Figure 8 suture; AB; nasal decongestant> 7mmClose with flapDislodgeDislodge into maxillary sinusPalatal root of maxillary first and thirdDislodge into infratemporal spaceMaxillary third molarCaudwell Luc technique incision: over canine fossaThe best time perform oral surgery on a patient receiving dialysis 3 times per week is 1 day after dialysisMaxillary artery is a direct branch from ECAEast-West (Cryer) elevator: Used to remove roots of lower molarsTrue cyst: dermoid (midline floor)can’t control bleeding after extraction, what to do next? Simple gauze pressureINR or PTExtrinsic pathway (2, 7, 9, 10)PTT – test for heparinIntrinsic system (8, 9, 11, 12)Three days after extraction patient bleeds, what happened? Infection fibrinolysisThe lesion between teeth 30 and 31 is treated by enucleation and curettage. Risks: devitalization of teeth 30 and 31; post-operative infection; damage to IANB; lesion recurrence. NOT is damage to lingual nerveNerve damaged during mandibular 3rd molar extraction: lingual nerveThe best initial management for the mandibular radiolucency would be incisional biopsyWhat should you NOT do initially with a patient with desquamative gingivitis: BiopsySmear biopsy or exfoliate cytology is for: candida or viral (herpes) or troponema infections (syphilis)Infections arising from the periapical region of the mandibular first premolars perforate through the lingual cortex to the: sublingual spaceSubmandibular space drainage through which muscle: platysmacauses speech problems in a patient with cleft palate? Inability of the soft palate to close the nasopharyngeal air flowmost likely cause for arkinsone 3 day after removal of a mandibular third molar? FibrinolysisBest orthognathic surgical option for a patient that has an 8mm anterior open bite? LeFort 1 osteotomyOrthognathic surgery that is unstable: moving maxilla downFracture of both condyles: posterior open biteHit on right mandible can cause: left sub-condylar fractureNasal adenoids lead to: open biteInfections arising from the periapical region of mandibular third molars perforate through the lingual cortex to the: submandibular spaceAfter receiving an inferior alveolar nerve block the patient develops a needle track infection. Anatomic spaces involved – pterygoidA patient complains of pain, trismus, fever and dysphagia associated with and impacted third molar. The best course of action for this patient is referral to OMFSMeyer-Overton theory: anaesthesia commences when a chemical substance reaches a certain molar concentration in the hydrophobic phase.Infections arising from the periapical region of the mandibular first premolars perforate through the lingual cortex to the submandibular spaceWhat incision should be made to remove a torus in palate? Y incisionReason for splint in palatal torus removal: hematomaManagement of mandibular tori: remove by grooving the superior surface then shearing the torus off with a mono-beveled chisel --- the area is then smoothed with a bone filemandibular fracture cases should the intermaxillary fixation be released earliest? High condylar fractureThe most frequent complication associated with mandibular fracture is: infectionCommon sign of mandibular fracture: paresthesiaTreatment of a tooth fractured below the alveolar bone level: ExtractionIn removing a torus palatinus, the practitioner inadvertently removed the midportion of the palatine process of the maxilla. One would expect to see an opening into the nasal cavitySecond gas effect: this occurs when one gas speeds the rate of increase of the alveolar partial pressure of a second gas. Potent agents are administered with nitrous oxide so that the potent agent will be delivered in increased amounts to the alveoli as gas rushes to replace the nitrous oxide absorbed by pulmonary blood.Pain referred to the ear derives most often from which teeth? Mandibular molarsParesthesia of the inferior alveolar nerve or lower lip numbness is most often seen after the fracture of which area of the mandible? AngleFracture of which part of the face would compromise patient’s respiration? # through the body of mandible (bilateral)Paresthesia of lip is due to: malignancyPt complaints of inability to close the right eye after LA injection in rt side, the affected nerve is facialNOT an indication for removal of a third molar: prevent crowding and displacement of incisor teethIf an odontogenic infection involves the pterygomandibular space, the most obvious clinical sign will be or when IAN injection into medial pterygoid: TrismusTrismus due to infection: submassetricTrismus is most commonly caused by: TetanusDuring closure of mandible, what is least important: Relaxation of lateral pterygoidAnesthesia of lower lip indicates: Malignancy or fracture of angle of mandibleEcchymosis of floor of the mouth after trauma on mandible indicate which site fracture: Fracture of body of mandibleA postsurgical condition that tends to occur more frequently in older patients: ecchymosis of soft tissuesLesion that resolves by itself: ecchymosisEast-West (Cryer) elevator: Used to remove roots of lower molarsBattle’s sign: Fracture/injury to cranial base or mastoid fractureInfection of which space will clinically present as a swelling: Canine spacePt. has lesion on posterior palate need biopsy. What nerve should get infiltration LA: Greater PalpatineBiopsy incisions on the face should follow: Langer's linesIndication for nitrous oxide sedation = AnxietyThere was swelling 3 x 3 on the floor of the mouth and the swelling is fluctuant. What will be the treatment = MarsupializationNeuropraxiaCN V2 should be anesthetized intraorally at the: pterygopalatine space (PP)Dental materialsMoisture greatest in: agarTissue conditioning materials are ideally classified as: plastic in naturetrue about setting expansion of plaster, stone, and improved stone (Type IV): Increasing the water/power ratio decreases the setting expansionresult when using a thinner mix of a gypsum-bonded casting investment? Decrease setting expansionA 10-15 second application of 37% phosphoric acid on prepared dentin will not result in: elimination of collagen fibresSetting expansion of casting investment is approximately: 0.1%-0.5%Hygroscopic setting expansion: Plaster expands during casting so gold casting will be smaller than expectedRefractory fillers: major constituent of the investment material (~70%), responsible for thermal expansionProperties found in materials that consist of ionic bonds: brittleness and high melting pointIf water to powder ratio is increased: expansion is reducedThe strength of dental investments for gold alloys is dependent upon: the amount of gypsumThe film thickness of cement at margin of restoration is thin because of: solubility of luting agentWhat won’t affect metal casting seated on master cast? Impression inaccuraciesWhen using the indirect technique for construction of an acrylic temporary restoration, you should use: quick set plasterMixedColorless, pure gasConsumptionGas and airReducingHottest zone - blueOxidizingOuter (red or orange)Classification of dental gold alloys:Type 1Soft; 83% noble metalsSmall inlays; easily burnished due to high ductilityType 2Medium; 78% noble metalsLarge inlays/onlays; thick 3/4Type 3Hard; 75% noble metalsCrown & bridges; capable of being heat treated; thin ?; short-span FPD; abutments; ponticsType 4Extra hard; 75% noble metalsRPDs; long-span FPDGold alloys compared to non-precious Most radiopaque in porcelain: barium and zirconium glassGreatest wear between: natural teeth and porcelain/zirconiaLonger the spatulation time, greater the expansionMetal CTE should be: higher than that of porcelainA major difference between light cured and chemical cured composite is that during setting or in function the light cures material tends to: shrink rapidlyIf the investment is burnout rapidly, what will happen: cracking of investmentHow do you make stone set up faster: slurry water or hot water?Major disadvantage of stone dies used for crown fabrication: Their overall dimensions are slightly smaller than the original impressionincreasing the amount of water in the mix of an improved gypsum die-stone will MOST likely result in: less expansion and less strengthDISADVANTAGE of gypsum dies: dimensional inaccuracyAdding water to gypsum: decreases setting expansionCalset temperature: Composite temperature (130 F – 155 F) causing the composite to flow and adapt to the internal morphology of the cavity preparationWhen is gypsum the strongest: final setCharacteristic of an impression material to change its viscosity when applied tension: thixotrophicPorcelain adhere to metal by which chemical bond: covalent bondBond least likely between a drug and a receptor: covalent bondChemical bonding is the least likely to be involved in a drug-receptor interaction: covalentTin-indium-zinc even though they oxidize why are they used? Chemical bondComposite bond is: chemical-microchemicalGIC bond with enamel and dentin: IonicConventional glass ionomer cements have: lower modulus of elasticity than ZPwhen a translucent material (like incisal edge) looks blue in reflected light: OpalescenceThe addition of what makes the porcelain opaque and are also colouring agents in porcelain: metal oxidesWhen casting the metal substructure for a metal ceramic restoration you should use: gas-oxygen torch and phosphate investmentHighDenture teethMedium fusing porcelainAll-ceramicLow fusing porcelainCrown and bridge; PFMGypsum productsType 1Not used2Ortho cast3RPD, diagnostic cast – yellow or micro stoneType 4 & 5Low expansion for FPD and implantsDevitrify a ceramic: porcelain is fired too many times it might become hard, milky, opaque, difficult to glaze and crystallineWhy is it advisable to dispense the liquid component of cement of cement immediately before mixing: to prevent evaporation of the volatile componentsIf dental stone is spatulated until it begins to thicken, the final cast will: weakened due to break up of crystalsConnection between enamel and composite: adhesive jointDouble decomposition: setting reaction of alginatePeople allergic to seafoods can be allergic to alginateWhat is component in alginate that react with calcium n give the desired working time: trisodium phosphateDisinfectants can be used with alginate impressions: Iodophor and glutaraldehydeTypical recommended w/p ratio of type 4 stone is 0.20 to 0.25Lowest w/p ratio is for type 5Typical bond strength of GIC to dentin: 5 MPa (3-10)Quenching make the metal more: soft and malleable (increases with increasing temperature; depends only on plasticity)Ductility: decreases with increased temperatureFritting: produce colour in porcelainMalleability increases with increased temperatureGreatest malleability and ductility: GoldLeast malleability: nickelLeast ductility: leadMalleabilityDeform under compressive strength; form thin sheetDuctilityDeform under tensile strength; ability to stretch into wireWhat is quenching: rapid cooling, which makes the metal soft, decreasing their hardnessAnnealing increases: ductility, hardness and strengthWhat is annealing: controlled coolingTempering: hardening (by heat treatment)Hysteresis: when melting temp. differs from gelation tempSintering: conversion of porcelain powder into solid state by heatingWhat is annealing: controlled coolingEffects of work/strain hardening: increases strength and hardness and decreases ductility and corrosion resistance (MOE remains same)Property of material that is able to absorb forces before fracture: ultimate tensile strengthDegassing: Heat treatment necessary for all gold-porcelain systems before adding porcelain at 980 C. Necessary for formation of oxide layer; elimination of surface impurities of porcelainSeparation at the porcelain-metal interface due to: degassing at too low temperature and fusing opaque coat of porcelain at too low temperaturePickling: Process of removing surface oxides from a casting prior to polishing (dipping in a hot acidic bath)Side effect of pickling: warping (bending or twisting out of shape)Smaller contact angle: greater wetting an adhesion/wettingStonesTypeType 3Dental stone/model stoneType 4Die stoneHigher strength and hardness of die stone compared with plaster are due to the lesser amount of water required by die stoneWhat influences more of strength of a solder joint/ metal connector between abutment and pontic is sufficient (in 3-unit FPD bridge: occluso-gingival widthSolder melts at 150 FSolder for stainless steel wire contain: copper and silverHigh modulus of elasticity, low elongation, high strength is: toughModulus of elasticityStainless steelHighNickel-titaniumLowBeta-titaniumMediumMOETooth11Direct gold14.4Amalgam22-28Composite28-35Unfilled resin81-92MOE (The stress-strain ratio within the proportional limit) is a measure of: stiffness or rigiditynormal setting expansion of gypsum is 0.5%Least resistant to fracture: high leuciteamalgam alloy provide the best clinical durability? High copper admixture and high copper sphericalStrongest and most durable amalgam: high copper spherical Easily condensed, post-op sensitivity and great leakage: sphericalHigh copper has no: gamma 2 phase (tin-mercury phase)From pt images, which amalgam filling has the lowest copper content: One that looks corrodedAmalgam more corrosive in: tin-mercury/silver phaseTarnishSilverCorrosionCopper & Tin (chlorides)Amalgam that works best to restore proximal contours: admixed (because of high condensation forces)Best type of amalgam: admixedThe discoloured, corroded, superficial layer frequently seen on surface of dental amalgam restoration is: sulfideAmalgam condensation removes: gamma mercuryYou will use a larger condenser and lateral condensation in which alloy: sphericalBest gas to melt alloy: propaneExcessive flare of the distobuccal cavosurface margin of a Class II amalgam cavity preparation will result in: weak amalgam at marginA decrease in the particle size of the amalgam alloy will affect the amalgam by: increasing early strengthEdge strength and setting expansion in amalgam: LowMicroleakage in amalgam: Initially high and later reducedOnly bevel needed in an amalgam restoration is: gingivalIf amalgam gets wet: post-op pain, excessive corrosion, reduced compressive strengthOpen margin on the proximogingival cavosurface angle (freshly condensed amalgam), most probable reason: using too large an initial increment of amalgamAmalgam working time before condensation: 3 minsBest Class II contact: amalgam, due to delayed expansionWhat happen to amalgam with moisture contamination: delayed expansionNot included in DO class II amalgam preparation: Mesio-facial line anglesPolycarboxylate CementErosion or solubility high with: polycarboxylateOther features: low compressive, high tensile and short working timeErosion or solubility least with: GICDoes not irritate pulpBonds mainly to enamel (weak bond with dentin)chemical phenomena common to zinc oxide-eugenol and polycarboxylate cementsCan replace eugenol in a Zinc oxide paste: Carboxylic acidChemical phenomena common to zinc oxide-eugenol and polycarboxylate cements: chelationGI mechanical properties are SUPERIOR to PCC and Zinc phosphate!RMGI have HIGHER strength and LOWER solubility than GI, but LESS fluoride release!Strongest cement that can be used under crowns: Resin reinforced GICGI contains water soluble polyacids and basic ion-leachable glassComposition of glass ionomer: aluminosilicate glass and polyacrylic acidWhat component of cement contributes to adhesion? Polycarboxylic acidBest describes porcelain: biocompatibleStrongest porcelain: firing under compressionDental ceramics are strongest in response to which force(s): compressionIncisal and coronal parts to be matched in porcelain metal crowns done by: Firing under high temperatureWhat is the function indium (tin & iron) used in alloys for making PFM? Chemical bond to porcelainIndium in amalgam: increases strength and reduces creepmaterial has the highest coefficient of thermal expansion or low thermal conductivity? Unfilled resin (least for tooth)Linear thermal coefficient is most for: compositeLow COTE is seen with: High filler + high Bis-GMAInternal voids and surface defects: decrease elastic modulusCause of isthmus # in amalgam: insufficient depth of preparationMost prone part of amalgam restoration to fracture: IsthmusLarge amalgam MOD restoration, crack of restoration in the Isthmus, no symptoms: Replace the entire restorationIsthmus for amalgamConvergentIsthmus for InlayDivergentCause of failure amalgam: improper cavity designTensile strength of amalgam is approximately 1/5th to 1/8th of its compressive strengthAmalgam often tends to discolour the tooth. This can be inhibited by: cavity varnishCavity varnish improves: marginal seal for the short termCavity varnish does not provide: thermal insulation!Following compression of acrylic into the denture flasks, placing the flasks into the processing tanks at curing temperature is delayed to: allows the flasks and the acrylic to reach a stable temperatureA cast gold restoration might be indicated for the replacement of a faulty amalgam to obtain: more ideal contoursFor a cast gold restoration, a gingival bevel is used instead of a shoulder because a bevel: improves marginal adaptationDuring a soldering procedure, flux serves to: displace gases and dissolve corrosion products or dissolve surface oxides and act as a barrier to oxidation in the solder jointFlux contains: sodium pyroborate, borax, silica or potassium fluorideWhat is anti-flux: used to outline the area to be soldered, usually soft graphite pencil; confine the flow of molten solderWhen soldering, what is the most important factor for strength? HeightMost likely cause of failure of pre-ceramic soldering: overheating the partsDistance (width) between parts to be soldered: 0.25 mmFor FPDs consisting of regular gold units with or without metal ceramic units, a solder must be used: low-fusingExcessive heating of the acrylic resin during processing should be avoided to prevent: evaporation of monomerDry and crumbly mix: under triturationPlastic mix or sets too fast or increased creep or decreased setting expansion or increased compressive strength: over triturationExcessive trituration of amalgam should be avoided because it will cause the amalgam to set prematurelyDuring matrix band removal, the risk of marginal ridge # of an amalgam is reduced by: completing most of the shaping of the ridge before removalCompared with high noble alloys for metal-ceramic restorations, base metal alloys are best used for which of the following? Long span bridgesComposition of high noble alloys: 60% noble metal and 40% gold contentThe best choice for an alloy used for a long span bridge with restricted occlusal space is/ can produce a hypersensitivity reaction: Ni-Cr-BeFixed partial denture: can be given in long spanMore base metal will give more: rigidityThe minimum thickness for a base metal coping is: 0.2 mmShort span: Pd-Cu; Pd-Ag; Au-PdComponent of base metal alloys related to allergic reactions: NickelPresence of silver in metal-ceramic alloys: increases alloy corrosion resistanceWhen high gold content alloys are compared to base metal alloys, the base metal alloys exhibit: a higher melting point, decreased specific gravity, and generally higher yield strength and hardnessMelting point of gold: 950Melting point of Co-Cr: 1350Fineness: parts of pure gold per 1000Alloy compositionNickelDuctilityChromium (less allergy)Anti-corrosionCobaltRigidityVitallium alloy: 65% cobalt, 30% chromium, 5% molybdenumproperty of RPD framework that will limit adjustments of clasps: yield strengthYield strength is directly related with: flexibilityWhat property effects burnishability in gold – Yield strengthWhat is the reason to burnish gold to the margin: Acute angle of gold marginProperty of material that is able to absorb forces before fracture: ultimate strengthProportional limitMaximum force causing deformation that can revertYield strengthMaximum force causing permanent deformationUltimate tensile strengthMaximum force causing breakagebest choice to avoid the effect of metamerism? Select the shade that looks optimal under multiple light sources or use natural light only or squint both eyes or glance for only 15 secondswhat is metamerism: porcelain appearing different under different lightsMaterial with high compressive strength but low tensile strength - composite? BrittleComposite will shrink towards: centreWhich polymer produces highest exothermic reaction? PMMAOil or water on impression for treatment casts causes: bubbles on castThe thinnest portion of the wax pattern should be placed in the: deepest part of ringThe casting shrinkage of cobalt-chromium alloys is approximately: 2.2%NO determinal effects are associated with shrinkage less than: 50 um/cmThe principal factor in minimizing the firing shrinkage of porcelain is the: thoroughness of condensationcomposite monomer: dimethacrylateCross linking with poly methyl methacrylate occurs with: glycol dimethylmethacrylate/BIS-GMARepeated fracture of a metal ceramic partial fixed dental prosthesis is primarily caused by inadequate framework designresponsible for creating a green discoloration in the marginal area of the metal ceramic restoration: Silver (at the margins or cervical 1/3rd: copper)Elastomers (mock up trials)limited shelf life of condensation silicones due to: deterioration of tin compoundcross linking of condensation silicone elastomers require: tin octoateImpression material that has water as by-product: Hydrocolloid (polysulfide)Impression material for making final impression for implant prosthesis is: additional siliconesWhat is added to reversible hydrocolloids to increase strength and viscosity: boraxOnly elastomeric that doesn't need a chemical reaction to set: AgarBest impression material for a patient who undergone radiotherapy: elastomersWhat’s the disadvantage of using an Elastomeric materials for recording CR? high permanent deformation, unpleasant taste and odor, a long working setting timeIdeal material for recording CR: high viscosity, more rigid and low flowElastomers that can be poured after a week: addition silicones and/or PVSMost stable elastic impression in moisture environment: Addition siliconeWhy elastomer is not a good interocclusal record: rebound when mountingProperty of interocclusal recording material: Low resistance to jaw closurePVS (smelly)Material that retards PVS: Latex (sulphur) glovesMaterial that inhibits PVS: eugenolBest impression for stability in moisture: PVSPVS: poured more than once and/or after 24 hours and still remain accurate; rebound from undercuts without permanent deformation; may release hydrogen gas during settingMost stable impression material or provides best dimensional quality: Additional silicones (PVS)Will distort when stored in air for 24 hours before pouring: irreversible hydrocolloidsLeast water resistant: reversible hydrocolloidPolyether is not recommended for full arch impression of dentate because they: exhibit a high elastic modulusDisadvantage of polyether: sticks to teeth, stiff, hard to remove, engages undercutsLeast wettability is seen with which impression material: condensation silicones (second is polyether)Condensation silicones by product: ethyl alcohol (CE)PolyetherNo by productPolysulfideWaterCondensation siliconeEthyl alcoholCan cause allergy if mixed with hand: condensation siliconeWhen pouring gypsum material into an impression, which material will cause the least amount of bubbles? SiliconeThe principle advantage of polyether material over polysulfide is: less dimensional change with time and high tear strengthWorking field has to be dry for: PolysulfidesElastomeric impression materials, which has the highest tear strength: polysulfideMost rigid of all impression materials: polyetherNatural affinity for water: polyetherThe most stable elastic impression in moisture environment: polyetherThickness of polysulfides: 3 mm uniform (max)Pour polysulfide impression within: 45 minutes (never sent to lab unpoured)Polymerization of polysulfides is accelerated by: temperature and humidity (water)Pour polyether impression within: 30 minutes – 1 hourBy-product of polysulfide: waterBy-product of addition silicones (PVS): Hydrogen (as secondary reaction)Catalyst of polysulfide impression material: lead oxideMaterial not used for a single crown: polysulfideImbibition is a property of: alginate and polyetherPolyetherHydrophilicCondensation/Addition siliconeHydrophobicHysteresis: having a melting temperature different from the gelling temperatureZinc phosphate contains: zinc oxide, magnesium oxide, bismuth oxideZinc chloride can cause: necrosis of epitheliumHardest cement to wash: resin; easiest: zinc phosphateWhich cement is the easiest to remove after procedure? Zinc Phosphate cementProlonged mixing works well for: Zinc phosphate (superior mix, better final strength and low solubility); opposite for gypsum productspH of Zinc phosphate is 3.5 (acidic to pulp)Strongest or highest compressive strength cement: Silicophosphate cementPouring of impressionsAddition or PVSMore than a day/weekPolysulfide45 minsPolyether30 mins – 1 hourMagnesium can cause: diarrhoeaDental porcelain is manufactured by a process called: frittingSS can be stabilized by addition of: titaniumcobalt decreases hardness of steelHeating gypsum above 1000 C liberates: sulfur dioxideGreen strength of gypsum product refers to its: wet strengthduring casting of noble metal alloys the mould should be held at the burn out temperature for atleast: 60 minsQuartz acts to strengthen in: porcelainMain component of the refractory skeleton: QuartzGreen discoloration of porcelain: silver or copperGreen discoloration of veneer with in less than a month: crack in bondMost discolour in composite occurs: gingivally and proximallyBinder in porcelain is: KaolinWhat are binders: minor constituent of the investment material (~30%) for strengthTo increase the strength of gypsum bonded investment, which binder is used: Calcium Sulphate Alpha HemihydrateReactor in alginate: calcium sulfateCauses gypsum to set faster: Potassium sulfateEpoxy resins are thermo setting resinsPotassium acetate acts as retarder in: plasterBest impression for flabby tissue: impression plasterFlabby tissue in anterior maxilla for a CD: passiveOther retarders: Borax, sodium citrate?Initiator of acrylic resin or PMMA: benzoyl peroxide by: tertiary amideActivator of PMMA: tertiary amineResponsible for discoloration in PMMA: Benzoyl peroxideFound in the powder of a denture resin: polymer and benzoyl peroxideInitiator of light cure or photo initiator of resin composite: camphorquinoneDiketones are activated by: visible lightMost common component for resins, sealants, bonding & glaze agents and resin cements: Bisphenol A-glycidyl methacrylateferrite and austenite are ductile forms of ironType v dental stone has: high strength high expansionsand is used for polishing of: base metal alloyssublimation is: conversion of solid directly to gashydroquinone added to resin monomer acts as: inhibitorPercentage of filler by weight in conventional composite resins is more than: 60%Use of fillers in composites: improve finishing and wear resistanceFlowable has: less filler contentFunction of filler: strengthLarge fillers have more strength, but: do not polish wellMetal appliance such as cobalt chrome RPDs should not be cleaned with denture cleansers containing: HypochloritesPossible causes of fractures of chromium-cobalt RPDs include: cold working; shrinkage porosity; low percent elongation; excessive carbon in the alloyEffects of cold working: decrease in ductility and increase in hardnessDuring setting of gypsum mass thickens and hardens into needle like clusters called spherulitesBorax provide body and strength to reversible hydrocolloidsIn noble metals platinum maybe substituted by: PaladiumIn order for an alloy to be considered noble metal, it should: contain at least 25% Pt or PdPrincipal hardener in noble metal casting alloys is: CopperExamples of noble metals: Palladium, Platinum, GoldHigh-gold noble alloys used to fabricate porcelain fused to metal contains: 98% gold, platinum and palladium (Gold helps with tarnish and provides ductility; Platinum and palladium acts as hardeners, increase corrosion resistance and whiten the metal)Aged yellow teeth has: very good tooth whitening prognosis.Self cured and heat cured resins are similar in: hardnessSealer components interferes with composite resin polymerization: eugenolThe main component of any root sealers is? Zinc oxideIt is preferable to not extrude sealer beyond the apex for: sealer does not resorbAdvantage of AH26 sealer: Low toxicityExample of compomer: DyractWhich sealant is more likely to cause tissue damage if extruded: AH pluswhat element added to alloy to produce corrosion resistance: Chromium (Dentin)The most important consideration in the strength of amalgam is: its mercury content (should not be more than 55%)Clove oil is 70-85% eugenolPrimary corrosion products of amalgam are: oxides and chlorides of tinHow does porcelain chemically bond to the metal in the construction of a metal framework: oxidesThe principal corrosion product of dental gold alloys that contain silver is: silver sulphidePolishing of gold alloy can be achieved by: Iron oxideHardness of gold alloy is related to: elastic limitLuting agent for gold restorations and orthodontic appliances = Zinc Phosphate cement (radio opaque)Zinc phosphate is used to cement: Gold and PFMWhy gold made alloyed = increase strengthBrinell hardness (uses a hardened steel ball indenting tool) number of pure gold is 25Available gold casting alloy: extra hard arkiGold CTE: 14.4 (tooth is 11.4)Composite compared to GIC has better: wearPorcelain is strongest in which stage: coolingSuck back porosity can occurs during casting of alloys (caused by entrapped molten metal after solidification has taken place, evidenced by shrinkage voids)Porcelain porosity: Inadequate condensation of porcelainGaseous porosity in the THICKEST part of the denture is due to: ‘Rapid/”over” heating or short curing cycle with rapid temperature build upGaseous porosity is commonly seen in which areas of the denture: lingual aspects of lower denture and slopes of palate in upper dentureContract porosity is due to: insufficient amount of dough or pressure in flaskPorosity if you don’t use flux: shrinkage porosityBackpressure porosity is caused by: too short of sprue sizeBack pressure porosity diagnosed: rounded edges (caused by entrapped air or air bubbles)Most common way of lowering a ceramic’s porosity and increase density is: sinteringComplete denture increased porosity is due to what? Improper heating cycle; excess heat; excess polymer/monomer ratioCasting defects prevented by vacuum investing: air bubbles and # of investmentA major difference between light cured and chemical cured composite is that during setting or in function the light cure material tends to: shrink rapidlyBlue light is not: 340 – 370 (450-750)Colour stability in light cure: TEGDMA and HEMAHas the best colour stability: PMMAContact dermatitis if you touch with hands: HEMMAHas the worst colour stability: Bis-GMA (high viscosity) ~bis-visMonomer in composite which decreases viscosity and increased hardness: TEGDMA and EGDMAMMA maintains: occlusal and interproximal contacts or maintains MD widthMonomer in light cure: dimethyl para-toludineIncreased monomer in acryl: LESS expansionBrown discoloration in porcelain gingival margin after a month of placement with resin cement, what is the most likely cause? MicroleakageIdeal dental stone for models is Type IVtrue about setting expansion of plaster, stone, and improved stone (Type IV)? Increasing the water/power ratio decreases the setting expansionmost frequent cause of porosity in a porcelain restoration? Inadequate porcelain condensationThe strength of a soldered connector is best increased by: Increasing its dimension in a direction parallel to the applied forceZinc (deoxidiser) is added to amalgam alloys because it makes the amalgam more plastic and acts as a scavenger preventing oxidationOne can accelerate the setting time of zinc oxide-eugenol impression pastes by adding a small amount of: waterA pt. has been using a cast partial denture made up from Base-Metal alloys, but gradually it got corroded, this corrosion is due to lack/relative lack of which metal? ChromiumDistortion or change in shape of cast partial denture during its clinical use probably indicates that: elastic limit was exceededThe minimum stress required to induce permanent deformation of a structure: elastic limityoung’s modulus defines stiffnessdisadvantage of using an elastomeric material for making an interocclusal registration? There is a potential for inaccurate mounting of casts due to rebound of the materialSome metal elements used in ceramic restorations have been known to cause reactions in patients. The most common causative element is NickleNickle in base metal alloys increase: ductility% of nickel allergy: 20%The dentist places a MOD amalgam restoration on tooth 30. The patient bites down immediately after carving, and the marginal ridge fractures easily. Which amalgam properties contributed to this failure? Setting timeKnown allergens: Nickel and berylliumPharmaLA are: weak basesMajority of injectable Las today are: tertiary aminesDrugs that accumulate in breast milk are: weak basesVasoconstrictor in LA affect: onsetComplete anesthesia occurs when 3 consecutive nodes of Ranvier are blockedSite of action of LA: Lipoprotein sheath of nerve blockIf pH and pka are equal: an equal mixture of ionized and nonionized formsIf pH is low, the action of LA is: less owing to a decrease in the free-base form of the drug or higher percentage of charged form of drugMOA of lidocaine: block sodium channels/prevent increase in membrane permeability to Na+ or prevent generation of nerve action potential (depolarization)Amides and esters have cross allergenicity with each other.Onset of anaesthesia is inversely proportional to: solubilityWhat infection does to LA: It reduces free base amount of anesthetic; LA in more ionized formWhy give hydralazine with chloral hydrate? Decreases nauseaMethylparaben (preservative) is cross allergic with: para aminobenzoic acid found in ester LasEsters are metabolized by: pseudocholinesterases in plasmaGreater the LA concentration, faster the penetrance, faster the onset.LA blocks only myelinated nerve fibres at nodes of ranvierLA technique that requires pre-medication: sulcular injectionEpinephrineActs on alpha and beta 1 & 2 – BP and heart RateLevoActs on alpha 1 & 2 – Only BPIncreased blood flowShort duration of actionIncreased protein bindingIncreased lipid solubilityTablespoon has: 15ml of liquidExponential or first order kinetics implies that: a constant fraction of a drug is eliminated from the body per unit timeZero order kineticsElimination of constant amountFirst order kineticsElimination of constant percentageIf you wish a patient to initiate drug therapy immediately after the prescription is filled, the instruction to the patient should specify that the drug is to be taken: statFDA of 1906 regulates: interstate commerce in drugsDEA stands for: Drug Enforcement AdministrationAt a pH of 7.4, lidocaine with a pKa of 7.8 will exist in: approximately 25% unionized formCardiovascular collapse elicited by the high plasma level of a local anesthetic is most likely caused by: myocardial depressionNot be attributed to the physiological effect of epinephrine: bronchiolar constrictionMost allergic reactions to local anesthetic agents are the result of: Type IVActivated efflux pumps can also affect the intracellular concentration of: beta-lactams and beta-lactamasesFollowing antibacterial chemotherapy, the resistant flora tends to: NOT maintain a survival advantageHormones competitively binds to estrogen receptors on certain tumor cells and other target tissues and produces a nuclear complex that decreases DNA synthesis and inhibits estrogen effects: TamoxifenWhen taken by a man, may suggest the medical diagnosis of prostatic carcinoma? Conjugated estrogenWhen a drug is converted to reactive metabolites capable of covalent binding to DNA, it may produce: an oncogenic effectAllergic reactions is associated with IgE antibodies fixed in tissue, mainly mast cells: Immediate HS reactionsPrescribed for the prevention of osteoporosis, more closely mimics the action of calcitonin: alendronateWhat is calcitonin: secreted by parafollicular c cells of thyroid glandHormones are associated with a hyperglycemic effect: prednisone, estrogen and progesteroneThyroid hormones and epinephrine: act synergistically with epinephrine to enhance gluconeogenesis and hyperglycemiaBinds electrostically to positively charged proteins in ulcerated tissue and retards acidic and proteolytic damage: SucralfateProkinetic agent, which is effective in decreasing the contact time between the gastric acid and the esophageal tissue and is also an effective entiemetic agent: CisaprideAtorvastatin seriously interacts with: ketoconazole, digoxin, erythromycinAnti-psychotic that has the highest risk of developing agranulocytosis: clozapineFacts about second generation anti-psychotic – Clozapine: block dopamine receptors and also serotonin (5-HT) receptors; few extrapyramidal side effectsInitial LA toxicity: Inhibition of central inhibitory neurons which results in CNS stimulation/excitation, proceeding to convulsions.Higher doses of LA: Inhibition of both inhibitory and excitatory neurons, leading to a generalized state of CNS depression, leading to respiratory/myocardial depression and deathHigh plasma level of LA may cause: depression of inhibitory neuron in CNSPharmacologic agonist is a chemical substance that: binds to a specific receptor and produces a responseEffective against both gram negative and positive: ClindamycinMore Ionized – More water soluble – Less effective-Excreted fasterDrug will cross glomerulus depends on: protein bindingAfter drug goes through liver: more water soluble and less lipid solubleWhat happens to a drug after conjugation: more ionicH-H equation states that weak acids become: more ionized in alkaline pHWeak acids in the kidneys: excreted more rapidlyBest predictor for pulpal anesthesia: Back pressureTeeth most difficult to anesthetize: mandibular molarsLA acts on nerve membrane by displacing: calciumNerve block produced by LA is: nondepolarizingWhich drug absorbs better in stomach acid? Weak acidWhen a drug does not exert its maximum effect is because it’s bound to: AlbuminWhen a drug exert its maximum effect is because it’s bound to: Plasma proteinsWhich nerve gets blocked first: small unmyelinatedThe Stabident local anesthesia system is used for: intraosseous injectionsSensation lost first with LA: pain; last is: motor (skeletal muscle tone)Topical LA: lido and benzoTopical AB: bacitracinTx of RSV: RibavarinSystemic anti-fungal with a low TI and not prescribed by a GP: Amphotericin BInhibits N-type calcium channels and used intrathecally for severe pain: ZiconotideParts of brainHypothalamusTemperature regulationNovobiocin is derived from: Strep. niveusPenicillin would be used to treat a Pseudomonas aeruginosa (gram negative) infection: Ticarcillin and carbenicillin (carboxypenicillin); Polymyxin BExtended spectrum penicillin: ticarcillin, piperacillin, ampicillinGram negative3rd generation cephalosporinGram positiveclinda/erythro/vancoPositive and negativeTetracycline/1st gen cephaloCeph 1 (ZLD)Zolin, Lexin, DroxilCeph 2 (CX)Clor, XitinCeph 3Axone, Axime, ZidimeSide effect of polymyxin B: renal necrosisMost resistant part of CNS: Medulla Oblongata (cardiac, vasomotor, respiratory center)Bacteriostatic meds works by: inhibiting protein synthesisMu (OP3) receptors are present in or opioids act in which part of brain: MedullaMorphine causes vomiting by: stimulation of CTZ (chemoreceptor trigger zone)Codeine binds to Mu, delta and Kappa receptorsDecrease in ventilation caused by morphine, meperidine depends chiefly upon: loss of sensitivity of medullary respiratory center to carbon dioxide.Anti-parasitic is: MalathionSodium reabsorption in the thick ascending limb of the loop of Henle is inhibited by: BumetanideAntibiotics cannot be made from virusesBacteriostatic AB: lancosamides, macrolids, tetra, chloramphenicolBactericidal AB: Pen, Ceph, Vanc, Metro Based on their metabolic characteristics, bacteria may be classified as: aerobic, anaerobic or facultativeAnti-congestant banned for use in sports and commonly misused for weight loss: ephedra (ephedrine)Drug that can cause renal lithiasis (kidney stones) is: sulfamethoxazoleThe combination antibacterial agent trimethoprim/sulfamethoxazole: sequentially blocks the folate pathway, produces synergism, and is bactericidalSulfonamides and Trimethoprim are synergistic in: they interfere sequentially with folinic acid productionEthyl alcohol is used as anti-dote for methanol poisoning because it prevents damage to: optic nerveIn the apothecary system 1 grain (gr) is equivalent to: 65 mgMost potent antacid: Aluminium hydroxide5 ml is equivalent to: 1 teaspoonPharmacokinetics and Pharmacodynamics of aging patients: increase in half life of drugs; decrease in renal excretion of drugs/biotransformation of drugs; alter volume of sequestration and distribution of drugs in body fat. Decreased gastro motilityNOT is increased plasma proteins binding of drugs.What the body does to the drug: pharmacokineticsThe time required for a 50 percent decline in the plasma concentration of a drugas the drug is partitioned throughout the body is expressed as the drug’s: distribution half-life (t1/2)Germicidal action of benzalkonium chloride is rapidly reduced in the presence of: soapSide effects of methyl testosterone: Premature closure of epiphysis of long bone; hirsutism in womenTx of hirsutism: EflornithineSynthetic opioids: meperidine, fentanyl, loperamide, diphenoxylateUses of barbiturates: anesthesia, anti-anxiety, anti-convulsantCorticosteroid inhibits phospholipase A2: TriamcinoloneDrug most likely to result in decreased metabolism of opioids that undergo hepatic metabolism: diltiazemCYP3A inducer: Carbamazepine, phenytoin, St. John’s wart and rifampicinMost common type of conjugation is: glucuronide conjugationPhase 1 reactionsOxidative and reductive by p450 (hepatic microsomal enzyme); inducible; hydrolysisPhase 2 reactionsConjugation to a specific substrateMuSupraspinalKappaSpinal analgesiaMechanism of how codeine causing nausea: works on medulla by stimulating CRZ (chemotactic receptor zone)Location of opioid receptors: brain, spinal cord and GI tractHow does morphine cause emesis (vomiting) in the body? via central action (medulla)Principle central action of caffeine is in: cerebral cortexCocaine produced powerful stimulation of: cerebral cortexSevere hypotension from toxic blood levels of LA is not seen with: Cocaine (vasoconstrictor)Only LA to block reuptake of NE into adrenergic neurons: CocaineIf patient allergic to both esters and amides: diphenhydramineLA safe in pregnancy: Lido 2% with 1:50,000 epiWhich properties increase the tendency of a drug to cross membranes or penetration of LA into nervous tissue: Non-ionized and high lipid solubilityHighly ionized drugs are: less lipid soluble, more easily excretedIn order for a drug to do its effect in what state should it be: lipid soluble and non-ionizedPotency of a drug depends on its: lipid solubilityIn relation to their parent drug, conjugated metabolites are what? more ionized in plasma (more water soluble)What is biotransformation: converting ionized form to water soluble form (iwater)Drug biotransformation is classified synthetic: sulfate conjugation and glucuronide conjugation; NOT is O-dealkylationDrug biotransformation is classified non-synthetic: oxidation, reduction, N-dealkylation and hydrolysisIf the drug's