MFDS PART2

By Dr.Priyanka varma

2022

DENTAL
priyankavarma.marutha@gmail.com
1. Orbital bones anatomy
2. Cranial base anatomy and foramens

Identify and structures passing through them

a. cribriform plate: olfactory nerve
b. foramen ovale: otic ganglion, mandibular division of trigeminal nerve, accessory meningeal,
lesser petrosal nerve, emissary vein.\
c. foramen rotundum: maxillary division of trigeminal nerve
d. foramen spinosum: middle meningeal artery
3. A. disinfection and sterilization:
Disinfection: inhibition or destruction of pathogens
Sterilization: destruction or removal of all forms of life

b. common link between them- both removes pathogens and avoids infection,decontamination.

c. difference between them- removes all kind of life including spores

d. criteria for handpiece sterilization: acceptable methods are chemical vapor sterilizers,
autoclave, dry heat
 steps: remove the bioburden from the surface with alcohol based solution
 lubrication of the handpiece
 removal of excess oil
 wrapping up
 sterilize at 134 degrees at 2.2 bar pressure for 3-5 minutes
4. Syncope:
a. causes: cardiac problems like atrial stenosis
dehydration
postural hypotension
anxiety
needle phobia
b. nervous system involved: autonomous nervous system
c. which neural network: parasympathetic network involving vagus nerve
d. management: lay the patient flat and legs elevated
loosen the clothing
monitor pulse
if recovery doesn’t occur rapidly try a tiny dose of atropine 100 micrograms iv
e. cardiac output: CO= VO2/Ca- Cv
CO= cardiac output
VO2= oxygen consumption in ml of pure gaseous oxygen per minute
Ca= oxygen content of arterial blood
Cv = oxygen content of mixed venous blood
5. CBCT showing a lesion involving teeth

a. differential diagnosis: dentigerous cyst, okc, ameloblastoma

b. radiological features: expansion of bone, resorption of bone,unilocular radiolucent lesion
with well defined borders.
c. Definitive diagnosis: dentigerous cyst
d. Identifying the planes: a. axial ct
b. coronal
c. sagittal
6. 46 tooth with gold crown and sinus tract opening in the buccal vestibule

a. Tests for pulp vitality:

 Thermal tests: cold test with ethyl chloride and heat test with GP
 EPT
 Pulse oximetry
 Laser doppler flowmetry
b. Pulpal diagnosis: pulp necrosis
c. Periapical diagnosis: chronic periapical abscess
d. Ideal requirements of access cavity preparation:
 Straight line access to the apical foramen or initial curvature
 Locate all root canal orifices
 Conservation of sound tooth structure.
7. Bilateral cross bite with buccally erupted canine

a. Identify the appliances: hyrax and quad helix

b. Investigations: OPG, UAO, CBCT, lateral cephalogram
c. Any removable appliance for the correction and its components:
Removable appliance with expansion screw
Components:
 Acrylic plate
 Adams clasps on canines and molars
 Expansion screw
8. Identify them

a. Erythema migrans
b. Squamous cell carcinoma
c. Referral points:
 Ulcers greater than 3 weeks
 Referred otalgia, fixed to surrounding tissues
 Perineural invasions leading to numbness or paresthesia
 Altered sensations.
 Not responsive to medication.
9. A patient underwent extraction but hemostasis is not happened
a. Systemic causes for bleeding:
 Liver failure
 Cirrhosis of liver
 Hepatitis
 Thrombocytopenia
b. General causes: injury to blood vessels, vitamin deficiency
c. Platelet count per litre : 1.5-4.5*109 per litre
d. Lifespan: 8-10 days
e. Origin of platelets: megakaryocyte of bone marrow.
10. A patient age 31 fell down and had an impact on chin
during a parade

a. Identify the diagnosis: bilateral condylar

fracture
b. Symptoms:
 Edema,trismus
 Bleeding
 Numbness
 Occlusal gagging
 Shortened facial height
c. Management:
 See whether the patient is conscious and no head injuries and bleeding
 Prophylactic tetanus shot if not taken before within 6 months
 If greater than 12 years of age and pain free occlusion is possible with elastic
traction , then do and suggest soft diet and analgesics and reassess after 7 days
 If not ORIF, MMF
11.
a. Identify the picture: squamous papilloma

b. Different appearance:
 Heavy keratinized cauliflower like appearance
 Less keratinized raspberry like
c. Causative virus: HPV 6 AND 11
d. Causative virus for oropharyngeal squamous cell carcinoma:
HPV 16 & 18
e. Management: surgical excision along with base
12. A 5 mm implant in the region of 36
a. Mesiodistal space: 5+1.5+1.5=8mm
b. Buccolingual space: 5+1+1=7 mm
c. Occlusal clearance for screw retained implant: 4mm or less
Occlusal clearance for cement retained implant:4-11mm.
d. Advantages of screw retained over cement retained implant:
 Less chances of periimplantitis
 Easy retrievability
 Less chance of fracture
13. A 8 year child fell down in school play ground and his central incisor has fallen out and patient and
parents came to the clinic with tooth in milk.