liver metabolism is very efficient, how it will influence to it potency? Decrease potencyLA with epinephrine is CI with: TCA, propranolol, amphetamine, MAO – Isocarboxazind, Phenelzine, Tranylcypromine, Selegiline)Acute asthmatic attack due to propranolol or severe attack: aminophyllineAnti-anginal drugs: nitro-glycerine, propranolol and calcium channel blockers - verapamilSide effects of anti-hypertensive drugs: xerostomia, lichenoid reaction, neutropeniaNitroglycerinIncrease oxygen by vasodilation of smooth muscleCalcium ChannelDecrease oxygen demand by reducing peripheral resistanceThe drug-of-choice for the treatment of adrenergically-induced arrhythmias is: PropranololPropranolol can be used in the treatment of HTN because it blocks: release of renin from juxtaglomerular cells and reflex tachycardia Propranolol does not: alter ionic movementPropranolol CI: hypoglycaemia; asthma; CHF; existing AV blockDuration of action of lidocaine would be increased in the presence of: PropranololConcentration of sodium ions determine: binding affinity to opioid receptors3rd generation cephalosporin: MoxalactamAllosteric: non-competitiveCHF medication: digoxin (cardiac glycoside), ACE inhibitors and calcium channel blockersEffectiveness = therapeutic efficacy + half lifeDrug dosage depends on: half lifeTranspeptidase enzyme is inhibited by: PenicillinAntihypertensive that causes coughing: AmlodepineTyloxAcet + OxycodoneEmpirin 3Aspirin + CodeinePharma MnemonicsAnti-hypertensives (ABCD): ACE inhibitors, Beta blockers, Calcium channel (amlodepine, veramapil) and DiureticsOsmotic diuretics (GUM): Glycerol, Urea, MannitolLido; Mep; articiane - plain4.4 mg/kg300Lido with epinephrine; articiane7 mg/kgPrilocaine6 mg/kg400Bup1.3 mg/kg900.5% is 5 mg/cc1:50,000 is 0.02 mg/ml1:100,000 is 0.01 mg/ml1:200,000 is 0.005 mg/mlMax. epi in a healthy patient: 0.2 mgMax. epi in a CVS patient: 0.04 mgAspirin in body2-3 hoursLow doses30 hoursHigh doses7 daysSystemic effect18 kgs2 carpules27 kgs3 carpules36 kgs4 carpulesSame intrinsic effect: same efficacyDifferent affinity: different potencyWhich acetylate COX: Aspirin Acitretin is CI with: AsparaginaseDuration of anaesthesia depends on amount of anaesthesiaNitrite vs. nitrate: Nitrite is for urine and nitrate is for cardioProphylaxis for angina: long acting nitratesNonselective, noncompetitive antagonist of nictoninc Ach receptors: Mecamylamine (Inversine)Ganglion blocking agent: MecamylamineMAC (Minimum Alveolar Concentration)Higher MAC: faster induction, lower potency (eg: NO – 104)Lowe MAC: slower induction, higher potency (eg: halothane – 0.75)What is MAC: concentration required to render 50% of patients immobileNitrous oxide cylinder: BlueOxygen cylinder: GreenMain cause of cardiac arrest in kids: respiratory problemsChildren who receive broad-spectrum antibiotics during their first year of life are at: increased risk of developing childhood asthmaExamples of broad spectrum antibiotics: SALT – GC (strep, amox, levofloxacin, tetra, gatifloxacin, chloramphenicol)Narrow spectrum example: Pen GEnhance the renal excretion of acidic drugs (e.g. NSAIDS): Sodium bicarbonate (increase reabsorption of weak bases)Two nonsteroidal antiinflammatory drugs (NSAIDs) that have minimal adverse gastrointestinal side effects are: Etodolac and RofecoxibDrug scheduling is based on: dependence and abuseControlled drugs (COP – M): Codeine, Meprobamate, Oxycodone, PhenobarbitalOtotoxic drugs: ADH (aminoglycoside, diuretics (high ceiling/loop), vancomycin)After giving LA, which sensation is lost the last: moto or proprioceptionRecently introduced LA claimed to be as potent as Procaine 0.05%, 30 mg 4 hour period = 33 cartridgesYou inject LA into parotid gland capsule. How long it take to recover from the parathesia: 24 hrsInhalation sedation should be administered when the patient is: lying down (NOT upright!)Drug with metallic taste: Metronidazole Tobacco cessation, what is contraindicated for patients with cardiac disease: BupropionReserpine causes: nasal stiffness and hypotension (Tx of HTN) and potentiation of narcoticsMOA of reserpine: Stabilize the axon terminal membrane preventing release ore depletes nor-epinephrine. Used for treatment of hypertensionPre-treatment with reserpine prevents a response to: amphetamine Make the drugs more easily absorbed form the gastric mucosa: if it is a proteinSmoking cessation drug: Chantix (varenicline) and Zyban (bupropion)If someone has a history of depression & wants to quit smoking: ZybanMOA of Chantix: mimics effect of nicotineMOA of Zyban: Acts on NE and dopamine reuptake inhibitorPatient on nicotine de addiction is not recommended: nicotine nasal sprayIndirect sympathomimetic drug: tyramine, ephedrine and amphetamine (TEA)The role of sodium metasulfite in Local anaesthetic agent is: reducing agentSide effects of smoking cessation drug: xerostomia, depression, vivid dreamsDrug allergenicity between penicillin and cephalexin: 8%Acet and ASA differ in their toxicityWhat kind of insulin is short acting: Insulin regularOral antidiabetic drugs don’t function as: direct insulin receptor agonistsInsulin medication is classified based on: onset and durationLack of insulin will lead to: ketoacidosisAction of sulfonyl ureas: secretion by direct stimulation of pancreatic beta cells or increase insulin by binding to ATP dependent K channelsAction of metformin: suppresses glucose production in liver from glycogen (decrease gluconeogenesis/glucagon); activates AMP kinaseAction of insulin: Decrease in glycogenolysisIntermediateIsophaneLongProtamine Zinctetracycline + penicillin: antagonize (Tetra Pack)LEAST effective against E.faecalis: tetracyclineBug very resistant to calcium hydroxide in the pulpal space and this especially true in re-treatment cases: Strep. FaecalisAppropriate to sterilize endodontic instruments: 250 F, 15 pounds pressure for 30 minutesTetracycline/Doxycycline inhibits: collagenase, MMPsDrug known to cause amelogenesis imperfecta: TetraTetra CI in relation to child’s age: 8 years and belowTetracycline interfering with action of collagenase makes it a: chelating agentCollagenase is produced by: Bacteroides and P. gingivalisProlonged use of tetracyclines can cause: superinfections, diarrhea and photosensitivityEffectiveness of tetracyclines is reduced by: concurrent ingestion of antacids and dairy products (also iron, multivitamins, calcium, laxatives)Significant factor in taking tetracycline: Binds to many metal ions – calcium, iron and magnesium, making it nonabsorbable.Advise to patients taking tetracyclines: Take medication between mealsHyaluronidase is produced by: StreptococcusDrugs fine with MAOI: barbiturate, LA, Pethidine. CI: AspirinLEAST likely to cause superinfection: Pen GAB inactivated by stomach acids: Methicillin and Pen G (injected)Penicillin with a broader gram-negative spectrum than Pen G: AmpicillinLeast effective against penicillinase-producing microorganisms: AmpicillinMacrolide antibiotics (erythromycin) are usually avoided in asthmatics because: it interacts with theophyllineMacrolides such as erythromycin inhibit the metabolism of drugs such as: seldane, digoxinExamples of macrolides: Azith, Clarith, Eryth,RoxithWhich antibiotic concentrates in gingival tissues: MacrolidesNaproxen safe for: liver diseaseNSAID for 8 hours or overnight relief: Naproxen/Diflunisal (longer half-life)Analgesic for a patient with diabetes: NaproxenLeast effect on platelet aggregation: NaproxenNo increased blood levels due to an active metabolite: TazocinEndogenous opioids: endorphin, enkephalin and dynorphin. NOT is bradykinin (inflammatory vasodilator)Effects of bradykinin: dilates blood vesselsWhich antihypertensive drug also increases bradykinin levels? LisnoprilAnti-hypertensives are known to cause erectile dysfunctions: diuretics and beta blockersThe disk sensitivity assay for antibiotic activity is used because: it allows for routine testing of sensitivity to a range of antibioticsSide effects of Mycophenolate (immunosuppressant): candida infectionMoon face seen in: Cushing’s syndrome or steroid treatment2 hyper and 2 hypo of cushing’s syndrome: Hyperglycemia, hypercholesterolemia, hypernatremia, hypokalemiaHemorrhage due to PSA can be reduced by: short needleAlbuterol side effect: xerostomiaDrugs that cause xerostomia: diuretics, CCBs, anti-histamines, anti-psychotics, anti-convulsantsDrugs that cause bad taste: metro, chantix, carbamazepineEnkephalins act on which opioid receptors: Mu and deltaCI for opiates: concurrent use of MOA inhibitorsPrimary role of epinephrine in LA: decrease systemic reabsorptionThe central skeletal muscle relaxation produced by depressing the polysynaptic reflex arcs is brought about by: diazepam; lorazepam; meprobamate. NOT is: d-tubocurarine (non – depolarizing NMJ blocker)Lorazepam is not used for conscious sedation in dentistry because of: long duration of action and slow onset (low lipid solubility)CI for lorazepam: pregnancyDeficiency in acetylcholinesterase treatment: d-tubocurarineTreatment with pararkinson’s is less likely to be accompanied by crystalluria if: a mixture of sulfonamides is usedMixture is better than single dose sulphonamides: misture reduces renal toxicitydrug poses the greatest risk of a cardiac arrhythmia when admistered at the same time as epinephrine: HalothaneGA for kids: sevofluraneInteraction between nitroglycerine/histamine and epinephrine. What type of antagonism? PhysiologicThe phenomenon in which two drugs produce opposite effects on a physiologic system but do not act at the same receptor site is: physiologic antagonismInteraction between erythromycin and penicillin: antagonism (or idiosyncrasy)A drug which has high affinity for a particular receptor but no intrinsic activity is a(n): antagonistIdiosyncrasy: abnormal response to drugs due to genetics (hard to predict)Erythromycin and tetracyclines are prescribed carefully in patients with: peptic ulcers# 1 side effect of erythromycin: stomach upset/GI damageKetamine can cause: Laryngospasm and dissociationKetamine increases: saliva and BPKetamine is given: IVKetamine MOA: blocks NMDA glutamate receptorsKetamine in low doses: good anxiolytic and analgesicSide effects of nitroglycerine or glyceryl trinitrate: headache and hypotension (orthostatic)MOA of nitroglycerin: Relaxes vascular smooth musclesNitroglycerin will cause: INCREASE in heart rate (natural reflex to decreased BP)Drug that affects perio treatment planning: NitroglycerinNitroglycerin increases the production of which enzyme: cGMPSuppression of cortisol: 20mg for 2 weeks in 2 years100 mg cortisol a day: suppression will happen after a week5 mg cortisol a day: suppression will happen after a monthPre-dental appointment sedation: 5 mgWhere does cortisol act: on a receptor in the cytoplasmStimulation of gluconeogenesis and lipolysis are most characteristic of which hormone: CortisolSpontaneous gingival bleeding and/or acute stomatitis may be induced upon withdrawal of this drug in pediatric patients that are being treating for seizures: Valproic acidEthosuximide is only for: Petit mal (absence seizures in children under 16; 5-10 seconds)Valproic acid is for: Grand mal, petit and myoclonicDrug for insomnia due to anxiety or night before the treatment to help him fall asleep (insomnia) and also deal with his/her anxiety: Zolpidem (ambien) when benzodiazepine is ineffectiveBelladona (increases intraocular pressure) - anticholinergic: Don’t use in narrow angle glaucomaName belladonna alkaloids: atropine, scopolamine and hyoscyamine)Why belladonna alkaloids are used with phenobarbital: To treat irritable bowel syndrome and ulcers in intestinesDrugs CI in narrow angle glaucoma: Meperidine, Scopalamine, Diazepam, Propantheline, AtropineDrug that obscures eye sign: scopolamineUses of scopolamine: peptic ulcer, euphoria, amnesia before surgery, Parkinson’s Use of phenylephrine: nasal decongestant; alpha agonist; vasoconstrictor3 vasoconstrictors: epi, levo and phenylephrineNSAID that causes blood dyscrasias or bleeding: IndomethacinInhibits release of catecholamines and is anti-adrenergic: Guanethidine (reserved for severe hypertension)Management of severe hypertension: guanethidine and ganglionic blockersMost vascular gingival growth seen with: cyclosporineMOA of Viagra: increase blood supply by vasoconstrictionStrongest/long acting glucocorticoids: DexmethasoneMost selective as a glucocorticosteroid: DexmethasoneLong term glucocorticoids does not show: hypoglycaemiaNegative effect of long term use of glucocorticoids: infection, reduced inflammation, hyperglycemia (gluconeogenesis), regulate cell metabolism at the level of translation and transcription.Treated with glucocorticosteroid: lymphocytic leukemia, asthma and allergic rhinitisGlucocorticoids are CI in: diabetesFanconi syndrome affects predominantly: kidneyA patient who is diagnosed with pseudocholinesterase deficiency, drug that should not be given: succinylcholine (depolarizing NMJ blocker; prevents laryngospasms)Management of laryngospasm: pure oxygen (if persists – succinylcholine)First skeletal muscles to contract after succinyl choline: eyelidsAdministration of succinylcholine to patient deficient in serum cholinesterase would cause: prolonged apneaA paralysing dose of succinylcholine (nicotinic receptor agonist) initially elicits: muscle fasiculationSuccinylcholine is a short acting NMJ blocking agent: subject to inactivation by plasma esterasesDrugs CI in pregnancy: Gentamicin (aminoglycosides), Metronidazole, Tetracycline, Vancomycin, chloramphenicol (MCAT), Propoxyphene, diazepam, codeineMost dependentOxycodone Least dependentPropoxypheneDrugs CI in breastfeeding mothers: codeine, tetracycline, benzos, atropineTreatment of BPH (Benign Prostatic Hyperplasia): Finasteride (Proscar) or saw palmettoSaw Palmetto is associated with which therapy: Estrogen hormone therapyPatient on saw palmetto, avoid: aspirinHerbal supplement that potentiates anti-coagulation: saw palmetto In diuretics administration, what is decreased: potassiumPotassium levels in blood: 3.6 – 5.2Metabolism of a drug will usually NOT result in conversion to: less ionized compound Drug-induced hypnosis can be produced by depressing reticular activating systemPhenytoin is most often recommended for controlling which of the following seizures? Tonic-clonic (grand mal); apart from phenytoin: phenobarbitalPhenobarbital withdrawal from a dependant patient can cause convulsionsTherapeutic uses of barbiturates: Induction of anaesthesia; anti-convulsant; anti-anxietyAnti-anxiety use of barbiturate: InsomniaBarbiturate as anticonvulsant is used in the long-term management of: Tonic-clonic; status and eclampsiaBarbiturates - SedativesUltra shortThiamylal; Thiopental; Methohexital – common (two stages of GA is typically bypassed by administration of barbiturates before the anesthesiaShort Pentobarbital; secobarbital (effective ways to decrease vasovagal syncope)IntermediateAmobarbitalLongPhenobarbital - contraindicated in respiratory disease or pregnant ptSedation in children: Secobarbital/pentobarbital (NEVER – Meperidine)Recovery from ultra-short acting Barbiturates is due to: redistribution by bloodChief mechanism by which the body metabolizes short-acting barbiturates is: oxidation (in liver)True regarding barbiturates: metabolized in liver; classified according to duration and depresses all levels of CNSOther use of phenytoin: arrhythmia (similar to lidocaine)Life threatening arrhythmias are treated using: LidocainePotent vasoconstrictor: Angiotensin IIArrhythmiasAtrial fibrillationDigitalis, verapamil, QuinidineDigitalis induced arrhythmiasPhenytoinParoxysmal tachycardiaPropranolol, Digitalis, VerapamilVentricular arrhythmia (life threatening)LidocaineSupraventricular tachyarrhythmiasVerapamil, QuinidineAdrenergic agentsPrazosinSelective alpha 1 blockerInhibits binding of nerve induced release of NE resulting in vasodilationPropranololNon-selective beta blockerReduces cardiac output and inhibits renin secretionMetoprololSelective beta-1 blockerReduces cardiac outputClonidineSelective alpha 2 agonistReduces sympathetic outflow to peripheral vesselsMethyldopaActs as false neurotransmitter stimulating alpha receptorsReduces sympathetic outflow resulting in vasodilationAlpha 1 agonistVasoconstriction, urinary retention, mydriasisAlpha 1 blockerVasodilation (Tx – benign prostate hypertrophy)Alpha 2 agonistGiven orally, cause hypotension by reducing sympathetic outflow from CNSBeta 1 agonist – Positive Inotropic and chronotropic Increase heart rate, bronchodilationBeta 2 agonistVasodilation, bronchiolar smooth muscle relaxationAdrenergic blockersPrazosin; PropranololAdrenergic nerve inhibitionReserpine; Guanethidine; Methyldopa; ClonidineIndirect acting sympathomimetic drugsAmphetamine, Tyramine, Ephedrine, TCA, MAOIPropranolol, AtenololBlocks peripheral beta receptorsMethydopa, ClonidineStimulates central alpha receptorsMAO of adrenergicsReceptor blockersCompetitive inhibitionReserpineDepletes NE by inhibiting reuptakeGuanethidineInhibit release of catecholamines - NEMethyldopaActs centrally as false neurotransmitter ClonidineStimulate alpha 2 receptors in CNSMAOBlock neurotransmitter enzyme destructionAmphetamine, Tyramine, EphedrineRelease of stored NEClass of anti-arrhythmiasType 1A – blocks sodium channelsQuinidineIncreasing the refractory period of cardiac muscle (most common)Type 1BLidocaineDecrease cardiac excitabilityDigitalisDecreasing the rate of AV conductionAnti-anginal drugs (insufficient oxygen to meet demands of myocardium)NitroglycerinIncreases oxygen supplyDirect vasodilatory action on smooth muscles in coronary arteriesPropranololReduces oxygen demandPrevents chronotropic responses to endogenous epinephrine, emotions, and exerciseCalcium channel blockersReduces oxygen demandReducing afterload by reducing peripheral resistance via vasodilationSide-effects of lidocaine: decreased cardiac output; respiratory depressionSide effects of phenytoin: ataxia, nystagmus, photophobia, blood dyscrasias, coarsening of facial features and hirsutismProlonged use of phenytoin will not cause: gastric irritationDisadvantages of oral sedation include: unpredictable absorption of drugs from the GI tractTx of tape worm infestation: PraziquantelConjugation: adding a molecule to the drugThe transfer of plasmid DNA by direct cell-to-cell contact between the donor and recipient microorganism takes place by: conjugationTx of xerostomia: pilocarpine (5 mg); sodium carboxymethylcellulose; neostigminePilocarpine and methacholine: nonselective muscuranic agonists; parasympthatomimeticToxic side effects of pilocarpine: bradycardia and hypotensionCholinomimetics: pilocarpine, methacholine, carbacholCholinomimetic drugs cause by exception: bradycardiaPilocarpine is not used in patient with: G6PD deficiencyAnticholinesterase and lower heart rate: parasympthatomimeticAnticholinergics and opioids might produce: paralytic ileusMOA of anticholinergics: inhibit binding of acetylcholine to muscarinic and nicotinic receptors. These receptors are found in eye, secretory glands and nerve endings to smooth muscle cells.Cholinergic crisis: lacrimation, bradycardia, extreme salivation, weakness voluntary muscleSedative for pregnant and lactating mother: Promethazine (Phenergan)Don’t give what to pregnant women: diazepam and codeine; barbituratesCI in asthmatics: anti - cholinergicsSulbactum is: beta lactamase inhibitor (others: clavulanic acid, tazobactam, avibactam)Drugs resistant with beta lactamase: flucloxacillin, oxacillin, dicloxacillinMedication associated with pancreatitis: Retrovir and valproic acid (also ototoxic)Synthetic agonist: MethadoneHelps alleviate withdrawal from heroine/morphine: methadoneInhibits methadoneCiprofloxacin (inhibits DNA gyrase; acts on both gran negative and positive)Increases methadoneRifampicinCI of St. John’s wart is warfarinHow St. John’s wart decreases immunity: interferes with protease inhibitorSt. John’s wart is used for: mild depressionChloral hydrate is CI with warfarinWarfarin affects which factors: 2, 7, 9 & 10 (by decreasing potassium)MOA of warfarin/dicumarol: Inhibit vitamin K reductaseAB and warfarin: increase anticoagulant effect because of decreased Vitamin K (by gut flora)Chlortetracycline acts by interfering with: protein synthesis on bacterial but not mammalian ribosomesBroadest antimicrobial spectrum: ChlortetracyclineDrug CI with milk: TetraDrug CI with cimetidine: SeldaneOmeprazole is used for: GERD Barbiturates: excess salivation and bronchial secretionBarbiturates taken in combination with very high doses of ethanol exhibit an interaction best described as: PotentiationUsing IV barbiturates as a general anaesthetic result in: patient moving fast through stage 2 (delirium and excitement)Barbiturates increase the duration of chloride channel openingPentobarbital: short acting; sudden withdrawal can cause convulsionsConvulsions for 2-3 mins: Grand malThiopental: quick onset, short duration, readily penetrates blood-brain barrier and leavesDisadvantage of using thiopental in GA: increased salivation and bronchial secretionErythromycin that is both enteric coated and long acting? ERYCSedatives and an antihistamine that is most likely to cause a dry mouth (anti-muscarinic)? Hydroxyzine (Vistaril?)Chloral hydrate for kids is given along with: HydroxyzineInhalation sedation used for a child can be supplemented by: HydroxyzineChloral hydrate is what to the GI ? Irritating to the GI tractKids under GA, give: chloral hydrate and midazolamSlowest rate of absorption: oralOnset of action is dependent upon: absorptionrepresents an amphetamine-like (CNS stimulant) drug that is widely used in the treatment of hyperkinetic children (ADHD)? Methylphenidate (Ritalin?) or AtomoxetineAmphetamine (myridos) is used for: ADHD (increases release of dopamine and norepinephrine in brain). If the kid is taking amphetamine, tell him not to take the medicine before dental appointment.Indirect acting drug: amphetamineDirect acting drug: epinephrine, Isoproterenol, NESide effect of amphetamine/ dextroamphethamine: Insomnia, lack of appetite, abdominal painAmphetamine abuse can cause: extreme violence and paranoid psychotic behaviourAmphetamines lead to release of what in brain: norepinephrine from central adrenergic receptors & at higher dosage, release of dopaminePressor dose of NE will cause: bradycardia due to baroreceptor reflexADHD features: inattention, combination of hyperactive and impulsive behaviours; manifest between 3 and 5Anti-inflammatory having the least effect on the GI system is: CelecoxibNSAID that has no effect on bleeding time/platelet adhesion or least likely to affect stomach: CelecoxibNSAID mostly associated with risk of heart attack: ValecoxibWhich NSAID does not block cox pathway: AcetaminophenCOX-1 inhibitors should be used with caution in patients: taking anticoagulants; with hepatic disease and hemophiliaMOA of Aspirinby irreversibly inhibiting COX (1&2); stopping the local signal production and transductionInhibits thromboxane A2, preventing platelet synthesisMOA of Clopidogrelirreversibly inhibits platelets aggregation by inhibiting ADP receptor; alter platelet function*Ibuprofen: reversibleWhen is Plavix is preferred over aspirin: if patient is allergic to aspirin and/or has a history of ulcerAspirin prolongs bleeding by: 1 week (platelet life is 1 week)Aspirin is CI with: coumadinAspirin is not recommended for: diabeticsAnalgesicInhibits synthesis of PGsAntipyreticInhibit PG synthesis in hypothalamic temperature regulation centreEffect on bleedingInhibit synthesis of thromboxane A2 preventing platelet synthesis – more bleedingThe antipyretic action of salicylates is explained in part by: cutaneous vasodilation leading to increased heat lossTinnitus is associated with: Aspirin (decreased tubular reabsorption of uric acd)Temperature regulation happens in: hypothalamus1 gm aspirin vs 650 mg aspirin: 1 gm will have better anti-inflammatory responseEthanol causes euphoria by: decreasing the inhibitory activity of frontal cortex/ removal of the inhibitory effect of the cortexNOT produced by ethanol: cutaneous vasoconstrictionEthanol can cause: gastric acid secretion, depression, duiresis and vasodilationCTZ (Chemoreceptor Trigger Zone): Responsible for nausea and vomiting symptoms associated with opioid analgesicsNausea and vomiting are induced by the activation of: dopamine, histamine and serotonin receptorsCocaine produces vomiting or stomach upset by: activating CTZ in brainAminopterin: Anti-neoplastic to treat acute leukemia in children (but now replaced with MTX)Buspirone: Sedative hypnotic to alleviate anxiety (not for panic disorders and does not cause CNS depression; least impairment of psychomotor skills with low risk of dependence)When 50 mg. of chlorpromazine (Thorazine?) is administered to a patient, on standing the patient might experience a fall in blood pressure due to: Alpha-adrenergic blockadeThe concentration of which of the following ions determines the binding affinity of agonists and antagonists to the opioid receptor? Sodium2 facts about demeclocycline: causes dermal photosensitivity; only tetracycline that causes nephrogenic diabetes insipidusCompetitive antagonists: high affinity; no intrinsic activityA drug that forms a reversible drug-receptor complex, which consequently is surmountable is: competitive antagonist (example: mechanism of action of H1 antihistamine)Occupation theory of drug-receptor interactionFollows law of mass actionAffinity of drug is independent of intrinsic activityAntagonist has no intrinsic activityThe quaternary ammonium group in the structure of a cholinergic agent allows for it to act as a: direct nicotinic agonistNot be predisposed to liver toxicity following a dose of 1000mg of acetaminophen: diabeticThe passage of drug molecules across cell membranes along a concentration gradient is achieved by: passive diffusionDosage of acetaminophen in kids: 15 mg/kgEccrine sweat gland innervation: sympathetic cholinergicMaximum ceiling effect of drug regardless of dose or measure of activity or onset; also its intrinsic activity: efficacy (potency)The magnitude of response obtained from optimal receptor site occupancy by an agonist is a reflection of the drug’s: efficacyPotency depends on: receptor affinityWhat increases as the intermediate chain of a local anesthetic increases: PotencyThe combination of a Schedule 2 narcotic with an antipsychotic drug produces: neuroleptic analgesia (mainly in elderly)Schedule 1 – Illegal for medical useHeroin, opium derivatives, marijuana, and hallucinogentsSchedule 2 (needs Rx) – legal medical use, but high abuse; refills needs new RxOxycodone + Acet (Percocet); Oxycodone + Aspirin (Percodan)Hydrocodone + acet. (Vicodin)Amphetamines, Morphine, Cocaine, Pentobarbital, Methadone, and straight CodeineSchedule 3 - <90 mg of codeine; refills without new RxCodeine + Acet (Tylenol 1, 2, 3)Schedule 4Darvocet (propoxyphene + acetaminophen)Diazepam, Lorazepam, Triazolam, Alprazolam, and chloral hydrateWhat are schedule 2 drugs: contain less then 15 mg of hydrocodoneWhat are schedule 3 drugs: contain less than 90 mg of codeine per unit dosageCorrect about schedule 3 drug: prescription order may be refilled, up to five times within six months after the date of issue, if so authorized by the prescriberAllergy to codeine: Propoxyphene (opioid agonist)Tx of CHF: Digitalis/Digoxin (cardiac glycosides) and ACE - captoprilPrimary action of therapeutic dose of digitalis on cardiac muscle is: increase in force of contractionDOC for digitalis toxicity: triamtereneSymptoms of digitalis toxicity: extrasystoles, nausea, yellow-green vision and A-V conduction blockDiuretics inhibits both sodium reabsorption and the secretion of potassium and hydrogen ions in the collecting tubules of the kidneys: triamtereneIndications for diuretics: edema due to CHF, hepatic/renal failureHeart failure usually originates with: left-sided ventricular failureA patient who gives a history of taking potassium chloride (Klor-Con?) is predictably also taking a(n): DiureticMost serious complication of digoxin intoxication: Ventricular arrhythmiaDrugs inhibits the sodium/potassium ATPase pump, increasing intracellular calcium ion concentrations and cardiac contractility (positive inotropic effect): DigoxinCharacteristic of CHF: inspiratory wheezing, dyspnea lying flat, increased systole, pedal edema, distended jugulars and orthopneaDigitalis should be given to patients with atrial fibrillation who require quinidine to avoid: ventricular tachyarrhythmias (other use: post myocardial infarction)Digitalis effect on heart: Increase Inotropic effect on heartMOA of digitalisBlocks Na/K ATPase; Increases influx of Ca and efflux of Na in cells to increase the refractory periodQuinidine has the same action as: procainamide (decreasing sodium influx and so increasing the refractory period)General question about arrhythmias: increased refractory period AND decrease repolarization rateDigitalis can cause: hypokalemiaACE inhibitors cause: hyperkalemia (related to convulsions)Competitive α1-adrenergic receptor antagonists are prescribed primarily for the treatment of: hypertensionTx of hypokalemia: hydrochlorothiazide diureticsDrug of choice for initial therapy for mild hyerptension is: chlorothiazideWhich drug wouldn’t raise a concern for perio problems: hydrochlorthiazideHypoglycemia is common in: HypokalemiaAldosterone release and presence of insulin causes uptake of potassium from blood stream causing hypokalemiaDiuretics is an aldosterone antagonist: spironolactoneSeizures are induced by: hyponatremiaHyponatremia is treated by: hemisuccinateCauses ventricular fibrillation at toxic levels: DigoxinDigitalis will decrease: ejection fraction or rate of AV conductionDigitalis side effect: yellow green vision; Inc. PR intervalTIA (Transient Ischemic Attack) should not take: NTGThe cardiac glycosides will reduce the concentration of which ion in an active heart muscle cell? PotassiumDisulfiram (Antabuse) action: acts at aldehyde dehydrogenase to treat chronic alcoholismDisulfiram reaction caused by: accumulation of acetaldehydeMain metabolite of isopropyl alcohol is: acetoneIf cartridge soaked in isopropyl alcohol for purpose of antisepsis, it may result in? burning sensation during injectionChemical agents is not a disinfectant? Isopropyl alcoholDisinfectants: Iodophors, sodium hypochlorite, synthetic phenol, glutaraldehydePatient has acetone/ketone breath and altered consciousness: HyperglycemiaKetonemia and ketonuria are characteristic of type 1 diabetesMajor locations of insulin receptors: liver and skeletal musclesBisphosphonates has effect on? Osteoclasts by inhibiting them (via apoptosis)Other drug that inhibits osteoclasts: denosumabOsteocytes are connected to haversian system by: Volkman’s canalHalf-life of bisphosphonates: 14 yearsLife time of bisphosphonates: 6 months (best to wait until then before invasive procedures)IV bisphosphonates: Zolmeda (Zolendronic acid), Aredia (palmidronate) for treating osteoporosis (osteonecrosis is more common with IV drugs).IV bisphosphonates is a CI for: extraction of teethOral bisphosphonates: Boniva or FosamaxSafe for patients on bisphosphonates: Endo proceduresBisphosphonates are NOT used for: Osteomyelitis and multiple myelomaOral: Fosamax, Actonel, BonivaLow-dose aspirin therapy prevents the formation of thromboemboli by preferentially inhibiting: thromboxane (A2) synthetase in plateletsCyclooxygenase (COX)-1 inhibitors impair platelet adhesion and aggregation primarily by inhibiting the synthesis of: thromboxane A2Aspirin does not increase: renal prostaglandinsProstaglandins are made in: hypothalamusWhy don’t you give aspirin to a diabetic patient: will potentiate the acitivity of sulfa drugs!Drug CI if allergic to sulfa drugs: IbuprofenIntolerance to which drugs may be confirmed by a history of generalized urticaria, angioedema, bronchospasm, or severe rhinorrhea, occurring within 3 hours following drug administrations: COX and ASAAnti-diabetics with very LONG duration: Chlorpropamide and Glibenclamide (should be stopped several days before surgery)MOA of anti-diabetic: blocks glucagon and catecholamine release; stimulate insulin release from B-cells; increase glucose metabolization in liverCondition caused by aspirin: hypoprothrombinemia, no effect on PT, irreversible COX inhibitionA dentist will make impressions for a patient who has an excessive salivary flow. To decrease the flow, this dentist might appropriately prescribe which of the following drugs? Propantheline (Pro-Banthine)Atropine and propantheline exert their effects on peripheral structures by: competing with Ach for receptor sitesFor a patient with myasthenia gravis, which medication is acceptable? PenicillinFor a patient with myasthenia gravis, which medication is CI? ErythromycinFor a patient with myasthenia gravis, which medication is not acceptable? Imipinem and FAM (Fluoroquinones, Aminoglycosides, Macrolides)Tx of myasthenia gravis: neostigmine/physostigmine; pyRIDostigmine; edrophonium (Cholinesterase inhibitor)Can worsen myasthenia gravis: Ciprofloxacin (Tx of pseudomonas aeruginosa)What is myasthenia gravis: progressive weakness of skeletal muscles, especially those innervated by cranial nervesMuscle not affected in myasthenia: smoothTherapeutic index or drug safety: LD50/ED50 (higher the therapeutic index, safer the drug)A drug with a high LD50 and low ED50 has a HIGH therapeutic index, thus is relatively SAFETetracycline have low tendency for sensitization but has: high therapeutic index.LD 50 means: drug was lethal in 50% of patientsFalse neurotransmitter: MethyldopaOnly amide metabolized in blood and NOT in liver: ArticaineAngioneurotic edema is mostly associated with which LA: ArticaineShortest half-life: ArticaineThe only available local anesthetic agent with a thiophene nucleus is: articaineDuration of pulpal anesthesia when using LA with vasoconstrictor: 1 hourDuration of pulpal anesthesia when using LA with vasoconstrictor: 1 – 1.5 hoursDuration of soft tissue anesthesia when a patient has been injected with 2% lidocaince without a VC: 1 hour (with VC: 3-5 hours)The optimal volume of local anesthetic solution delivered for a true anterior superioralveolar (ASA) nerve block is usually about: 1.0 mLSystems is thought to malfunction in the hereditary form of angioneurotic edema: C-1 esterase (C1 inhibitors are used to inhibit the complement system)PkaOnsetLA with low pkaLarge number of free base molecules or fast onsetProtein binding and hydrophobicityDurationLipid solubilityPotency (higher lipid solubility, higher potency)When the anaesthetic is 50% dissociated (50% free base) what’s is the Ph? Ph=Pkaleast risk of inhaling N2O: patientmost risk of inhaling N2O: dental assistantAmantadine is anti-viral for influenza A and parkinson’s (increases dopamine release)The antiviral agents amantadine (Symmetrel?) and rimantadine (Flumadine?)), which are effective in the management of influenza A, exert their antiviral effect by: inhibiting transmembrane M2 protein essential for uncoating the virus, a step essential for viral penetration into a host cellThe antiviral agents zanamivir (Relenza?) and oseltamivir (Tamiflu?), which are effective in the management of influenza A and B, are: neuraminidase inhibitors, which inhibit mucoprotein breakdown and the release of the virus from infected cellsAntiviral agents prescribed in the management of HIV infection: protease inhibitors, nucleoside reverse transcriptase, nucleotide reverse transcriptase EXCEPT: neuraminidase inhibitorsShort term memory loss is seen in parkinson’s: trueNot a sign of dementia (short term): long-term memory lossAmantidine not give with: LA without epiAction of levodopa: Replenishes insufficient dopamine levels in parkinson’s; sympathomimetic; crosses BBBLevodopa therapy can result in: Development of abnormal involuntary movements, especially in the face b. Extreme sensitivity to sympathomimetic drugs; c. Exacerbation of an acute psychosis. D. nausea; E. arrhythmias; NOT is extreme sedation Why Levodopa becomes ineffective with age: causes sensitization of dopamine and produces dyskinesia An excess of dopamine and an increase in the number of dopaminergic receptors in the CNS characterize: psychosis (schizophrenia)Antipsychotic drugs act on: dopamine receptors and are anti-emeticConditions relates to low concentrations of norepinephrine, dopamine, and/or serotonin: DepressionOpioid used as transdermal patch: Fentanyl (100 times more potent)Opiate which is part of intradermal system: FentanylOpioids are CI in: head injuries (raises CSF pressure) and chronic cancer painOpioids side effects: constipationCancer chemotherapeutic agents interact with tubulin, disorganize the mitotic spindle and arrest cell division: plant alkaloidNot an effect of opioids: peripheral inhibition of pain nerves, mydriasis, diarrhoea, xerostomia, diuresisAnti-viralsCMV in patients with HIVGanciclovir (IV) and Valancyclovir - oralHerpes simplex/herpes zosterValcyclovirHerpes I, II, VZV, EBV; labialisAcyclovirPalliativePrimary HSVMOA of acyclovir: Selective toxicity on only infected cellsBest describes why L-dopa eventually becomes ineffective in the treatment of Parkinson’s disease? Neuronal cell loss in the substantia nigra is progressive and continuous over the course of the diseaseWhy do you give a patient carbidopa: decreases the amount of levodopa that can be inactivated in the periphery; prevents breakdown of levodopa before it crosses the blood brain barrierDrugs that pass BBB: Minocylicne, Chlorophenicol, 3rd generation cephalosporins (ceftriaxone), Pen G when meninges are inflamed, SulfonamidesParkinsonism what don’t you see: excessive gag reflexDisadvantages of oral sedation include: Unpredictable absorption of drugs from the GI tractHallmark of anticholinergic drug = Mydriasis (pupil dilation)Alpha receptor response: MydriasisOpioid without miosis: MeperidineAnti-cholinergic that does not cause miosis of eye: AtropineAnti-cholinergic type reaction: hot and dryDrugs that cause miosis: Pilocarpine, Physostigmine, Phenoxybenzamine, Morphine, ReserpinePathognomonic symptoms of narcotic overdose: miosis, coma and depressed respirationSide effects of mydriasis: dry mouth, decreased GIT secretions, mydriasisCocaine overdose; ephedrine (adrenergics)Mydriasis (dilated pupil – due to contraction of iris dilator or relaxation of ciliary muscle)Opioid overdose; alcohol (cholinergics)Miosis (constricted or pinpoint pupil)Mercapto bromideMydriasis and cytoplagiaAntidote for warfarin/dicumarolVit K or fresh frozen plasma or phytonadioneAntidote for heparinProtamine sulphateAntidote for benzodiazepine and barbFlumazenil; given IVAntidote for opioidNaloxone/NaltrexonePhysiological antagonist of histamineEpinephrineAntidote for TCAs, Scopolamine and Atropine (anticholinergics)Physostigmine (reversible anticholinesterase) or NaHCO3Neuromuscular blockade (paralytics)Anticholinesterase agentsCholinestrase inhibitors overdoseNeostigmineFluoride overdoseMilk & calcium; syrup of IpecacAspirin overdosePotassium salt and sodium bicarbonateBarbiturate overdoseSodium bicarbonateAcetaminophenN-acetylcysteine; syrup of ipecacLidocaine overdose or lidocaine induced seizuresDiazepam; phentolamine mesylate (AAA); oraverse or regitine; MidazolamBeta or calcium blocker overdoseGlucagonSide effect of beta blockershypoglycemiaTheophylline overdoseBeta blockerTetracyclineMilk of magnesiaMercuryDimercaprol, penicillamine, EDTALeadEDTA (calcium sodium); dimercaprolIronDeferoxaminePotassiumalbuterol inhaler, insulin & glucose, NaHCO3, kayexalateCopper poisoningPenicillamineCyanideMethylene blue; amyl nitrate, sodium nitrate, sodium thiosulfateCarbon mono-oxideHyperbaric oxygenEthyl alcoholMethanol poisoning Organophosphate (irreversible non-competitive anticholinesterases)Atropine; PralidoximeEthylene glycolFomeprizoleMethotrexate; FluoroucilLeucovorin calciumDopaminePhentolamineDigoxinDigibindCyclophosphamideMesnaExtrapyramidal symptoms (EPS)DiphenhydramineDrug interactionsEpinephrine + halothaneSerious cardiac irregularitiesEpinephrine + nitroglycerineAntagoniseEpi + Propranolol (mild)HypotensionEpi + Propranolol (severe)Malignant HTNErythromycin interferes withDigoxin and Seldane (terfenadine)NSAIDs + sympathomimeticsIncrease BPPt. on TCAAvoid epinephrineMethotrexate + AmoxDecreases renal clearanceTCA + EpiHTNMAO + EpiHTNTetra + penicillinCancel each otherBroad spectrum and coumarinBroad spectrum antibiotics enhance the action of coumarin anticoagulants because of the reduction of Vitamin KMAO typesCompetitive antagonismH1 anti-histaminesSide-effectsEpinephrineCardiac arrhythmiaZolesLetrozoleAnti-cancerCotrimaxazole (best topical antifungal)Anti-infectiveMethimazoleAnti-thyroidDrugs CI in renal impairment: sulphonamides, tetracycline, itraconazoleWhy benzodiazepines are better than barbiturates: safer and less dependence, less CNS depression, better therapeutic indexHang over effects are seen with: benzodiazepines (due to active metabolism)Neostigmine: synthetic version of physostigmine. Differs from physostigmine because it has an additional direct effect on NMJ and causes reversal of skeletal muscle paralysis.Neostigmine (effects are reversible) produces its effect by: inhibiting ACHase activityWhen neostigmine is administered before acetylcholine, the action of acetylcholine will be: enhanced and prolongedNeostigmine can stimulate denervated skeletal muscle because it: is capable of acting directly on the end-plateNeostigmineReversible anticholinesterase/Indirect acting cholinergicInsecticidesIrreversible anticholinesteraseThe drug-receptor activity of naloxone is best characterized by which of the following pairs: high affinity, no intrinsic activityMOA of Naloxone: Non-selective and competitive opioid receptor antagonistAntibiotic for sinusitis and LAP/GAP? Augmentin (amoxicillin + clavulanic acid – widest spectrum)Beta-lactam antibacterial agents is effective against Gram positive and Gram-negative organisms and is mostly beta-lactamase resistant: amoxicillin w/clavulanateFeature absent in sinusitis: swellingBacteria that causes sinusitis: Strep pneumoniaBest AB for children: amoxicillinPregnant, third trimester (36 weeks was given), why we don’t administer ibuprofen: premature ductus arteriosus closureReversible NSAIDIbuprofenIrreversible NSAIDAspirinAcet if renal disease and Ibuprofen if liver disease & alcoholicsWhy Ibuprofen should not be given in patients with hepatic failure: as it is metabolized in liverNSAID with much less GI irritation: IbuprofenCeiling dose for Ibuprofen for analgesia: 400 mgPatient has obstructive sleep apnea which pain medication we can give: Ibuprofen or acetObstructive sleep apnea syndrome (OSAS) often results in: aggressive behaviourErythromycin (associated with nephrotoxicity) is metabolized in LiverNephrotoxicity and ototoxicity is associated with: Aminoglycosides (cidal)AB for mycoplasma: erythromycinMacrolide has an extended spectrum against facultative and some obligate anaerobes and a twice a day dosage schedule: ClarithromycinErythromycin increases breakdown of: statinsThe most appropriate antibiotic used for management of osteomyelitis: Erythromycin or penicillinNatural or intrinsic drug resistance example: Many oral Gram-negative anaerobes appear to be inherently resistant to erythromycinDrug interaction resulting in serious adverse cardiovascular events, including death, might occur between erythromycin and Terfenadine (antihistamine)H1 antihistamine (chlorpromazine, chlorpheniramine)Stimulate and depress CNS; reduce motion sickness, block vasodilation & bronchoconstrictionH2 antihistamine (cimetidine)Anti-androgenic effects (impotence) and inhibit liver enzymesH1 receptorsSmooth muscles, heart, brain, vascular endothelial cellsH2 receptorsStomach, heartCimetidine is usually contraindicated with H1-antihistamines (2nd generation) EXCEPT: Fexofenadine (Viastaril); terfenadine, hydroxyzine, diphenhydramine, astermizoleTx of hay fever: FexofenadineOTC for heart burn: FexofenadineWhich drug blocks H1 histamine receptors but is least likely to cause sedation? FexofenadineH2 antihistamines are: anti-acidsH1 blocker do not: cross BBB and cause drowsinessAntihistamine least sedative: second generationAntihistamine most sedative: first generation (doxylamine)MOA of antihistamine: competitive inhibitionSecond generation H1 blocker: Claritin/Loratidine (least likely to cause drowsiness)Centrally acting analgesic: Tramadol (structurally similar to codeine, not morphine; synthetic)Patient on Tramadol abuse what not to give: LA with epiTramadol inhibits: NE and serotonin reupdate & a weak mu receptor agonistMost distinct characteristic of morphine poisoning: pin point pupilsMorphine is used for: pulmonary edemaMorphine overdose will cause: loss of sensitivity of medullary respiratory centre to carbon di oxideSide effects of morphine: constipation (loperamide & paregoric – tincture of opium), urinary retention, euphoria and dysphoriaMethoxylation of morphine will give: codeineSigns indicates severe CNS oxygen deprivation: dilated pupils with an absence of light reflexCodeine allergy: Use meperidine, tramadol or pentazocineWhat happens if you give Meperidine with MAO: life-threatening hyperpyrexiaMeperidine is not used in: kidsKetorolac (Toradol) and diclofenac (voltaren) can be given: orally or IMRifampin can cause oral contraceptive failure, followed by erythromycin and ampicillinTB treatment drugs: PRIEST (Pyrazinamide, Rifampin, Isoniazid (most potent), Ethambutol, Streptomycin)For the empirical treatment of immunocompetent patients with pulmonary and extrapulmonary tuberculosis likely to be caused by susceptible organisms, the initial drug regimen is with: Daily isoniazid (INH?), rifampin (Rifadin?), and pyrazimanide for two monthsMOA of Isoniazid: Inhibits mycolic acid synthesisStreptomycin and gentamycin affects: 8th nerve (balance & hearing)Streptomycin side effects: competitive inhibition of ACH receptors; reduce ACH release; cause block of NMJ resulting in respiratory difficultyAntiviral drug contraindicated with rifampin: ritonavirRifampin can turn body fluid: red Most frequent and most dangerous adverse effect associated with oral contraceptives: thromboembolic disordersOther side effects of oral contraceptives: liver disturbance, abnormal pattern of skin pigmentationOral contraceptives are CI is you have: H/O of breast cancer; HTN; Undiagnosed genital bleeding and thromboembolic disease.Anti-cancer drugs are least likely to cause what: thromboembolismIrreversible anticholinesterase overdose may lead to: respiratory failure and death due to diaphragmatic and intercostal muscle paralysis (respiratory failure)Anti histamines (H-antagonist) work by? Blocking histamine at the receptorPt with COPD and N20 sedation increased O2 leads to what? Oxygen induced apneaWhich side-effect of sertraline (Zoloft) has implications for the patient’s oral health? Salivary hypofunctionMOA of Zoloft (SSRI): Serotonin reuptake inhibitorsFluoxetine mechanism of action is to increase: SerotoninDirect serotonin will: damage MOASerotonin syndrome: Tramadol (narcotic) + SSRICharacterized by a functional excess of norepinephrine and serotonin: maniaMethylparaban has cross sensitivity with: PABA estersProduce a pharmacologic decrease in saliva production? Atropine; scopolamine; glycopyrrolate. NOT is pilocarpineSaliva control under GA: Glycopyrrolate (0.2 mg) – muscarinic anticholinergicScopolamine is also given in: diarrheaMotion sickness (anti-emetic) drug: Scopolamine (has effects similar to atropine – anticholinergic/antimuscarinic) and hyoscineUsed in eye drops to induce mydriasis: ScopolamineCholinergic crisis symptoms: brady, lacrimation, salivation, muscle weakness, diarrhea, bronchoconstrictionTx of cholinergic crisis: AtropineScopolamine overdose: Disorientation, confusion, hallucinations, dry mouth, hyperthermiaTx of scopolamine overdose: PhysostigmineMethacholine and PilocarpineDirect-acting cholinergic agonistsNeostigmineIndirectly acting cholinergic agonistsPropantheline, Atropine, Scopolamine - PASCompetitive muscarinic receptor blockers – control saliva; blocks vagal reflexive control of heart resulting in TachycardiaPhysostigmine (central & peripheral) and Neostigmine (only peripheral)Reversible anticholinesterases; indirectly treats xerostomiaPilocarpine and MethacholineDirectly treats xerostomiaOrganophosphates and insecticidesIrreversibly inhibit cholinesteraseTx of organophosphate or nerve gas toxicityPralidoximeSuccinylcholineDepolarizing neuromuscular junction blocker; Prevents laryngospasmd-tubocurarineNon-depolarizing neuromuscular junctionblockerMecamylamine and HexamethoniumGanglionic blockers thatproduce orthostatic hypotensionDrug of choice for marked bradycardia: atropinePatients complain of dry or “sandy” eyes when receiving large doses of: atropineAtropine can also cause: smooth muscle relaxation (prazocin?)MOA of prazosin: Inhibit the postsynaptic action of NE on vascular smooth muscleAtropine poisoning: burning dry mouth and orthostatic hypotensionAtropine side effects are: blurred vision, xerostomia, urine retention, tachycardia, mydriasis, CNS excitation, constipation.Causes of death by irreversible cholinesterase: Respiratory paralysisFor GA, which drug has little effect on CNS: AtropineACH is in the same group as: MethacholineDrugs which potentiates the effects of ACH: Methacholine, Neostigmine and PilocarpinePenicillin V and Benzyl penicillin are secreted mostly: unmetabolized in urineBenzyl penicillin is excreted mainly by: renal tubular secretionCholinergic means muscarinicDecreases salivaAtropine, Scopolamine, Propantheline, Methantheline, Glycopyrrolate, DicyclomineIncreases salivaPilocarpine, Methacholine, Neostigmine, PhysiostigmineThe prostaglandin analog misoprostol (Cytotec) is most commonly used in treating gastric ulcers associated with chronic use of anti-inflammatory drugCorticosteroids not given in: peptic ulcer patient, TB, AIDS, CandidiasisProlonged treatment with steroids causes: osteoporosis, hyperglycaemia and redistribution of body fatDrug-induced hypnosis can be produced by depressing: reticular activating systemBeclomethasone is used for bronchial asthma because it has a short duration of actionAn extended course of cortisone therapy can produce: osteoporosis and hyperglycemiaA dentist considers using nitrous-oxide conscious sedation for a patient. This type of sedation will be contraindicated, however, if the patient has a history of psychosis.Hypotensive effect and itching from oxycodone is due, in part, to: release of histaminemajor classes of drugs used to treat angina? Beta blockers; nitrates and nitrites; calcium channel blockers; NOT – thiazidesPt is on something thiazides, what lab value is necessary for pt. maintenance: electrolytesDiuretics: Thiazides, loop diuretics, potassium sparingPt on thiazide diuretics will need: potassium supplements MOA of thiazide diuretics: Increase renal excretion of sodium, chloride and potassium; hyperglycemiaThe most useful diuretic drugs act by: decreasing the renal reabsorption of sodiumAgents is active against herpes simplex virus, varicella-zoster virus, and cytomegalovirus: Valacyclovir (Valtrex)Virus associated with chicken pox also causes: Herpes Zoster (reactivated latent VZV)A prodrug, which after oral administration is metabolized to acyclovir, a nucleside analog, and is effective in treating HSV infections: valacyclovirWhat is prodrug: Drug made active by metabolismPhosphorylated derivative of famciclovir, a nucleoside analog, and may be helpful in treating recurrent herpes labialis in immunocompetent patients: PenciclovirValuable in treating immunocompromised patients who are either intolerant to acyclovir or are infected with an acyclovir-resistant strain of HSV: Foscarnet (Foscavir)Antifungal agents is a fluorinated pyrimidine, which is converted into 5-fluorouradine triphosphate, an inhibitor of DNA synthesis? FlucytosineOpiates do NOT produce diuresis (cause urinary retention)Tx of angina with glycoside causes diuresis, why? Increased blood flow causes increased blood flow to kidneyAnalgesic if you have liver and renal toxicity: OxycodoneOxycodone vs codeine: oxycodone has higher risk of dependenceOrder of dependence: propoxyphene<codeine<pentazocine<oxycodoneOpioid CI in preg: propoxypheneWhich drug causes withdrawal symptoms in a patient taking Oxycodone (addict) or avoided in heroin patients: Nal-Bup-Pen (Nalbuphine, Buprenorphine, Pentazocine – mixed agonists)best describes the outcome of and intrapulpal anesthetic injection? Provides anesthesia by back-pressure or apply pressure while delivering anesthesiaavailable in the form of troches for the topical treatment of oral candidiasis? ClotrimazoleNaltrexone (Revia) can be used in opioid rehabilitation programAnalgesic during cocaine rehab: Ibuprofen (Advil)Angioedema due to increase in bradykinin is associated with: ACE inhibitors (can be teratogenic)Side effect of ACE inhibitors: dry coughAlpha and beta blockers side effects: tachycardia, nasal congestion and dry mouthAtropineMuscarinic antagonistAnti-cholinergic (anti-dote for cholinergic poisoning) Decreases salivation and brachial secretionBlocks vagal reflex (due to activation of baroreceptors) control of HR leading to tachycardiaBlurred visionCan relieve ptosis in myasthenia gravis patientsIncreases heart rate in: moderate to high dosesMydriasis and cycloplegia (paralysis of ciliary muscles of eye)Occurs with the use of diphenhydramine (Benadryl): antagonism of motion sicknessdiphenhydramine (Benadryl) side effect: xerostomiaWhat effect of diphenhydramine allows it to be anti-puretic when applied topically: LAMost common side effect when administering nitrous oxide and oxygen? NauseaNitrous oxide/oxygen is contraindicated for patients in the first trimester of pregnancy ONLYGanglionic blocking agents causes: orthostatic hypotensionDreaming while on nitrous oxide is: normalAdministration of nitrous oxide/oxygen is contraindicated in nasal congestionDentist is considering the use of nitrous-oxide conscious sedation for a patient. However, this type of sedation will be CONTRAINDICATED, should the patient have a history of: psychotic careManagement of nausea caused by nitrous oxide: give 100% oxygenSubstances is contraindicated for a patient taking ginseng (anti-platelet)? Aspirin, NSAIDs, WarfarinGinseng is used to treat: diabetesBeclomathasone (Beconase AQ) is used for bronchial asthma because it has a short duration of actioncommon side effect of the alkylating-type anticancer drugs such as mechlorethamine (Mustargen)? Bone marrow suppressionCancer chemotherapeutic agents bind covalently to double stranded DNA and prevent DNA transcription: alkylating agentsSide effect of MTX: bone marrow suppression. NOT is hair growthSide effect of phenylbutazone: Aplastic anaemia and bone marrow suppressionIf a local anesthetic without a vasoconstrictor is required, use mepivacaine (best for hyperthyroid patient). Trade name is carbocaineLocal anesthetics causes the least amount of vasodilation: MepivacaineMax amount of Mepivacaine that can be given to an adult: 5 carpulesAdrenal suppression may result from which of the following regimens of hydrocortisone? 20 mg for 2 weeks within 2 yearsCortisone uses: fight or flight hormone with epi, increase BPCortisone side effects (cushing’s): hyper, osteoporosis, anxiety, glaucoma3.6 ml of prilocaine (4%) has: 144 mg (40 mg every 1 ml)Which local anesthetic is most hydrophobic and has the highest degree of protein binding? Bupivacaine (Not approved for kids)Most potent LABupivacaine (highest pka)Least potent LAPrilocaine and ArticaineLA estersProcaine, cocaine, tetracaine, benzocaineShort actingProcaineLeast effective in producing topical anaesthesiaProcaineLA more water solubleProcaineModeratePrilocaine, lidocaine, mepivacaineLong acting, slow onsetBupivacaine, tetracaine, etidocaineLA that is cardiotoxicBupivacaineMost selective anaesthesia for sensory nerveBupivacaine (Marcaine)Esters metabolize inPlasmaAmides metabolize inLiverMethemoglobinemia (Tx with methylene blue) associated withPrilocaine (> 500 mg), pilocarpine, acetaminophen at high doses and amyl nitrite (not for HTN)Inhalation of amyl nitrite does notIncrease motility of small bowelLidocaine may show cross-allergy withMepivacainePrilocaine is not used inG6PD deficiencyMost longest and most toxic LADibucaine2% lido equals20gm/100ml or 20mg/1mlToxic effects of LidocaineStimulation and then depress the CNS Too much epinephrineIncreased pulse rate; bronchoconstrictionPowerful CNS stimulation/LA with vasoconstriction propertiesCocaineAmpicillin works best againstGram negative bacteriaPen that can be injected (IV/IM) or is acid resistant; excreted primarily by renal secretion; not given orallyPen G (Benzylpenicillin); also methicillinBroadest spectrumPen G (Procaine)Pen that can be given orallyPen VAgainst penicillinase producing staphylococcusDicloxacillin and oxacillinDecreases the renal clearance of penicillin G/increases the effect if amoxicillinProbenecidmixed agonist antagonist opiod or partial narcoticPentazocine and NalbuphineCI for barbituratesIntermittent porphyria and emphysemaAgainst pseudomonas and indole-positive proteus; extended spectrumCarbenicillinTx of EndocarditisAmpicillin/GentamycinAB cannot be administered orallyMethicillinCidal MOAInhibiting cell wall synthesisStatic MOA (tetra)Interfere with protein synthesisNystatin binds withErgosterolLantaprost (PG analogue) is used to treatGlaucomaSide effect of gentamycinAuditory nerve deafness (CN – 8)Use of lidocaine in CVSLife threatening ventricular arrythmiasMOA of SulfonamidesBind to PABA in folic acid synthesis; causes folic acid deficiency; bacteriostaticMOA of Flumazenil (lasts only 20 minutes)Competitive GABA receptorDrug that promotes overgrowth of c.dificile and causes GI upset and pseudomembranous colitisClindamycin (300 mg QID)AB with high concentration in bone than serumClindamycin (best for treating bone infections such as osteomyelitis)AB with high concentration in gingival fluidTetraSide effect of chloramphenicolAplastic anaemia/bone marrow suppressionSide effect of tetracyclineLiver damagetetracycline AB that chelates with calciumhigh concentration in GCF than bonebroadest spectrumbacteriostatic (binds to 30s)causes hepatotoxicityErythromycin Estolate leads toallergic cholestatic hepatitisFirst line in the Tx of depressionSSRI (Inhibit reuptake of 5-HT)2nd generation of SSRIFluoxetine (Prozac) and TrazodoneBest systemic anti-fungal that can be also be used topicallyKetoconazoleAnti-fungal that can be oral or IV and used to treat vaginal candidiasis and oropharyngeal candidiasisFluconazole (best systemic)Anti-fungal that can be used as a tablet and creamMiconazoleAnti-fungal for hair and nail infections. Also for athlete’s foot; dermatophytesGriseofulvinAntifungal that causes nephrotoxicity and hypokalemiaAmphotericin B (systemic)Don’t give to patient taking MAO inhibitorsMeperidine (ok with gastric ulcer)Anti-septic for the urinary tract (quinolone)Nalidixic acidshould be taken only once daily due to long half lifeDoxycycline (slowly excreted)AB that inhibits drug metabolism of drugs that interact with cytochrome p450ErythromycinIncreases duration of action of lidocaine; potentiates effects of epinephrine (causes hypertension and bradycardia)Propranolol (non-selective beta blocker)Alpha blocker and can be used for epinephrine reversal (Decrease in BP rather than increase)Prazosin or chlorpromazine or phenoxybenzaminealpha blocker; causes orthostatic hypotension; Antipsychotic, Anticholinergic, Antiadrenergic effectsChloropromazineNon-selective alpha blockerPhentolamineTx of anginaNitroglycerin, Propanolol, VerapamilUse of verapamilSupraventricular arrythmiasQuinidine useAnti-arrythmicTx of atrial fibrillation or supraventricular tachy arrythmiasMorphine side effectsRespiratory depression, euphoria, sedation, dysphoria, analgesia, constipation, urinary retentionBeta 1 stimulationIncrease HRBeta 2 stimulationBronchodilation, vasodilation in skeletal muscle, reduced renin secretion – increased urine outputBeta 2 agonistAminophylline; Isoproterenol; salbutamolAlpha 1 stimulationVasoconstriction of peripheral vessels (smooth), urinary retention, mydriasis (pupil dilation)Alpha 1 blockers or antagonistVasodilationAlpha 1 blocker exampleEpinephrine and levonordefrinAlpha 2 stimulationEffects are on CNS; causes hypotension by inhibiting release of NENon-selective beta blocker AND an alpha-1 blockerCarvedilolAction of ClonidineStimulates alpha 2 receptorsDecreased sympathetic (lytic) activityTCA haveAnticholinergic effectsUse of halothaneGASide effect of halothane (halogenated hydrocarbon)hepatotoxictyNasal congestion caused byParasympathetic systemOnly bacterial protein synthesis inhibitor that is bacteriocidalAminoglycosides (have curare-like properties)antihypertensive agents acts directly on arterial smooth muscle to cause vasodilation – peripheral?Hydralazine (Apresoline?)Centrally (vasomotor center of medulla) acting vasodilators or adrenergic or sympatholytic – Tx of HTNClonidine and methyldopaSympathomimetic agent most potent bronchodilator: IsoproterenolHigh ceiling/loop acting diuretic (ethacrynic acid)Furosemide - Lasix (deafness and ototoxic)Potassium sparing diureticSpironolactone; Thiazide; TriamtereneOpioids that suppress coughCodeine and meperidineMOA of Ranitidine & Cimetidine(H2)Reduce gastric secretion; Tx of gastric ulcer or GERDMOA of IbuprofenReversible platelet inhibitionMOA of acetaminophenAntipyretic effect by acting on centers in hypothalamusMOA of clindamycin (effective against most anaerobes)50s ribosome, blocking bacterial protein synthesis (translocation)MOA of AzithProtein synthesisMOA of aspirinIrreversibly inhibit platelet aggregationMOA of quinolonesInhibit DNA replicationMOA of propranololReduce HR and COMOA of benzodiazepamModulate activity of NT at GABA (gamma-aminobutyric acid) receptorH1 anti-histaminesPromethazinePre-op for sedation, anti-emetic, anti-cholinergicDiphenhydramine (Benadryl)Tx of parkinson’s; LA if allergic to both amides and esters;Motion sicknessChlorpheniramineTreating dermatologic manifestations of allergic responseUse of diphenhydramine (Benadryl ) in controlling the symptoms of parkinsonism is based upon: anti-cholinergicAnti-psychotics: Phenothiazine (2nd), Haloperidol (1st), Chloropromazine (2nd)Diphenhydramine causes dryness due to its: anticholinergic and anti-muscarinic effect (in parkinson’s)Diphenhydramine (indirect sympathomimetic)MOST sedative effectChlorpheniramineLEAST sedative effectBlocks dopaminergic sites in brainDental patient on clonidine most often complains about: xerostomiaAnti-cholinergic effects and tardive dyskinesia are due to extrapyramidal stimulation of basal gangliaIrreversible side effect of phenothiazine: tardive dyskinesia (Parkinson-like effects)Mechanism of antipsychotic action: blockade of dopaminergic sites in brainGood effects of phenothiazines: anti-emetic, sedation, anti-histamine, narcoticsPhenothiazine blocks: dopaminePt taking antibiotic which is metabolized in the liver, metabolism is decreased by which drug: PhenothiazinePhenothiazine and MAO inhibitor interaction: additive anticholinergic effectExamples of MAO (antidepressants) inhibitors: tranylcypromine or phenylene or amitriptylineMAO inhibitors causes adverse reactions with: epinephrine, amphetamine, tyramineDrugs that cause extrapyramidal stimulation: anti-psychotics (Phenothiazines - chlorpromazine)Onset of action of antipsychotic is: 5-6 daysTx of Tourette syndrome and schizophrenia: haloperidol (butyrophenones)When used for intravenous conscious (moderate) sedation, midazolam (Versed) produces: Amnesiawhy is midazolam preferred to diazepam for IV injection: more water solubleThe duration of activity of diazepam depends mainly on the elimination of active metabolitesDrugs that have a long duration of action due to liver generated active metabolites: diazepam, flurazepam, chlordizeperoxideNarcotic used in outpatient anesthesia: fentanyl, meperidine, morphine; NOT is diazepamWhy is diazepam IV not preferred: long duration of action and clinically significant sedative effectWhy diazepam is preferred over barbiturate as an antianxiety agent because diazepam: has less addiction potentialPre-operative medication for children: MidazolamBest benzo for IV sedation: MidazolamTx of PTSD: MidazolamWhen administered IV, least likely to produce respiratory depression: DiazepamThe most effective agent in the initial treatment of respiratory depression due to the overdose of barbiturates is: Oxygen under positive pressureBarbiturates CI: Patients with respiratory disease and pregnant Midazolam vs diazepam: Midazolam has more respiratory depression and recovery is faster. Also, rapid onset when given intramuscularly, lower incidence of thrombophlebitis, less active metabolites, and shorter half lifeBenzodiazepam as muscle relaxant is used in the Tx of: TrismusBenzodiazepam vs diazepam: Diazepam has no effect on respiration as opposed to BDZIf midazolam is injected intra arterially: severe pain in extremitiesFacts about Midazolam: Induces insomnia and is most commonly used (even in children)Benzodiazepines not forming active metabolites and metabolized outside liver: MOTL (Midazolam, Oxa, Tema, Lora)Benzodiazepines are CI in: pregnancy, myasthenia gravis, acute narrow glaucoma, COPD, emphysemaBenzodiazepines are metabolized in the liver via: glucoronidation Benzodiazepines decrease what: REM sleepSide effects of BDZ: Form active metabolites; IV can cause thrombophlebitis (use large vein) due to the solvent BDZ is dissolved inDiazepam action in GABA: anti-convulsant & sedativeThe benzodiazepine receptors BZ1 and BZ2 are located on which ion channel? chlorideBenzo in moderate doseAnxiolyticBenzo in high dosesSedativeBenzodiazepines are great for dentistry due to an action of: amnesia and little memory of the eventMost common pre-medication prior GA is: VERSEDgreatest margin of safety for a patient with renal disease: acetaminophenBlocking the synthesis of prostaglandins does NOT produce which of the following conditions? Increased gastric mucous productionBlocking the synthesis of prostaglandins produces: antipyresis; decreased platelet aggregation; decreased renal blood flow; decrease pain and inflammationProstaglandins are derived from: unsaturated fatty acids in cell membraneA 32-year-old male patient reports a history of having been hospitalized for psychiatric evaluation, and is currently taking lithium carbonate on a daily basis. Which of the following diseases does this patient most likely have? Bipolar disorder or manic depressionWhich benzodiazepines is used for depression & anxiety for obsessive compulsive disorder? Xanax (alprazolam)MOA of Xanax: Increase frequency of chloride channels on GABA receptorWhat is associated with depression: AgeLithium is also used for: schizophreniaFor lithium toxicity, which drug is fine: acetaminophenAcetaminophen is preferred over aspirin in patients taking: probenecid or MTXLithium intoxication affects which organ: kidney (inhibits ADH)MOA of Lithium: blocks conversion of inositol phosphate to inositolDiazepam-mediated effects include retrograde amnesiaDiazepam can cause: cleftingMeprobamate: Barbiturate and non-selective CNS depressant; minor tranquilizer (similar in action to diazepam and causes muscle relaxation)Signs of CNS depression: dilated pupils, absence of light reflex, pee/poo/cum, acidosisCNS depressant drugs: Phenothiazines, Barbs, MAOMeprobamateNon-selective CNS depressant (no CNS depression)DiazepamSelective CNS depressantEpinephrine and anti-hypertensiveEpinephrine CANNOT be given with a NON-selective blockerIf you give Epinephrine with a non-selective blocker: hypertensive crisis (synergism)Epinephrine CAN be given with a selective blockerMetoprolol (bronchodilator)The use of epinephrine for local hemostasis during surgery might result in: cardiac arrhythmiaCompetitive β1-adrenergic receptor blocking agent which is thought to be cardioselective: MetoprololAdverse drug effects may be attributable to competitive β1-adrenergic receptor blocking agents: bradycardia, heart failure, mentalDrugs may mask hypoglycemia in diabetic patients? competitive β1-adrenergic receptor blocking agentsAdverse drug effects are attributable to treatment with an ACE inhibitor: dysgeusia, angioedema, persistent coughAdverse with calcium channel blocker: recurrent hypoglycemiaPatients taking a calcium channel blocking agent may have: angina pectoris, supraventricular tachycardia, BUT NOT - CHFPharmacological effects are attributable to calcium channel blocking agents: relaxation of vascular smooth muscle, relaxation of myocardium and increased myocardial oxygen deliveryDiazepam IV adverse effects: thrombophlebitis due to propylene glycol solutionWhat benzo do you give to a 37 yo pt with liver cirrhosis: Oxazepam/Temazepam/Lorazepam – LOT (short half life and does not generate active metabolites; no hepatic metabolism)Which of the benzodiazepine don’t you give to elderly? Long acting one (like diazepam)Which of the benzodiazepine you give to elderly? oxazepam, temazepam, midazolam (TOM)MOA of benzodiazepines: Facilitates GABA receptor binding by Increasing the frequency of chloride channel openingThe net effect of the interaction of benzodiazepines with their receptors is to enhance the inhibitory properties of the neurotransmitter: GABAThe basic mechanism for all seizures appears to be related to biochemical lesions that interrupt the synthesis, storage, release, or post-synaptic actions of the inhibitory neurotransmitter: GABAAlcohol inhibits: GABA effects on cortex of CNSTypes of cells in liver cirrhosis: fibroblastsEpinephrine (Adrenalin) should NOT be used with tricyclic antidepressantsAntidepressants MOA: blockage of amine re-uptake & selective serotonin re-uptake inhibitorsTheophylline relaxes smooth muscles by inhibition of Phosphodiesterase. Used for asthmaShort actingAlbuterolLong actingTheophyllinePathology of asthma: constriction and inflammation of bronchiolesTreatment of xerostomia in patients with Sjogren’s syndrome: Cevimeline HClDrug form to do the desired effects: Free in plasmaWhat is NOT an effect of opioids: Peripheral inhibition of nervesConscious sedation, which reflex: VerbalMode of action of Montelukast (tablet): Inhibition of Leukotrienes (used for asthma and seasonal allergies); selective and competitive leukotriene receptor antagonist effective in the management of chronic asthmaMethotrexate for Rheumatoid arthritis can cause: ThrombocytopeniaWhich drug increases the toxicity of Methotrexate: AspirinMethotrexate overdose: LeucovorinDrugs relaxes bronchial smooth muscles by acting on β2-adrenergic receptors: AlbuterolMTX is responsible for which oral condition: ulcerationNon-alkylating anti-cancer side effect? myelosuppressionWhich medication for anticancer works on folate synthesis/prevents folic acid production/inhibits DNA synthesis during S phase: MethotrexateMTX and penicillin: Penicillin decreases excretion of MTXTx of rheumatoid arthritis: Adalimumab and Infliximab (bind to TNF-alpha receptors)Folic acid analogue: MTXFolic acid inhibited by: MTX, FluorouracilThe most common medication for Trigeminal neuralgia: Tegretol (Carbamazepine); Phenytoin; baclofen; oxcarbazepine; gabapentinFor trigeminal neuralgia and epilepsy, which both can be used: carbamazepine and phenytoinCarbamazepine blocks: sodium channelsPhenytoin induced hyperplasia is more common in: childrenMore common trigeminal neuralgia: right and femalesDrug for neurogenic and manic disorder (prevents self injury): Tegretolprimary drug for treating oral candidiasis in patient with HIV is nystatinTopical antifungals: Nystatin and KetoconazoleAnti-fungal with no associated hepatotoxicity: NystatinAnti-fungal agents is a polyene, which binds to ergosterol in the cell wall of susceptible fungi and alters membrane permeability, but is to toxic for parenteral administration: NystatinTCAs: Imipramine and amitriptyline (mainstay of treatment in depressive psychoneurotic disease)Tx of severe mental depression: ImipraminePt was had depression n hypertension which antidepressant with propanol will cause severe increase in blood pressure: ImipramineThe administration of norepinephrine, levonordefrin and MAO should be avoided in: TCAsSide effect of TCAs: XerostomiaMOA of TCAs: Inhibit neuronal reuptake of NE & Serotonin (5 HT) in brainOCD (depressive psycho-neurotic disease) treated by: TCAMedicineA 65-year-old white male smokes 2 packs of cigarretes per day. He had a heart attack six weeks ago and continues to have chest pains even while at rest. He is transported to the office by wheelchair because be becomes extremely short of breath with even mild exertion. The physical status that best describes the above patients is P.S.IVHypertensive pt. BP is 140/90. It is appropriate to: defer txHair thinning which gland: hypothyroidism (opioids are CI)Hypothyroidism in a child: CretinismHypothyroidism in an adult: Hashimoto’s; MyxedemaExopthalmos is not seen in: toxic nodular goiter/plummer diseaseFeatures of hypothyroidism: underdeveloped mandible and overdeveloped tonguePatient with hypothyroid disorder can be prevented by: calcium and Vitamin DOral cytology is not useful in the diagnosis of: LipomaOral cytology smears most appropriately used for: pseudomembranous candidiasisLupus (SLE) affects which organs: renal & heartWhat kind of a disease is Lupus: collagen or CT diseaseObstruction of the respiratory passages may result in: hypoxic hypoxiaLupus endocarditis other name: Libman-sacks endocarditisOncocytoma is associated with: parotid swellingPregnant woman with hypertension: PreeclampsiaChronic bronchitis can lead to: lung cancerPast history of episodic recurrent syncope and shortness of breath , examination reveal slight systolic and minimal murmur { valve problem }, this patient suffer from: Mitral Valve ProlapseSubstances that occur naturally in acute tissue damage: histamine, bradykinin and ATP; NOT is prostaglandinNeuropeptide found in synaptic vesicles of nerve fibers involved in pain perception and is considered to be the neurotransmitter specific for pain: Sub PFetal Alcohol Syndrome: mid face discrepancyDown’sTrisomy of 21 (47 chromosomes)Patau’sTrisomy of 13Edward’sTrisomy of 18Klinefelter47 chromosome XXY genotypePainNerve that transmits painC myelinated fibersAlarm clock headache: Cluster headache, Horton's headache, red neuralgia, histamine headache, and Sphenopalatine neuralgiaReye’s syndrome: Do Not give aspirin on children with viral infection.Vital capacity: VC = TV+IRV+ERVPatient with difficulty in swallowing, sore throat, very erythematous: pharyngitisHoarseness of voice: VagusPhlebitis: inflammation of superficial veinIf temporal vasculitis is not treated, it will impact: visionAB prophy for cardiac pacemaker: NOChvostek's sign and Trousseau's sign: acute hypocalcemia and tetanyWith age cranium becomes: thick and denseRagged ulcer in gingiva and palate: agranulocytosisBleeding in eyes is called: hyphemaTuberculids are seen in: lupus scrofulosorumSchick test is for: DiptheriaReid index is for: chronic bronchitisSystemic effects of obstructive sleep apnea syndrome (OSAS) does not include: aortic aneurysm0.5% of blood alcohol level is the most likely to produce a lethal effect in 50% of the populationDrug not checked in CBP: ApexabenWhich tissue show most growth in first 6 years and then plateau: neuralFungus in diabetes mellitus: MucormycosisHIV patient with sinusitis due to what: MurcomycosisToo much pressure on xyphoid process causes: liver damageAspirin + COPD: hemoptysisBUN (Blood Urea Nitrogen) values: 10-20 mg/dl OR 3.6 – 7.1 mmol/LHypersensitivity to penicillin is type 1 and 2 & type 2 and 4HypersensitivityType 1Mediated by IgEType 2Cytotoxic reaction based on antibody-antigen reaction complement release and cell lysis, as in Rh reactionsType 3Antigen-antibody complexes and resultant destruction by polymorphonuclear reactions, as in poststreptococcal glomerulonephritisType 4Sensitized T helper lymphocytes and macrophages, as in purified protein derivative reactionInfective endocarditis (causative: viridans streptococcal – mutans, mitor, salivarious & sanguis; diplococcus – S. pneumoniae)Gram negative rodsAaGram positiveStrepHigher BUN valuesDiabetesLower BUN valuesLiver problemLow hematocritAnemia, chemotherapy, cancerHigh hematocritPolycythemia, dehydrationTestsSweat test (shows elevation of sodium and chloride)Cystic fibrosisSchilling testPernicious anaemiaSchick testDiptheriaPaul bunnel testInfectious mononucleosisHeterophile testEBVTzankHSVDick testScarlet Coomb’s testHaemolytic anemiaEllswoth Howard Distinguish hypothyroidism and pseudohypoMinimal haematocrit for surgery: 30%Acrodynia (pink disease) related to: heavy metal and mercury in childrenSymptoms of acrodynia: irritability, photophobia, pink discoloration of the hands and feetGlucose transporter in myocyte is stimulated by: GLUT4Main content of paranasal fluid is GlucoseHighly polar compounds are excreted best through the: kidneyAddison’s disease you will see: diffuse pigmentation (intraoral melanosis), hypo, weakTx of Addison’s: 2ml (100mg) of hydrocortisoneSystemic disease most associated with an increased susceptibility to periodontitis: Addison’s diseaseNerve injury when giving a patient an injection on buttocks: sciaticFacial xanthomas may help in recognition of: HyperlipoproteinemiaPerson with hyperlipidemia is high in: triglyceridesMetabolic syndrome does not cause cancer of: thyroidCondition that gets better by lying down away from light and loud noises: migraineObstructive jaundice is associated with bradycardiaUse hyperbaric oxygen: before and after extraction to prevent osteoradionecrosis or who received radiation therapyA patient has begun radiation therapy in the mandible and needs teeth extracted. What do you do: DO endo, and amputate the crown without any trauma to soft tissue or boneVessel used for IV sedation: median cephalic vein (avoid brachial artery)Tx of BRONJ before surgery or osteoradionecrosis: hyperbaric oxygen for angiogenesisTx of BRONJ after surgery: debridementRisk of BRONJ increases if bisphosphonates therapy exceeds: 3 yearsStage 2 BRONJStage 3 BRONJAB with superficial debridementAB with surgical debridementBulimia common among: young black femalesPatient Undergone Kidney Transplantation may develop: SCCDegeneration of the myelin sheath of the peripheral nerves in a diabetes may be manifested intraorally: glossopyrosis and glossodyniaDeficiency in strict vegetarians: calcium, iron and Vit B12Cerebral palsy does not have: mental impairments30 mg triglycerides in blood will lead to: CREST syndromeMost pre-malignant nevus is: junctional nevusHypovolemic shock starts after loss of: 20% blood volumeLaryngeal obstruction is seen in: anaphylactic shockCharacteristics of hypovolemic shock is: hypotension, tachycardia, low pulse pressureTx of otitis media in children: amoxicillinConstitutional symptom: affects many systems/organs simultaneously such as fever/chillsVerrill's sign: 50% ptosis (indication to stop sedation or diazepam sedation end point)End point for diazepam, IV conscious sedation: Verrill’s sign (altered speech and blurred vision)Which joint besides the TMJ is a synovial joint with a disc: sternoclavicularDose calculation for a child depends on: clark’s and young’s ruleClark’s rule: weight of child in pounds/150 * adult doseOrgan NOT associated with metabolic syndrome (diabetes): colonBone healing begins after 1-3 weeksDiabetic valuesFasting> 126Random> 200Normal 70-120Stages of wound healing1Clot formation + granulation tissue2Bone modeling (woven bone after 1 week)3Bone remodeling (lamellar bone after 3-4 weeks)Breast cancer most commonly metastasizes to: mandibleS/S of endocarditis: FROM JANE (Fever, Roth's spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nail haemorrhage, Emboli)TestsTest for kidney failure: Creatinine testTapir or pout lips: patient unable to whisper or smile- myopathic facies) is seen in: muscular dystrophyHow treatment is different between kid and adult infection: dehydration risk among childrenLower motor neuron lesion: same sideUpper motor neuron lesion: contra-lateral sideBell’s palsy most common because of: HSVBell’s palsy usually associated with: parotid gland tumour or injection into parotid glandEtiology of bell’s palsy: IdiopathicDrug for cerebral palsy: BaclofenCN affected by bell’s: facial nerveRespiratory rate in 3 year old kid: 22-30 or 24-40 breath/minBlood transfusion before surgery should be done when the platelet concentration falls below: 20, 000What crystals are deposited in TMJ in gouty arthritis: monosodium urateMOST frequently among temporomandibular-joint dysfunction patient: psychosisdiagnostic of a trochlear nerve dysfunction: eyes fail to move down and outpostural hypotension is a common complaint of patients who take antihypertensive agents because many of these agents interfere with the: sympathetic control of vascular reflexesWhy antipsychotics cause postural hypotension: alpha adrenergic blockageComplication of cirrhosis: ascites, hepatic encephalopathy, portal hypertension (esophageal varices), variceal bleeding, spontaneous bacterial peritonitisCirrhosis you don’t see: blood in the urineDigestion enzyme supplement: lipaseProphylaxis for valves – yes; joints – noAB prophy for child: multiply age in kgs with 50Death of parietal cells will cause deficiency in which vitamin: B12Intracellular parasite: Histoplasma and CryptococcusMost common reason for cardiac arrest in children: respiratory depressionmanifested with seizure: Encephalotrigamino haematosisMost common effect of the chronic use of therapeutic medication on nutritional status: impaired nutrient absorptionPulmonary edemaLeft sidedPeripheral edema (CHF)Right sidedAcute adrenal crisisHypotension, Cardiac shock, CV collapseChronic adrenal crisisCardiovascular collapseTx of adrenal crisis: 100 mg 0.9% hydrocortisone with salineASA classificationIA normal healthy patientIIMild systemicSmoker, alcoholic, pregnancy, obese, well controlled diabetes and HTN, mild lung diseaseIIISevere systemic, but not incapacitatedPoorly controlled diabetes/HTN, H/O of MI, CVA, TIA; COPD; active hepatitis; dialysis; morbid obese (BMI > 40); alcohol dependent or abuse; implanted pacemaker; premature infant; H/O MI, CVA, TIA or stents (> 3 months)IVSevere systemic that is a constant threat to lifeRecent (< 3 months) MI/CVA/TIA; implanted ICD; sepsis; DIC; ESRD not undergoing dialysisVMoribund, not expected to live 24 hours regardless of operationMassive trauma; multi organ dysfunctionVIOrgan donorMuscles to elevate tongue: styloglossus and palatoglossusLingual varicosities associated with: HTNRisk factor for CVA: HTNTest for cyclic neutropenia: periodic total CBCMost common deep fungal disease in USA: candidiasisFrom anterior to posterior: IAN, IAA, LAHaemophilia A is: factor 8 (Tx: aminocaproic acid – interferes with fibrinolysis)Haemophilia is characterized by: hemarthrosisTest normal in haemophilia: PTTest used for haemophilia: PTTMost common bleeding disorder: Von WillbrandTx of von willbrand: desmopressinRheumatoid fever what you see: heart murmurBacteria responsible for rheumatic fever or post-streptococcal glomerulonephritis is: Strep. pyogensPopulation with herpes virus in their bodies in USA: 80-85% (60-90% worldwide)Grave’s disease: exophthalmos and hypertensionLeukemiaALLChildren, most responsive to therapyAMLMost malignant (30% of blast cells contain auer rods)CLLOld, least malignantCMLPhilly chromosome – infiltration of gingival tissues is common* oral findings common in MMost common leukemia in a child: ALL (lymphoblastic)CD specific for myeloid series is: CD 117Lymphoepithelial Cyst: Round yellow-white bump underneath tongueHeart RateRespiratory RateBPBirth60-76/31-45Neonate (<28 days)100-20567-84/35-53Infant (1 month – 1 year)110-19030-5372-104/37-56Toddler (1 – 2 years)98-14022-3786-106/42-63Pre-school (3-5 years)80-12020-2889-112/46-72School (6 – 9 years)75-11818-2597-115/57-76Pre-adolescent (10-11 years)102-120/61-80Adolescent (12 – 15 years)60-10012-20110-131/64-83AgeHeart rateAgeRespiratory rateAge 3110Age 325+Age 5-6100Age 5-6>20Age 1275Age 12<20adult70adult15Most likely among infants, pemphigoid like lesions; child formed blisters/ulcerations with minor lip irritation: Epidermolysis bullosaPatient with sickle cell anaemia takes folic acid to prevent: hypoxiaWhat does NOT set off an event in sickle cell patient? Nitrous Oxide (N2O)Symptom of poisoning by an organophosphate insecticide: diarrhea; excessive salivation/lacrimation. NOT is hot/dry skinCause of death in poisoning from an irreversible anticholinesterase, such as diisopropylfluorophosphate? Respiratory failure, resulting from paralysis of the intercostals and the diaphragmMost common cardiac arrest in children: respiratory failure or distressCause of death from acute barbiturate poisoning is: respiratory failureTrue regarding anticholinesterase: Organophosphates are readily absorbed through the skinMacrocytic anaemia is associated with which vitamin deficiency: BMicrocytic and hypochromic: Iron deficiency anemiaMacrocytic: pernicious anemia (lack of vit b12 and the protein needed – intrinsic factor)Normocytic: hemolytic and sickle cell anemiaTracheal deviation is seen in: pneumothoraxPregnant woman drinking alcohol will cause: encephalopathy Wheezing during expiration: asthmaWheezing during inspiration: vocal cord obstructionHand-foot-mouth: CoxsackieExample of entero virus: HerpanginaWhat is seen in cellulitis: neutrophilia or leukocytosis?Acute pyogenic bacterial infections produce: leukocytosisPus does not contain: neutrophils, only dead neutrophils eaten by macrophages)Acromegaly is caused by hyper secretion of: growth hormone (affects mostly lower denture)Clubbing fingers nails in children indicates: Cyanotic heart problemCodeine toxicity: bluish coloured fingernails and lipsAll can happen in shock except = HypertensionHypoglycemia causes all EXCEPT = BradycardiaRisk factor for hypoglycaemia: alcoholNSAIDS are CI in diabetic patients because they cause: severe hypoglycaemiaChronic alcohol use can cause: hypoglycemiaThe common sign of all types of shock: lack of perfusionWhat final process in coronary arteries causes myocardial infarction rather than angina is: thrombosisAngina attacks while sleeping, which angina is it: prinzmetalHeart rate in a 4 year old: 110Penetration of bone: TrephinationFAS syndrome characteristic: mid-face discrepancy or neural crest apoptosis or anecephaly OR Cleft palate, microcephaly, micrognathia, palpebral fissures60 year old patient presents with lingual erosion of maxillary incisor. Likely cause is: ulcerative colitisPatient complains of fatigue, abdominal pain and nausea. Clinical examination shows sclera is yellow as well as oral mucosa. Likely diagnosis is viral hepatitisXerostomia in elderly is due to an increased incidence of chronic diseasesHep without a carrier state: Hep ARoute of infection for Hep A: food and drink/feco-oral (NOT BLOOD or Body fluids)Type 1 HS results from cross-linking of which Ig on mast cell: Ig EPresence of Hep B surface antigen (HbsAg) and Hep B envelop antigen (HbeAg) in the blood of patient indicate: Pt. is infectious for Hep BThe risk of contracting Hep B through a needlestick injury from a chronic Hep B carrier is increased when the patient’s serology report indicates: HBeAgManagement of needlestick injury while working on a HIV patient: wash with soap and water and nothing else (no squeeze or topicals)Most resistant to sterilization: Hep B (dane particle)Organ not affected in Hep B: thyroidRisk of transmissionBC30%1.8%*HIV: 0.3% from percutaneous exposures and 0.09% from mucous membrane exposuresDiagnosis of Hep BHep B surface antigenImplies active infectionHep B core antibodyConfirms active infectionHep B e-antigenInfectivity and replication of virusHep B surface antibodyBody’s reaction to virusHep B scenariosSuccessfully vaccinated workerSurface antigen-negative and surface anti-body-positiveCarrierAntigen-positive and antibody-positiveActively infectedAntigen-positive and antibody-negativeRecoveredAntigen-negative and antibody positiveHepatitis with vaccines: A & B (B provides coverage for D; Hep D cannot replicate without presence of Hep B)Tx of Hep B unvaccinated worker following needle stick: Hep B immune globulin and vaccine (due to long incubation period, person develops own antibodies from vaccine before development of disease)No vaccine for hepatitis: CSpread of Hep A: feco-oral route (rest of hepatitis: blood and body fluids)Which hepatitis has antigen in serum: Hep AHep A vs Hep B: Hep A is difficult to kill with a surface disinfectantHep associated with epidemics: EHep Ass RNAHep Bds DNAHIVRNA Pallor, chest pain and tachycardia: Heart attackDrugs for asthma can cause: tachycardiaWhat percent of the blood alcohol level is the most likely to produce a lethal effect in 50 per cent of the population? 