a. Diagnosis: avulsion
b. Immediate assessment:
 Obtain thorough history to know the type of injury, medical condition of the patient
and find out any child abuse situations
 Check for other injuries like lacerations, concussions, loss of consciousness,
fractures etc.
 Soft tissue examination
 If possible administer tetanus shot
c. Management:
 Hold the tooth by the crown and clean the root surface and apical foramen with
saline
 Administer local anesthesia and clean the socket with saline and examine to find out
any alveolar fractures.
 Replant the tooth slowly with digital pressure
 Suture the gingival laceration especially in the cervical area
 Radiographic verification
 Followed by flexible splint for 1-2 weeks [0.016” or 0.4mm]
 Analgesics and antibiotics
d. Prognostic factors:
 Extra alveolar time
 Maturity of root apex
 Type of storage medium
e. Complications:
 Ankylosis [external replacement resorption]
 Loss of tooth vitality
 External surface resorption
f. Storage medium:
 Hanks balanced [HBSS], saline
 Milk ,saliva
14.
a. Identify the object: bite guard

b. Identify the markings:

 Incisal guidance
 Canine guidance
 Interocclusal points
c. Main use: protection against wear and harmful forces, aid to prevent harmful effect of
bruxism
d. Material of choice: polymethyl methacrylate
15.
a. Identify Kennedy’s classification

b. Identify the following: Surveyor parts: horizontal arm, vertical arm, analyzing rod

c. Functions of surveyor:
 To locate undercuts for retention
 To block out undercuts which are not used or making obstruction
 To know the path of insertion
 Used as paralleling instrument
 Tripodisation
d. Use of analyzer rod: to locate the maximum bulbosity on the crown/tooth in path of
withdrawl
 August 2022
16.
a. Facial nerve origin: 7th cranial nerve, origin – lateral side of the brainstem between pons and
medulla oblongata

b. .
Branches Muscle innervation Test
Temporal Orbicularis oculi, frontalis, Frowning, wrinkle forehead
corrugator supercili
Zygomatic Orbicularis oculi Close eyes tightly
Buccal Orbicularis oris, buccinator, Puffing up cheeks, smile
zygomaticus with full exposure of teeth
Marginal mandibular mentalis Drooping and asymmetry of
lip
Cervical platysma Shrug the shoulders
17. A figure showing root canal treated teeth with periapical radiolucency

a. Tests for pulp vitality:

 Thermal tests: cold test with ethyl chloride and heat test with GP
 EPT
 Pulse oximetry
 Laser doppler flowmetry
b. Periapical diagnosis: chronic periapical abscess
c. Factors contributing to this condition:
 Incomplete removal of necrotic pulp tissue
 Systemic conditions
 Irritation to the periapical tissue
 Infection spreading from periodontal tissue
d. Management: re root canal treatment, if it changes into cystic lesion apicectomy followed
by retrograde filling.
18. A picture of unilateral crossbite

a. Causes: skeletal abnormal growth, thumb sucking, lowered tongue position.

b. Effects of thumbsucking:
 High palatal vault
 Procline upper anteriors
 Retrocline lower posteriors
 Posterior Crossbite
 Anterior open bite
c. Management: quadhelix, URA with midline screw, habit breaking appliance
d. Investigations: panoramic radiograph, lateral ceph
19.
a. Disinfection: inhibition or destruction of pathogens
b. Sterilization: destruction or removal of all forms of life
c. Temperature for handpiece sterilization: sterilize at 134 degrees at 2.2 bar pressure for 3-5
minutes
d. Normal autoclave parameters: 121degres , 15 minutes, 15 lb pressure
20. A picture of implant supported denture

a. Indications:
 Failure of conventional CD
 Resorbed bridge
 Long span partial denture
 Opposing natural teeth
 Opposing implant restoration
 Patients desire for palatal free restoration
 Post cancer surgery
b. Difference between implant supported and implant retained denture:
Implant retained Implant supported
Retention from implants and support from Retention and support from implants
soft tissues
2 to 3 individual implants may be with a Long bar with 4 implants
short bar
21.
a. Identify: intrusion