0.05%Comatose sleep will have: pin-point pupilsIn Emphysema, the anteroposterior of the lung is: lengthenedLA in emphysema: LA without epiPatient has emphysema, taking 3 inhalers, he stops taking breath after every 10 steps, what he could not do: be in horizontal positionEmphysema: decreased tissue in alveolusChair position after emphysema is: uprightThe respiratory rate of patients with which of the following diagnosis is most likely to be modulated by O2 concentrations: EmphysemaPerio surgery, air into sulcus: subcutaneous emphysemaPathology of emphysema: destruction of air space or sacs distal to terminal bronchiolesAcute hyperventilation in anxiety causes: Carpopedal spasmCondition associated with hyperventilation: Thyrotoxic crisisCleft lip (doesn’t occur in midline) happens in which week: 5-6 weeksCleft palate happens in which week: 6-8 weeksLone cleft lip or palate is: genetic multifactorialCleft lip and palate patients often require expansion. Appliance of choice: cap splint type of expansion applianceAspirin is a teratogen for: cleft lip and palateMore common clefts: leftAngle’s in clefts: Class IIICleft lip is: x-linked or autosomal recessiveCleft lip is the defect between: medial nasal process and maxillary processIf there is insufficient tissue for cleft repair, option is: tongue flapCommon between Gardner’s syndrome and Neurofibromatosis: Autosomal dominantAI is: autosomal dominantDrugs that cause cleft lip and palate: anticonvulsantsCleft lip is more common in males (more LEFT) and cleft palate is more common in femalesCleft lip correction10 weeksCleft palate correction18 weeksBifid uvula seen in cleft palateCause of nasal speech in cleft palate patient: Inability of soft palate to close airflow into nasal areaseen in osteoporosis: thin trabeculaeNot seen in osteoporosis: ROOsteoporosis is associated with which disease: hyperparathyroidismMona Lisa (microstomia) face: Scleroderma (progressive systemic sclerosis)Purse string lips seen in: sclerodermaWidening of PDL spaces and bilateral resorption of the angles/ramus of the mandible, trismus, resorption of condyle and coronoid, deposition of collagen in organs lead to organ failure: sclerodermaMulti-organ what in scleroderma: fibrosis of tissues leading to organ dysfunctionWidened PDL: Non-hodgkin’s lymphoma, Scleroderma, Osteosarcoma (SON)Non-hodgkin’s biopsy: lymphocytes and neutrophilsCollagen types in scleroderma: 1 & 3Tetralogy of Fallot needs: antibiotic prophylaxisTetralogy of Fallot is not associated with craniofacial dysformityUncontrolled diabetes: inhibits osteoblastic activityExpected to happen first after osseous recontouring surgery: increased osteoclastsHep A route of infection: food and drinkHBA1c: detects glycosylated Hb (normal: 4-6; controlled: <7)Diabetes in children or type 1 can lead to: Blindnessmain cause of death in diabetes type 1Renal failuremain cause of death in diabetes type 2MIWhat NOT to do in COPD patient? = 100% oxygen Anaesthesia for COPD: volatileCrowing sounds are seen with: COPD and acute asthma; laryngospasmTx of COPD patient: upright chair positionDrugs CI in COPD: narcotics, anti-cholinergic, anti-histamine, barbiturates (NAAB)Drugs CI in COPD taking theophylline: Cipro, macrolide, erythromycin (CME)Medical procedure CI in COPD: nitrous oxideCOPD patient for extraction of multiple teeth you will give: 4L oxygenAsthmaProblem breathing in (wheeze when exhaling)COPDProblem exhalingBleeding time is a measure of platelet functionAspiring affects on: bleeding timeAspirin has no effect on: PT, PTT, INRWhat determines bleeding time: platelet adherenceNormal bleeding time1-9 minNormal prothrombin time11-16 secondsNormal platelet count150,000 to 450,000Normal PTT32-46 secondsNormal INR0.8 – 1.2INR for anticoagulants2.5 – 3.5Adrenal crisisHypotension and CV collapseThyroid crisisHypertension and increased heart rateMinimum platelet count for oral surgery: 50,000PT is increased by: warfarin, heparin, liver disease, DICWarfarin inhibits: Vitamin KVitamin K antagonist (prevents conversion of vitamin K to prothrombin): Dicumarol (used for coronary infarcts)Test if you are on dicoumarol: PT time (measure of extrinsic pathway)Test if you are on heparin: PTT (measures intrinsic pathway)Heparin inhibits: Factor 10 and 2 (thrombin)Heparin activates: Plasma antithrombin (3)MOA of heparin: prevents conversion of fibrinogen to fibrin and inhibits thrombinMOA of coumarin: Inhibits GI absorption of Vit K and prevents synthesis of blood clotting factorsCoagulation factors is/are the most sensitive to heparin-antithrombin III complex inactivation? Factor 2 and 10Pediatric patient with bluish lips/ cyanosis/ clubbing of fingers, what is going on? Congenital heart diseaseA patient with Stage I medication related osteonecrosis of the jaw (MRONJ) with exposed bone in the maxilla is best treated with CHX rinsesMOA of CHX: membrane disruption0.12% (12% alcohol) CHX rinses (Peridex or Perioguard) are effective in modifying plaque quality and quantity because of their selective activity against: Strep. Mutans10% CHX is used in: secondary caries prevention0.1% CHX is for: interproximal caries0.12% CHX more effective than 0.2% CHXWhat percentage of CHX remains after rinse: 30%patient with untreated acromegaly: excessive mandibular growthA new patient presents with severe chronic periodontitis and has a history of two heart attacks. The patient is not sure when the heart attacks occurred or the severity. The dentist’s next step in treatment should be to: consult patient’s physician prior to any treatmentA patient with hypertension arrives for a scheduled crown preparation appointment with a blood pressure of 160/100 mm Hg and a pulse rate of 90 bpm. The initial response by the dentist should be to: wait 15 minutes to re-take vital signsAverage pulse rate of a 4 year old child: 80-120 (new born: 100 – 160; 11 years +: 60 – 100)The complement cascade is activated by the immune complexAfter a patient places an aspirin directly on his oral tissue for an extended period time, the tissue become white. What accounts for this change in color? NecrosisAn HIV-infected patient’s viral load is 100,000 and T cell count is 30. The T cell count is low, putting the patient at risk for infection and complicationsKaposi Sarcoma is caused by human herpes 8First stage/sign of HIV infection is: asymptomaticLab results for HIV: CD4 200-500; platelets less than 50,000 and neutrophils less than 500Not AIDS defining oral candidiasisAIDS defining: disseminated fungal and viral disease; atypical mycosis; TB beyond lungs and oesophageal and pharyngeal candidiasisHIV testsELISAPreliminary test (does not detect virus, instead AB made by the patient)Western BlotConfirmatory test for AB production. It eliminates false positive ELISAT-cellMost important in staging the progression of the disease (T cells falls as disease progresses). The T-cell numbers help determine the need for antibiotics for dental proceduresViral loadAlso used to stage disease, count viral particles, and show effectiveness of TxEndodonticsSecond number indicatesThird number indicates: angle between the blade and shift in degreesInflammation of periapical tissue is sustained by: microorganismsCommonest tooth for vertical root fracture: mandibular molars 1Width of the blade in tenths of mm2Primary cutting edge angle3Length of blade in mm4Blade angle, relative to long axis of handle in clockwise centigradeIf a rubber dam is abnormally wrinkled between teeth, highest chance of leakage, the probable reason is holes were punched too far apartParaformaldehyde-containing obturating materials: are below the standard of care for RCTPulp is CTEllis classificationClass 5 - luxationDislocation of tooth from its alveolusClass 6 - avulsionComplete separation of tooth from its alveolusRoot FractureCoronal (# at or above level of crest of alveolar bone)Stabilize for 6 – 12 weeksPoorMidStabilize for 3 weeksApicalBestCross-section of maxillary central incisor is round; mandibular is ovalPulp horn at risk of exposure in a mandibular first premolar: facialLedermix is a: antibioticCoronal seal of RCT is more important than apicalWhen testing, what is the minimum number of teeth that should be testes prior to testing suspected tooth: 3Endodontically treated posterior teeth are more susceptible to fracture due to: destruction of coronal structureThe role of anaerobes in endo was established by Sundqvist as a result of a classic 1976 study. Used an ‘anaerobic glove box’ to demonstrate anaerobes in infected pulps.Aspiration of odontoblasts into dentinal tubules is caused by: insufficient cooling, desiccation of dentin by extensive air drying, chemical desiccants (alcohol, chloroform)Following trauma, bluish-grey discolouration of the crown is due to: pulpal hemorrhageTrue about endogram: extent of internal resorptive lesion; radiography is used in producing itFalse about endogram: used to confirm correct working lengthIn their study of maxillary molars, Kulild and Peters noted: A high incidence of two canals with separate foramina in the mesiobuccal root (71%)Papillae protruding under rubber dam: holes punched too closeExplain leaking from rubber dam clasps on buccal surface of mandibular molar: holes too closeThe reason to invert a rubber dam is: provide a complete seal around the teethMost likely indicates pain that is not of pulpal origin: pain that has paraesthesia as a componentStatements accurately describe phantom tooth pain: may be a form of deafferentation painFalse regarding age changes in pulp: There is decrease in cellularity and collagenous fibres in radicular pulpA perforation caused by the side of a file going round a curve: zip perforationAngle of root to be resected during apicectomy for short rooted tooth in upper lateral incisor: 10 degreesWhen two canals were present and join at the apex for maxillary second premolar: lingual canal is straightestStieglitz pliers is used to remove: silver pointsClinical sign of staph infection: carbunclePhoenix abscess (tooth is mobile and depressible in socket) results from a previous: GRANULOMAReason for parulis: incomplete root canalStrip perforation is towards: side of furcationGold standard obturation method: cold lateral compactionBest prognosis for endo-perio lesion: perio started from endoHow do you differentiate between endo-perio lesion: EPTWhat will not regenerate after RCT: dentin formationRC filling for primary teeth: ZOEwhat is the technique used or operation were GP will shrink after cooling: thermoplasticWhere is an 'extra' canal often found in upper molars? mesiobuccalGP errorsUnderextensionSingle cone GPOverextensionGP extruding beyond apical foramen and the apex is not sealed (incomplete filling)UnderfillingVoids – incomplete filling of canal spaceOverfillingGP extruding beyond apical foramen and the apex is sealed (complete filling)Endo diagnosisTooth with chronic periapical periodontitis is: tender to percussionCommon cause of discoloration of non-vital teeth is: haemorrhage of pulpArtery used for BP: brachial arteryManagement of lost apical seating by over instrumentation: increase file size and reduce filling lengthMain reason for pain after RCT: coronal leakagesMaxillary molars usually have: 4 canalsC-shaped canals: mandibular second molar/mandibular first premolarMost consistent canal morphology: maxillary canine and mandibular premolarsThe initial instrumentation in endo treatment is done until: CD junctionDefence cells of pulp: histiocytesTissue emphysema after endo treatment by: spontaneousElective endo use: short crownHistologically, dental pulp most closely resembles: loose connective tissueaccess cavity preparation on a mandibular molar with four canals: trapezoidalaccess cavity preparation on a maxillary molar: triangularWhat percent of the time is fourth canal present in the maxillary first molar: 30-40%The reason you give triangular access cavity prep to a max central incisor is to: expose unseen pulp hornsHighest density of pulp nerves is in: pulp hornsMain function of pulp: dentin productionMost likely cause pulp necrosis after trauma to the tooth: pulp hyperemiaThermal reaction test produces a quick, sharp pain that passes away immediately. The EPT produce more response than normal at low levels; pain intensified by applying cold: hyperemiaMost critical in endodontics: access openingmay be used on dentin as a cavity medicament because it does not irritate the dental pulp: prednisoloneDrugs enters the target cell and acts on a nuclear receptor? prednisonecapable of adapting to either a high or low oxygen containing environment: facultative organisms Formocresol causes mummification (not necrosis!)Less toxic than formocresol: ferric sulfateFormocresol should be placed inside the tooth for: 5 minutes (when doing pulpotomy)Zones of formocresol: acidophilic zone, broad zone of pale staining and broad zone of inflammationMost common medication used for pulpotomy procedures in children: FormocresolThe effect of formocresol on the pulp tissue is controlled by: concentration usedBetter than calcium hydroxide in case of apexogenesis pulpotomy: formocresolThe rubber dam does NOT protect patients from: mercury vapours when removing old amalgamsBacteraemia least likely with: RCT VRFFacio-lingualPain on bitingCrack tooth syndromeMesio-distalPain on releasing biteCrack tooth syndrome more common in: Mandibular second molars, followed by mandibular first molars and maxillary premolarsEPT works on which pain fibres: A deltaPain, which arises slowly after injury, and is characterized as burning, aching,dull, poorly localized, and persistent, is most likely to be due to the activation of: C fibresNociceptive painA-delta and C fibresAllodyniaHyperalgesia of A-beta fibresPulpal A-delta over c fibres: large myelinated with faster conduction velocities (quick sharp)If C fiber pain predominates: Irreversible pulpitisWhat induces hyperalgesia in local-nerve fibers: Prostaglandin and serotoninEPT, to determine whether: stimulus applies to a tooth is perceived by cortex of brainUntrue about EPT: gives degree of healthy pulp statusBest for pulp health: EPTWhich test to be used in full gold crown? Thermal testBest test for pulp necrosis: EPTEPT not done on: primary teeth (thin enamel)Highest incidence of pulp necrosis is associated with: full-crown preparationsfibres most sensitive to pressureGroup Afibres least sensitive to pressureGroup CPremolars is most likely to have three canals: Maxillary firstA dentist has planned in-office-bleaching and porcelain laminate veneers for a patient’s maxillary anterior teeth. What would be the best sequence of treatment? Bleaching, 2 week delay, tooth preparation, bonding proceduresPorcelain laminate veneer after few days shows black margins. This is due to: some of the component amines wear offBleaching can cause: external root resorption and acute apical periodontitis (if the tooth is non-vital and inadequately obturated)Acute apical periodontitis presents with: tooth that feels ‘long and extremely painful on bitingWait for a better adhesion to enamel after bleaching: 1 weekTooth bleaching affects both: enamel and dentinWait time for anterior veneer preparation after bleaching: 2-3 weeksThe prognosis for bleaching is ehaviour when the discoloration is caused by: necrotic pulp tissueleast reliable finding from a clinical examination of teeth subjected to traumatic injury: vitalityPulp fluid flow is detected by: dopplerMost important in giving a canal resistance form: tapering of canal wallsFile diameter calculationFile taperness increases 0.02 mm every mm distance, so for D16, it is 0.32Diameter of the file at tip: 0.01 mm × file #Diameter at D16 = diameter at tip + taperness at D16FilesFor curved canals, use: NiTi (used in crown down; not resistant to fracture)K files are the STRONGEST but cut LEAST aggressively; cut counter cloackwiseWhat is an S file? → modification of HedstromHedstrom files (most efficient) plane dentinal walls much faster than K filesWhy Hedstrom files are efficient: flutes cut only in one directionFile most susceptible for fracture: H file fabricated from round SS blankAccurate regarding H file: made from round cross-sectional wireFiling action of H file: push and pull producing irregular shaped canalsMost flexible point of file: tipEndo file breaks at #15, what would you do: refer to endodontistColour of files# 10Purple# 15White# 20Yellow# 25RedReamers: cut cloackwiseTwisting a triangular wire best describes the manufacturing process of a: reamerBest describes the Quantec files: instruments exhibit varied tapers with a constant D0 diameter of 0.25 mmThe effect of sterilization on endodontic files is: neutralSequence of endo instrumentation: file-reamer-broachTechnique is usually used for the production of an apical flare with hand files: step backTo create an apical flare, larger files are used at decreasing lengths. How much difference should there be between the lengths: 1 mm Size 6 – 40SquareSize 45 – 140TriangularRed colour endo file: # 25What is the 02 taper on hand K-files: 0.02 mm increase in diameter per 1 mm increase in lengthWhat are profile rotary instruments: they exhibit sizes that are ISO and ANSI standardizedStatement regarding ultrasonic root canal instrumentation is accurate: It is not very useful for dentin removalNOT true about Gates Glidden drills: leave a smooth step-free surface on the canal wallUse of Gates Glidden: enlarge coronal canal areasRC prep: EDTA + urea peroxide (both chelation and irrigation)EDTA is active up to: 5 daysEDTAC, C for: cetavlonInactivator of EDTAC is NaOClAqueous EDTA is primarily used to: dissolve inorganic matterWhich irrigant is better tolerated by PA tissues: Urea peroxide-glyoxideCurved canals or normal PA with a wide apex: Use Urea peroxide (Gly-Oxide)Swelling above canine: drain with RCTRetrieval of separated file coronally: ultrasonicContraindications of pulpotomy: Leukemia, recent MI, Diabetes, calcified pulpElective RCT CI in: LeukemiaElectronic apex locators are not used in: minor perforationLoss of the apical seat caused by over instrumentation is best managed by: increasing the file size and decreasing the file lengthIn complete removal of bacteria, pulp debris, and dentinal shavings is commonly caused by failure to irrigate thoroughly. Another reason is failure to: obtain straight line accessWalking bleach (internal bleach): 35% sodium perborate or 30% hydrogen peroxideBleach most often used in internal bleaching: sodium perborateBleaching that does not cause cervical resorption: sodium perborateSafest recommended Intracoronal bleaching chemical: sodium perborateNINJA access: small accessOffice bleach: Superoxol (hydrogen peroxide 30-35 %)Office bleach does not change shade through: surface demineralizationDisadvantage of Superoxol: cervical resorptionWorst outcome of non-vital bleaching: internal/cervical resorptionNon-vital bleaching agents: 35% hydrogen peroxide, carbamide peroxide, and sodium perborate% of carbamide peroxide for home bleaching & vital bleaching: 10%The most common risk associated with vital bleaching using 10% carbamide peroxide in a custom tray is: soft tissue reactionDifference between office (35%) and home bleaching: strength of peroxideHome bleaching causes: sensitivityThe prognosis for bleaching is favorable when the discoloration is caused by: necrotic pulp tissueInternal bleaching causes: cervical root resorptionMost effective way of bleaching teeth: In-home vital bleachingWorst stain to bleach is: grey/tetracycline stainsBest response to bleach: Yellow, followed by brown and orangemost reliable method for determining the pulp responsiveness of a tooth with a full coverage crown: thermal testTrue regarding internal resorption: it is continuous and asymptomaticStatement regarding internal resorption is accurate: It is continuous and rarely in permanent teethStatement regarding the degree of pulp pathosis is accurate: does not correlate well with the level of pain a patient perceivesIn describing the sensory innervation of the dental pulp, which of the followingstatements is accurate: domination of C-fiber stimulation produces pain that is not well localizedSingle visit is not recommended? Necrotic pulp with a draining sinus tractStatement regarding one-appointment root canal treatment is accurate: equally successful as multiple-appointment root canal treatmentIn their study of mandibular molars, Skidmore and Bjorndal noted: access opening should be rectangularTx of external resorptionInflammatory (bowl-shaped)RCT with calcium hydroxide; replace every 3 months and place GP after 1 year with calcium hydroxide sealerReplacementNo TxCervicalRemove granulation tissue and repair with restorationTx HRF: splintWhat percent of hydrogen peroxide should be used for debriding and intraoral wound? 3%Effect hydrogen peroxide: hypertrophy of filiform papillaWhich disinfectant quickly breaks down into useless products: H2O2Disadvantage of NaOH: toxic to vital tissueGlass fiber post compared to custom has: less chance of fractureRestoration following endo therapy, primary function of the post is to improve: retention of definitive restorationFor apex in apexification (apical barrier), least irritant: MTAFor pulpotomies, the best material to use is: MTAIf tooth has open apex, and it gets avulsed, how you close it: MTAWhich pulpotomy medicament demonstrates better success rates than formocresol: MTAFacts about MTA: sets in moisture, long setting time, non-resorbable (great sealing), consists of calcium phosphate and oxideGrey tooth: blood products in dentinal tubulesGrayish-blue-green: hyperbilirubinemiaFor apexification tooth has to be: symptoms free!Apexogenesis does not do: root vascularizationThe access opening for a maxillary central incisor of a 14-year-old patient is triangular in shape: to include any remnants of pulp horns within the access openingcan best determine asymptomatic apical periodontitis? Radiographs (It appears as an apical radiolucency and does not present clinical symptoms (no pain on percussion or palpation)Most common perforation in maxillary lateral/central incisor during access preparation: mesialEndo with best prognosis: perforation in internal resorptionWhich surface of distal root of lower molar is most likely to perforate: mesialworst prognosis regarding perforation: 3 mm apical to gingival levelPerforationsIf above the crestSeal immediately and do RCTIf below the crestSeal immediately and postpone RCT% of two canals in mandibular second premolar: 1-3% or 14%?Best test for teeth with open apex or newly erupted: thermalTest for reversible and necrotic teeth: ColdHow does a tooth covered with crown react to pulp testing: ColdTest for irreversible: EPTTest for tooth with crown: percussionleast useful in endo diagnosis of children: EPTEPT tests: responsiveness (not health)Test most reliable on newly erupted primary tooth: percussioncold testing agent least effective in producing a response: ethyl chloridecold testing agent most effective in producing a response: ice water bath or DDM – dichlorodifluoromethane% of 3rd canal in maxillary first premolar: 6%A tooth is not responsive to cold, not to percussion, and palpation is tender: Necrotic pulp and chronic apical periodontitisFollowing the removal of a vital pulp, the root canal is medicated and sealed. The patient returns with apical periodontitis. The most common cause is: over instrumentationGG drills should ideally be used: to blend the coronal third of the canal in to the access cavityOutline best describes the access cavity preparation on a mandibular molar with 4 canals? RectangularFor access preparation, the root canal anatomy of a maxillary second molar with 4 canals requires which outline form? TriangularSplintingSplinting of avulsed teeth if less than 1 hour: 7-10 daysSplinting of avulsed teeth if more than 1 hour: 4 weeksSplinting avulsed tooth with non-rigid fixation: 10-14 daysAlveolar process4 – 6 weeks (rigid splint)Mid-root/apical2-3 monthsSubluxation7-10 days if mobileLuxation14 daysSplinting is NOT recommended for: primary teethSplinting for root #: 3 monthsAvulsed primary central incisor: no need to replantAvulsed tooth and extra oral time is greater than 1 hour: RCT requiredWhen do you do calcium hydroxide therapy in an avulsed tooth? wait 2 weeksDoes not splint teeth: Lingual plateHome internal bleach causes mostly: external root resorptionPercussion of a tooth is a test for: Acute periradicular inflammationConstant excruciating pain from a tooth that feels “long” and is very sensitive to pressure: acute periradicular periodontitisA radiograph reveals a radiolucency associated with the apex of tooth 15. There is a large restoration but the tooth is asymptomatic and the associated soft tissue appears normal. Most likely diagnosis is chronic periradicular periodontitissymptoms or clinical findings would indicate that a tooth has an irreversible pulpitis? Spontaneous toothachesIndication for a pulpotomy on a primary tooth: S/S of irreversible pulpitisHardest to anesthetize: Irreversible pulpitis (most likely to have referred pain) and mandibleReferred painForeheadIncisorsNasolabialCanines & PMsTemporalSecond PMEarMan molarsradiograph sign of successful pulpotomy in permanent tooth: formation of apexbest aid in the diagnosis of an irreversible pulpitis: thermal testAfter application of heat, pain for 10 mins is indicative of: acute pulpitispatient with the history of bite on bread feeling sensitivity to cold: cracked tooth (VRF)Most common tooth associated w/ cracked tooth syndrome: Mandibular 2nd molarsSecond most common tooth associated w/cracked tooth syndrome: Mandibular first molar and maxillary premolarscommon cause for VRF: GP condensationGP does not: adapt to tooth surfaceOptimal length of GP left at the apex of the tooth: 3-4 mmA common gutta-percha solvent is: chloroform, ether, xylol (methyl chloroformate, halothane, rectified white turpentine, eucalyptol)Gutta mainly contains: Zinc oxideNot a property of gutta: adaptationmost reliable method for determining the pulp responsiveness of a tooth with a full coverage crown? Thermal testpremolars is most likely to have three canals: maxillary firstWhich form external root resorption is associated with pulpal necrosis: InflammatoryThe treatment-of-choice for an inflammatory external root resorption on a non-vital tooth is: Removal of the necrotic pulp and placement of calcium hydroxide (do it every 3 months until PDL is healthy)Root resorption seen in ankylosis or avulsed and replanted tooth or metallic sound: replacement resorptionBiggest long range concern in replantation of avulsed teeth: external resorptionMain side effect of bleaching an endodontically treated tooth? External cervical resorption (ragged – moth eaten appearance)What is the best way to prevent replacement resorption after reimplanting a tooth: gently wash with salineWhen a tooth is ankylosed what type of resorption: replacement resorptionFeatures of surface resorption: reversible and limited to cementumResorptionInternalContinuousDiscovered in LATE stages and is progressiveExternalPerforation at which of the following sites has the poorest prognosis? 3 mm apical to the gingival sulcusPurpose of periapical palpation: To determine if the periapical inflammatory process has penetrated the cortical bonediameter, in ehaviourl, of a 21 mm long, #35 K-file at D16? 0.67 (A file has two designated points called D0 and D16. D0 is the starting point of the file and D16 is the point where the cutting/abrasive part or in other words the flutes/blades end. Distance between these two points is fixed at 16 mm. Doesn’t matter however long the file is, the distance between D0 and D16 is always 16 mm. Now, the diameter at D0 is hundredth part of the size of file. So here file #35 would have diameter at D0 as 0.35 mm. If not specifically mentioned the general taper of the file is 0.02mm per mm. So, as you move upwards to D16 from D0, each mm adds 0.02 mm in diameter)Total 16 mm adds 0.2 * 16= 0.32mm and the diameter at D0 was already 0.35mm so at D16 would be 0.35 + 0.32 = 0.67 mm.When performing a pulpal evaluation, the dentist should ideally use which of the following as controls? Adjacent teeth and contralateral toothsingle most important factor affecting pulpal response to tooth preparation? HeatDuring a routing examination, the dentist sees a large radiolucency at the apex of the maxillary right first premolar. The tooth is not painful, does not respond to pulp testing, and has no evidence of a sinus tract. The most probable diagnosis is asymptomatic apical periodontitisproperty of sodium hypochlorite: lubricating agent; solvent of necrotic tissue (lubricant); antimicrobial agent; NOT – chelating agentChelating agent: EDTA (decalcification of dentin or removal of inorganic material/smear layer)During root canal you notice you left debris in the canal most likely due to lack of use of which: chelating agentsChelating agents are good for: sclerotic canalsViricidal properties are seen in: sodium hypochlorite (bleach)% of hypochlorite for irrigation in RCT: 2.5%% of sodium hypochlorite as an irrigant: 5.25%Sodium hypochloriteDissolve organic; removes debris; no smear layer; disinfectionEDTA (17%)Removes inorganic and smear layerDistilled water is not used for irrigation because it is: hypotonicmost describes the purpose of using sodium hypochlorite during biomechanical preparation? Dissolves necrotic tissue and remove organic layer or is toxic to vital tissuesmost likely to be misdiagnosed as an endodontic lesion: lateral periodontal cystsingle most important factor affecting pulpal response to tooth preparation? Remaining dentin thicknessThe purpose of electronic pulp testing is to differentiate: Between responsive and unresponsive pulpal nervesWhat is the most likely pulpal diagnosis for a primary molar with deep caries and a history of transient cold sensitivity with an intact periodontal ligament space on radiographic examination? Reversible pulpitispainful response that subsides quickly with stimulus: reversible pulpitisPain on eating sweets or cold foods/drink: reversible pulpitisPain aggravated by cold and relieved by heat: reversible pulpitisPain aggravated by heat and relieved by cold: irreversible pulpitisThe diagnosis of pulpal status is predicated upon assessing the amount or extent of inflammationUsed to disinfect GP points: chemical solutions (full strength sodium hypochlorite)For extirpation of entire pulp, necrotic debris and foreign material (cotton, paper points), one should use: barbed broachesIntrinsic stain can be caused by: Porphyriawhat is the file used to explore the apical third of a canal called? Seekerthe file used to explore the apical third of a tooth is usually: size 8-10if a canal is narrow, which one can be used to make exploration easier? EDTAHow deep can EDTA penetrate? 50 mm9 year old girl presents with class 3 fracture of 11, which appeared an hour ago. The apex is not closed. Possible line of treatment? Pulpotomy with caoh restorationthe desirable degree of taper of a preparation to receive a cast restoration is 5-7 degreesThe dental pulp contains proprioceptive nerve endings therefore characteristic of pupal pain is that the patient is able to localise the affected tooth. FalseThe majority of cells in dental pulp are: fibroblastsRestorative DentistryLipopolysaccharides are found on the surface of: gram negative bacteriaAmalcore: an amalgam restoration that enters and plugs the canal orificeMaterial of choice for post of a composite canine core: fibre reinforced postOrder of restoration: line, base, varnishWhen you want to cement crown, what is the sequence? Look inside the crown (internal fit), contacts, then marginCommon among class 1 amalgam, DFG and gold inlay is: divergence of mesial and distal walls occlusallyThe contact area on the distal surface of a maxillary first premolar should be placed in the occlusal third of the proximal surface with the: lingual embrasure greater than the facial embrasureWhich doesn’t need replacement or repair: ditched restorationThe day after a routine class V composite was placed, patient reports discomfort from the tooth. Most likely complaint: exposure of root dentin during the finishing proceduresFeatures of tooth morphology responsible for food deflection include: marginal ridges, facial and lingual contours, and facioproximal line angles (not central fossae).A practitioner is restoring the mesio-occlusal marginal ridge of a maxillary left second molar. If the marginal ridge is higher than the adjacent tooth, then it can create a problem in: retrusive excursionReasons for cuspal fracture of onlays: infraocclusion and accentuation of previous non-working contactsReversible carious lesions: white spot is detected upon dryingWhen viewed from the occlusal, contact area between maxillary premolars is normally positioned at the junction of facial and middle 1/3rd of crownsTo provide proper deflection patterns for food, contact area between premolars is: wide lingual and narrow facialA Class II cavity preparation in a primary molar for dental amalgam restoration will not require a gingival bevel because the: enamel rods in the area incline occlusallyCannot be used on dentin as a cavity medicament: alcohol, calcium hydroxide, ethyl chloride, silver nitrate, 10% h202What is the purpose of heating the metal structure of a metal- ceramic crown in a furnace prior to opaque application: oxidises trace elementsAuxiliary resistance from features in fixed dental prostheses such as boxes and grooves should ideally be located? ProximallyThe dark space visible between maxillary and mandibular teeth when patient laughs is called as: negative spaceEnamel demineralization at: 5.5Cementum demineralization at: 6-6.7Reason to replace composite: discolouration at marginBest initial seal is with: acid etched composite resinFrank caries: caries that has progressed into DEJTreatment of root surface caries, what kind of dentin should not be restored? Eburnated dentin (Sclerotic dentin)Pulp has several defense mechanisms to protect it from irritation: sclerotic dentin, reparative dentin, and vascularityPit and Fissure caries is described as two cones: Base of both triangles facing the DEJWhat type of caries detection is the Difoti used for? Class I Class II, Class IIIMechanism of caries indicator: Enters the dentin and binds to the denatured collagenWhich is prevented by using a matrix band? Open contactHand piece air speed during dento-alveolar surgery: 120,000-200,000 rpmSlow speed: <12,000 rpmMost desirable finished surface for a composite resin: aluminum oxide disksWhen two adjacent class II lesions: prepare the larger first and fill the smaller firstOne month after polishing class V amalgam, gingival tissue receded apically. Dentist should suspect: irreversible tissue change related to finishingContact area between maxillary premolars are normally found on: facial half of proximal surfaceZones of carious enamelsurface outermost, unaffected by cariesbodylargest, demineralizingdark zone Remineralization; does not transmit polarized lighttranslucentDeepest; advancing front of enamel lesionZones of carious dentinInfectedMust be removedTurbidBacterial invasion; must be removedTransparentSoft and no bacteriaSub-transparentDemineralization present, but no bacteriaNormal (deepest)Zones 3 – 5 can remineralizePit & FissureSmoothInverted VVMostly S. sanguisCariogenic bacteriaSS. mutans, sanguis, mitis, salivariusAA. viscusLLactobacillusI-VVeillonellaAA. naeslundiiBacterium frequently cultured from heart valves after attacks of subacute bacterial endocarditis: Strep. mitisto account for mesial concavity on maxillary 1st premolar when restoring with amalgam: custom wedgeWedge will not prevent: over contouring of the contact areaMost diagnostic tool for pit and fissure caries is: explorer catchMost important etiologic factor in getting caries: refined sugarMost appropriate treatment for a patient who reports persistent thermal sensitivity 4 weeks after placement of a posterior composite resin restoration with acceptable occlusion: replace the restoration with a reinforced ZOEFilling most difficult to remove: ZOE (most sedative base)ZOE, IRM, ZP setting time can be accelerated by adding small amounts of: waterZOE is not used for permanent cementation of crown and bridges, because of: poor initial sealing abilityZOE is a good temporary restoration because: it provides good sealZOE is a good temporary filling because it gives a: good bacterial sealA typical polymer-reinforced ZOE cement retains approximately: 20% by weight of PMA in powder componentZOE and varnish is CI for use with: self-curing resin/composite resinCool glass slab: more powder incorporatedWhat can replace eugenol in zinc oxide pastes: ortho-ethoxybenzoic acidZinc oxide eugenol setting time can be accelerated by: adding water (same for zinc phosphate cement, alginate and polysulfide) Lining material that should not be used with composite: ZOE (Kalzinol)How do you remove a deep carious lesion: from periphery to center with large round burWhat is added to zinc oxide eugenol to make IRM: Polymethyl metacrylateMain disadvantage of using PMA: low resistance to abrasion and high coefficient of thermal expansion What is the material in reinforced IRM that give it strength: Poly methyl methacrylate (PMMA)Composition of IRM: ZOE with polymer reinforcementTeeth are resistant to crush, but not to: shearMost important factor for strength of preparation is: B-L widthOral feeding VS tube (stomach) feeding ‘ plaque accumulates at the SAME rate but calculus accumulates FASTER in tube feeding!In early caries, the first structure to show destruction is: interprismatic substanceBonding is difficult to accomplish where: sclerotic dentin is not removedSclerotic dentin is: calcification of dead tracts Which layers of dentin contain bacteria: zone 4 (turbid) and 5 (infected)First increment in a class 2 composite if NOT using snowplow technique1 mmIf using snowplow technique2 mmBest for abfraction lesions: micro filled GICBest composite for incisal edge: micro hybridFemale patient with multiple cervical caries: lemon suckingTooth not similar to any other tooth: primary mandibular first molarComposite compared to GIC has better: wear resistanceCorrect method of excavation of deep caries: large bur from periphery to centerIn ceramic luting, most important step is: cement typeThe decision to reduce a cusp and restore it should be based primarily upon which principle? Resistance formRemoving cusp affectsRetention formIncreasing inter-cuspal space affects; Marginal ridges affectsResistance formLoss of marginal ridge affectsBothIn preparing a class I cavity for dental amalgam, the dentist will diverge the mesial and distal walls toward the occlusal surface. This divergence serve to: prevent undermining of marginal ridgesMarginal ridges of posterior teeth are frequently involved in cast restorations. It is necessary that the restored marginal ridges be in contact with the cusps of opposing teeth and be rounded to help form the occlusal embrasures.Class II amalgam restoration has a overhang at gingival margin. This might have been caused by: no wedgeCI taller then LI by: 1-1.5 mmIncipient caries: V shapePrimary canine vs permanent canine: more sharp tipSonic fill theory in filling: decrease shrinkageClass II inlay walls: diverge from pulpal to gingival?Line angles in class II inlay: sharpWhat you wont use as retainer: InlayCharacteristic common to all inlay preparations for class II is: lack of undercutsBest case selection for an inlay: low caries indexShoulder with bevel is used in: proximal box of inlaysWhere is the MOD inlay hitting when it contacts early during seating: InterproximalDeep stain in composite class 4: re-doIn selecting a dental base, the dentist should give greatest consideration to: thickness of remaining dentinEnamel rods or cuticle (most resistant to acids) in gingival third of primary and permanent slope: occlusallyInstrument used to handle resins are made of: Teflon coated metalDentists use barrier membranes (Teflon membranes) to treat: osseous defects in an attempt to block the formation of a long junctional epithelium.Purpose of barrier: coronal movement of cellsSelf drilling pin is used on: flat surfacePinsPins in amalgam: perpendicular to pulp floorHow to use pins: one for each missing line angle and not parallel to each otherPlacement of pins: parallel to external surface of tooth or outer wallPurpose of pins for amalgam: secondary retentionMost common pin used” self-threaded pinInto dentin2 mmInto amalgam2 mmInto DEJ1 mmSealants (6 – 12 years) bond to teeth by: micromechanical retentionWhat type of bond is composite on tooth structure? Mechanical bond (micromechanical)Sealant failure is due to: saliva contaminationocclusal sealants succeed by altering: the host’s susceptibilitySealants best retained on: maxillary and mandibular bicuspidsCusp reduction is resistance formcorrect range of light emitted from a curing light (in nanometers): 400-499Precaution to be taken in which condition if using curing light: cataract removalPart of eye damaged with curing light: RetinaWhy LED is better than regular curing: lasts longer, narrow spectrum that matches camphorquinone, more energy efficientNot an advantage of LED cure in comparison to halogen: curing depthTo prevent eye damage, the protective eyewear that u wear should effectively filter light rays below: 500 or 509A ‘W” in front of the rubber dam clamp number indicates that the rubber dam clamp is winglessFerruleFunction of ferrule: prevents fractureMinimum ferrule: 1.5-2 mmFor bevelling gingival margin, what not to use: hatchets/tapered diamondAngle for composite bevel: more than 90 degreesWhat bevel does for restorations: decrease composite leakageBevel anterior teeth, why: esthetic and retentionBevelWide bevelEnamel and dentinFull bevelFull thickness of enamelShort bevelOnly external 1/3 of enamel prismsFacial bevel2 mm for anteriorsHatchets and GMT differ in blade angleGMTHatchetCurved blade and angled cutting edgeCutting edge in the plane of the handleBeveling gingival margins, and for rounding or ehaviour the axio-pulpal line angle of Class IIEffectively plane enamel of the facial and lingual walls of a Class II amalgam preparationAdvantage of using GMT over enamel hatchet: angle of bladeNot used to bevel an inlay prep or gingival margin of MOD: enamel hatchetIf the angle formed by cutting edge with blade edge is away from handle: distal GMTIf the angle formed by cutting edge with blade edge is towards the handle: mesial GMTWhat are angle formers: combination of chisel and GMTsAngle formers used mainly for: sharpening line angles and creating retentive features in dentinChisels cut: enamel# of GMT used to bevel occlusal floor: 15, 80Chisels are CHAD (chisels, hoe, angle former, discoid-cleoid)Hatchets are HEG (hatchet, excavator, GMT)ChiselHatchetCutting edge is 90 degrees with plane of bladeCutting edge is parallelPushPullHand pieces stones or stone bur can be used primarily to sharpen: spoon excavatorNociception through dentin occurs because: fluid movement deforms nerve terminals in the tubulesNib: working end of a non-cutting instrument (e.g. condenser)Sensitivity related to a non-carious cervical lesion is best explained by: hydrodynamic theoryWall missing in class V: pulpalClass V GIC, no: bevelClass 1 and V have in common: both slightly extend into dentinFor ideal class V, retention form should have: retention grooves in occlusal and gingival wallsThe primary determinant of the outline form of a Class V preparation is: extension of the carious lesionThe external shape of an initial Class V carious lesion in enamel is related to: the contour of the gingivaRemoving cusps affects: retention formBest material for treatment of non-carious Class V cavities in unstable acid erosion cases: compositeBefore filling a class V abrasion cavity with GIC you should: clean with pumice, rubber cup, water and weak acidThe axial wall of a large Class V cavity prepared for direct filling gold is: convex in a M-D direction in order to conserve tooth tissue and minimize pulpal irritationClass V on a maxillary canine: conical decay pattern with the base of the cone in enamelGrooves for resistance: buccal and lingualShort clinical crown, how to improve retention and resistance? Buccal/lingual groovesIn Class V amalgam preparation for incipient lesion, the internal form should have: axial wall deep into dentin and convex; mesial and distal walls are divergent; undercuts placed incisally and gingivallyHow far do you extend the pulpal floor in class I amalgam cavity on primary dentition: just into dentinLeast useful retention/resistance form in crown: total area of 2 axial wallsA routine class V composite restoration was placed and patient returned the following day complaining of pain. Which best explains why: cervical dentin was exposed during polishingComposite that should ideally be used for a class 5: microfilm because it polished betterMicrofill composite mostly used in: Class 5Composite materials not indicated to restore the incisal edge of a tooth: macrofilledDirect composite: better marginal adaptationIndirect composite: better contourClass II amalgam: bothAmalgamComposite90 degrees cavosurfaceCavosurface greater or equal to 90 degreesPrimary retention through convergenceNoneSecondary retention through grooves, slots, locksSecondary retention through bondingResistance through flat floors, rounded anglesNoneNo bevels45 degree bevelGold Features of gold inlay: convergence from gingival to pulpal wallFeatures of gold onlay: sharp point and line angles for increased retentionMain indication of DFG: small class 3 lesionDFG is 99.99% pureCrystalline or mat gold is good for: bulk fillingsPowdered gold: short working time and dense than foilMoisture is absolutely CONTRAINDICATED in: gold foilsPowdered gold: spherical shape, denser than foil, easier to manipulate, less time requiredCrystalline or Mat gold: used for bulk filling; flow and adaption poor compared to gold foil/powdered goldWhat are gold substitute alloys: they contain no gold, because they form a protective film layer for maximum corrosion resistanceCohesion of gold is an example of: atomic attractionPrimary retentive feature of onlays: Parallelism of axial wallsWhat parts of tooth prep can be managed by operator/dentist: parallelismIndirect composite inlay does not have over the direct composite: good retentionAdvantage of direct composite veneer vs ceramic porcelain veneer: conservation of tooth structureHow do you repair a porcelain veneer with composite? Micro abrasion, etch and silanemost important factor affecting pulpal response? Depth to which dentinal tubules are cutFlow of dentinal fluid inside the dentinal tubules is proportional to the: square diameter of the tubulesIt may be possible to place a restoration on 36 in an elderly without LA due to an increase in: deposition of secondary and tertiary dentinCarious destruction of dentin is slower in adults than in adolescents because of a/an: increase in dentinal sclerosisdisadvantage of glass ionomer cement? Moisture sensitivity during initial setWhen odontoblasts are destroyed as a result of cavity preparation: new cells differentiate from pulpal mesenchymal cellsTooth 11 has a small fractured mesioincisal corner exposing dentin. True with respect to the preparation for the restoration: An enamel bevel 1mm wide is placed where enamel thickness allowsComposite resin is an acceptable core build up material for an endodontically treated molar provided: there is adequate coronal dentinA dentist is restoring an endodontically treated posterior tooth with a pulp chamber-retained amalgam restoration. Ideally, the dentist should place the amalgam: 3mm deep into each root canal to obtain satisfactory retention.In the restoration of the proximal surface of posterior teeth, periodontal involvement is most likely to develop, when the restoration: has an inadequate contactTechnique of amalgam bonding can be: effective in providing an improved initial sealCaries start first at: below contact pointThe highest incidence of caries around Class II composite resin restorations occurs on gingival proximalIn the preparation of a cavity for restoration with composite resin, all cavosurface angles should be: obtuse anglesCavosurface of 90 in an amalgam preparation in important to prevent: ditching of amalgamThe major difference between a Class V cavity preparation for amalgam and for composite resin by the acid-etch technique is: the angulation of the enamel cavosurface marginsFrom facial to lingual, the axiopulpal line angle of an onlay is longer than: axiogingival line angleRetentive features: undercuts, parallel walls, elastic deformation of dentin, friction and dovetailsResistance features: pulpal and gingival walls perpendicular to occlusal forces and proper angulation of cavity walls; box shape; enough thickness of restorative material; roundingFor a short clinical crown, greatest advantage to adding buccal grooves to the participation: increase resistancePrincipal reason for a cavosurface bevel of an inlay is: marginal adaptationIn relation to marginal ridge, height of matrix band for class 2: 1 mm higher and 1 mm below gingival marginNot important in class 3 cavity preparation: extension for preventionLongest lasting composite restorations: class 3Retention points in class 3: entirely in dentinNot acceptable in class 3: you never leave unsupported enamel nor do you bevel the cavosurfaceFor a class 3 on a canine, appropriate materials: gold inlay, amalgam, GICFor a class 3 on a canine, not appropriate material is: compositeUnsupported enamel is allowed in which class: occlusal wall of class 5Unsupported enamel is acceptable in: class 3Root least likely to form ledge on it: shortWhere does caries start: apical to proximal contactSilicate cements are BAD for: proximal contactsPrep cavity: large bur from peripheral to centreWhich bacteria is involved in caries progression but not the initiation of caries: LactobacillusMost effect on caries formation: bacteriaMost common caries: Pit and fissureCWF least effective on: pits and fissuresC factor: with the increase in bonded surfaces, increases shrinkage (worst c factor is 1)Which has the highest C factor: Class 1 & 5Less bonded walls, lower the C factorHigh C-Factor = Class-1 (Occlusal)Class 1 and 55Class 22Class 31Class 40.5Smooth surface0.2Base1-2 mmLiner5 microns or 15 mmSuspension liner15 micronsCement0.5 mmPrimary baseDirectly over pulp, can be calcium hydroxide (under amalgam) or zinc phosphate (under gold)Secondary baseZinc phosphate over calcium hydroxideSolution liners should not be used under: compositesTypes of linersSolution liner – thinVarnish (2 – 5 microns)Suspension liner – thickCalcium hydroxide (20 – 25 microns)Calcium hydroxide thickness: 0.5 mmMinimum thickness for cement is 0.75 mmCalcium hydroxide in primary tooth causes: internal resorptionCalcium hydroxide in x-ray: radiolucentMain function of calcium hydroxide in endo is: antibacterial (high pH of 12.5 causes superficial necrosis; encourages pulp to induce hard tissue repair with secondary odontoblasts)CI for calcium hydroxide: symptomatic pulpWhy calcium hydroxide is advocated as an interappointment medication: for its antimicrobial activityJob of calcium hydroxide during root canal procedure: intra canal medicamentBacteria primarily for caries initiation: S. mutans; S.sobrinus and S.viridansTrue of strep. mutans: has to live on a non-shedding surfaceMost commonly associated with root surface caries: mutansThe level of streptococcus mutans has been shown to be significantly higher in the bacterial plaque adjacent to which type of posterior restoration: compositeMutans role in caries is because: it produces organic acids and gelatinous matrixThe least likely microbial species found in dental plaque is: Staphylococcus aureusOral bacteremias after a tooth extraction are rare with: strep. Viridans?True for dual cure resin cement: need initial light cure then let it set; used for large posterior cavities of crownsReason for sealing caries into the cavity: to allow formation of secondary dentin before complete excavationA patient on intravenously administered bisphosphonate therapy for 2 years has carious and non-restorable anterior teeth. Which is the best treatment option? Endo therapy of retained rootsSensitivity following composite restoration in post, most common cause: polymerization shrinkage in marginBlack margins seen around the composite filled restoration. This is due to: polymerization shrinkagePolymerization temperature: 60 – 77 CCritical pH for dentin demineralization: 6.2Demineralized enamel is: darkerLarge amalgam on maxillary first, patient broke amalgam on one cusp, what to do: CrownRapid progression of decay occurs at DEJDisto-occlusal restoration, which line angle doesn’t exist: Disto-axialMost likely for amalgam to fail: outline cavity designGreen and orange discoloration of anterior teeth is due to: bad oral hygieneGreen and orange stain on teeth: stain from demineralization caused by chromogenic bacteria in plaquebest material to use for buccal restoration in posterior upper molar: amalgamType of amalgam that needs more condensation or has the best mechanical properties: sphericalBurnishing of dental amalgam doesn’t reduce: creepWhat’s the best way to prevent proximal dislodgement/fracture of class II amalgam filling: retentive groovesThe most important cause for the marginal failure of amalgam restoration: increased creepFor amalgamResistanceFlat floors, rounded angles – 1; bevel in axio-pulpal line angleRetentionBL walls convergence - 1If a dentist notices that a large but acceptable composite is too light a few weeks after placing it, what should he do? Veneer with compositeIf amalgam gets contaminated with moisture, the most uncommon result is: secondary cariesSecondary caries is most likely at: gingival marginCreep means: material will deform under static loadPercolation: Opposite of creep; amalgam shrinks upon reduction in intraoral temperature causing marginal leakage; ingress or egress of fluids at restoration marginAxial pulp should be: 0.2-0.5 into DEJBevel occlusal floor: 15,80Hardest metal/most rigid: Gold type IV (used for fab of saddle bars and clasps)Bur used that converges F and L walls: # 169 (if not, pick 245)Sterilization best for bursdrySterilization destructive for bursSteam Most accepted theory for dentinal sensitivity: hydrodynamic theoryMore blades/flutes – less depth: less efficiency; more smooth; decreased cutting efficiency – best for polishingBur used for polishing amalgam: steelInstruments used for polishing composites: fine white stone, plastic finishing strip, finishing diamonds, mounted abrasive rubber discsMOST IMPORTANT design characteristic of a bur blade: Rake angleNegative rake angleMinimizes fractures – good for amalgamPositive rake angleGood for acrylicKind of bur that cuts most efficiently: cross cutSmooth finishing or cavity preparation is achieved by which bur: plain cutLarge diameter burs will generate: more heatSmoothest cutting, least amount of heat while cutting, but not efficient: carbide burOn a carbide bur, a greater number of cutting blades results in: less efficient cutting and smoother surfaceBur for finishing ceramic or extra-coronal preparation or porcelain occlusal adjustment: diamondBur formula – WALA (blade width; cutting edge angle; blade length; blade angle)earliest clinical sign of a carious lesion? Change in enamel opacityA patient has a 7-years-old chipped porcelain veneer on tooth 9 and desires to have the veneer repaired instead of replaced. What should be done to the porcelain before repairing with composite? Micro-etch, etch, silanate, bonding resinCurrently, bonding of composite restoration materials to dentin depends on: difunctional coupling agentWhen do you see microleakage with composite restoration done without rubber dam? 2 weeks laterCoupling agent (link between resin material and filler particles) in composite resins: organosilanesA posterior tooth has a large carious lesion extending subgingivally. Which of the following is the best initial treatment? Crown lengthening surgeryLEAST important in determining the outline form a class III composite restoration: extension for preventionExamples of excavators: spoon, angle former, hoes, ordinary hatchet. NOT is GMTExcavators have: 2 bevelsArrested caries show: shiny dark black or leathery brown-white lesioninternal line angle found in a disto-occlusal (DO) class II cavity preparation? Axio-pulpal; axio-gingival; mesio-facial (Not – distofacial)Inlay should have: sharp internal line angleA patients with a large composite resin restoration placed 1 year ago reports sensitivity in the tooth. Most likely cause is microleakage of restoration40-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? Periodic observationmost likely to create complications when making an acrylic resin temporary restoration for a large MOD onlay preparation? Occlusal surfaces left in slight infraocclusionWhen the isthmus of a MOD cavity preparation is extended beyond 1/3 of the cusp-tip to cusp-distance, the restoration of choice is a MOD onlayOnlay indication: when cuspal coverage is needed or when cusp is undermined by not enough dentinCI for onlay: high caries (best indication: low caries index)Best method for evaluating centric occlusion on a newly placed onlay: Shim stockWhere is the gold directed on an MO onlay spruce: faces pulpal axial line angleClass III amalgam restorations are usually prepared on distal surfaces of canineTwo class III lesions adjacent to each other (kissing lesion). Which one do you prep first & which will be filled first? Prep larger 1st, Restore smaller 1st pulp be protected from etch in a very deep cavity: Line it with Life or Dycal, covered with Vitrebond (a light-cured resin modified glass ionomer)In a deep cavity, what is the order of placement: calcium hydroxide, varnish and lastly baseCause of colour change around resin modified cement: microleakagereason for anterior composites to be replacedshadereason for posterior composites to be replacedmicroleakageMost fluoride release is from GI compared to RMGI factor affecting retention of restoration: Cavosurface, shape of the proximal boxTransillumination is used to detect: Class 3 cariesTransillumination of soft tissue can be used to detect: ehavi spots, salivary gland tumours, VRF and cracked toothTransillumination in children is used for: sialolithiasisTransillumination is most useful in diagnosis of anterior proximalWhen you transilluminate a tooth, which one will transilluminate the entire crown? Split toothCraze line (Whole tooth)fluorescent lightCrack and VRFtransilluminationthe 3 essential factors for the initiation of the carious lesion: Bacteria, suitable carbohydrate, and susceptible toothSensitivity to cold and pressure 2 weeks after cementation of a posterior crown is most likely related to occlusal traumaWhich type of enamel caries has a broad area of origin with a conical or pointed extension towards the DEJ? Smooth surface cariesOne advantage of using a fiber-reinforced post for restoring an endodontically treated tooth is that it has a modulus of elasticity similar to dentinWhat is the LEAST likely reason for postoperative sensitivity after a Class I occlusal composite restoration is placed? Direct toxic effects of a 15 second acid etch on pulpThe reduction of which of the following represents the most significant advantage of acid etch technique? MicroleakageDifference between acid etch and self-etch bond: smear layer is not removed in self etchingActive material to remove smear layer is: EDTA 17% (chelating)Action of etch: remove smear layer and exposed collagen to form hybrid layer with resinHybrid layer: Primer with intertubular dentina tooth gets acid etched, how long will it take for it to remineralize: 24 hoursIf bonding agent is not placed on part of enamel that has been etched by an acid solution, you would expect: enamel to return to normal within 7 daysetchant remove smear layerprimer micromechanical and chemicaladhesive micromechanicalYou did over etching, what is anticipated: dead space in dentine tubulesWhy is etch usually presented as a gel instead of a solution: to allow better control over placementLack of frosty from etching is due to: excess fluorideSubgingival margin of crown is indicated when cemental hypersensitivity is suspectedDiagnoDent detects only: Class – I occlusal caries (P & F)DYFOTI detects: Class-I, II and III cariesmajor cause of pulpal damage associated with cavity preparation: heat generationTooth least commonly involved in fracture: Mandibular premolarsHorizontal root fracture in middle third and the crown is slightly mobile: Splint and recall patientTx of HRF: Immediate reduction and immobilizationDiagnosis for HRF: take multiple vertical angulated x-raysRoot fractures in primary teeth: rare due to malleability of boneApical halfNo TxCoronal halfRigid splint or extractionThe primary advantage of an external splint over an internal splint is: conservation of tooth structureMost recurrent caries after MO composite restoration: GingivalG.V. Black concluded that the following areas on tooth surface are relatively non self cleanable: pits and fissuresDentine hypersensitivity decreases with age but has a high prevalence in young adultsAmalgam cavo margin should be at least: 70when preparing a restoration what do you use to prevent overhang of the filling: wedgewedge is used to: compensate for bandMateria alba consists of microorganisms, dead epithelial cells and leukocytesAcute pyogenic bacterial infections: leucocytosisCells in chronic pulp inflammation: Lymphocytes, Macrophages and Plasma cellsWhat's type of cells secreted by platelet in healing stage after 3 days from begin of healing? Macrophage Body’s monocytes in reserve are in: SpleenThe optimum depth of a self threading pin for an amalgam restoration is 2 mmChild Behaviour ManagementPedodonticsEruption of permanent in upper arch: 6-1-2-4-3-5-7Eruption of permanent in lower arch: 6-1-2-3-4-5-7To achieve normal occlusion, provided the molar relationship is correct, the most favourable eruption sequence in the maxillary arch is: 4-3-5A child’s behaviour problem can be managed by desensitization or familiarization if the basis of the problem is FearCompared to permanent molars, primary molars have a narrow occlusal table buccolinguallyFamiliarization is used on children who: ‘ mirror their parents’ fear of the dentistCoronal dentin in primary teeth: 50%A 6 years old child is initially frightened on sitting in the dental chair for the first time. The best approach for ensuring a productive dental visit for this child is for the dentist to: ask child about fearsYou should record the letters PNYE when charting: tooth that is unerupted but you can see it on radiographStrip crowns: Primary incisors with proximal cariesKey tooth that can be used to determine if a disruption in enamel calcification occurred before or after the age of 12 months: permanent lateral maxillary incisorDental consideration for 18 months – 3 years: allow parent to be presentMastery of skills: 7 to 11 yearsWhat is the primary reason for restoring primary teeth? To maintain arch spaceHand over mouth: not used in childrenWhat happens with intercanine distance after mixed dentition? IncreasedMaxillary intercanine width increases by about 6mm between ages 3 and 13Modelling for fearful child: Show him the procedure in non-fearful child (usually sibling)A 4 years old child has a history of frequent spontaneous pain in a primary mandibular second molar. This molar has a necrotic pulp which of the following represents the treatment of choice: pulpectomyPrimary mandibular M2 (second molar) has how many canals: 4Scammon curve is for: growthWhy apply varnish in primary tooth restorations: pulp horns are high and varnish is compatibleCurrently, fail-safe mechanism on portable nitrous oxide and oxygen machines are designed so that: oxygen concentration can never fall below 20%Common area of failure for primary composites: gingival marginMost common route for furcation involvement of the maxillary 1st permanent molar is from the MESIAL sideTooth managementPrimary 1st molar with furcation involvementExtractionPrimary 2nd molar with furcation involvementPulpectomyNo furcation involvement but other endo symptomsPulpotomyAmount of root developmentAverage tooth pierces boneWith 2/3rd root formationAverage tooth pierces gingivaWith 3/4th root formationASDA - when a permanent tooth clinically emerges, how much of root is most likely to have developed: 2/3Rule of 7Primary molar lost before age 7Eruption of premolar is delayedPrimary molar lost after age 7Eruption of premolar is acceleratedCategories of behaviour1Definitely negativeRefuse of Tx2NegativeReluctant, negative attitude but not pronounced3PositiveAccepts Tx, but at times4Definitely positiveAll goodPrimary tooth are to be percussed to exclude: ankylosisWhen preparing a cavity in a deciduous molar, a dentist causes a small mechanical exposure of one of the pulp horns. There is a slight hemorrhage and the dentin surrounding the exposure is sound. The treatment of choice is: pulpectomyWhy pulpectomy is CI in primary first molars: Because they have lots of accessory canalsClass 4 malocclusion: mesio on one side and disto on oppositeMixed dentition appliances: Nance, lip bumperPrimary upper first molar has: 4 root canalsNeutrophil of child for surgery critical: less than 1000Primary failure of eruption is due to the defect in the: dental propulsive mechanismMost common location for caries in a 4 year old child: distal of mandibular first molarPatient is 4 years old, dentist did not see a permanent second premolar in Panoramic: Dentist should assume missing second premolar and close spaceNo space maintainer before: 3-4 yearsEnamel deposition on lower second molar: 2 year oldEctopic eruption: upper first molarSpace maintainer in a 8 year old: Band and loop if mandibular anterior teeth have not eruptedWhat tooth is the most important to keep for space maintenance: Primary 2nd molarWhat does band and loop NOT do? Does NOT create a vertical stopHabit control appliance is not recommended for children under: 8 yearsSpace maintainer in a 8 year old: Lingual arch if mandibular anterior teeth have eruptedTechnique employed for lingual arch wire: twin wireActive occlusal guidance: lingual arch What do you see when your max is constricted by 3mm: shift midline towards the effected sideSpace maintainer if teeth are decayed: Crown and loop Hank’s balanced salt solution (HBSS): ViaspanSaliva VS milk storage – 2 hours VS 6 hoursHardest space to maintain: missing mandibular second molar in 5 year oldA developmentally-disabled patient should be treated with consistencyAutisticTSDDisable and uncooperativeHome usingMentally retarded Permissiveeasiest method for examining a 12-month-old child? Dentist and parent in a knee-to-knee position whit the child’s head on dentist’s lapThe most dominant emotional factor in management of 4-to-6-year-old children is fear of unknownModerately developmentally disabled 5-year-old child is crying excessively and resisting during an emergency dental visit. Which method of patient management should the dentist use in this situation? Physical restraintLoss of a primary right molar in a 3-year-old child requires placement of a: noneWhat’s the most important to prepare for class 2 primary molar: broad contactCommon occlusion in primary teeth: flush terminalAvulsed luxation in child: No TxCalcification of first molar starts at: birthCalcification of first molars end: 2-3 yearsCalcification of second molars start at: 3 yearsCalcification of second molars end: 7-8 yearsWhat percentage of permanent lower incisor starting to calcify just at birth? 0A radiograph of a 4-year-old child reveals no evidence of calcification of mandibular second premolars. This means that: these teeth may develop laterBest initial treatment for a 16 year old patient presenting with multiple extensive caries lesions on 20 teeth: place the patient on a preventive regime and delay any treatmentAge 11 dentition: Maxillary canines and first premolarsCommon seizure in kids: febrile seizures (increase in body temperature)Common seizure in adults: grand malPinkham pre-coperative child is: 3 years or younger3 years with subluxated maxillary central. Management: soft diet and monitorCI to CaOH: deep caries with pain since 1 monthPrimary direction of luxation when extracting a primary maxillary molar is: palatalLevel of co-operation based on age< 2 yearsUncooperative2TSD (reduces stress, fear and anxiety)3-7 Generally cooperative8 aboveCooperativeWhat should the dentist use to begin managing an apprehensive 5 year old child? Tell-show-do techniqueTell-show-do technique not advised in: ADHDRe-call for children: 6 monthsX-ray shows caries on distal and mesial on one primary tooth, pulp is not involved, cannot detect lesion clinically, how do you tx? SSCMost common error in preparation for SSC is: leaving interproximal ledgeWhich surface of mandibular first primary molar requires least reduction for a SSC: lingualIndications for SSC: extensive caries beyond axial line anglesEffect of extraction of primary second molar on eruption of second premolar if1/3rd root is formedIt will erupt slower2/3rd root is formedNo effectDentist ignoring unacceptable/bad behaviour is: ExtinctionUse of oral appliances to eliminate habits or punishment to deter unwanted behaviour or HOME is an example of: Aversive conditioning (positive punishment to extinguish negative bahaviour)Aversive conditioning is not routinely used, but as a method of last resort for 3 – 6 years. Unacceptable for very young, immature, those with physical disabilities or those with metal or emotional disabilitiesOther aversive examples: voice controlCI of aversive: timid and tense-coperativeAversive conditioning should always be followed by: positive reinforcement or praiseX rays are recommended for a 4 yr old kid: bitewings Compared to permanent molars, primary molars have: comparatively higher pulp hornsindicated treatment for a primary molar with a carious pulp exposure and a furcation radiolucency? ExtractionA child watches her older brother receive dental treatment. The dentist notices that the next time the child is in the dental chair her ehaviour is greatly improved. This is an example of modellingOcclusion most common in primary teeth: edge to edgeA radiograph of a 12-year-old child’s asymptomatic permanent maxillary right central incisor reveals an obliterated root canal. Treatment of choice: periodic observationPrimary dentition calcification begins at 4 months in uterocontributes most to a successful pulp capping procedure? An isolated fieldSuccess of indirect pulp capping depends on: coronal sealMaterials used in pulp capping: calcium hydroxide or RMGIWhich procedure is most unsuccessful (internal root resorption) in primary tooth with deep caries? Direct pulp cappingIf after six weeks, a pulp-capped tooth were asymptomatic, one can conclude that the lack of adverse symptoms might be: temporaryDirect pulp cap is recommended for teeth with: mechanical pinpoint exposures < 2mm and < 24 hoursIndication for direct pulp capping: accidental mechanical exposure in a clean dry fieldProcedure recommended when deep caries has been excavated and cavity close to pulp: Liner of calcium hydroxide, coat entire area with cavity varnish followed by Zinc Phosphate cement baseHow do you improve the success of calcium hydroxide on a direct pulp cap? Place GI liner over calcium hydroxideVital pulp therapy materials: Calcium hydroxide and MTAWait time until final restoration can be placed after pulp capping procedure: 3 – 4 monthsException to extraction of primary teeth: second primary molarA 6-year-old patient exhibits defiant behaviour or uncooperative at a recall examination. Which of the following techniques is indicated for the examination? Voice controlChild starts throwing fists/defiant kid: voice controlMethod should be used in a moderately developmentally disabled child in emergency treatment procedure: voice controlChild 4 years uncooperative: talk to parentbest treatment for a traumatically intruded primary tooth which in not impinging on the permanent tooth bud: allow tooth to spontaneously re-erupt4 years child Primary central intruded 5 mm what to do: let re-eruptFor a prominent maxillary frenum accompanied by large midline diastema, treatment should be: Delayed until centrals, laterals and canines have eruptedA furcation radiolucency in a 5-year-old child’s primary molar is most due to pulpal necrosisWhen can the dentist take x ray for 4 years old child caries free clinically: When spaces are closedHOME is an example of positive punishmentWhat age does a child develop dexterity for brushing teeth on his/her own? 2-3 years (Floss is 6-8 years)Dexterity comes by what age: 7-8 yearsSpeech develops at what age: 5 years (maturation at 7 years)Restoring a carious tooth relieved the toothache in a patient which further motivated him to perform better oral health care. This is a type of negative reinforcement After age 6, mandibular growth of a child mostly happens: posterior to 2nd molarsWhich primary tooth, if lost prematurely, will most frequently result in space loss? Mandibular second molarEarly mesial shiftWhen there is spacing between primary teethTemporary class 2Late mesial shiftWhen there is no spacing between primary teethClass 1OrthodonticsA patient has a severe tooth-size/arch-length discrepancy in the maxillary arch. Which of the patient’s permanent maxillary teeth are most likely to be blocked out of the arch? Canines (second premolars in mandibular arch)Methods of bite opening includes: extrusion of posterior teeth and intrusion of anterior teethLeast likely to be observed during orthodontic treatment: Devitalization of teeth that are movedClass III and lower facial height: no increaseRate limiting step in tooth movement: boneOrtho stripping: IPR/ContacEZ if 1-3 mm crowdingModerate crowding: 3-4 mm (extract primary canines)V shaped principle seen in: mandibular condyleCleaning for an orthodontic patient: every 3 monthsDental arch perimeter: mesio-distal length of all teeth summed upIn a ceph the most anterior point of the mandible on the midline is: PogonionIn a ceph the facial plane joins Nasion to Pogonion In a ceph lowest point on the contour of the chin is: GnathionIf patient has their nose always stuffed (chronic nasal congestion) & they breathe through their mouth, what happens? Anterior open biteBest illustration of V principal of growth is: ramus of the mandible Ortho bands and wires are made of: austenitic steelExpansion produced by expansion screws in treatment of crossbite is: 0.20 mm per quarter turnLow occlusal plane leads to: decreased biting forceA light force applied to the periodontal ligament during orthodontic treatment is considered? DirectWhere would the fulcrum be located when an uncontrolled tipping force is applied to the crown of a single rooted tooth: 1/3 of the root length from the apexLischer’s classification of mesio-occlusion corresponds to: Angle class 3 malocclusionThe average interincisal angle in the 12 to 17 yrs age group is: 135 degreesSoft tissue response as a reaction to ortho bands is: gingival fibrosisThree points that determine skeletal convexity: Nasion, Subspinale and pogonionWhen orthodontic force exceeds normal physiologic limits on the pressure side of alveolar crest is termed: undermining resorptionAt what age is the calcification of the fibrous tissue at the mandibular symphysis complete: 6 to 18 weeksWhat age does mandibular symphysis fuse? 6-9 monthsIf the coil and tag of a palatal retractor is placed too far distally the tooth will tend to move: buccallyIn a ceph the highest point on the upward curvature of the retro condylar fossa is termed: Bolton pointDistractionone or both halves of the dentition are at a greater distance from the median line than they are in the normal archAttractionocclusal plane of teeth lies nearer the frankfort plane than it does in the normal occlusionMandibular expansion appliance expands the arch by: tipping the teethForce delivered by a coil spring used over an arch wire segment to regain space is: 90 to 120 gramsGreatest variation in respect to the onset of mineralization: permanent mandibular second premolarA tooth rotated on its axis is termed as: torsiversionAppliance that utilizes band free technique is: CrozatCompletely tooth borne appliance: bilmerBand and crib space maintainer: unilateral, fixed and non-functionalA skeletal cross-bite, as contrasted with functional cross-bite, usually demonstrates: interference free closure to centric occlusionWhich tissue show most growth in first 6 years and then plateaus? NeuralSystem most fully developed at birth: neural systemMajority of the tissues in FACE are derived from? ectodermOssificationIntramembranous (without cartilaginous precursors)Maxilla; cranial vaultEndochondralCondyle; cranial base (ethmoid, sphenoid and occipital)BothMandiblePrimary growth centre of mandible is in: condylar cartilageAdditional space for successive eruption of permanent maxillary molars is provided by: appositional growth of maxillary tuberosityOsteoarthritis causes: open bite due to erosion of condyleMorning stiffness of muscle after 30 minutes of walking and increases during day time: osteoarthritisMaximum lateral movement of mandible is: 12 mmHow much % of adolescents have severe crowding (requiring extraction): 15%The palate of adults is vault-shaped (as opposed to flat in children), this is due to ‘ deposition of alveolar crestal boneAcanthion: tip of ANS (craniometric point at the anterior of the intermaxillary suture)Growth of condyle: upward and backwardDifficult to treat orthodontically if the growth is: clockwiseNormal SNA: 82Normal SNB: 80Normal wits angle in girls is: 0Normal wits angle in boys is: -1If wits angle is < - 3, then: class IIIWits is similar to: ANB (measures skeletal growth)ANB greater than 2: IIANB less than 2: Class IIIEarly closure of sutures: synostosisCampbell line: occipitomental projection/water’sFrankle functional device performs: increase VDO, mandible downward/forward, expand arches, BUT NOT: retract maxillary molarsTissue born appliance: Frankel (pushes the mandible forward and downward by pushing against lips and cheeks)Tooth born appliances: HABTActivator: Activates mandibular growth to correct class 2 malocclusionBionator is same as Activator, but more comfortableDescribe Bionator: lingual, horseshoe-shaped acrylic with a wire in the palatal area to guide maxillary and mandibular posterior teethHerbst connections: maxillary 6 and lower 4Herbst appliance tendency: procline mandibular incisorsFatigue resistant device: Efficient in treating class 2 with minimal compliance and breakage problemsGrowthMandible growthepigenetic, genetic and functionalMaxilla growthgenetic and functionalRapid accelerator phenomena: corticotomy around teeth to be movedTongue thrusting does NOT cause open bites or cross bites! It is the result, not the causeWhich one first ortho or frenectomy: orthoAtypical enlargement of orbicularis oris is indicative of: tongue thrustingWhen trying to take a CD impression, which will interfere with the buccal space: Orbicularis OrisFUNDA: In crowding, maxillary canine and mandibular 2nd premolars will pop out in crowding, the LAST succedaneous teeth will be out of the arch)Most stable area to evaluate craniofacial growth: anterior cranial baseTrue about alveolar bone: It is in a state of constant fluxwhat does the moyers and tanala probability chart predict when a transitional dentition analysis is performed? Width of permanent canines and premolars using mandibular incisorsWhich dimensions are compared in the transitional dentition analysis: space available to space requiredTanaka: Predict MD canine & premolar width using ? of sum of all 4 lower incisorsWhat does the Moyers probability chart predict when a transitional dentition analysis is performed? The space available for permanent canine and premolarsMoyers' mixed dentition analysis. Which teeth will be measured to predict the size of the unerupted canines and premolars? Mandibular incisorsEsthetic brackets are: ceramicFrankfurt-horizontal plane is constructed by joining: porion and orbitaleCamper’s line: occlusal rim parallel to ala tragus lineLowest point on the lower margin of the bony orbit on a ceph is termed: orbitaleBest representation of the natural orientation of the skull: Frankfurt horizontal planeBest retention in removable is obtained by: Adam’s claspBest retention for bridge work in general: Upper first premolarClasp used on second molars and canines: Circumferential claspClasp that provides ‘push type’ retention on PD: Circumferential (aker’s) claspClasps generally used on a tooth-supported removable denture: circumferential claspPure translation (bodily movement) center of rotation is at: infinityTooth movement that causes root resorption: translationCentre of rotation for crown movement is at the: root apexCentre of rotation for root movement is: crownEarly loss of upper e leads to anchorage loss of upper first molar as: mesial tipping, mesio-palatal rotation and mesializationOptimum force required for tipping a single rooted tooth: 10-20 grams Couples are usually created by: edgewise bracketsDoubling the force applied at the bracket of a tooth would have what effect on the moment affecting tooth movement: moment would doubleEdgewise appliance is: rectangularOrtho for intrusion motion: Edgewise In edgewise appliance tooth movement is carried out by: arch wireExtraction pattern of class II surgical cases is: lower first premolars onlySunday bite is defined as: habitual forward posturing of mandible to Class 1 or pseudo class 3Pseudo Class III is defined as: posturing of mandible to Class II due to a premature contactmajor etiologic factor responsible for Class 11 malocclusion is: tooth:jaw size discrepancyClass II elastics are given from: upper canine to lower first molarClass III elastics, maxillary molars will: extrusion and distalization of molarsCO-CR shift is normal: 1-2 mmCanine guided occlusion means: canine to canine on balancing, no contact on working sideHow balancing side should look like: 3 cusps should touch but not canineSerial extraction indicated for: anterior mandibular crowding of more than 10 mm and 35% overbiteDecompensation is done as part of: pre-surgical orthoDental compensation in skeletal class III cases is: retroclined lower and proclined upper incisorsFlat angulationLong teeth Short faceClass 3Steep angulationShort teethLong face (open bite)Class 2Optimal force for bodily movement is: 75-125 grams force per toothCortical drift is a growth process involving: deposition and resorptionMoment is defined as: force * distance from centre of rotationMinimum anchorage is defined as: 2/3rd of extraction space is utilized by the movement of anchor unitFirst order bend are: in and out bendsFrontal ceph is used to: assess facial symmetryFace mask produces: AP effectIn RPE, activation is done: twice dailyTissue-borne RPE is: HassRPE is assessed by: upper occlusal Most ectopically erupted tooth is: upper first molarANB is used to assess: sagittal jaw discrepancyAnterio Bolton is: 77.2%Excess in lower anterior Bolton is an indication for: stripping in lower incisors or lower incisor extractionTAD uses what for its main support: cortical boneCancellous bone provides: new boneBaker anchorage is a type of: intermaxillary anchorageAnchorage (resistance to movement)Absolute means zero anchorage lossReinforced Adding additional teeth to a unit to distribute the force over a greater area and therefore slowing the movement of anchor unit. Examples: headgear or interarch elasticsStationaryAnchor teeth undergo translation or root movement and the reactive unit undergo tippingCorticalAnchor teeth roots are moved into cortical bone, which resorbs more slowly than medullary bone. However, this may cause root resorptionImplantPalatal implants and mini-implants are used as absolute anchorage for holding of moving teethChildren in the primary dentition most often presents with: decreased overbiteSpheno Occipital synchondrosis resembles: epiphyseal platesWhat is Spheno Occipital synchondrosis: cartilageLast synchondrosis to calcify: Spheno occipitalFirst synchondrosis to calcify: IntersphenoidWhich type of bone density is compact bone with dense trabecular: Type 2A patient has a skeletal deformity with a Class III malocclusion. This deformity is the result of a maxillary deficiency. The treatment-of-choice is: surgical repositioning of the maxillaConsequences of up righting molar: Hyper occlusionTooth and tissue borne appliance: Nance (intra-oral anchorage reinforcement)Classical pattern of extraction in Class II camouflage is: Extraction of upper 1st premolars and lower 2nd premolarsLeast successful treatment of diastema: compositeRelapse less likely for which movement: ExtrusionRelapse most likely for which movement: RotationWhich fibres are responsible for orthodontic relapse: oblique, circumferential or transseptalStable point in child ceph: Mandibular canal and Sella (underneath sella – sphenoid sinus)Sella is not a ceph landmarkOn a lateral cephalogram of the 10 y.o girl what is the radio opacity that crosses her maxillary posterior teeth? Palatine process of maxillaSerial lateral cephalometrics: predict the exact spot on the growth curveA lateral cephalometric radiograph for a patient with a 3mm anterior functional shift should be taken with the patient in: initial contactMain images used in treatment planing for orthognathic surgery: lateral cephMost useful in diagnosing bimaxillary protrusion: CephalometricsReliable indicator with respect to the timing of treatment of growth modification: skeletal ageBraces for a person with bad oral hygiene: removableLight or heavy ortho forces cause: direct or indirect resorptionDirect force is: continuousDolichocephalic face is: long facebest describes adjunctive orthodontic treatment: Orthodontic treatment to enhance restorative and periodontal rehabilitationMandibular growth occurs by: posterior deposition and anterior resorptionIn 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? Making sure there is adequate spaceis related to reciprocal anchorage in orthodontic therapy? Equal and opposite forcesA posterior crossbite in the deciduous dentition will most likely = present in permanent dentitionMost common tooth to erupt in crossbite: lateral incisorAnatomic crossbite, as contrasted with a functional crossbite, usually demonstrates: smooth closure to COUnilateral crossbite is a true crossbite, midline coincidesAnatomical/skeletal crossbite: smooth closure into CRCrossbite appliances: Hyrax (tooth-borne), Haas (tooth+tissue), Hawley (expansion + fixing rotated teeth), Transpalatal arch, Quad-helix & W-arch (correct rotated molars)Hawley appliance is NOT used for correction of: skeletal crossbitesMost common type of active tooth movement in primary dentition: correct a posterior crossbite (transverse problem)Crossbite correctionPosterior crossbite in mixed dentitionImmediatelyAnterior crossbite in mixed dentition – mildImmediatelyIn primary dentition, anterior and posteriorImmediatelyOrthodontic correction of anterior crossbite is the most easily retainedOld patient with posterior cross bite or patient in mixed dentition: Quad helix (passive occlusal guidance)Tx during mixed dentition: anterior/posterior crossbite and class 2 molar relationshipNot tx during mixed dentition: maxillary incisor rotationTooth in the anterior arch is the most common to erupt in a cross bite: upper lateralIf crowding in mandible, which tooth will pop out: second premolarMost difficult ortho movement to achieve: intrusionWhat requires LESS force than uprighting: IntrusionIntruded tooth is treated first by: repositioningtrue regarding orthodontic tooth movement? Blood flow within the PDL is altered after force application; Chemical changes in the compressed PDL stimulate cellular differentiation; Oxygen tension is increased in some areas of the PDL and decreased in other areasPDL fibres (immature elastic – oxytalan and eluanin): regulate blood flowPain (first sensation to disappear)Free, unmyelinatedPressure (last sensation to disappear)Large, myelinatedpain; temperature; touch; pressure To achieve ideal overjet and overbite in an adult patient with a 16 mm pre-treatment overjet, orthodontic treatment would most likely require: combined ortho/surgical treatmentArch length discrepancy or most important in retaining space or loss of which primary tooth leads to the most drastic space loss: premature loss of primary canine or primary second molar?The greatest amount of space closure following premature deciduous tooth loss occurs in the: mandibular second premolar areaPremature loss of which tooth will cause mesial drift of permanent tooth: primary second molarPremature loss of primary maxillary canine most directly results in: midline shift (Not affected is – molar relationship; posterior crowding)Decrease of arch length (during growth) in maxillaDue to uprighting of incisorsDecrease of arch length (during growth) in mandibleDue to loss of leeway spaceArch lengthDistal 2nd PM to distal 2nd PM or Mesial M1 to Mesial of M1Arch widthInter-canine spaceHow many hours per day should a cervical pull headgear be worn to achieve the most effective results? 