b. Investigations: percussion test, visual examination [comparing incisal height with adjacent
tooth], Radiographic intervention
c. Factors affecting management:
 Maturity of tooth apex
 Type of tooth [whether permanent or temporary]
 Extension of intrusion[severity in mm]
22. A picture of right facial swelling

a. Which space infection: buccal space infection

b. Normal blood sugar levels: fasting- 5.6 mmol/l
Post lunch[2hr]: 7.8mmol/l
c. Why diabetics easily get infected: diabetic patients may have peripheral nerve damage and
reduced blood flow to the extremities and organs which lead to reduced immune system
defense and becomes more prone to infection.
d. Which blood test is used for checking blood sugar levels: oral glucose tolerance test, glycated
hemoglobin[A1C] test
23. Platelets:
a. Origin: Megakaryocyte of bone marrow
b. Lifespan: 8-10 DAYS
c. Function: hemostasis, thrombosis, wound healing
d. Action: activation, adhesion, aggregation, formation of primary hemostatic plug
e. Deficiency of it: thrombocytopenia
f. If they increase what disease: thrombocytosis, thrombocythemia
24. Tongue:

Intrinsic Transverse, longitudinal, verical

Extrinsic Genioglossus, hyoglossus, styloglossus,
palatoglossus.
Nerve supply Sensory-
a. anterior 2/3rd – chorda tympani, lingual
b. Posterior 1/3rd – glossopharyngeal.
Around epiglottis vagus via its superior
laryngeal.
Motor: except palatoglossus all are innervated
by hypoglossal. Palatoglossus innervated by
accessory nerve via pharyngeal plexus
Papilla a. Fungiform
b. Filiform
c. Foliate
d. circumvallate
25. White lesion on buccal mucosa

a. Diagnosis: leukoplakia
b. Malignancy rate: homogenous-3%
Heterogenous- 14.5%
c. Management: referral for incisional biopsy, removal of etiology
Medical: retinoid, vitamin A, lycopene, beta carotene
Followup for every 3 months
26. Lesion on lateral border of tongue of an ill fitted denture patient
a. Features observed: induration, elevated margins
b. Differential diagnosis: squamous cell carcinoma, verrucous carcinoma, major apthous
c. Tests to diagnose: biopsy, PET scan
27.
A. Different types of impression trays identify them.
 Perforated dentulous
 nonperforated
B. A picture of alginate: irreversible hydrocollide
C. Syneresis: expression of fluid on to the surface of gel structure
D. Imbibition: the process of watersorption
28. Orbital bones anatomy
29. identify [landmarks IAN ]
30. Posterior superior alveolar nerve block

a. Areas to be anesthetized:
 pulps of maxillary molars except mesio buccal root of maxillary 1st molar. [72%
chance it may get anesthetize]
 buccal periodontium and bone overlying these tooth
b. landmarks:
 Mucobuccal fold and its concavity
 zygomatic process of the maxilla
 infratemporal surface of maxilla
 anterior border and coronoid process of mandible
 maxillary tuberosity
c. indications:
 when treatment involves 2 or more maxillary molars
 when supra periosteal injection is not possible or contraindicated
 when supra periosteal injection is not adequate or ineffective
d. complications:
 risk of hematoma
 inadequate anesthesia
 mandibular anesthesia
 a rare chance of bells palsy
e. artery and vein nearby:
a posterior superior alveolar artery[ a branch of maxillary artery]
and pterygoid plexus[vein]
31. a white lesion on the buccal musosa of a patient using atenolol and no history of smoking or any
kind of tobacco use

a. Differential diagnosis:
 lichen planus
 lichenoid reaction
 frictional keratosis
 candidiasis
b. investigations:
 biopsy
 autoantibody serum
c. definitive diagnosis: lichenoid reaction
d. microscopic features: hyperparakeratosis,civatte bodies, saw tooth appearence
e. extraoral features:
 alopecia
 rigid nails
 wickhman striae
f. drugs causing: [ MNEMONIC-PIGM3NT3D Lichenoid ABC3]
 P- Pencillinamine
 I-interferon
 G-gold
 M-methyldopa, metformin,meparaine
 N- NSAID’s
 T- tetracyclines, thiazides, tolbutamide
 D- dapsone
 L- levamasol
 A- allopurinol
 B-beta blockers
 C- captopril, chlorpromides,chloroquine
32. A HIV patient having a intraoral swelling at alveolar ridge region. lesion leading to mobility of the
teeth and the patient lost some teeth as well