12 – 14 days (min – 8)HeadgearWhich headgear moves maxillary teeth forward or correction of class 3?Reverse pull head gear (protraction)/facemask (uses elastics)Corrects class 3 caused by mandibular/condylar growth. It does so by redirecting mandibular condylar growth into a superior and posterior direction (brings the mandible back)Chin cupClass 2 Div 1Straight pull headgearCorrection of class 2 by restricting maxillary anterior/downward growth and by causing distalization and intrusion of maxillary molars as they eruptHigh-pull headgearCorrects class 2 with DEEP BITE, but unlike high-pull, it causes extrusion (rather than intrusion) of maxillary molars in addition to the distal forceCervical pullClass 2 but is the only one which is NOT orthopaedic. It retracts maxillary canines and incisors (dental)J-hookUse of protraction headgear: Class 3 where there is maxillary deficiencyWhich headgear protracts maxilla only: reverse pullMajor disadvantages of treatment using a cervical headgear is: extrusion of maxillary molarsWhich teeth most likely to be crowded/blocked out of mandibular arch? Second premolarsTongue blade is used in: thumb sucking (should be stopped before permanent incisors erupt)Third order bend: torquemost optimal treatment time to use cervical headgear based on skeletal maturation indicators (SMI): SMI 4-7Growth spurts: 12 for girls and 14 for boysClass III malocclusion will have difficulty with sounds: f and vWhat can’t the patient not say if upper anterior are too superior and forward for denture teeth? F-VFirst sound we form: P and BSound teeth should contact lower lip: fWhat’s labioalveolar sounds? ‘ Kb,GpThis, That, Those are the linguodental sounds which help determine: the labiolingual position of anterior teeth.PeriodonticsA normal stimulated salivary flow rate for an adult patient should be: 1 ml per minute or 1.5 L/dayA normal unstimulated salivary flow rate for an adult dentate patient should be: 0.1 ml per minutePerioChip: CHXDiagnostic test is based on the ability of complementary nucleotide strains to bind: DNA probeExperimental gingivitis model does not prove that: gingivitis progresses to peridontitisEnzyme incorporated into a mouthwash most likely to interfere with microbial aggregation in the plaque mass: DextranaseSalivary gland responsible for stimulated saliva: ParotidWater pik devices can only: dilute bacterial productsMost effective means of controlling post-surgical root sensitivity after periodontal surgery: plaque controlRemoval of gingival overhangs and correction of open contacts come under: initial stage of tx planTechnique that permits specific identification of plaque microorganisms: Immunofluorescent microscopyBest instrument to determine location of subgingival calculus: double-ended curved explorerWhy do you check occlusion in pts with perio abscess: edema can cause teeth to supra eruptNecrotizing periodontal disease is characterized by: necrosis of marginal gingival tissue and interdental papillaeNot a mode of action of an ultrasonic instrument: sharp cutting edge of tipWhat has the biggest effect on the flap? Final position of flapCI for distal wedge: lack of attached gingivaPerio first or Ortho first? Perio firstControlled vs. non have same: perio problemsA.A. is not: acidogenic bacteriaIn perio, only bone resorption occurs: FalseHydrotherapy “waterjet” is used to: ‘remove pellicle from tooth surfaceListerine or triclosan is: phenolic compound – negative or uncharged charged (most common mouthwash)CHX charge: positiveClass II furcation, which instrument is the worst to clean a class II furcation: rubber tip (interdental papilla)Where does the epithelial cells for a graft come from: recipient CTScope or cepacol: Quaternary Ammonium compoundsAtropine is more potent than: quaternary ammonium derivative (methylatropine)Perio Aid: tapered tooth pick for class 2 furcationsStippling of gingiva is indicative of: degree of keratinizationStippling absent in childrenFestooning of gingiva: distinct rounding and enlargement of margins of the gumInterproximal bone is apical to radicular bone, this is: reverse or negative architecture (common in maxilla)Positive bone architecture: alveolar bone is more coronal interdentally than facially/lingualFremitus indicates: tooth contact during lateral excursionsMature plaque happens in: 24-48 hoursHow many hours until plaque accumulation (after brushing or eating?): 1 hourBacteria present in gingivitis: gram positive cocci and rodsDominant serotype AB: IgG2Perio and cerebral palsy: No increase in periodontitis; more prone to anterior tooth fractureMiller Class I recession defects can be distinguished from Class II defects by assessing the: involvement of mucogingival junctionHow many days does it usually take for surface epithelialization to be complete following a gingivectomy: 5-14Greatest chance for recurrence of periodontitis is: maxillary second molarsIn crown lengthening procedure which surgical technique is best performed: osseous recontouringControlled diabetes has same perio problems as those who don’t have diabetes: TRUEDrug induced gingival hyperplasiaDrugs: C-VPN (cyclosporin, verapamil - CCB, phenytoin, nifedipine)# 1 cause of medication induced gingival hyperplasia: dilantinDrug that causes inter-papilla gingiva to swell: dilantinGingivitisInitialPMNEarlyLymphocytesEstablishPlasma cellsPeriodontal health/early plaqueStreptococcus gordonii and actinomycesGingivitisForsythus (gram positive rods and cocci and gram-negative cocci)Adult periodontitisP. gingivalis (gram negative)Periodontitis classificationCase typeProbing depthBone lossMobilityFurcationCALSlight4-510111-2Moderate5-6331 & 21 & 23-4Severe>6>331, 2 & 31, 2, 3 & 4> 5Adult periodontitis is characterized by: periods of attachment loss and longer periods without any attachment lossPrimary defense cells of Innate immune system: NeutrophilsAdaptive immune system: T-lymphocytesT-lymphocytes attack what in lichen: basal keratinocytesAntigen-presenting cells: MacrophagesPlasma cells produce: AntibodiesBismuth line: marginal gingivaLead line: dark marks on gingivaNon-specific plaque hypothesis: disease is caused by bacterial toxins (regardless of bacteria type) and is dependent on the quantity rather than quality.Specific plaque hypothesis: Pathogenic potential of plaque depends on the presence of, or increasing specific microorganismsEcologic plaque hypothesis: putative pathogens are present in both healthy and diseased sites Oral rinses (apart from CHX and listerine) that reduce gingivitis: Stannous fluoride, Cetylpyridinium chloride (quaternary ammonia), SanguinarineThe normal range of gingival depth “Epithelial attachment” in a healthy mouth is: 0-3 mmDifference between prophylaxis and SRP: prophylaxis when pockets are 3mm or less, SRP is for pockets > 3mmBacteria in plaque communicate through: quorum sensingCalculus is NOT irritating to the gingiva! Plaque isCalculus is clinically significant because it is rough, retains plaque and: absorbs harmful, toxic chemicalsTeeth most affected by periodontitis: mandibular incisorsPrevalence of subgingival calculus in US ADULTS as suggested by surveys is 0.5-0.75Chronic periodontitis most commonly found in: blacksBleeding during circumferential probing means destruction of: non-keratinized epiIf stimulation not mentioned: 1 L/dayMost cervical enamel projections: mandibular molarsPhase III is: periodontal reconstructionSmoking and plaque: decreases inflammation in response to plaqueHow long does it take for osteoblasts to produce woven bone: 1 monthLeast effective in removing crevicular plaque: toothpickDrug has the highest concentration in crevicular fluid: tetracyclineCell highest in the crevicular fluid: PMN What to check in perio maintenance: root cariesBiological width: 2 mm (implants: 3-4 mm) (JE (0.97) + CT (1.07)Center of resistance in a healthy tooth: ? the distance from alveolar crest to root apex (it is more apical in periodontal teeth)What happens when a force is applied at a point other than center of resistance: moment (rotation)Putting a force through what would cause pure translation of a tooth without rotation, tipping, or torque? Center of resistanceForce through the centre of resistance: translation or bodily movement Single rootedLong axis of tooth 1/3rd – ? from alveolar crest to apexMulti rootedApical to furcation“Random burst” periodontal theory: progression of bone loss at individual sites is INDEPENDENT of previous bone loss and ageUsed to check JE: explorerIn smokers, you don’t see: Increased BOPWhich appears on tooth first: pellicleWhat comes first after tooth brushing: pellicleInitiator of plaque before bacterial attachment: pellicle (not part of plaque)Most damaging to PDL: lateral luxationA patient’s measured stimulated salivary flow volume is 0.5 ml/minute. The term that best describes this condition is hyposalivationWhat will you not do for aids/hiv patient? Multiple free gingival graftsPeriodontal disease is associated with what systemic diseases? Diabetes and HIVIn a free gingival graft, what determines the type of epithelium that is going to be present: epithelium of donor siteWhere does the epithelial for a graft come from? Recipient connective tissueFree gingival graft gets blood from base firstFree gingival graft, which area can be affected: Greater palatine nerve bundleMain reason for failure of free gingival graft: failure of blood supply. The second reason is infectionFollowing placement of FGG, the graft epithelium undergoes: desquamationSloughing of free gingival graft after 1 week: normalRecession of a single tooth, what do you do: Free gingival graftCorrection of an inadequate zone of attached gingiva on several adjacent teeth is bestaccomplished with a/an: free gingival graftGraft for root coverage: CT graftSuccess of a free gingival graft depends upon: graft being immobilized at recipient siteDistance from marginal gingival to mucogingival junction is 5 mm and the probing depth is 7 mm. Acceptable treatment is: an apically positioned flapProcedure of choice in obtaining root coverage when recession has occurred on the facial surface of a tooth with interproximal bone and soft tissue intact: connective tissue graftHemostasis is doubtful with: FGAGTooth CI in a grafting procedure: maxillary canineFree mucosal graft or subepithelial CT graftOften used on caninesFree gingival graft Often used in conjunction with a frenectomyPeriodontal pathogens: Porphyromonas gingivalis, Eubacterium sp., and Campylobacter recta (CPE)Early onset periodontitis is likely caused by: Porphyromonas (bacteroides) ginigivalisSyndrome with high P.gingivalis: Down’sEndo pathogens: Eubacterium, Porphyromonas, Prevotella intermedia, Bacteroides, Peptostreptococcus, Fusobacterium (PPP EFB)Bacteria capable of producing black pigments are: porphyromonas gingivalisPerio with chemotaxis: aggressiveStrawberry gingivitis: Wegener’s granulomatosis (Tx: cyclophosphamide; Rituximab)Strawberry tongue and pharyngitis: scarlet fever (fungiform papillae involved)Scarlet fever caused by: Strep. Pyogens or some strains of group A strepOther name for scarlet fever: Kawasaki disease & toxic shock syndromePatient with a white coating of the tongue that sloughs off leaving a deep red surface with swollen hyperplastic fungiform papillae: Scarlet feverScarlet fever does not involve: gingival bleedingScarlet fever manifestation in children: skin rash caused by erythrogenic toxinAB help to reduce pockets by: shrinkageCoe-pak: non-eugenol pasteSurgical flap access therapy is indicated and most beneficial when used: for those early to moderate defects not resolved with initial therapyFunction of lateral sliding flap/pedicle graft: cover isolated denuded root and narrow gingival recession or to fix gingival recession in anterior regionLeast desirable place to place graft: mandibular 1st premolar spaceRequirement for lateral sliding flap procedure: adequate amount of keratinized donor tissue & ultra-thin recipient tissueCI for lateral sliding flap: shallow vestibule; prominent recipient rootFlap around second or third molar will affect: external oblique ridgeAn apically displaced flap is generally impossible in: Maxillary palateAllowing the ultrasonic-scaler tip to remain on the tooth surface too long will: damage the tooth surfaceNot a characteristic of sickle scaler: rounded backSickle scalers have: 2 cutting edgesDevice to accurately measure tooth mobility: Perio-testPapillon-lefevre syndrome is characterized by: hyperkeratotic skin lesions; early loss of primary teeth; If permanent teeth as well: AcatalasiaAngulation of scaling and root planning: 45-90 (if more than 90, will slip)Root planing strokes are LONGER and LIGHTER than scaling strokesScaling: removing calculus from root surfaceScaling and root planing does not remove: enamelRoot planing: removing calculus from cementumRoot planing should be performed between the: JE and CEJCrush heavy calculus: Hoes and filesFeatures of hoe: Cutting edge 90 degrees to handle and used for Class 3 and 5 gold prepsFeature of hatchet: Cutting edge is in same plane as long axis and is bi-bevelled; used on anterior teeth for preparing retentive areasCalculus formation takes 12 daysCalculus attach to teeth by 4 different ways: acquired pellicle; mechanical interlocking, penetration into cementum, adaption to surface depressionsAcquired pellicle is derived from: salivaBiologic width (2 mm): JE+CTWidth of periodontal ligament: 0.2 mmPathogens evaluated in DMDx test: eikinella, campylobacter, fusobacterium and treponemaSevere spreading abscess: FusobacteriumDistance from CEJ to the beginning of the furcation entrance on the distal of a maxillary first molar: 5 mmIn a maxillary molar, the furcation that is more apical than the other: distal FurcationMaxillary first premolarApicalMaxillary first molarCoronalMandibular first molarJunction between middle and coronalIn a healthy gingiva the JE should be entirely: ABOVE the CEJFacts about AA in aggressive perio: AA invades soft tissues, so SRP is less likely to succeedPeriodontal disease most nearly ehavi Koch’s postulates: LAP (AA) and P. gingivalisDiameter of soft brush bristle: 0.007 inch or 0.2 mmNew plaque principally accumulates after a patient brushes their teeth: inter-proximallyTooth brush penetrates 1 mm and floss 2 mm into the sulcusExplorer to detect calculus and root roughness: 11/12Red complex (last colonizers) consists of: porphyromonas gingivalis, troponema denticola and Tannerella forsythus (PTT)Red complex associated with: chronic periodontitis with deep pockets and recessionRed complex is associated with: chronic periodontitis with deep pockets and recessionOrange complex (FPC): secondary colonizers seen in gingivitis (fusobacterium, prevotella, campylobacter)Green complex: capnocytophaga, eikenella, A.A.Purple, green and yellow complexes: primary colonizers of sub-gingival calculusFirst colonizers/initiate caries: streptococcus and actinomyces - SAEarly colonizers of supragingival plaque: S. SanguisMiddle/bridging colonizers: fusobacterium nucleatum – facilitates coaggregation between early and lateLate colonizers: Prevotella, Aa, Capnocytophaga, Treponema - PACT2 year old plaque consists primarily of: filamentous organismAggressive periodontitis localized: A.a.Teeth most lost in local aggressive periodontitis? Max molarsSupragingival calculus composition: 58% hydroxyapatite Stages in dental plaque formation - PACFirst phasePellicle (glycoproteins, enzymes, proteins, phosphoproteins)Second phaseInitial adhesion and attachmentThird phaseColonization and plaque maturation / “coadhesion” – mature biofilmFourth phasePhases of specific bacteriaSupragingival calculus is always AttachedSubgingival calculus is alwaysUnattachedComplex of bacteria associated more with chronic periodontitis: orange-redPregnancy/puberty bacteria: P. intermediaPregnant gingivitis high in: ProgesteroneTooth most lost to perio: Maxillary second molarTooth most lost to endo fail: Maxillary first molarThe probe tip penetrates: to the most coronal intact fibers of the CT attachmentCorrect probe force is 10-20 g (depress the thumb 1-2 mm)Horizontal bone loss is usually associated with: suprabony pocketsSystemic AB do not play any role in management of: chronic periodontitisTwo earliest signs of gingivitis: increase in GCF and BOPEstablished gingivitis has: plasma cells with significant levels of immunoglobulins and migrating leukocytes in the JEWhich cell is greatly increased in the progression from mild to severe gingivitis: Plasma cellMeasurementsThe width of attached gingiva is the distance between the mucogingival junction and: bottom of sulcus or pocketWhat is attachment loss: loss of CT attachment; apical migration of JE away from CEJAttachment level: CEJ to depth of pocket/sulcusDistance between JE and alveolar bone: 1.07 mmWhat position of the gingival margin would result in the probing depth being the same as the attachment loss: at the CEJDehiscence 2 mm, pocket 6 mm, loss attachment: 8 mmPocket depth: free gingival margin to base of pocket (JE)Attachment level: CEJ to base of pocketBiological width measurement: base of sulcus to alveolar crest or most apical extension of crown margin to alveolar crestRecession: pocket depth + CALHyperplasia: pocket depth – CALDepth of sulcus is 5mm the distance between CEJ and the base of sulcus 3mm..How much is the attachment loss? 3 mmAttachment loss is: distance from CEJ to base of pocketEpithelial attachmentLamina lucida + lamina densa + hemidesmosomesJEEpithelial attachment + sulcus + apical extentJE is entirely aboveCEJEpithelial attachment has noRete pegsJE is connected to tooth via hemidesmosomesAcute infectionNeutrophilsChronic infectionLymphocytes, macrophages, plasma cellsPredominant cell in gingivitisPMNEarly gingivitisLymphocyteEstablished gingivitisPlasma cellsFirst group cells to arrive at site of injury or pulp necrosisNeutrophils/PMNViral infection and chronic gingivitisLymphocytesAnaphylactic & allergic responseMast cellsHuman gingiva or gingival sulcus high inMast cells and IgGIg concentrated in GCF: IgGIg concentrated in saliva: IgAGreatest amount in normal GCF and acute periodontitis; migrate into the gingival sulcus in the largest numbers in response to the accumulation of plaque: Neutrophils/leukocytes/PMLCells that are significantly phagocytic: neutrophil and histiocyteGCF in smokers: decreasesNutrition for GCF is from: carbohydratesChemotaxis in the sulcular fluid: C5aInitial periodontitis: lymphocytesMucous glands are not seen in: gingivaLEAST likely to lead to the development of root surface caries on facial surfaces: Streptococcus sanguis dominating adjacent plaqueA 14-year-old female has gingival tissues that bleed easily on gentle probing. The color of the gingiva ranges from light red to magenta. Probing depths range from 1 – 3mm. Some of the interdental papillae are swollen. Which of the following represents the most likely diagnosis? Gingivitisbest initial treatment for a patient with localized aggressive periodontitis? SRP plus systemic AB (tetracycline)Neutrophil chemotactic defect/depressed is associated with: localized aggressive periodontitisRinse for localized aggressive periodontitis: H2O2Associated with periodontal disease: smoking; age; genetics. NOT – nutritional deficienciesA two-day old developing plaque would consist primarily of: gram positive cocci and rod-like organismsPathogenic bacteria that invade periodontal tissues: Porphyromonas gingivalis and A.A. Cells of periodontium considered to have the greatest progenitor ability: PDL cellsWidest zone of attached gingiva: anterior>molars>premolarsAttached gingiva thickest in: lateral maxilla and lower first premolarNarrowest width of keratinized gingiva: mandibular first premolarWidth of keratinized gingiva: free + attachedSupra-gingival plaque: gram positiveSub-gingival plaque: gram negativePeriodontal abscess: gram negative, anaerobicWhen compared to non-smokers, smokers present with: periodontal disease at an earlier age; poor response to conventional therapy; recurrent perio in spite of treatment. NOT is increase in plaque induced ehaviourlGingival response to plaque microorganism in elderly is: exaggerated due to an altered host immune responseTo increase crown length for a fractured maxillary central incisor: periodontal flap with osseous surgeryNOT a direct physiological response to additional forces placed on abutment teeth: Decrease in width of PDLInitial management of localized periodontal abscess: pocket debridement/SRPMost commonly lost tooth to perio: Maxillary premolarsinflammatory mediators may be indicator of disease activity: interleukin 2Interleukin related to bone destruction or perio: interleukin 1PST is a newly developed genetic test aimed at screening patients who are at risk for perio. PST screens for abnormally high levels of: Interleukin - 1MMP 1 is secreted by: neutrophilsMMP 8 is secreted by: macrophagesIL 8 is: chemotaxisIL 10 is: macrophagesMMPs are majorly associated with: diabetic patientsMost important proteinases involved in destruction of periodontal tissues: MMPWhich mediator produced by plaque bacteria induces bone loss: endotoxinImportant constituent of gram-negative bacteria that contributes to initiation of host inflammatory response: EndotoxinAdvantage of distraction osteogenesis: Less relapse; bigger stable movements; easier in children; hospitalization time is less; increase bone length and volume simultaneouslyWhat is distraction osteogenesis: surgical procedure used to reconstruct skeletal deformities and lengthen long bones of body or biologic process of new bone deposition and formation between osteotomized bone surfaces that are separated by gradual tractionDisadvantage of distraction osteogenesis: Long term follow up; compliance is difficultWhen is distraction osteogenesis preferred over a traditional osteotomy: When a large advancement is needed such as reconstruct skeletal deformities and lengthen long bonesEpithelium growth per day: 0.5-1mmWhich Antibiotic can be given in gingival ehaviour fluid for periodontal bacteria: doxycyclineonly tetracycline that is INDEPENDENT of renal or hepatic failure, because it is excreted inactive in the feces: DoxycyclineTetracycline hydrochloride or citric acid conditioning of root surface will enhance what: binding of fibronectin and fibroblastsWhich population is associated more commonly with chronic periodontitis? Black males20 mg doxycycline hyclate’s primary mechanism of action is inhibition of collagenaseMesial root surfaces is unlikely to be thoroughly cleaned with the use of floss or What tooth has developmental groove, which influences to development of primary periodontitis: Maxillary first premolarFormulations of subgingival doxycycline? Periostat 20% and atridox 10%AB used in GCF: doxycycline and minocyclineMOA of Periostat (low dose – 20 mg of doxy): Inhibits collagenase/protein synthesis – inhibition of tissue destructive enzymesLocal drug deliveryAtridox10% doxycyclineArrestin2% minocyclinePeriostat20% doxyDrug used for host modulation: Doxycycline and tetraMOA of Doxycycline: Inhibit collagenase/inhibit MMPFacts about doxycycline: bacteriostatic and interferes with 30s How to make patient comply to oral hygiene: ask him to note when he doesn’t flossmost common osseous defect? CRATER (2 wall)Appearance of an osseous crater in a bitewing x-ray will show: more bone than what is actually lost4 walled defect is: trough/moatOne wall defect: hemi-septum (only proximal or distal wall left); ramp (only buccal/lingual wall left)Hemi-section with best prognosis: furcation that is more coronalHow do you extract molars with divergent roots: HemisectionCI for maxillary molar with class 2 furcation: hemisectionMost prevalent wall defect: 2 walledLeast likely to need a bone graft: 3 walled (best would be 2 walled)Type of bony defect that has the greatest potential for regeration: narrow 3 walled defectBony defect is best determined by: full flap explorationDehiscence or fenestration (there is a fence) – 0 walled defectCircumferential defect over a root: dehiscence Osseous resective surgery is best suited for periodontal sites with: early – moderate boneless Movements in piezoelectric ultrasonic devices: Linear (back and forth), 2 sidesMovements in magnetostrictive: elliptical, all sides are active (4 sides)Movements in sonic: linearTrue about sonic ultrasonics: water and air from sonic kills bacteriaThe primary etiologic factor associated with periodontal attachment loss in a furcation is the presence of oral biofilmFact about biofilm: Planktonic bacteria are recruited into the ecosystem of a biofilm byquantum sensingA 45-year-old patient has undergone scaling and root ehaviou in all 4 quadrants. The oral hygiene of the patient is excellent but generalized 5 mm and 6 mm pockets remain that bleed upon probing. What is the next step and the best treatment for the patient? Periodontal surgeryPerio epithelium migrates at what rate during healing? 0.5-1 mm/24 hoursbest indicator of periodontal stability over time for the patient on periodontal maintenance therapy? Bleeding on probingSRP most effective on which type of tissue: edematousUpon mastication, a patient has severe pain in a mandibular first molar. Clinical examination reveals furcal bone loss, a sinus tract that is draining through the sulcus, normal interproximal bone height, and no response to vitality testing. The treatment of choice is: RCT first, then periodontal therapy, should the lesion not resolve.Periodontal maintenance following completion of active periodontal therapy: should be tailored to the needs of the individual patientThe purpose of scaling is to remove acquired deposits on the teeth. Scaling can be performed on both enamel and root surfaces: First true, second is falsePlaque microorganisms produce extra-cellular substances that separate one bacterial cell from another and that form a matrix for further plaque accumulation. This “matrix” is made up of dextrans and levans (formed by lactobacillus)Caries is caused by: dextrans (insoluble and sticky)Bacteria adhere to teeth by: dextransThe dietary carbohydrate most Iikely involved in the etiology of dental caries: dextran (insoluble and sticky)Plaque is able to adhere to teeth because: dextrans are insoluble and stickyAn indispensable factor in the Etiology of dental caries is: activity of bugsPrincipal component of plaque is: bugsCarbohydrate present in greatest amounts in the matrix of supragingival plaque is: dextranmost likely the major consideration prior to performing a gingivectomy: width of attached gingivaThe base of the incision in the gingivectomy technique is located: above or coronal to the mucogingival junctionGingivectomy is NOT indicated when the base of the pocket is located apical to alveolar crest or infrabony or pocket beyond or at the mucogingival junctionPosition of blade during gingivectomy: apical to JEIncision for gingivectomy: External bevel incisionpurpose of “bleeding incisions” in gingivectomy: guide for incisionFollowing gingivectomy, epithelial cells come from: surrounding attached gingivaGreatest influence on the type of incision to use in flap surgery: amount of attached gingivaAfter flap surgery, PDL moves: occlusallyGreatest influence on the type of incision to use in perio flap surgery: amount of attached ginigvaIncision for flap procedures: Internal bevel incision (better healing, less discomfort)While doing external bevel incision the curette is touching which structure apically: JEInternal bevel incision is from: free gingival margin to crest of bone or at least 3 mm coronal the MGJPurpose of internal bevel incision in a periodontal flap: help adaptation of gingival margin to bone-tooth junction; conserve uninvolved surfaces of gingival tissues; remove epithelial lining of pocketBleeding spots established in gingivectomy to: outline incision lineAfter a gingivectomy, how does the site heal: endothelium of blood vesselsWhat direction is the reverse bevel (internal bevel) incision? Axial toward boneRisk of perio on maxillary molars: re-occurrence due to trifurcationLEAST effect on the prognosis of a periodontally involved tooth: suppuration from the pocketmost common form of wound healing after perio flap surgery or root planning: long junctional epithelium (secondary intention) and CT adhesionForceps slips and causes the puncture wound. How it closes? Secondary intentionLJE and CT are associated with: repairThe soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease is a: long junctional epitheliumType of healing in SRP and free gingival graft: LJE and CTWhich flap allows the best surgical access to the apical aspect of a tooth root with the least reflection of soft tissue: semilunar (submarginal curved)Flap surgeryLJESurgeryRegenerationSRPNew CT attachmentHealingFlap heals byPrimaryGingivectomy; external bevel; extraction siteSecondary (from epi of adjacent alveolar mucosa or pockets)GraftTertiaryHealing of periapical radiolucency is slowest in: diabeticLocation of cutting blade of gracey: lower 1/3rd Angulation of gracey: 60-70Angulation of universal: 90Why electro laser is better than curettage: promotes regerationCurette used in gingival curettage: Columbia universal curette (2 cutting edges & face of blade at 90 degrees to lower shank)Laser in periodontal surgery, recent studies shows that: new attachmentWhen sharpening a curette, angle between the sharpening stone and face of blade is: 100 – 110 degreesScalerRemove supragingival depositsCuretteRemove either supragingival or subgingival depositsGracey curette (off set angle)1-2 and 3-4anterior5-6Anterior and premolars7-8 and 9-10Posterior – facial and lingual11-12Posterior – mesial13-14Posterior – distalGraceyUniversalOne cutting edgeTow cutting edgeCurved in two planesCurved in one planeBlade angle is 70 and offsetBlade angle is 90 and not offsetUsed with terminal shank parallel to tooth surfaceThe epithelium of a free autogenous gingival graft undergoes degeneration at the recipient site. Genetic information as to the nature of the epithelium overlying the connective tissue is contained within the graft connective tissue: Both trueMajor source of epithelium: recipientWhich part of the cutting edge of the curet should be adapted to the line angle of the tooth: lower thirdThe gingival around teeth and the mucosa around implants have similar non-keratinized JEExamples of non-keratinized epithelium: Col and crevicular (sulcular) epitheliumarea of the mouth has the LEAST amount of keratinized tissue on the buccal aspect? Mandibular premolarsInfrabony defects: trough; hemiseptum; interdental crater. NOT is dehiscence (suprabony)Bony area between two premolars or one wall remaining: hemiseptumPockets in occlusal trauma: angular/infra-bonyMost likely to cause vertical bone loss: occlusal traumaFenestrations and dehiscence occur most often in the: facial bone of anterior teethTo prevent exposure of dehiscence or fenestration, what kind of flap do you do: partial or split thickness flapMain advantage of extra-coronal splinting in periodontally involved teeth: conservation of tooth structureteeth are the most susceptible to recurrence of periodontal disease after active periodontal treatment is completed? Maxillary molars because of anatomy of their furcationsIn examining a maintenance patient, the dentist observes residual calculus, bleeding on probing, and probing depths less than 5 mm. The dentist should do scaling and root planning Regeneration of the periodontal attachment apparatus include Junctional epithelium, gingival fibers, and periodontal ligament or cementum, bone, and periodontal ligament?Gingival fibers: CAD (dentogingival, alveologingival, circular)Periodontium includes gingival but attachment apparatus: does not include gingivaFirst fiber group destroyed to allow junctional epithelium to migrate in apical direction is: DentogingivalLamina densa of the basal lamina beneath the epithelium is composed of: Type IV collagenFibers in the lamina propria of the gingiva, help to bind the free gingiva to the tooth: CircularPathogenic microorganisms of chronic periodontitis includes: Porphyromonas gingivalis; Prevotella intermedia; Tannerella forsythensis, bacteroides forsythus. c. rectus. NOT is actinomyces viscosusBacteria seen in pellicle and root surface: Actinomyces viscosusANUG bugs: Fusiform, Spirochetes & Prevotella intermediaBacteria in deep pockets and ANUG: P. intermedia, treponema, denticola, sokranskiiThe most common black-pigmented bacteria cultivated from endodontic infections is: prevotella nigrescensEndodontics microbesPrimaryUnsuccessfulGram negative bacteroides and gram positive actinomycesEnterococcus faecalisPrevotella is more common during: pregnancy, puberty and menarcheLeukemia is suspected when a patient demonstrates: Spontaneous gingival bleedingparent complaining of enlarged swollen gingiva that didn’t decrease in size after two months, and has been treated for skin infections, what’s the diagnosis: myeloblastic leukemiaLeukemic gingivitis, because of spontaneous ehaviourl and necrosis, may be misdiagnosed as: thrombocytopenic purpuramost common form of periodontal disease seen in school-aged children or puberty or blacks is: marginal gingivitis - localizedPeriodontal flaps are frequently extended into non-diseased areas for adequate access to the diseased sites. These non-diseased root surfaces are not instrumented. The flaps are returned to their previous level where the flap collagen fibers reunite with the Sharpey’s fibers in the cementum of the root surfaces. Which of the following types of healing is described? ReattachmentNew attachment/ RegenerationOccurs after flap surgery, most desiredRe-attachmentOccurs after surgical detachment of fibers (SRP, trauma, fiberotomy)characteristic of a modified Widman Flap procedure? Submarginal incision, replaced flap, inverse bevel incisionnot a characteristic of a modified Widman Flap procedure? Flap margin placement at the osseous crestWhich graft uses the 3 horizontal incisions (internal bevel, crevicular, and interdental) but is not reflected beyond the mucogingival line: modified Widman flapWidman flap is an example of: full thicknessDuring modified Widman flap third incision is by: Orban’s knifeModified Widman flap: full thickness flap coronal to mucogingival junctionMain difference in the apically positioned and modified Widman: final position of flap marginIn modified Widman, what form of attachment occurs in most cases: LJEA modified Widman flap would be indicated when goal of therapy is to provide: access to root surfaces for debridementFull thickness flap will result in bone atrophy (or loss) in: thin periradicular bonePartial thickness flap is used mainly to: prepare recipient sites for free gingival graftsPartial thickness flap is not used if: tissue is thinRepositioned flaps and MWF are healed mainly by: repair (i.e LJE)Disadvantage of partial flap: poor blood supply16 yr old girl with ectopic canines. What do you see? Gingival recession (Tx: Lateral displaced or pedicle flap)Gingival recession is related to: ageOn the vestibular aspect of tooth 23, there is 4 mm of recession with a 3 mm probing depth, no keratinized gingival and no radiographic interproximal bone loss. Most predictable outcome is achieved with SECTGThe most important factor to reduce sensitivity of root after periodontal treatment is: Plaque controlthe greatest impact on the success of a periodontal flap procedure: level of postoperative plaque controlGingivoplasty can be done in: ANUG (associated with plaque)An indirect temporary restoration can cause periodontal disease when: margins impinge on soft tissuesOcclusal trauma causes: widening of PDL, cemental tears and gingival recessionWhat epithelium is found at the base of sulcus: Junctional epitheliumTime taken by JE to re-establish: 10 daysFacts about JE: can form on either cementum or dentin; re-established as early as one weekMost common pattern of osseous defect in chronic periodontitis = Horizontal (Facebook friend went with Crater something if horizontal not in option!)Perio-chip contains: Chlorhexidine (absorbs over 8 days)Phenomena associated with CHX: substantivity (anti-plaque) – high concentration for long timeSecond generation antiplaque agents differ from first generation in: substantivityArestin contains: Minocycline (sub-gingival)Which antibiotic is most likely to cause oral pigmentation: Minocycline, chloroquine, cyclosporineAB reaches high levels in gingival fluid (4-10 times its concentration in serum after oral administration): minocycline/doxycyclineTx of Class III furcation defect: tunnellingGTR best results if on: mandibular teeth buccal sideGTR contact: PDL cells to toothPurpose of GTR is to prevent: migration of LJE and CT or blocking the downgrowth of epitheliumGTR allows: cells from PDL and boneGTR allows: PDL cells to grow coronallyGTR best results: class II furcation (cul-de-sac) and deep 3 walled defect3 things you need when doing GTR: bone, sharpey’s fibers & cementumBone graft best results: narrow 3 walled defectBone grafts are effective only in class II furcationWhat you don’t do with Class II furcation defect: Extraction and implantMost common furcation: maxillary M1 mesialBest method to clean furcations after perio surgery: Irrigation with CHXFormation of indicates success of periodontal regeration or regeneration of periosteum needs: sharpey’s fibres, cementum and boneWhich suturing technique permits different tension on facial and lingual flaps: continuous sling sutureWhich kind of suture is used when only the buccal surface of an area has been flapped: sling suturePatient ManagementThe mother of an 8-year-old patient insists on staying in the room during treatment. In the past, she seemed to be very overprotective of her child with her body language and comments. Which were disruptive to treatment. How could the dentist best address this patient’s mother? “I’m sorry, but I need you to stay in the waiting room so we can get his work done”Dental phobia is classified as a personality disorder. Dental anxiety can result from the pairing of previously innocuous stimuli with an unpleasant experience: First statement is false, the second is trueWhich best describes the interpersonal distance zone in which dentist usually treat patient: personalThe best strategy for addressing dental fear that is based upon distrust of the dentistis to: enhance informational and behaviour controlSuing to collect fees is a proven route to being counter sued for malpractice: True Safe distance for talking to patients: 18 inches / 6 feetWhen there is no barrier, protection of dentist = 6 feet; 90-135 degreesEmancipated minor: Under 18 person who has been married, has been pregnant, or responsible for his or her own welfare and is living independently of parental control and support can give consent.Operant/Instrumental conditioning: method of learning that occurs through rewards and punishments for behaviourMost effective way to teach OH: repeated supervised trainingAccording to house classification, class 1 is physiologicDenture soreness from inflamed ulcerated tissue, what should you do first: talk with pt.Hygienist harms the patient: hygienist and the owner is liableDental assistant harms the patient: only the owner is liableBehavioural Change TheoriesSocial Cognitive Theory (SMEAR) – Often used in oral health educationSelf-efficacy, modelling, reinforcementHealth Belief ModelPerceived susceptibility to disease and its consequences; perceived costs and benefits and cues to action (stimuli to change)Theory of Planned BehaviourAttitudes; social norms, degree to which the individual perceives the ehaviour to be within his/her controlSelf-determination Theory (CAR)Competence, Autonomy, RelatednessAnxiety according to Eriksonfirst psychological crisis occurs during the 1st year of life and is one of trust VS mistrust (part of growing process). This infant will carry the basic sense of mistrust with them to other relationships, which may result in anxietyAnxiety according to Freudanxiety results from a conflict between the ego and superegoConstructive aggressionself-assertiveness in response to threat, used for protectionDestructive aggressionunnecessary hostility for self-protection directed toward an external object or personYou r going to do RCT for upper lateral with perapical abscess for which possibility you have to take informed consent from the patient: prognosisDental phobias are very hard to eliminate because they are: self-reinforcingChild objective fear: own bad experienceSubjective fear: Because of parent’s experiencePremack principle: If you finish your homework, you can play outsidePersonal fable attitude: It won’t happen to meAdolescents undergoing orthodontic treatment often have problems with home oral hygiene regimens. The MOST effective management plan is to provide limited praise for small progress made at each visitThere is a patient who don’t believe any dentist in his life was good, all of the sudden he believes u r the best and no one else is good, what kind of personality is this: borderlinePredominant method of financing dental care in Health Maintenance Organizations (they are most common as well) (HMO)?: capitationCapitation: Dentist is paid fixed amt, usually monthly for providing certain services to a fixed number of peoplePPO: Preferred Provider Organization (certain number of doctors and the fees is set)Child abuse is the most commonly involves children in which age group: birth – 3 years (Dentists are required even if there is no proof)Patient will drug abuse, alcoholic and recently divorced his wife: Just treat oral health, don’t bother about other advises.Patient start crying that she is going through a divorce: show empathy by rescheduling appointmentsWhat not to do with an uncooperative patient: Reschedulefirst step to perform during a re-evaluation appointment? Update medical historymost important factor in determining patient satisfaction with dentures: patient personality traitsFrank behavioural rating scale1Def negativeRefusing2NegativeReluctant3PositiveWilling4Def positiveGood rapport with dentistThrough the bloodborne pathogen standard, the occupational safety and health administration directs: using barrier techniques; communicating hazards to employees; obtaining Hep B vaccines; performing house keeping – exposure control plan; instrument sterilization and storage; disposal of medical waste. NOT is using MSDS and transportation of waste from officeYou have to disclose that patient has cancer. How will you do this? Prepare first, then tell himYou smile and praise/assure the patient: social reinforcementManipulative kid: Positive reinforcement or (operant extinction)Positive reinforcementA father gives candy to his daughter when she picks up her toys. If the frequency of picking up the toys increases, the candy is a positive reinforcerNegative reinforcementA person puts ointment on a bug bite to soothe an itch. If the ointment works, the person will likely increase the usage of the ointment because it resulted in removing the itch, which is the negative reinforcerPositive punishment (habit breaking appliance)Daddy yells at babby when he stands on ledge If babby stops standing on ledge, the yelling acts as positive punishment because daddy presents (adds) an unpleasant stimulus in the form of yellingNegative punishmentA teenager comes home after curfew and the parents take away a privilege, such as cell phone usage. If the frequency of the child coming home late decreases, the removal of the phone is negative punishment because the parents are taking away a pleasant stimulus (the phone) and motivating the child to return home earlier.Domestic abuse is an act of: power of controlA child’s ehaviour problem can be managed by desensitization if the basis of the problem is fearAccording to Piaget, at what age is the child not able to another person’s point of view and think in a very concrete concept: 2-7 yearsPiaget’s theory: Comprehensive theory about the nature and development of human intelligence. Piaget believed that the child learns by doing more than learning.Sensorimotor—birth to 2 years; preoperational—2 to 7 years (egocentrism & animism); period of concrete operations—7 to 11 years (animism declines); period of formal operations—11 years to adult (imaginary audience, personal fable)Letting patient listen to music: distractionDentist tells a boy that local anesthetic will hurt like a pinch, what is he doing: relabelingChess and Thomas theory is about: temperament (slow to warm up)What dec with age: learning skillDentist is mis-behaving with staff: Beneficence is violatedIn your dental practice, want to keep good harmony and relationship with all your staff, what is that u follow: beneficenceReplacing words like LA with sleepy juice is called euphemismFemale said to doctor she hears that fluoride is not good, how to respond to her: conflicting info is puzzlingRapport includes: bond and empathyDoes not show empathy if you: share personal experiencesBest way to build rapport with patient: persistent eye contactFirst step of clear communication: attentionProfessional code of conduct means: legal rules in and out of officeWhen dentist provide rebates for care, he harms which ethics? JusticeShowing frustration towards someone else: displacementAutism patient have a habit of repetitive actionsAutism presents as a problem due to: inability to communicate or impaired communicationChild with autism. How to bond with him well: desensitizationDental management of autism: remove any source of heavy light, minimal noise, avoid big words, avoid open ended questions, be sure to rewardNoise inducing hearing loss> 90 dbNoise protection recommended85 dbPatient said I can’t quit smoking/ don’t have time to stop: Pre-contemplationChildren with cardiac problem feel more vulnerable because of: parent’s overprotectionInformed consent reflects: autonomyInformed consent is waived in: emergenciesTelling patient about risks and benefits of a treatment is a part of: AutonomyWhich principle in the code refers to “self-governance?”: autonomyAdolescent son comes to the office with a mother that doesn’t speak English, what is the best to do? Use a certified call center for translationsHow to communicate and establish a good relationship with a hearing impaired patient? Speak to the patient and allow time for interpretationA patient says, “I have been avoiding coming to see you because there is an ugly, red sore spot on the roof of my mouth”. Which of the following responses by the dentist best exemplifies a reflective response? It sounds as if you’re quite concerned about this conditionAn 82-year-old presents as new dental patient. The son provides paperwork that names the patient’s guardian. How will that impact the dentist approach to care? The guardian must be consulted for consentbest approach for a a patient who becomes very uncomfortable when a planned surgical procedure is discussed: Explain post-operative instructions, obtain informed consent, and help the patient to resolve anxiety before the procedureA person best exemplifies active listening by doing: direct eye contact; have pt repeat what you sayBilling for a full-mouth series of radiographs as if they were a number of individual radiographs is an example of unbundlingMultiple procedures cut down to increase reimbursement: UnbundlingDoctor billed insurance couple of procedure when actually there is a global procedure that combines them: Unbundling Dentist does the treatment for crown and post but the insurance company pays the money for crown only OR a practice of third-party payers in which the benefit code has been changed to a less complex and/or lower cost procedure than was reported except where delineated in contract agreements: Down coding (practice of third-party payers)Up coding or over coding: Reporting a more complex and/or higher cost procedure than was actually performed.Bundling: dentist charge separately for crown, core, insurance will say its part work (decreased benefit for patient)LEAT: Least expensive alternative treatment policy. Dentist recommends FPD, but insurance says RPD does the job as well.represents the dentist primary responsibility when caring for the elderly dental patient: involve a caretaker/surrogate in decision makingPatients with low health literacy are more likely to fail to show for dental appointmentstrue regarding paraphrasing: restating the patient’s views in one’s own words; secret to good paraphrasing is voicing patient values; paraphrasing is attempt to understand and acknowledge another’s perspective. Not true is agreeing with and accepting the other person’s positionRephrasing: Interpretation of what speaker saidA patient is complaining about bleeding and pain when they brush. Which is the most appropriate initial response to initiate the patient’s oral health ehaviour change? “So you want healthy teeth and the gums but it hurts when you brush”Preventive oral health ehaviour is influenced by: social context; psychological factors, access to preventive measures. NOT is public policyAdolescents undergoing orthodontic treatment often have problems with home oral hygiene regimens. The MOST effective management plan is to: provide limited praise for small progress made at each visitterm refers to a physician or dentist performing an operation for which there was no consent? Battery (Intentional infliction of offensive or harmful bodily contact, unwanted touching)Tort Law: If you treat without consent then technical assault and batteryTort law can be intentional (battery, defamation) and unintentional (negligence and malpractice)What is malpractice: Failure to meet the standard of care or failure to foresee consequences that one’s education should foreseeThe patient should sign the informed consent for surgery: After a full discussuion of the surgical treatment planA patient says, “I have been avoiding coming to see you because there is an ugly, red sor spot on the roof of my mouth”. Which of the following responses by the dentist best exemplifies a reflective response? ‘It sounds as if you’re quite concerned about this condition”Anxious patient feels helpless at dental appointment. What do you tell her? Raise hand whenever she feels anxiousHow biofeedback works: it enables the patient to gain control of certain physiological function (Biofeedback therapy involves training patients to control physiological processes such as muscle tension, blood pressure, or heart rate. These processes usually occur involuntarily, however, patients who receive help from a biofeedback therapist can learn how to completely manipulate them at will. Biofeedback is typically used to treat chronic pain, urinary incontinence, high blood pressure, tension headache, and migraine headache) Cognitive coping = INNER. Cognitive coping involves teaching a patient to identify negative thoughts and behaviors that increase their stress burden and the situations where stress occurs.Example of cognitive coping: deep breathhow does parent of special needs child feel most of the time? AgitatedFear of choking because of dental treatment = CatasphoringThrough the bloodborne pathogen standard, the occupational safety and health administration directs activity for using barrier techniques; Obtaining hepatitis B vaccines; Communicating hazards to employees; Performing housekeepingThrough the bloodborne pathogen standard, the occupational safety and health administration directs activity for, except: using material safety data sheets.Stress and illness are often related. The best description of their relationship is Stress is contributory to illness and illness is usually stressfulIn pursuit of what the dentist believes is best for the patient, the dentist attempts to control patient ehaviour. This is known as paternalismIn assessing patient’s dental fears, the dentist should use verbal statements, physiological responses and behaviour, but not personalityA patient after extraction says “Thank you,that wasent as bad as ? expected,but my sister told me that the first night after having a tooth pulled is very painful. What if the medication u gave me isnt strong enough!?Choose the most appropriate answer – It sounds like you are worried that you might not have enough pain relief when ur homeA moderately mentally challenged 5-year-old child becomes physically combative. The parents are unable to calm the child. Which action should the dentist take? Discuss the situation with the parentsWhich of the following is the principal nonverbal cue that two or more people can use to regulate verbal communication? Eye contactPrimarily communicated nonverbally: emotions, vocal tone, rate and rhythm of speechOn a prepayment basis, dental patients receive care at specified facilities from a limited number of dentists. This practice plan is classified as closed panel (related to HMO)Closed panel: HMO (HMO is like paying a monthly salary to dentist; Since the dentist suffers from HMO the dentist forms a committee with other dentist to share the cost with another dentist. If you visit provider outside HMO, insurance won’t cover)HMORequires the patient to select a primary care physicianDentists are paid on a per capita basis at a fixed rate irrespective of # of services and or # of times seenPPONo need to select a primary care physicianProviders agree to accept certain payments in anticipation of higher volume of patientsIPA – Individual Practice AssociationSystem that combines the risk sharing of HMO with fee-for-service reimbursementOpen panel: PPO (payment is made only when care is provided)Which is an agreement between an insurance company and a grp of dentists whereby the dentists agree to accept discounted payments: PPO (client only goes to a certain number of dentists and the fees is set)Network panel: IPO (Independent Practice Organization – fee for service plan)Which of the following computer databases contain references to dental literature electronically? Ovid-MedlineThe measure of the quality of care (standards met or not) provided in a particular setting is called: Quality assessmentThe measurement of the quality of care and the implementation of any necessary changes or steps to either maintain or improve the quality of care: Quality assuranceSocial enforcer for a child: Pat on the back of the child’s shoulderThe closest act (most personal relationship) the dentist would have for comforting a patient: tap on the shoulder.The best way to communicate with the patient: talk to the patient while making eye contactPart of classical conditioning: acquisition, discrimination, generalization, extinction, spontaneous recovery; NOT is equilibrationmost important feature of systematic desensitization: exposureNetwork model is often used in: IPA (most common)Example of network: Anchor dentalA patient has difficulty inhibiting the gag reflex during x-ray procedures. The patient is asked to take an x-ray packets home and practice holding the packet in his mouth for increasingly longer periods. Which technique is being used? Graded exposureThe substitution of a relaxation response for an anxiety response using a relaxation strategy such as diaphragmatic breathing when one is exposed to a feared stimuli is called? Systemic desensitizationYou let the child walk around and touch the instruments, how is that called: Systematic DesensitizingWith no other intervention or instruction, which is most likely to trigger a physiological relaxation response: diaphragmatic breathingA child patient who demonstrates resistance in dental office is usually manifesting: anxietyWhen faced with a frightened child patient, which would be the most appropriate ormost effective response? Ask the child about his or her fearsFear decreases pain and anxiety increases painwhat do we watch in a patient during dental dental treatment to find out if he’s in pain: eyesOne of your patient is having a dental problem that is not under your capability and you are referring that patient to a specialist, this type of behaviour comes under which of the following codes? Non-maleficencept referral to surgeon—> Non-maleficenceSurgeon sending patient back to dentist is justiceWhen a patient expresses anger about a physician’s colleague, which of the following statements would be the most appropriate response? What concerns do you have about how you were treated?A patient says that, “Even if there is some pain, it will be brief. I have effective methods of coping.” The patient reminds himself of this during dental procedures. This patient’s statement exemplifies which strategy? Rational responsecomponent of a scientific article provides the reader with detailed information regarding the study design: methodsRyan white care act provides dental care to HIV + / AIDS individual. They get their funds via HRSAbest question to ask a slightly nervous child? “Can you tell me what is bothering you?” Are you worried about the needle?”A 38-year-old man is fearful of injections. First, you show him the syringe. You talk about the characteristics of the needle. You then place the needle in his mouth with the cap on and simulate the procedure with the cap on. You then simulate the procedure with the cap off. Eventually, you proceed with the injection. What method is being used to reduce fever? Systemic desensitizationSystemic desensitization uses a hierarchy of slowly increasing the anxiety provoking stimuli like from least anxiety provoking to most allowing the pt to use his coping skills. In flooding there is a intense prolonged exposure to a feared stimulus at a time wherein the pt uses coping skills to deal with the exposure. In simple language systemic desensitization is step by step increase stimulus. And In flooding, it is everything at a single stepdisadvantage of systemic desensitization: time consumingMost important feature of systemic desensitization is: exposureBehaviour therapy examples: conditioning, ehaviour, systemic desensitizationafter the initial visit, a patient’s decision to return is MOST likely to be influence by the dentist: interpersonal skillsIntense and prolonged exposure to a feared stimulus while using coping skills: FloodingA student performs a complicated symphony, and he becomes less anxious each time he performs. Which phenomenon is this? HabituationNecessary for a test to be accurate: validity While extracting a maxillary molar, you lose a root down the maxillary sinus which cannot be retracted at the moment. You do not inform the patient of the incident. Which code of ethical principle did you break? VeracityDentist duty to practice truthfully, which type of ADA ethics: VeracityAmalgam redo: veracityBilling a patient solely because of patient’s insurance or recommended unnecessary advice: veracity is violatedKnowing when to refer: non maleficence Will aid in the cognitive appraisal of a threat: Controllability, familiarity, predictability, and imminence (CFPI)If a dentist is stuck with a needle while treating an HIV-infected patient, which should he perform? Antiretroviral therapyCorrect regarding behaviour change:The behaviour model theory consists of antecedents, behaviors, and consequences (ABC)Goals are long-term targets, whereas objectives are reachable steps along the way.Positive consequences will strengthen a ehaviour and negative consequences will weaken it.Consequences of today’s ehaviour will affect ehaviour tomorrowDental Public HealthAn act from 1997 that gives free treatments (including vaccinations) to poor children: CHIP (Children’s Health Insurance Program)Good Samaritan act: In all states, but dentists are not included in all the statesCMS Centers for medicare and medicaid servicesEarly and Periodic Screening, Diagnostic, and Treatment (EPSDT)Dental for childrenNIDCRBranch of NIH that deals with dental researchHealth Resources and Services AdministrationOffers health care services for uninsured live in rural areas and urban neighbourhoods plus dental services for HIV ptsAdministration for Children and Families (ACF)Social well-being, especially low-income children get free food meal in schoolStatute of limitations: patient can sue dentist for a malfunction within 2 years and the time starts when dentist informs the patient about the incident.Good behaviour law: accepted at all states but dentists are NOT included in all states!Protected under Americans with disabilities act? AIDS patientsPrevalence of ECC (maxillary molars and incisors) in USA: 5%Fluoride containing product should not be more than: 264 (bulk) or 300 (individual) mgAfter how long of wearing does a face mask become useless: 1 hourAerosol remains in air for hoursOral bacteremias after a tooth extraction are: generally transient & last for less than one hourDentist studied 4 unrelated patients with myofascial pain & myalgia, What type of study: Case seriesWhat percentage of adults have tooth decay (treated or untreated): Approximately 87% of adults aged 20 to 39 years have coronal decayThe American society for health has made recommendations to limit maximum volume of hand rub in an operatory to be: 2 LMaximum allowed fluoride in the water by EPA (Environmental protection agency)? 4.0 mg/liter (4 ppm)Fluoride works best in: smooth surfaceFluoride in well water: hydrofluorosilic acidFluoride in water: sodium silicofluorideFluorosis does what? Inhibits remineralizationFluoride is least effective on: occlusal surfacesFluoride not approved by FDA: prenatalToothpaste which have Desensitization action, work by? Depolarize nerve endingsWhich type of fluoride is not in toothpaste: Acidulated fluoride (ruins crown polish)What fluoride toothpaste should not be used in a patient with multiple porcelain crowns: acidulatedDentifrice component most likely to inactivate fluoride ion: dicalcium phosphate0.05% F equals how many ppm: 500A 2 y/o child has ingested 20mg fluoride pill. What will likely happen? nauseaFluorosis can affect both primary and permanent teeth2.2 mg of sodium fluoride will provide: 1 mg of fluoride1 mg of sodium fluoride will yield 0.43 mg of fluorideWhich fluoride do you use to not stain the veneer? Sodium fluorideFluoride is cidal or static: cidalConsidered least important in the beneficial effects of fluoride: Fluoride makes enamel more resistant to acidFluoride is best in prevention of which types of lesion: Class 2, 3 & 5Fluoride effectiveness irrespective of method: 30%Physical water filters will not change/alter the fluoride. Only chemical and electric ion removers can alter fluorideMisconception about fluoride: F does not make enamel harder, but decreases its rate of solubilityAbout stress: positive situations are more stressful than negativeHow fluoride sample is collected: 500 ml water with 2 CC of 6N HClExperimental epidemiology is primarily used in: intervention studies.Control test strips should: test positive as they are not autoclaved, but incubatedExample of adverse selection: tendency of those in dangerous jobs to get life insuranceManagement of scrap amalgam: sealed container with ehaviou solutionHow long after eating is the PH in the mouth significantly lower: 2-4 minswhen does plaque accumulate after eating? 1 hourRisk of fluorosis: excess of 3 ppm3 ethical principles applied to all: Beneficence, Justice and Autonomy2 ethical principles that will be in conflict when a dentist prescribes CWF: autonomy and beneficenceFluoride most effective in: small doses and high frequenciesFluoride known to cause staining: Stannous fluoride (not used in CWF)School water fluoridation is 4.5X CWFFluoride is primarily excreted through urine, remaining stored in: skeletal tissueStannous fluoride can arrest root caries due to: TinFacts about stannous fluoride (8%): short half life and bitter metallic tasteWhich fluoride should be given to cancer patients: 0.4% stannous fluoride and 1% NaF (min 10 minutes)Form of fluoride most effective in toothpaste: stannous fluorideCAMBRA does not include: genetic factorsPatient management system: SuccessRelationship of sugar and cavity except one: concentrationMost fluoride is absorbed from: StomachWhat are the proper ways to reinforce OHI: verbal and written in the dental officeTable of allowancePatient pay the difference btw the dentist’s fee and the amount insurance company payingFee guide (Eg: Medicaid)Dentist agree to charge pre-established fees only. So patient is not charged anything extraRule of 6 for fluoride supplementIf water fluoride is more than 0.6 ppm: no fluoride supplementationIf the age of child is less than 6 months or more than 16 years: no fluoride supplementationFluoride dropsUp to age 3Fluoride tabletsAfter age 3Fluoride mouth rinse> 6 yearsDaily dose<0.30.3-0.6>0.6Birth-6 monthsNoneNoneNone6 months – 3 years0.25 mgNoneNone3-6 years0.5 mg0.25 mgNone6-16 years1 mg0.5 mgNoneFluoride toxicity depends on weight, fluoride supplementation depends on age Rinsing weekly with 0.2% is BETTER than daily rinses with 0.05%Medicare insurance for elderly (> 65 years) and disabled cover medical but not dental, vision or hearing (unless emergency): trueMedicare will pay for dental if that is an integral part either of a covered procedure or examination done before surgeryMedicaid: dental coverage for retired, low income, disabled and children less than 3 yearsIf a particular test is to correctly identify 95 out of 100 existing disease cases, then that test would have a sensitivity of 95%Sensitivity: measures people with disease or true positive (TP/TP + FN × 100)Positive predictive value: TP/TP + FP × 100Negative predictive value: TN/TN + FN × 100Sensitivity is presented as: proportionSpecificity: true negative (TN/TN + FP × 100)Specificty and Sensitivity are: INVERSELY proportional!Histogram shows: varianceTest for 3 variables: avon testP>0.05 and you reject null: Type 1 errorPercentage of fluoridated community water in US: 74% (65 – 70)CWF in US is 67-74%Following tooth eruption, fluoride uptakes occurs on the enamel surface because: fluoride substitutes for hydroxyl ions in the apatite crystalsTest to test the means: t-testThe water supply of a community has 0.28 ppm fluoride. Which of the following procedures is appropriate for a 4-year-old child exhibiting moderate caries risk? Systemic fluoride supplementGreatest risk for latex allergy: spina bifidaFoods allergies that can cause latex allergy: banana, kiwi, chestnuts, strawberries, avacodoLatex allergies types: Type I and IVAn approved method for reducing microorganisms in water output from dental units is: retrograde (reverse) flushing of all water linesTo prevent cross-contamination to patients from dental operatory units, a dentist should use handpieces and water spray hoses that are fitted with: anti-retraction valvesWhy shunt used for spina bifida? To reduce intracranial pressurePt taking narcotic for long term what causes: headache due to increase intracranial pressureSpina bifida is seen in which condition: cleidocranial dysplasiaYour fees is high: harmonious or changes with geographic areaNon-fluoridated area, 10 years: 1 mg F per dayHow many mg of fluoride in 1ppm in 1 litre: 0.5 mg8.2 ounce toothpaste contains 232 mg of fluorideFluoride supplements start at: 6 months6 handed dentistry means: 2 assistantsExample of self-efficacy: Pt who is confident in flossing will be more likely to flossWhen determining the appropriate dose of systemic fluoride supplement for a child, it is most important for the dentist to consider: The child’s age and the fluoride content of the drinking waterBest to preserve root supported over denture: daily fluorideHow many minutes do you leave topical fluoride? 4Fluoride in toothpaste: 1000 ppmWhy are inorganic pyrophosphates (interfere with crystal formation in calculus) added to toothpastes: anti-tartarAnti-tartar in tooth paste: tetra sodium pyrophosphateUSDA recommends that 30% of your daily diet should come from: fatFluoride used nightly for gold and porcelain crowns: 1.1 % NaF1 mg of NaF will give how many grams of fluoride: 0.5Therapy for a 8 year old living in a non-fluoridated community with closed contact in the posterior quadrant and disto-occlusal restorations on all primary first molars: daily fluoride tabletsFluoride toxicityFatality from fluoride in adults2 gFatality from fluoride in children16 mg/kgDose with symptoms3-5 mg/kgToxic dose 5-10 mg/kgLethal dose in adults4 – 5 g or 5 mg/kgLethal dose in children500 mg or 15 mg/kgTooth brushingMost efficient to clean periodontal pocketsModified Bass or sulcular for adultsFonesChildrenCharterAfter surgery or ortho treatmentRollLeast effectiveCo-insurance – charge which is different for different service%Co-payment – fixed (common in capitation plans or HMO)$APF solutions must be stored in containers that are made of: polyethylene (never glass)Most effective way to increase fluoride content in the external layers of teeth: daily 1.23% APF for 4 minutesHome based (4 mins) fluoride gel: 0.4% SnF + 1% NaFPlaque index is used mainly for: patient motivationMotivational interviewing includes: I’m motivated to engage in fucking Eva’s plan (engaging, focusing, evoking, planning)2.5 years in a community with 0.5 ppm in drinking water: regular recall appointmentsIn the section of a scientific article, the researcher interprets and explains the results obtained in? discussionif there is an article and if you want to understand the definition of dependent and independent variables, which part of the article you look: introductionIndependent variable: You control; Dependent variable: you measure in an experimentWhat are confounders: not part of real association between exposure and diseasestudy designs is the best suited to control for both known and unknown confounders: RCT (does not have sample sizes)Other methods to control confounders: randomization, restriction, matching, stratification, adjustment, multivariate analysisBiocompatibility tests conducted in vitro: can be more easily standardized than clinical studiesA waiting room is commonly used by immunocompromised patients. Procedures that will protect them from nosocomial infections contracted in the room would be: policy for isolation of specific patients; HEPA filter; UV treatment of room air.A mercury spill in the laboratory or office is appropriately cleaned up by: aspirating the mercury into a wash bottle trap, then dusting the spill area with sulfur powderOSHA standard for mercury is 0.05 mg cubic meter for 4 hour shift or 0.1 mg per cubic meter in 8 hours shiftMercury poisoning causes: vision impairmentMSDSBlueHealth hazardYellowReactivity and stability of chemicalsWhiteUse PPEMedical treatment of mercury poisoning can include chelating agents like: dimercaprol (most effective) (BAL – british anti-lewisite); EDTA; Penicillaminethe GREATEST risk for mercury contamination of employees in healthcare institutions comes: BP apparatus or sphygmomanometersConcerned about the mercury toxicity in the dental office: free mercuryMercury poisoning causes: gingivitis, speech difficulties, tremors and visual disturbancesType of mercury used in dentistry: elementalMercury worst for dental office: methyl mercury (organic mercury)Chronic or subacute mercury toxicityNeuro, nephron, skin, metal fume feverAcuteSOB, fever & chills, respiratory distress syndromeFirst sign of acute mercury toxicity is: nausea, hypotonia, hair lossIn a dental unit water line, the water flow is: slowest at the peripheryBacteria in contaminated water lines: E. coliWater lines should not be used for: implant placementsGreatest risk for dental health care personnel to acquire a blood born pathogen: percutaneous injuryYou want to do a study to compare DMFT of girls and boys at school, which test to use? T-testDMFT vs DMFS: DMFS takes into consideration third molars as well.Morality differs from ethics principally in that morality is more concerned with: situational or relative good and badThe cornerstone of professionalism is self-regulationAnti-sensitivity toothpaste has: postassium nitrate (KNO3) or 5% KNO4Fluoride mouthrinse that can be given to a disabled child or 5 year old: Sodium Fluoride (NaF)Children with interproximal caries, which school program will be the most effective: F mouthrinseConcentration of fluoride in fluoride mouth rinse: 0.2% sodium fluoride weekly or 0.05% NaF dailyIn normal dentifrice what kind of fluoride is present ? NaF% of abrasives in dentifrice: 20-40%Effectiveness of CWF: 20-40%Fluoride tablets: 30%Most soluble: hydroxyapatiteWhat ion gets replaced in hydroxyapatite by fluoride? HydroxylHydroxyapatite (HA) cannot be utilized for: osteoinductionHydroxyapatite can be utilized for: osteoconduction; encapsulation by collagen; excellent tissue compatibilityMost common caries among 5-17 years: occlusalCommunity water = 0.38ppm fluoride, what to give to a 4 years child: systemic supplementsOutliers control: Standard deviationPeople in US without dental insurance: 65-70%Study to know the effect of gastric bypass surgery on nutritional status: cohortIncidenceCohort (can find out history of disease)PrevalenceCase-controlCohort study is to find out: risk factorsCohort (disease is known)1. Good to study rare exposures (common/fatal disease)2. Can examine multiple diseases3. Can provide absolute riskCase-control (exposure is known)1. Good to study rare diseases (common exposures)2. Can examine multiple exposures3. Can provide population at risk4. Tests – chi-square, odd’s ratio, logistic regressionDescriptive: prevalence and incidenceAnalytical: cohort, case-control and cross sectional One of the disadvantages of cohort studies is that: prone to selection biasWhich study does the rare diseases: Case control (odds ratio)Most dental financing is from: self-payDental people should have to be screened annually for: TBSpread of TB in the outpatient dental office is: difficult because contact is not long enoughDifficulty swallowing, sore throat, oral ulcer (ulcer that mimicks cancer): TBGhon’s complex: primary childhood TBThe water supply of a community has 0.28 ppm fluoride. Which of the following procedures is appropriate for a 4-year-old child exhibiting moderate caries risk? Prescribing a systemic fluoride supplementRising with a new mouth rinse results in a statistically significant decrease in the Gingival Index (GI) score, but does NOT result in improved oral health for the patient. This finding suggest: non-clinical significanceNominalGender; severity (m,m,s)OrdinalGingival indexIntervalCelsiusRatioBP, pulse, height, weight, kelvinWhen designing a clinical study, one uses the power of the statistical test to: reject the null hypothesisAccording to ADA recommendations, a professionally applied topical neutral sodium fluoride application or in-office fluoride foam tray should remain in contact with teeth for 4 minutesHow to treat a patient with implant supported dentures: neutral sodium fluorideNOT true regarding topical fluoride: Enhances enamel pit and fissure coalescencetrue regarding wheelchair transfers: A wheelchair-bound patient is often the best source of how to do the transfer In conducting a patient interview, the dentist should begin by asking questions that are general, because it provides the patient with a greater opportunity to express his or her concerns and emotions: Both statement and the reason are correct and relatedA dentist administered a survey to patients to determine their satisfaction with practice characteristics and services provided. The survey was administered to patients seen during 1 month. Which type of study design was used by the dentist? Cross-sectionalThree months ago, an epidemiologist conducted clinical examinations to assess the dental caries experience of elementary school children. The study could best described as cross-sectionalProfessional code conduct: legal rules in and out of the officeA new diagnostic test is evaluated against an independent “gold” standard” in 100 subjects with the following results: True positive = 48; True negative = 8; False positive = 12; False negative= 32. What is the negative predictive value of this new diagnostic test? 20% (TN/TN+FN*100)When designing a clinical study, one uses the power of the statistical test to accomplish: Reject nulloptimal average amount of fluoride, in ppm, for public drinking water of most communities is 1 ppmIn a clinical trial, what would the power of statistical test be used for or purpose of statistical tests in clinical trials: determine validity (gold standard with high sensitivity and specificity)strongest point of statistics: p value70% of dentists become anxious with anxious dental patientsResearches showed to remove plaque from the resident’s teeth more effectively with mechanical toothbrushes than with manual ones. What is the independent variable in this study? Type of toothbrush used (independent can be changed – manual to electric)Dental waterlines should be flushed at beginning of day for 30 secondsFlush air/water through handpieces after each patient for: 20-30 secondsacceptable CDC water quality in a dental office? <500 CFU/mlIf you go out of ehaviou or replace an owner – must notift the Director of National Institute of Occupational Safety & Health at LEAST: 3 months before disposing recordsOutliers control standard deviationDFS is more in Caucasians1L of 1 ppm of NaF contains how many grams of fluoride: 0.5Test result which erroneously assigns an individual to a specific diagnostic or reference group, due particularly to insufficiently exact methods of testing is known as: False positive testTest failed to report 5 cases of true diseases: false negative (type 1 error)A test result that erroneously excludes an individual from a specific diagnostic orreference group is called: false negativeStudy design for prevalence (% of individuals having a disease at a given time): Cross-sectionalIncidence is rate; prevalence is percentageCausality (cause and effect) may NOT be inferred from which of the following studies? Cross-sectionalAlthough the results of a diagnosis test are NOT necessarily accurate, they are consistent. This test has high reliability (reproducible and repeatable)Not part of scientific article: InterpretationOn the basis of diagnostic test results, a dentist classifies a group of patients as being free from disease. These results possess high – specificitymeasures the proportion of those without disease who are correctly identified by a negative test: specificityMost epidemiologic studies indicate that gingivitis in children is relatively common. A strong positive association between specific nutritional deficiencies and the presence of periodontal disease in children and adults has been demonstrated: 1st is true and 2nd is falseHIPAA was designed to ensure the security and privacy of health informationinformation about subjects in a study included their ethnicity. What level of measurement is ethnicity? Nominalmost appropriate test to determine the differences between two means is T testIn an experiment comparing the effectiveness of new fluoride gel verses an older fluoride gel, a null hypothesis is rejected when a chi square is high (there is a high likely chance of your p-value being less than 0.05)Test with two ehaviourl variables: chi square (before and after; data is qualitative)Median: value exactly in the middleMode: most repeated valueMeasure(s) of central tendency in statistical methods: mean, median, modeCorrelation analysis shows that as the income of population increases, the number of decayed teeth decreases. Therefore, an expected value for this correlation coefficient would be -1Federal agency protects the health of Americans and provides essential human services? DHHSWhat does the Weight and height stand for in recordings: ratio or ordinalMOST personal ehaviour by the dentist: touching the patient gently on the armacronym for a patient management system: optimumpersistent and repetitions questions asked by an 8 years old patient during treatment are: attempts to delay treatment EpidemiologyHighest prevalence of caries or ECCHispanicsHighest DMFT or highest restoredWhiteHighest untreated primary teethHispanicHighest untreated perm teethBlackModerate periodontitisBlack malesClass II cariesWhiteClass III cariesBlackCleft lip in USA prevalence1:700 to 1:800Cleft palate prevalence1:2000Cleft lip aloneAsianCleft lip/palate w/ Class III occlusionNative AmericanClass 2 malocclusionWhiteClass 3 malocclusion and root resorptionAsianLip cancerWhiteOropharyngeal cancerBlackAnterior open bite (usually asymmetric)BlackDeep biteWhiteMiscWhich microbe is least likely to be killed in an autoclave: Bacillus & mycobacterium bovisThrough the bloodborne Pathogen Standard, the Occupational Safety and Health Administration (OSHA) directs all health-care workers, in carrying out infection control, to use universal precautions. Based on these OSHA guidelines, patients identified as carriers of blood-borne pathogens require special infection-control considerations: The first statement is true, the second is falseHazard communication standards; Hep B vaccine (blood borne pathogens): OSHAOSHA also includes: engineering and work practice controlsWho considers part-time, temporary & probational workers as employees: OSHAOSHA oversees 2 main areas of dental worker safety: exposure to biological and chemical hazardsOSHA concerned with what in dental clinic: Regulated wasteDisinfectant not used because it is a respiratory irritant: glutaraldehyde (to sterilize plastic instruments)Correct concerning sterilization of dental instruments: chemical indicators are sterilizer specific Responsible for regulating handpieces, autoclaves and recommending sterilization procedures to CDC: FDAAdverse reaction to medication in your office, you should report to: FDAGuidelines on prescription of dental radiographs have been determined by: ADA and FDACDC recommends autoclaves should be monitored: weeklyWhich federal agency does NOT issue regulations: CDCRegistration number on disinfectants is issued by or biohazard waste is regulated by: EPAHow many human drug testing phases are carried out before a drug is marketed: 3Best autoclave used in clinic: class BPasteurization kills: TB!Powerful OXIDIZING agent that inactivates bacteria and viruses by oxidizing sulfahydryl groups: ChlorineLiquids (mostly nitrocellulose) are generally sterilized by: filtrationFlash gravity displacement sterilization of rubber and plastic items: 10 mins at 132 C or 270 FFlash gravity displacement sterilization of non-porous or surgical instruments: 3 mins at 270 FActionAction of alcohol and autoclavedenaturation of proteinsAction of dry heatcoagulation of proteinsAction of CHXDisruption of membraneAction of Listerine or triclosanDisruption of adhesionPovidone IodinePore formation within the bacterial cell wall, resulting in cellular leakageEthylene oxide gasIrreversible inactivation of deoxyribonucleic acid and proteins via alkylationChlorine compounds (hypochlorite)Oxidization of free sulfhydryl groupsSpecies of spores used for testing autoclaves: Geobacillus stearothermophilus and bacillus artrophaeus4 zones in dental office: dentist, assistant, transfer, staticIn four handed dentistry what is the position of the nurse in relation to the dentist for maximum vision: 10 cm higher than dentistinitial consideration in the treatment planning progress? Medical/systemic evaluationProtocol between patients: clean area first, then spray disinfectant and allow 10 minsNot part of prescription: Conscriptiona virus that is particularly difficult to kill with surface disinfectants is: HAVa medication that is a compound or extracted derived from a plant would be which of the following: botanicalDifference between mild and low disinfectant is the ability to kill: TBNot recommended for steam sterilization: solid metal containerBoiling water is a: ' high-level disinfection!Regular use of betadine is contraindicated in patients with: thyroid disordersAn advantage of rapid-steam autoclave over traditional autoclave: rapid-steam has a shorter sterilization cycle than traditional autoclaveLEAST useful surface disinfectant: alcohol (evaporates too quickly)Sterilization TechniquesWhat is sterilization: Absence of all life formsMost reliable agent for destroying microorganisms: heatUses the lowest temperature for instrument sterilization: steamSuperior for sterilizing sharp-edged instruments or glass: dry heat sterilization Least desirable sterilization technique: glutaraldehyde (best for cold and heat labile; 24 hours to achieve sterilization)Glass bead sterilizer15 seconds at 220 degrees CAutoclave121 C for 15-20 minutes at 15 psi, or 134 C for 3 minutesDry heat160 C for 2 hours or 170 C for 1 hourSteam250 F or 121 C for 15 minsChemicalEthylene oxide or glutaraldehyde for 10 hours at 48 C (lowest)Chemical vapour132 C for 20-40 minutesRapid heat transfer - wrapped191 C for 12 minutesRapid heat transfer - unwrapped191 C for 6 minutesMinimum time for chemical vapour20-40 minutesEmergenciesChild in dental office u gave him LA with epinephrine only one cartridge he felt agitated after giving la what do u suspect = too much epinephrine in LAThe first sign of a patient suffering from insulin shock: sweating, confusion (not convulsions), weaknessMost systemic side effect of LA toxicity is post convulsion CNS depression.Crown disappears down patient’s throat, what position do you put them in: uprightTx of malignant hyperthermia (autosomal dominant): DantroleneMOA of dantrolene: Drug that relaxes skeletal muscle without blocking nicotinic receptors; used for upper motor neuron disordersStages of shock: compensatory, progressive (metabolic acidosis), irreversible/refractoryWhich syncope is most common in the dental office: psychogenicNo Tx if BP is >200/>115 (ASA 4)BP in ASA 2: 140-160/90-95BP in ASA 3: 160-200/95-115 A diabetic child is experiencing insulin shock in a dental office. In managing this emergency, the dentist should immediately: have the child drink a glass of orange juiceInsulin diabetic patient with LA without sedationnormal insulin + normal foodInsulin diabetic patient with LA/sedationdecrease insulin + decrease foodInsulin diabetic patient with LA/IV sedationdecrease insulin + no foodGAno insulin, no food#1 cause for problems during IV sedation: hypoxiaPregnant woman faints = Turn to LEFT SIDE and raise hip 15 degreesPregnant on left side to avoid pressing on: IVCWhen a pregnant women lies on her back, what might happen: Supine hypotension syndromeCrown in mouth, best position: supineInjury that causes the tooth to loosen but not displaced: SubluxationManagement of concussion and subluxation of primary: No TxIf kid ingested lots of fluoride, do not give: sodium bicarbonateCommon respiratory emergency: Hyperventilation (kussmaul breathing)Cheyne-Stokes breathing ? alternating hyperpnea, shallow respiration and apnea (transient cessation of breathing) xxxAllergic reaction to penicillin: hypotensionHow would you treat an unconscious diabetic: 50% dextrose in water (IV) or IM glucagonCommon CNS emergency: SyncopeFeeling of impending doom: anxiety (NOT panic attack!!)How many chest compressions in 1 min indicated: 120Depth of CPR compression: 1.5 inchesCompression rate in CPR = 120/minuteCompression/ventilation ratio: 30/2How do you know if CPR is effective: pupils constrict or chest risesAlways occurs during CPR: acidosisAfter doing CPR to an adult patient the pulse returns but without breath. Management is? Provide rescue breathing at rate of 10-12/minCNS depressionAcidosisCNS excitementAlkalosisSigns of syncopeBlood pressure and heart rate fallsSigns of epinephrine overdoseBlood pressure and heart rate risesPatient with acute asthma attack what is the best position to put him: straight up position and oxygen through nose with oximeterAsthma patient, most important thing NOT to give: O2Not given in syncope: epinephrineEffect of epinephrine on BP: increase systolic and not diastolicHow much epinephrine do you give to an adult in anaphylactic shock: 0.3 mgEpinephrine is given in syncope if due to: penicillinTx of syncope: inhaled ammoniaSwollen crown: put upright76 years is on warfarin therapy and needs emergency extractions of a decayed tooth. Select the appropriate protocol: Do not stop warfarin and perform surgery using local anesthetic and administer Vit. KAED should be avoided: under 12 years of agePatient with cardiac arrest, most important is: early defibrillation (NOT CPR!)patient feels cold and clammy and the BP goes down to 46, respiration is slow and radial pulse is low: syncopeSymptoms of too much codeine: Cold and clammy skinIf the patient is lying backwards and going into syncope, which artery is being squashed? abdominal aortaFirst sign of lidocaine toxicity = CNS stimulation/NervousnessEpinephrine is avoided in: hyperthyroidism (can cause hypoglycaemia)In Angina, DO NOT put patient in Trendelburg position (OK for anaphylaxis)While giving CPR, what to check: Carotid pulseHigh plasma levels of LA: depression of CNS45 year old insulin dependent diabetes mellitus has a morning dental appointment during the examination, the patient complains of being lightheaded and weak, sweating is observed. The patient is most likely experiencing: HypoglycemiaChamomile (natural anticoagulant) is used to treat: gastric upsetsIn concussion, there is no: mobilityConcussionNo displacement or mobility; PDL inflamed and tender to percussionLet tooth restSubluxationNo displacement, but mobilitySplint for 1-2 weeksExtrusion/lateral luxationExtrusion – 65% pulp necrosisLateral – 80% pulp necrosisIntrusion96% pulp necrosisPrecautions should the dentist observe when providing dental care for a child with insulin-dependent diabetes: the patient should be seen after a meal and postpone the insulin injection until after the procedureIn young children with avulsed and replanted permanent teeth that have open apices, the blood supply is usually regained within: 20 daysReplantation sequence of mature avulsed teeth: repositioning, splinting, canal debridement, calcium hydroxide, GPIf periapical radiolucency is present at the apex of a tooth with a middle third root fracture and the apical canal space is non-negotiable, tx: extraction with removal of apical segment and replantation of coronal segmentReplantation after 2 hours or more: soak in 2.4% fluoride for 20 minutes, curretage and irrigate with saline and replant for 4-6 weeksFracture at apical 1/3, how long do you splint? 