a. Diagnosis: non hodgkin’s lymphoma

b. Symptoms:
 Occurs most commonly the gingiva, palate, or the buccal vestibule.
 Patients often present with signs and symptoms such as tooth mobility, localized
swelling with ulcer, unexplained dental pain, or ill-defined lytic osseous changes.
 Oral lesions mimic a dental abscess, periodontal infection, or benign reactive
hyperplasia.
 NHL presenting as a growth from the extraction socket is rare and has been
previously reported in both HIV positive and negative patients.
c. Management:
 Biopsy[ small lesions will be gone with biopsy itself
 Multidisciplinary approach
 Wait and watch approach
 Chemotherapy along with steroids
 radiotherapy
 monoclonal antibody therapy
33. sterlisation:
a. tests to check autoclave functioning:
 vaccum leak test
 bowie-dick test
 helix test
b. How to ascertain whether sterilization parameters met:
 By biologic checks [spore test]
 By chemical checks [tape indicators]
c. four parameters of autoclave:
 steam
 pressure
 temperature
 time
d. what to do if helix test fails:
 check the expiration of test kit
 check the steam traps quality and wetness
 run a vacuum leak test
 repeat the test
 repair and replace the autoclave
e. what is the allowed minimum pressure leak according to HTM:
 0.013bar/minute
 1.3mbar/minute
34. Resin bonded bridge:
a. Types:
 By position- anterior and posterior
 By retention:
a. Micromechanical: chemically etched, electrolytically etched[Maryland]
b. Macromechanical: perforated[rochette] ,mesh like[kletto
‘o’bond],particular[crystal bond]
c. Chemical: sandblasted, tin plated

b. Advantages:
 Cost effective
 Conservative and fixed
 No LA required
 Easily rebounded
c. Designs: cantilever, fixed-fixed, fixed-movable
d. Contraindications:
 Long span edentulous space
 Parafunctional habits
 Weak abutment
 Extensive caries risk
 Unfavourable occlusion
35.
a. Identify: extrusive luxation

b. Investigations: percussion test, visual examination [comparing incisal height with adjacent
tooth], Radiographic intervention
c. Factors affecting management:
 Maturity of tooth apex
 Type of tooth [whether permanent or temporary]
 Degree of displacement
 Mobility
 Ability of the child to cope with the emergency situation
d. Management:
1. Primary teeth:
a. Immature teeth- care full repositioning or leaving the tooth for spontaneous alignment
b. Mature teeth- extraction
2. Permanent teeth:
a. Repositioning digitally
b. Stabilize it with flexible splint for 2 weeks
c. Mature teeth if pulp necrosis has indicated then go for RCT after removal of splint.
36. Anterior openbite:

a. Etiology:
 Skeletal: increased FMPA, increased lower facial height
 Soft tissue: tongue thrust, digit sucking
 Localized failure of alveolar development-cleft lip, cleft palate
b. Treatment:
 No treatment in primary dentition, just advise ortho dummy
 Habit cessation
 Habit breaking appliance [thumbguard]
 Ortho camoflauge to align the arches
 Growth modification- restrain vertical development of maxilla or molars with high pull
headgear
37. Canine impaction

a. Technique of radiograph: SLOB

b. How to assess:
 Clinical assessment by palpation and visual examination of inclination of lateral
 Parallax radiographic technique
 DPT and UAO
c. Etio:
 Missing laterals
 Delayed exfoliation
 Hypo or microdontia
 Lack of space/guidance
 Hereditary
d. Treatment:
Interceptive orthodontics
Surgical exposure and ortho alignment
Surgical repositioning [autotransplantation]
Extraction
38. Rootcanal treated tooth with periapical cyst formation

a. Mention a surgical approach: apicectomy

b. Flaps used in that technique:
 Triangular
 Semilunar
 Trapezoidal/rectangular
 Oschenbein-leubke/submarginal
 Papilla preservation flap
 Papilla based
c. Indications:
 Failure of orthograde filling
 RCT failure
 Persistent pathology
 Difficult anatomy
 Need for biopsy
 Creation of apical seal
 Curettage of apical granulation tissue
d. Contraindications:
 Proximity to neurovascular bundle
 Near to maxillary sinus
 Less accessible areas [ 2nd mandibular molar region-thick cortical plate]
 Medical issues
 Periodontal considerations [ deep pocket, loss of buccal plate, recession, short root]
e. Steps:
 LA
 Incision and Flap refection
 Osteotomy
 Curettage
 Apicectomy
 Retrograde preparation
 Retrograde filling
 Sutures
39. a 55 year old female having burning sensation of mouth which increases as the day passes and
there is no evident mucosal disease
a. diagnosis: burning mouth syndrome
b. other name: oral dysaesthesia
c. clinical features:
 subjectively less saliva
 altered taste sensation
 tingling/paresthetic/dysaesthetic sensation
d. treatment:
 reassurance
 neuropathic mediaction’s: amytriptilin, gabapentin
 cognitive behaviour therapy
40. implants:
a. mesiodistal dimensions for a narrow implant: 7mm
b. dimensions between two implants: 3mm
between implant and natural teeth:1.5 mm
c. horizontal and vertical bone loss after extraction:
horizontal: 3.5-4mm
vertical: buccal- 1.2 to 1.5mm
mesial- 0.8 to 1.5mm
distal- 0.8 to 1.6mm
41.
A. Identify: lingual bar

B. Kennedy’s classification:

C. How to prevent tipping in distal extension case:

RPI system [occlusal rest, distal guide plane, gingivally approaching I bar]
 June 2022

42.

a. Identify the foramen: mandibular foramen

b. Nerve passing through: inferior alveolar nerve
c. Branch of: posterior division of mandibular branch of trigeminal nerve
d. Divisions: mylohyoid and mental nerve
e. Muscles supplied by IAN: mylohyoid muscle and anterior belly of digastric
f. 3 areas to which lingual nerve supplies:
 Lingual gingiva of all mandibular teeth
 Anterior 2/3rd of the tongue
 Floor of the mouth
43.

a. Origin and insertion of masseter muscle:

 Superficial head-
 origin: anterior 2/3rd of lower border of zygomatic arch
 Insertion: lower half of the lateral surface of ramus
 Orientation of fibres: downwards and backwards
 Deep head-
 origin: deep surface of zygomatic arch
 Insertion: upper half of the lateral surface of ramus particularly over coronoid process
 Orientation of fibres: vertically downwards
b. Blood supply: maxillary and facial artery
c. Nerve supply: masseteric branch of anterior division of mandibular branch of trigeminal nerve
d. Functions:
 Elevation of the mandible
 Posterior fibres of deep head may have some retrusive capability
 Mastication
44.

a. Identify: Early childhood caries

b. Aetiology:
 Frequent ingestion of sugar
 Prolonged night time bottle feeding
 Reduced salivary flow
 Sugar based medication
c. 5 ways to provide fluoride and their concentration:
 Silver diamine fluoride- 44600ppm
 Fluoride varnish [5% NaF]- 22500ppm
 APF jel- 12300 ppm
 Tooth paste-1000 to 1500ppm
 Tablets- 1mg NaF
 Water fluoridation- 0.7 to 1.2ppm
d. Preventive advise:
 Reduce night time feeding
 Reduce the frequency of sugar intake
 Monitor and practice good oral hygiene
 Dilute or replace the caries causing drinks
45.

a. Identify: quadhelix
b. Types:
 Custom made
 Preformed ready type
c. Materials: NiTi, blue elgiloy
d. Efficiency depends on: size of appliance and diameter of wire used
e. Parts:
 Anterior helices
 Anterior bridge
 Palatal bridge
 Posterior helices
 Outer arms
f. Uses:
 Upper arch expansion
 Posterior crossbite
 Molar derotation
 Correction of mild class2
 Provides anteroposterior and transverse anchorage
 Provide access and space in cleft palate before bone grafting
g. Disadvantages:
 Chance of open bite
 Sore and inflamed tongue
 Limited skeletal change and palatal relapse
 Outward positioning of maxillary teeth
 Restricted tongue functions
h. Appointment stages:
 Clinical examination with radiographic assessment and making impression
[Wire bending and soldering it to molar band]
 Checking the adaptability
 inserting the appliance bonding with GIC
46. Identify them

a. Erythema migrans
b. Squamous cell carcinoma
c. Which is urgent: SCC
d. Tests: incisional biopsy followed by TNM staging, MRI, CT
e. Referral points:
 Ulcers greater than 3 weeks
 Metastatic cervical lymphadenopathy
 Rapidly growing
 Febrile illness with rapid weight loss
 Referred otalgia, fixed to surrounding tissues
 Perineural invasions leading to numbness or paresthesia
 Altered sensations.
 Not responsive to medication.
47.