4-6 weeksAvulsed closed apex tooth should be immersed in what and for how long (to reduce root resorption) and at what pH? 2.4% sodium fluoride solution, pH of 5.5, 20 minReason for failure of replantation of avulsed tooth: external resorptionAccurately describes external resorption: appears to be superimposed over the root canalWhen you replant teeth, what will happen? Replacement bone formationWhen a re-implanted tooth presents external resorption, what is the treatment? Instrument and place calcium hydroxideA patient’s permanent tooth crown fractures, creating a small pulp exposure for about 30 minutes. The most appropriate tx for this patient? Direct pulp capping with calcium hydroxideRecommended for primary teeth with mechanical exposures: mechanical exposuresIn primary teeth, failure of Ca(OH)2 pulpotomy is MOST likely to produce: internal resorptionAn 8 year old child has an exposed vital but inflamed coronal pulp in tooth 14. Tx is: pulpotomyPin point exposure in permanent less than 1 hour: DPCPin point exposure in permanent more than 1 hour: pulpotomyAn increasingly popular technique for pulpotomy in primary teeth is: electrosurgeryPulpotomyRegular pulpotomyCvek’s - partialExposures after 72 hoursExposures longer than 24 hours and greater than 2 mmCoronal pulp is removedSmall portion of coronal pulp is removedElectrosurgery will remove: think layer of crevicular gingival tissueObjectives of electrosurgery: coagulation, hemostasis, access to cavosurface margins, and reduction of the inner wall of the gingival sulcusA practitioner has stabilized a permanent anterior tooth that had a fracture in the apical one third of the root. The tooth will MOST likely: remain functional and vitalthere is a root fracture in the middle third of the root in an 11 year old patient. The tooth is mobile and vital. What will you do: splint and observeFive hours ago, a 12 year old boy fell and fractured his maxillary right central incisor at the level of gingival tissue. The exposed pulp is vital. Tx is: RCTDental trauma MOST often results in pulpal necrosis: avulsionProlonged, unstimulated night pain suggests: pulpal necrosisMost common traumatic injuries to primary dentition: intrusion (cut blood supply)PDL most affected by or most likely to cause pulp necrosis: intrusion (least likely is concussion)Most common tooth injury among children: IntrusionTx of intrusion for permanent teeth: splintTx of intrusion for primary teeth: spontaneous re-eruption11 year old comes to dentist after an hour of injury to upper central. Tooth is vital but little mobile. X-ray shows apical third fracture. Treatment is Splint.Child with permanent upper central fractured 15 minutes ago showing pin point exposure and a wide open apex, treatment: DPC with CaOHTooth with a small area of internal resorption has: best prognosisAcc to WHO classification, avulsion in classified as: soft tissueAvulsion requires AB prophylaxisAvulsion success rate at 15 mins: 90%Avulsion success rate at 30 mins: 50%For primary tooth avulsion, try apexification after 7-10 daysFor permanent tooth avulsion, do RCTAvulsion of primary teeth: replantation of primary teeth has poor prognosis< 30 minutesReplant, flexible splint for 1-2 weeks, soft diet, antibiotics (Pen or Doxy), and endo treatment; TT> 30 minutesNo need to replant and space maintenance as neededAvulsion (Class 6) of permanent teeth0-60 minsReplant, clean socket with saline, splint, AB, TT>60 mins2.4% Na F for 5 minutesSharps does not require: metal containerMost common site of fractures in children or mandible is: condyleMost commonMost common impacted anterior toothMaxillary canineMost common ectopically erupted toothmaxillary permanent first molar?Most common benign tumour of oral cavityfibromaMost common benign epithelial tumourPapilloma (pedunculated)Most common retained toothprimary mandibular second molar?Most common recurring cystOKCMost common cyst in oral cavityperiapical cyst?Most common dermatosis to affect oral cavityLichen planusMost common topical fluoride in adultsstannous fluoride?Most common topical fluoride in children or dental office1.23 APF gelMost common brushing techniqueScrub technique?Most effective brushing techniqueSulcular or bass techniqueMost common developments cystnasopalatine cyst?Most common complication of GA (op) nauseaMost common used drug for petit-mal epilepsy or absence seizuresEthosuximide/valproic acid (PE)Most common used drug for grand mal (tonic – clonic)Phenytoin/dilantin (GP) – Grand party dil seyMost common used drug for status epilepticus (successive epileptic seizures without recovery)Diazepam (Valium) or midazolam -VADi status enti - maddaMost common drug used for temporal epilepsy or single partial seizurescarbomezepineMost common used claspSimple circlet claspMost common used face bow in fpdKinematic Most common complication of RA involves TMJFibrous ankylosisMost common salivary malignancy in childrenmucoepidermoid carcinomaMost common salivary malignancy in palate area and perineural invasionAdenoid cystic carcinomaMost common type of haemophiliaHaemophilia AMost common type of gingivitis in childrenEruption gingivitisMost common type of cerebral palsyAthetoid/spasticMost common nerve involved in cavernous sinus thrombosisAbducent nerveMost common complication of surgical extraction of lower third?molarLoss of blood clotMost common susceptible tooth for cariesLower 6Most common contrast mediaIodine in oilMost common cause of light radiographsExhausted developerMost common cause of failure of RCTincomplete debridementMost common isolated yeast strain from RCTCandidaMost common bacteria found in root canalsGram positiveBest postParallelBest pinSelf threadingMoth eaten radiographChronic osteomyelitis or external resorptionS/S of Von Recklinghausen or neurofibromatosisCafé au lait; Lisch spots (freckles) on Iris; Crowe’s sign (axillary freckles)Tooth floating in airEosinophilic granuloma (Langerhan’s histiocytosis X)Snow appearanceCEOT (always in adults)Honey comb or soap bubble (MACHO)Myxoma, ameloblastoma, aneurysmal bone cyst, cherubism, CGCG, hemangioma and OKCSoap bubbleAneurysmal bone cyst; CherubismScooped out at mid root levelHistiocytosis XWidening PDL with dissolving boneNon-Hodgkin’s Less recurrence and snow flake calcificationsAOTReverseReverse polarityAmeloblastomaReverse bevelClass 2 gold inlay for retentionReverse curveFor resistanceReverse bevel incisionIn undisplaced flap when the incision is done coronal to sulcusReverse occlusal planeIn pan when chin is tipped upwardsReverse 3/4th crownMandibular 3rd molarthe primary dentitionWhat is the ideal occlusion?Midlines coincide, all max teeth overlap the mand, there is spacing between teeth, 0-2mm overbite/overjet; 20 primary teethWhat type of spacing is there in the primary dentition?Generalized and primate spaceWhat is the primate space?Anterior to the max primary canine and distal to the mandWhat are potential causes of excessive spaces?Frenum, supernumerary, poorly fused midpalatal sutureWhat are deviations from normal?Crossbites, ankylosis, exfoliation problems, number problems, crowdingWhat are the types of crossbites?Bilateral crossbite, unilateral crossbite, and functional crossbiteWhat is a bilateral crossbite?Both sides are in crossbite, caused by relatively narrower maxilla as compared with mandibleWhat is a unilateral crossbite?A true crossbite, one side only and midlines are coincidentWhat is a functional crossbite?Maxillary constriction causes premature contacts and one side appears in crossbite in CO, midlines are NOT coincident What are causes of crossbites?Constricted arch (skeletal), tipping of teeth (dental), and displacement of tooth (dental)What is a functional posterior crossbite?Upper teeth have crossed to outside of lower teeth, one side of max arch completely misses mand arch, needs immediate correction b/c it can lead to increased asymmetry of lower jawWhat types of anterior crossbites are there?Skeletal, dental, and combinationWhat is the primary molar classification based on?Relation of the D of the man second primary molar and the D of the max second primary molar. What types can you have?D step, flush terminal plane, and M stepWhat is a flush terminal plane?The normal position. Distal edges of both primary molars are at the same positionWhat is distal step?Class II tendency. Distal margin of mandibular second primary molar distal to max molar. Can be recognized as early as 3 yearsWhat is mesial step?Class III tendency. Distal margin of mand second primary molar mesial to maxillary molarWhat is ankylosis?Fusion of bone to dentin and or cementum. It is probably geneticWhat is criteria for ankylosis?Percussion, lack of mobility, lack of PDL on radiograph, and infraocclusionHow is it clinically seen?Tooth fails to continue eruption; bone fails to develop in area, 20% related to congenitally missing teeth, can prevent premolar eruption, and can cause space loss, usually exfoliates normally and can cause deflection of permanent toothMany teeth that ankylose late with _______, but might not exfoliate _____?Exfoliate on time, but might not exfoliate easilyThe _____ the ankylosis the more the _____ is affected?Earlier, occlusionWhat are number problems?Congenitally missing vs. extraction, supernumeraries, and fusion vs. geminationExfoliation should be_______________________?Bilaterally symmetrical within 6 mo of contralateral teeth and should occur before the permanent tooth eruptsExfoliation should be in the same order as?The eruption of permanent teethWhat do supernumeraries prevent?Teeth from eruptingWhat is fusion related to?Reduced number of permanent teeth and give decreased space for permanent teethWhat is the difference between fusion and gemination?Fusion is one fewer tooth than expected and gemination is normal complement of teeth, but it appears that there is one extra How do suckling and infantile swallowing affect teeth?Rooting stimulating maternal milk flow. Tongue covers lower incisionrs and acts as path for milk. Tongue brought forward to lips. Swallowing pattern changes during 1st year of life normally and only 40% have it at age 8. Retained pattern in open bite cases with extreme lip pursing in some. Lip action does not occur in adult swallow patternHow do sounds develop?With control of anterior then posterior tongueWhat are the first sounds we form?P and bWhat comes later and ultimately what comes last?S and Z come later with posterior control and R is usually last and require more tongue controlWhen does sucking usually disappear?Age 2-5 and can cause occlusal damageHow does a baby open compared to an adult?Baby—laterally and adult—straight down usuallyWhen does the transition occur?At the time of the eruption of the permanent canine (~age 12)Who retains the infantile chewing pattern?People with open biteseruption and exchange of the dentitionPrimary teeth are generally larger in which sex?MalesAnomalies of development are (more/less) frequent in primary teeth?LessT/F: it is necessary to have a permanent tooth to have resorption of the primary tooth roots?F: it is not necessaryWhat is the sequence in the eruption of the primary teeth?Man I, Max I, Max L, Man L, Man/Max 1st molar, Max Canine, Man Canine, Man 2nd molar, Max 2nd MolarAt birth, the mandible is ____ relative to the maxilla? When does this change and how?Retrognathic, it is reduced progressively up to 21 months of ageWhat are the 10 normal signs of the primary and mixed dental arches?Spaced anteriors, primate spaces, shallow overbite and overjet, flush (straight) terminal plane, or mesial step (class I molars), Class I canines, almost vertical anterior teeth, ovoid arch formWhat are two patterns to a class I?Flush terminal plane line down distals of primary 2nd molars and mesial step, lower 1st molar mesial to max molar—ideal because allows permanent molars to come into class IIf you see a distal step in the primary teeth, what does it often lead to?Class IIWhat is the most usual precursor to Class III?Mesial stepWhat is mixed dentition?The period where both primary and permanent teeth are in the mouthWhat are accessional teeth?Those that erupt posterior of the primary teethWhat are the dental arch perimeters used for?To align the permanent incisors which typically are crowded upon eruption. Space for cuspids and premolars and adjustment of the molar occlusionAs the larger incisors erupt, how do they find space?By increasing the arch width by pushing the primary canines distalHow is this possible in the mandible?Because the space is distal of the primary caninesWhat about the maxilla?The spaces are mesial of the caninesAs the permanent canines and premolars erupt, are the bigger or smaller than the primaries?Slightly smallerAfter the loss of the primary “E,” what happens?There is a late mesial shift of the molars and is much larger in the mandibleWhat is incisor liability?The discrepancy in size between the primary and permanent incisor teethWhich are bigger?PermanentHow can you overcome incisory liability?By interdental spacing, intercanine growth, and anterior incisor positioningIf you lose one primary canine, what should you do?Remove the other because if you don’t it will shift to one sideWhat are some factors regulating the eruption of the permanent dentition?Teeth do not begin to move occlusally until the crown is formed. Root formation can give rough estimate for eruption. The rate of eruption does NOT correlate well with root elongationHow long does eruption take to reach occlusion after the crown reaches the alveolar margin?12 to 20 monthsThe sequence of eruption for girls is on average how much earlier than boys?5 monthsIn the maxilla, the appearance of the second molars before the canines or premolars is (more/less) common?LessWhich tooth is most often ankylosed?Primary mandibular molar teeth, but the etiology is unknownDo they occur bilaterally? What do they manifest as?Yes, as a posterior open bite due to failure of the ankylosed tooth to keep up with vertical drift of the adjacent teeth and their alveolus What is the order of frequency of ectopic development of permanent teeth?Mand 3rds, max canines, mand and max 2nd premolars, max CITransposition of teeth is a rare form of ectopia, and typically involves what?An exchange between cuspids and first bicuspids or cuspids and lateral incisorsWhich teeth are most variable with respect to development, size, and shape? They are also most likely to what?Teeth which are the most distal in the genetic field. They are also the most likely to display agenesisWhat is the complete absence of teeth?Anodontia What is incomplete formation?OligodontiaWhich are the most commonly missing teeth?Mand 2nd premolars, max lateral incisors, and max 2nd premolarsCan congenitally missing teeth be passed from parte to child?YesWhat are classifications of supernumerary teeth?Peg laterals, normal form and size, but supplemental to the regular dentition, teeth showing variation in size and cusp form, but are in the proper placeWhat is the difference between gemination, twinning, fusion, and concrescence?Gemination—one bud, one tooth; twinning—one bud, two teeth; fusion—two teeth, dentin union; concrescence—two teeth; cementum unionthe late mixed dentitionWhat is late mixed dentition? **Stage of occlusal development in which the primary canines and molars are exfoliating and the permanent canines and premolars are erupting. This is also the stage in which comprehensive ortho tx is started for many patientsT/F: there is a strong relation between tooth eruption and puberty?F: there is notWhat do you need to know to maximize the effect of ortho tx on skeletal malocclusion?When the growth spurt is taking placeWhat is the effect of puberty on ortho treatment?Prepubertal growth spurt physical changes significantly affect the face and the dentition. Make correction of class II work easier and class III harder. What releases releasing factor and what does this stimulate?Hypothalamus, RF stimulates anterior pituitary to produce pituitary gonadotropinsWhat do gonadotropins stimulation?Adrenal glands and sex organs to produce sex hormonesWhat do sex hormones stimulate?The development of secondary sex characteristics, accelerated growth of genitalia, and accelerated general body growthWhen is neural growth essentially completed and are they affected by sex hormones?Age 6, noWhat does scammon’s growth curve show? **Way different tissues accelerate. Lymph tissues rise at 10 and level at 20. Neural tissues level at about age 6. Maxilla grows similar to _____, while the mandible grows similar to _______?Neural; normal skeletal growthWhat are methods of determining maturity?Secondary sex characteristics, hand wrist films, cervical maturationHow many secondary stages of development do males have? What are they?4: stage I: fat spurt; stage II: fat decreases, pubic hair appears, growth of penis, growth spurt begins (about yr. later); stage III: axillary hair, facial hair on upper lip, muscle growth, less fat, harder body form, peak height velocity (8-12 months later); stage IV: height growth ends, hair on chin, darker pubic and axillary hair, more muscle strength (15-24 months later)What are they for females?3: stage I: breast buds, pubic hair appears; stage II: noticeable breast development, darker pubic hair, axillary hair appears, peak height velocity (about 1 yr later) stage III: bbroadening of hips, more adult fat distribution, breast development complete, growth spurt almost complete (1-1 ? years later)In which sex is it harder to id maturation? When does it occur?Boys about two years after girlsPuberty is longer in which sex? How long for each?Boys—5 years; girls 3The stage of development of __________ provides an individual physiologic calendar?Secondary sexual characteristicsWhat does earlier sexual maturation relate to?Early cessation of growthWhy must the timing of ortho be done earlier in girls than boys?To take advantage of the adolescent growth curveHow can you use the hand-wrist film?Measure the amount of progress the child has made toward attaining physical maturity, distinguish the poorly from the adequately mineralized skeleton (nutritional status), reveals imbalances in skeletal development, discloses scars of interrupted growth—record of past illnesses. So how do you determine the rate of skeletal development?By repeating the films_______ can never be precisely known until it has bee attained?Terminal statureWhen is the final stage of skeletal maturation reached?With the epiphyseal-diaphysial fusion of the last bone in which it occurs.What are Fishman’s indicators?The thumb, 3rd 5th fingers and radiusHow do you measure maturity with TW2?Allot a numerical score to each stage of each bone. The bones in the hand and wrist could then each be scored and the scores averaged to give an overall maturity scoreWhat do the score range?The overall score extends from 0-100 and the scale for each bone starts at 0 (bone is invisible)What about with Atlas?Film chosen as the standard—most representative of the central tendency of 100 films and is based on maturity indicatorsThere are positive correlations between skeletal growth and what?Facial growth, particularly in relation to the mandibular changes. When does the maximum rate of circumpubertal facial growth occur?Slightly later than peak growth in statural heightWhat is skeletal maturation assessment—SMA (fishman’s)?Uses only 4 stages of bone maturation, all found at 6 anatomical sites located on the thumb, 3rd and 5th fingers, and the radius. There are 11 discrete adolescent SMA’s covering the entire period of adolescent development found on these 6 sitesWhat are the 4 ossification stages?Epiphyseal widening on selected phalanges (SMI—when epiphysis is the width of the diaphysis), ossification of the adductor sesamoid of the thumb (SMI—first observation of the small, relatively round center of ossification medial to the junction of the epiphysis and diaphysis of the proximal phalanx), capping of the selected epiphyses over diaphyses (rounded lateral margins of epiphysis begin to flatten and point toward diaphysis) and fusion of selected epiphyses and diaphyses (completion of fusion—smooth continuity of the surface at the junction)Which is most important?Fusion—growth completeWhat cervical vertebrae do you look at when determining maturity?2nd, 3rd, and 4thWhat are the categories of the cervical maturation index?Initiation, acceleration, and transition, deceleration, maturation, and completionWhen can changes be seen with this?From birth to full maturityWhere does vertebral growth take place?From the cartilaginous layer on the superior and inferior surfaces of each vertebraeWhat happens in initiation?Adolescent growth just beginning. Inferior borders of C2, C3, C4 were flat. Vertebrae wedge shaped and superior vertebral borders tapered from posterior to anteriorWhat happens in acceleration?Growth acceleration beginning and concavities developing in the inferior borders of C2, C3, inferior border of C4 is flat. C3 and 4 are nearly rectangularWhat happens in transition?Adolescent growth still accelerating toward peak height velocity. Distinct concavities in inferior borders C2 and 3. concavity beginning to develop inferior border C4What happens in deceleration?Adolescent growth dramatically decelerates. Distinct concavities on 2,3,and 4. C3 and 4 becoming more square in shapeWhat happens in maturation?Final maturation of vertebrae. More accentuated concavities 2,3 and 4. C3 and 4 nearly square to squareWhat happens in completion?Growth is completed. Deep concavities on C2, 3, and 4. C3, 4 square or greater in vertical dimension (they are taller than they are wide)Early permanent Dentition yearsWhat are the two mechanisms of nasomaxillary complex?Passive displacement and active growth of maxillary structuresWhat happens in passive growth?Growth of cranial base pushes maxilla forward. Important during primary dentition years. Slows with completion of neural growth at age of 7 and accounts for about 1/3 of the total forward movementWhat happens with active growth of the maxillary structures and nose?Surface remodeling and downward and forward growthWhat happens with mandibular growth?Steady rate before puberty, ramus height increases 1-2 mm per year. Body length increases 2-3mm/year and you get a prominence of the chinWhat is the sequence in which growth is completed?Width, length, heightHow long does the length and height of both jaws continue to grow?Through pubertyWhat direction does the female maxilla grow slowly and until when?Downward and forward to age 14-15Where does late growth occur and when does it end?Primarily in the mandible and is vertical ending in early 20s in boys and earlier than that for girlsWhat are some dental changes during facial development?When permanent tooth erupts the pulp is large. The pulp chamber becomes smaller with increasing age. At the time of eruption gingival attachment is high on the crown and the downward migration of gingival attachment results from vertical growthWhat is passive eruption? When does this occur?Actual gingival migration of the attachment without any eruption of the tooth. As long as the gingival tissue is healthy this doesn’t occurWhat is active eruption?Compensation for the vertical jaw growth during the teen years. This is the current thoughtWhen classifying facial types, there are three common systems. What are they?Headform type, malocclusions, and facial profileWhat are dolichocephalics?When brains are horizontally long and relatively narrow. Basicranium is more flat and horizontally longer. The nasomaxillary complex is in a more protrusive position relative to the mandible and is more lowered relative to the mandibular condyle which causes downward and backward rotation of the mandibleWhat happens to the occlusal plane with them? It becomes rotated into a downward-inclined alignment. There is a tendency toward mandibular retrusion and class II molar positionWhat are brachycephalics?Rounder, wider brain. More posterior placement of maxilla, horizontal length of masomaxillary complex is relatively short (but wider). Overall, tendency toward a prognathic profile and a CL III molar relationshipadult dentition and facial growthDoes facial growth continue into adult life? (in reference to the study)Yes according to the study in the 1980’s. Found there was an increase in all facial dimensions, the size and shape of craniofacial complex altered with time. Where were the most prominent changes? Least?They found that the vertical changes were more prominent than anteroposterior and width changes were least evidentWhen do women have a decrease in growth? Does it resume? Decrease in late teens. Yes, resumption in growth in 20’s. What can pregnancy cause?Some growth of the jawsWhat led to an increase in the mandibular plane angle in women?The tendency toward backward rotationWhat does forward rotation of the mandible in men lead to?Decrease in the mandibular plane angleWhat did the study find with the patients who had had ortho?That the growth pattern associated with the original malocclusion continued to express itself in adult lifeWhich kind of profile changes were greater, soft tissue or skeletal? Soft tissue changes. Elongation of the nose, flattening of the lips, and augmentation of the chinWhat is acromegaly? What can it cause orthodontically?Anterior pituitary tumor that secrets excessive growth hormone. This may cause excessive growth of the mandible creating a class III malocclusion starting in adult lifeHow do you stop the growth?The excessive growth stops when the tumor is removed or irradiated, however, the skeletal deformity persists and orthognathic surgery may be needed to correct the mandibular positionWhat is hemimandibular hypertrophy? Who is affected most commonly?Unilateral growth of the condyle for no known reason. The patient is metabolically normal and it is most likely to occur in girls between the ages of 15 and 20What ortho problem can be seen in those with muscular dystrophy?Lengthening of the face in patients with muscle weakness syndromesetiology of orthodontic problemsWhat are types of disharmonious skeletal relationships?CL I—bimaxillary protrusion (both max and man are too far forward from the norm); CL II—maxillary excess with normal mandible, maxilla normal with retruded man; CL III—normal maxilla with prognathic mandible or retruded max with a normal man; constricted maxilla; deep bite/open biteWhat causes a cleft lip?Failure of fusion of median and lateral nasal processes and maxillary prominence. What does it affect and how many patients also have CP?Affects the alveolar ridge and teeth, constricted maxilla with cleft palate. 60% of pts with CL have a cleft palate as wellWhat are some etiologic factors of malocclusions?Maternal use of: aspirins, cigarette smoking (hypoxia), dilantin, 6-Mercaptopurine-immunosuppressive drug, or valiumWhat are disturbances of dental development?Congenitally missing teeth (anodontia, oliogodontia, hypodontia), malformed teeth (3rd molars, max lat incisors, 2nd PM), supernumerary teeth (mesiodens—most common)What is anodontia?All or almost all of the teeth are missingWhat is oligodontia?When 6 or more of the teeth are missingWhat is hypodontia?When 5 or less are missingWhat is ectopic eruption?Malposition of a permanent tooth bud. It can lead to eruption in the wrong position and can be caused by a retained primary toothWhich teeth are the most commonly retained?The max primary 2nd molars. The premolar will be pushed off to the b when it tries to eruptWhat is gemination?When the teeth are fused, partly split, but share a common pulp chamberWhat is important about Cleidocranial dysplasia in ortho terms?Numerous supernumerary teeth and the permanent teeth often fail to eruptWhat happens with the early loss of primary teteh?You need to maintain symmetry, there will be a mesial drift of molars, distal drift of incisors and canines. Avoid loss of arch perimeter, lower lingual arch, maxillary hayes nanceWhen the left max central erupts, when should you expect to see the other?Very soon because teeth tend to erupt about the same time to maintain symmetry. If it hasn’t come in in 3 months there is a problem What is ankylosis? What does it look like?When the tooth attaches to the bone. The primary tooth appears to submerge and the adjacent teeth can tip giving a loss of arch perimeterWhat environmental factors can lead to malocclusions?Thumb and digit sucking, tongue thrust, mouth breathing, loss of arch perimeter d/t caries or early loss of primary teethWhat will you see with thumb suckers?Narrow palatal vault, retro man incisors pull out max incisorsWhat do you see with mouth breathers?Max collapse in because no pressure from the tongue. Get an open biteWhat are causes of traumatic displacement of the teeth? what does tx depend onTrauma, defect in crown, dilacerations, treatment depends on the type of displacementIf a tooth is intruded what does it almost always need?EndoWhy do you only stabilize a displaced tooth for 7-10 days?To prevent ankylosispsychosocial growth and developmentWhat are erikson’s stages of emotional development?Development of trust, development of autonomy, development of initiative, mastery of skills, development of personal identity, development of intimacy, guidance of the next generation and attainment of integrityWhen is the development of trust? What occurs in this stage? What does it depend on?Birth to 18 months. Basic trust develops and depends on a caring mother/mother substitute. Physical growth can be retarded if emotional needs are not met. What does a strong bond create?Separation anxietyWhat are some dental considerations for this stage?If dental work is necessary have the parent present and have them hold the child. Children who haven’t developed basic trust will need special effort by dentist and staffWhen is the development of autonomy? What happens during this stage?18 mo to 3 years. Uncooperative behavior, child developing autonomy. Child struggling to exercise free choice. And still dependent on parents in times of insecurityWhat are dental considerations?Have child think whatever dentist wants is his/her choice. Offer simple choices—color of bib. Allow parent to be present. With complex tx either sedate or use general anesthesiaWhen is the development of initiative? What happens during this stage?3 to 6 years. Continued development of autonomy. Physical activity and motion, extreme curiosity and questioning and aggressive talkingWhat are some dental considerations?Usually first visit is during this time. Exploratory visit with mom present and little tx. After initial visit, will tolerate separation from mother and usually will behave better. Reinforce independence over dependenceWhen is mastery of skill and what happens then?7 to 11 years. Acquiring academic, social skills. They are learning rules and competition within a rewarded system. They start to decrease their attachment to their parents and increase attachment to peersWhat are dental considerations?Often ortho tx started, phase I or functional appliances. Set attainable goals. Positively reinforce success and likely to faithfully wear headgear and or removable appliances. Instructions explicit and concreteWhen is the development of personality and what happens then?12 to 17 years. Intense physical development. Psychological development can exist outside the family—belonging to a larger group. Complex stage and a time of stress and rewards. It is when you establish your own identityWhat are dental considerations?Most ortho is done at this time. Behavior management is a challenge and motivation is key (both external and internal)When is the development of intimacy? What happens then?Young adult. Development of relationships. Factors of acceptance and success (appearance, personality, emotional qualities, intellect, and others)What are dental considerations?Trying to correct a dental appearance they see as flawed. Feel change in appearance will change outcome of relationships. Potential psychological impact of ortho should be explored from startWhen does guidance of next generation occur? What happens then?Adulthood. Successful parenting, supporting services for the next generation, opposite characteristics (stagnation, self-indulgence, and self-centered behavior)When is the attainment of integrity and what happens then?Late adulthood. Individual has adapted to the combination of gratification and disappointment that every adult experiences. Opposite is despairWhat is assimilation?The application of a general schema to a particular instance?What happens during sensorimotor?Goes from reflex activities to behavior to cope with new situations. Concept of objects and communication is limitedWhat about preoperational?Literal nature of language. Understand the world through senses. Abstract ideas are hard to grasp. Egocentrism and animismWhat about period of concrete operations?Improved ability to reason. Ability to see another point of view. Animism declines. Instructions must be very clear and concreteWhat about the period of final operations?Abstract concepts and reasoning. Imaginary audience and personal fableWhat does the personal fable refer to?The it won’t happen to me attitudeForamens and bonesbone??location?? foramen?? vessels?? nerves??frontal-supraorbital foramensupraorbital artery, supraorbital veinsupraorbital nervefrontalanterior cranial fossaforamen cecumemissary veins to superior sagittal sinus-ethmoid-foramina of cribriform plate-olfactory nerve bundles (I)ethmoidanterior cranial fossaanterior ethmoidal foramenanterior ethmoidal arteryanterior ethmoidal veinanterior ethmoidal nerveethmoidanterior cranial fossaposterior ethmoidal foramenposterior ethmoidal arteryposterior ethmoidal veinposterior ethmoidal nervesphenoid-optic canalophthalmic arteryoptic nerve (II)sphenoidmiddle cranial fossasuperior orbital fissuresuperior ophthalmic veininferior ophthalmic veinoculomotor nerve (III)trochlear nerve (IV)lacrimal, frontal and nasociliary branches of ophthalmic nerve (V1)abducent nerve (VI)sphenoidmiddle cranial fossaforamen rotundum-maxillary nerve (V2)maxilla-incisive foramen/incisive canals-nasopalatine nervepalatine-greater palatine foramengreater palatine arterygreater palatine veingreater palatine nervepalatine and maxilla-lesser palatine foraminalesser palatine arterylesser palatine veinlesser palatine nervesphenoid and maxilla-inferior orbital fissureinferior ophthalmic veinsinfraorbital arteryinfraorbital veinzygomatic nerve and infraorbital nerve of maxillary nerve (V2)orbital branches of pterygopalatine ganglionmaxilla-infraorbital forameninfraorbital arteryinfraorbital veininfraorbital nervesphenoidmiddle cranial fossaforamen ovaleaccessory meningeal arterymandibular nerve (V3)lesser petrosal nerve (occasionally)sphenoidmiddle cranial fossaforamen spinosummiddle meningeal arterymeningeal branch of the mandibular nerve (V3)sphenoid-pterygoid canalartery of the pterygoid canalnerve of pterygoid canalsphenoid and palatine-sphenopalatine foramensphenopalatine arterysuperior nasal nervenasopalatine nervesphenoid, temporal, and occipitalmiddle cranial fossaforamen lacerum(or carotid canal)internal carotid arteryinternal carotid nerve plexustemporalposterior cranial fossainternal acoustic meatuslabyrinthine arteryfacial nerve (VII)vestibulocochlear nerve (VIII)temporal-stylomastoid foramenstylomastoid arteryfacial nerve (VII)temporal-mastoid foramenemissary vein-temporal-petrotympanic fissure-chorda tympanioccipital and temporalposterior cranial fossajugular foramenposterior meningeal arteryascending pharyngeal arteryinferior petrosal sinussigmoid sinusinternal jugular veinglossopharyngeal nerve (IX)vagus nerve (X)accessory nerve (XI)occipital-hypoglossal canal-hypoglossal nerve (XII)occipital-condylar canaloccipital emissary vein-occipitalposterior cranial fossaforamen magnumvertebral arteriesmeningeal branches of vertebral arteriesmedulla oblongataspinal roots of accessory nervesparietal-parietal foramenemissary vein-mandible-mental foramenmental arterymental veinmental nervemandible-mandibular forameninferior alveolar arteryinferior alveolar veininferior alveolar nervezygomatic-zygomaticofacial foramen-zygomaticofacial nervezygomatic-zygomaticotemporal foramen-zygomaticotemporal nerveSmart notesMandibular molar, not fused17Mandibular molar roots or pedo cowhorns23Mandibular adult cowhorns32Mandibular 3rd molar, fused222Mandibular premolars74 0r 151AMandibular primary teeth151SMaxillary right molar89Maxillary left molar90Maxillary 3rd molar210Maxillary premolar and molars150AMaxillary premolars only or root stumps65 (bayonet shaped)Maxillary primary teeth150SMaxillary premolars, incisors and root tips286Periosteal elevator9East west elevator: extraction of rootCreyer’s: root fragments for mandibleYou are about to extract a maxillary first molar. In which position should the maxilla be in relation to the floor: 45-60 degreesUnintentional crush injury to the lip are caused by which part of the forceps: HingeFind outFerrel effectBP and Tx planningKennedy’s classificationcognitive behavior decrease in a normal process of aging? (learning, attention, reaction time)Epinephrine reversalIf patient gets 1 mg/liter of fluoride how much fluoride are they getting….0.5 mgIn forced excursion of central incisors u pull it: 1 mm in 1 weekPOMP and MOPP regimenAB prophylaxisInterferences in protrusion? Db/Mb; interferences in centric? Mb/DbMuscles of mastication origins and insertionsIn non-working lateral interference, which muscle can possibly experience spasm?Primary reason in replacing composite restoration due to?Best response to amputation: maxillary first molarHow many mg of fluoride in 1 L of water at 1 ppmProliferative verrucous leukoplakia associated withWhat property makes a substance liquid over compressionPSA artery is a branch of: maxillary ICA?ChecklistASDA – J, K, L, MPatient management – MosbyProstho – Know BULL and DUML; working and non-workingImplants – coolants; right temperature0-635 ................
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