a. Define lichenplanus: autoimmune chronic inflammatory condition mediated by T- cell

lymphocytic attack on stratified squamous epithelium results in hyperkeratosis with
characteristic remissions and relapses
b. Types: atrophic, reticular, bullous, erosive, plaque like, popular
c. Lichenoid reaction causes:
Dental:
1. Metals: Co, palladium, Cr, Cu, Ag, Ni
2. Nonmetals: epoxy resins, composite restorations
Drugs: NSAIDS, antihypertensives, antimalarials etc
d. Management:
 Removal of cause
 Drug alterations
 Symptomatic treatment with topical steroids, betamethasone mouth rinse, systemic-
dexamethasone, prednisolone
48.
a. 5 moments of handhygiene:
1. Before touching the patient
2. Before a procedure
3. After a procedure/body fluid exposure risk
4. After touching a patient
5. After touching the patients belongings
b. Fluids for hand hygiene:
1. Soap
2. Water
3. ABHR[antibacterial hand rub]
c. DUWL management:
When to flush-
1. Flush in the morning for 2 minute[ also expel the water out of the handpiece lines and
every appropriate handpiece every morning]
2. In the evening after the last procedure
3. In between the patients for greater than 20 seconds

Frequency of checking DUWL: Biannual checking

Microorganisms in DUWL: legionella, pseudomonas aeruginosa, candida, nontuberculous
mycobacteria, staphylococcus and streptococcus
49.

a. Types:
 By position- anterior and posterior
 By retention:
d. Micromechanical: chemically etched, electrolytically etched[Maryland]
e. Macromechanical: perforated[rochette] ,mesh like[kletto
‘o’bond],particular[crystal bond]
f. Chemical: sandblasted, tin plated
b. Other names: adhesive bridges, glued bridges
c. Alloys: NiCr, silica based
d. Advantages:
 Cost effective
 Conservative and fixed
 No LA required
 Easily rebounded
e. Designs: cantilever, fixed-fixed, fixed-movable
f. Contraindications:
 Long span edentulous space
 Parafunctional habits
 Weak abutment
 Extensive caries risk
 Unfavourable occlusion
50. Temporary crowns/provisional restoration:
a. Ideal properties:
1. Biologic: pulpal protection,maintaining periodontal health, occlusal compatability and
tooth position, prevention of fractures
2. Mechanical: resists functional load, resist removal forces, maintain inter abutment space
3. Esthetic- restore contour, color, translucency and texture
b. Materials:
1. Preformed :
plastic- polycarbonate/acrylic
Metal-Al,SS,NiCr
2. Custom made:

Self or light cured resins- PMMA, PEMA, UDMA,

Cast metal- NiCr, silver, scrap gold

c. Ideal finish lines: lingual shamfer ; labial shoulder

51.
a. Objectives of RCT:
 Complete removal of microorganism and defective pulpal tissue
 Attaining hermetic seal with proper obturation
 Prevents reinfection
b. Sealers: Tubliseal, AH plus, seal apex
c. Any one technique of obturation: warm vertical condensation
d. Composition of sealer [ZOE]: B3CES2TZ
 bismuth subcarbonate,bismuth subnitrite,barium sulphate
 canada balsam
 eugenol
 sodium borate and stabellite resin
 thymol iodide
 zinc oxide
52.
A. MILLER’S CLASSIFICTION OF MOBILITY:
 Class-1: less than 1 mm horizontal movement
 Class-2: greater than 1 mm horizontal movement
 Class-3: greater than 1mm horizontal and vertical movement
B. Features of periodontally compromised tooth/dentition:
 Compromised PDL
 Probing pocket depth of more than 3 mm
 Significant mobility
 Boneloss
 Furcation involvement
 Absence or missing of 2 or more teeth
 Food lodgement
 Gingival recession
 Hyperplastic features of gingiva
C. MILLER’S CLASSIFACTION OF RECESSION:
 Class-1: recession that do not extend to mucogingival junction with no periodontal
bone loss in the interdental area.
 Class-2: extends to/beyond mucogingival junction with no interdental bone loss
 Class-3: extends to/beyond mucogingival junction with some periodontal attachment
loss in the interdental area/ malposition of the teeth
 Class-4: extends to / beyond mucogingival junction with severe bone and soft tissue
loss/ severe mal positioning of the teeth
53. Saliva
a. Functions:
 Regulates ph
 Remineralization
 Buffer capacity
 Ion reservoir
 Antimicrobial
 Sense of taste
 Digestion
 Lubrication
 Water balance
 Pellicle formation
 excretion
b. Systemic diseases causing salivary hypofunction:
 Sjogren’s
 Mumps
 HIV
 Diabetes
 Scleroderma
 Sarcoidosis
 lupus
c. Oral and pharyngeal effects of salivary hypofunction:
 Depapillation of tongue
 Caries activity
 Lobulated or fissured tongue
 Altered gingival architecture
 Oropharyngeal dysphagia
 Speech difficulties
 Hoarseness, Soar throat
d. Flowrates:
Normal Abnormal
Unstimulated 0.1-0.5ml/min Less than 1.5 ml/15 minutes
stimulated Greater than 1ml/min Less than 0.6ml/min
54. OAF
a. Aetio:
 Extraction of upper posterior teeth close to antrum
 Dentoalveolar infection
 Cysts
 Tumors
 Pathological resorption of lower border
 Osteomyelitis
b. Prevention:
 Perform a carefull preoperative radiographic examination
 Use surgical extraction if there is possibility of OAC
 Avoid excess apical pressure to elevate fractured roots
 Avoid excessive force to remove maxillary molars
c. Surgical techniques:
 Buccal advancement flap technique
 Palatal pedicle flap technique
d. Precautions:
 Do not blow your nose
 Do not use straw
 Avoid keeping anything into communication
 Avoid Valsalva maneuver
55. A case about diabetic having periapical abscess
a. 3 Questions to ask:
1. Did you have food
2. Did you have morning dose of medication
3. Is diabetes under control
b. Medical name of limited mouth opening: trismus
c. What surgical complications will arise if limited mouth opening is there – limited access, strain
to the jaw muscles, chance of lock jaw
d. Why diabetic patients have frequent infections:
 Increased leukocyte apoptosis
 Impaired neutrophil chemotaxis, phagocytosis
 Increased need for exogenous insulin
 Less vascular supply to organs and extremities
Leading to decreased immune response and delayed healing
October

56. Impression materials

a. Classification:
Elastomeric Nonelastomeric
Elastomers: Hydrocolloids:  Zoe
 Polysulfides  Agar[reversible]  Impression compound
 Polyether  Alginate[irreversible]  Impression plaster
 Silicone  Wax

b. Identify: sports gumshield or mouthguard

c. Ideal dimensions:
 4mm thickness
 Cover all the surfaces of all maxillary teeth till the distal surface of 2nd molar
 Labial flange 2mm in to the sulcus
 Palatal 2mm above the gingival margin
d. Classification:
 Stock
 Self adapting [boil and bite type]
 Custom made[best]
e. Material used: poly methylmethacrylate
57. Triangles of the neck:
58. Occipitomental view of skull:
59.
a. Define lichenplanus: autoimmune chronic inflammatory condition mediated by T- cell
lymphocytic attack on stratified squamous epithelium results in hyperkeratosis with
characteristic remissions and relapses
b. Types: atrophic, reticular, bullous, erosive, plaque like, popular
c. extraoral features:
 alopecia
 rigid nails
 wickhman striae
d. Lichenoid reaction causes:
Dental:
Metals: Co, palladium, Cr, Cu, Ag, Ni
Nonmetals: epoxy resins, composite restorations
Drugs: NSAIDS, antihypertensives, antimalarials etc
e. drugs causing: [ MNEMONIC-PIGM3NT3D Lichenoid ABC3]
 P- Pencillinamine
 I-interferon
 G-gold
 M-methyldopa, metformin,meparaine
 N- NSAID’s
 T- tetracyclines, thiazides, tolbutamide
 D- dapsone
 L- levamasol
 A- allopurinol
 B-beta blockers
 C- captopril, chlorpromides,chloroquine
f. Management of OLP:
 Removal of causative agent
 Meticulous OHI
 Topical steroids and mouthwashes
Topical:
 Betamethasone [1mg in 20ml water] mouth rinse
 Dexamethasone
 Prednisolone mouth wash
 Tretinoin gel
 Topical tacrolimus
Systemic:
 Azathioprine
 Mycophenolate mofetil
 Hydroxy chloroquine
 Oral steroids
60. OAF
a. Aetio:
 Extraction of upper posterior teeth close to antrum
 Dentoalveolar infection
 Cysts
 Tumors
 Pathological resorption of lower border
 Osteomyelitis
b. Prevention:
 Perform a carefull preoperative radiographic examination
 Use surgical extraction if there is possibility of OAC
 Avoid excess apical pressure to elevate fractured roots
 Avoid excessive force to remove maxillary molars
c. Surgical techniques:
 Buccal advancement flap technique
 Palatal pedicle flap technique
d. Precautions:
 Do not blow your nose
 Do not use straw
 Avoid keeping anything into communication
 Avoid Valsalva maneuver
e. Diagnosis:
 By clinical examination
 Intraoral film shows absence of lamina dura
 CBCT shows disruption of bony sinus floor
f. Difference between buccal advancement flap and palatal pedicle flap
Buccal advancement Palatal pedicle
 Healing by primary intention[donor  Heals by granulation tissue
site]  Entire flap is raised and rotated to
 A mucoperiosteal flap is raised and close the OAF
periosteum is divided in the flap  The denuded area is protected with
 Mattress suture is placed resorbable cellulose
 Done under LA  Done under GA
 Disadv: decrease in buccal sulcus,  Disadv: open donor site, more
difficult to achieve tension free susceptible for infection
closure
61. ANUG:

a. Synonyms:
 Vincent’s disease
 Fuso spirochetal gingivitis
 Trench mouth
b. Etio:
 Fuso spirochetes: treponema, Prevotella intermedia, fusobacterium, selenomonas
 Nutritional deficiency
 Stress
 Alcohol/drug abuse
 Immune deficiency
c. c/f:
 punched out crater like depressions of interdental papilla
 covered by pseudomembranous slough
 fetid odour
 spontaneous bleeding
 increased salivation
 metallic foul taste
 pasty saliva
 radiating and gnawing pain, lesions sensitive to touch
d. systemic signs:
 high fever, lymphadenopathy
 leukocytosis, loss of appetite
 decreased pulse rate
e. histopathology:
 surface epithelium replaced by meshwork of fibrin, necrotic epithelial cells, PMN’s etc.
 connective tissue is hyperemic with engorged capillaries and dense infiltration of PMN’s
f. D.D:
 herpetic gingivostomatitis
 desquamative gingivitis
 diptheric and syphilitic lesions
 agranulocytosis
 chronic periodontitis
g. management:
 ultrasonic scaling with LA
 cessation of smoking
 chlorhexidine rinse 0.2%- 10ml twice daily
 if systemic effects are present-metronidazole 200mg tds for 3 days, pencillins are also effective
 once healed- non surgical treatment, if persistent craters are present- gingivectomy
62. mucous membrane pemphigoid:

a. tests: A diagnosis of MMP is made based upon a thorough clinical evaluation, a detailed
patient history, identification of characteristic findings and certain tests known as a biopsy and
direct immunofluorescence. For a biopsy, a small sample of skin tissue is removed (biopsy)
and microscopically examined. For direct immunofluorescence, a second biopsied skin sample
is tested to detect the presence of the specific autoantibodies (e.g., IgA, IgG, and C3) that
cause pemphigoid.
b. Topical: Anaesthetic (analgesic) mouthwashes are available if your mouth becomes sore and
are particularly helpful if used before meals. Benzydamine (Difflam) mouthwash may be
helpful.
Topical steroids which can be applied locally to the mouth are helpful for most patients but
often require additional oral medication (tablets).
Triamcinolone 10mg/kg weekly

c. systemic therapy for mild disease may include a tetracycline antibiotic (doxycycline,
minocycline, lymecycline), or less often, colchicine, nicotinamide, salazopyrin, sulfapyridine or
sulfamethoxypyridazine.
d. Systemic therapy for severe disease usually involves a combination of systemic
corticosteroids (sometimes in high dose), dapsone and immunosuppressive agents,
particularly

 Cyclophosphamide
 Azathioprine
 Mycophenolate
 Methotrexate
 Ciclosporin
 Rituximab.
63. Local anesthesia:
a. Dosage:
LA Child[20kg]- per catridge- Max adult dose
2.2ml
2% lidocaine 2 catridges 4.4mg/kg-300mg
3%prilocaine 1.8 6mg/kg-400mg
4%prilocaine 1.4 6mg/kg-400mg
4% articaine 1.5 7mg/kg-440mg

b. Complications:
 General: fainting,allergic, light headedness, sedation, circumoral paraesthesia
and twitching,convulsions,loss of consciousness,respiratory depression,
cardiovascular collapse
 Local: soft tissue trauma, trauma to the nerve
Intravascular injections into veins- hematoma, into arteries- ischemia
and vasoconstriction
c. Concentration of articaine: 4% solution with 1:100000 or 1:200000 adrenaline
64.
a. identify:
1. Frontalis muscle

2. Infraorbiatal foramen

b. nerve supply to that muscle: temporal branch of facial nerve

c. test to know whether muscle is functioning properly or not- ask the patient to frown or
wrinkle the forehead
d. structures passing through the foramen: infraorbital branch of maxillary nerve
e. fossa posterior to maxillary sinus: pterygopalatine fossa/ sphenopalatine fossa.
65. Large restoration on molar
a. Possible pulpal diagnosis:
 irreversible pulpitis
 reversible pulpitis
 pulp necrosis
 pulp polyp
b. If tender to percuss what is the periapical diagnosis: peri apical abscess
c. Pulp diagnostic tests:
 thermal tests: cold, heat
 EPT
 Pulse oximetry
 Laser doppler flowmetry
66. Identify
a. Biohazard

b. Corrosive chemical

c. How to prevent NSI:

A comprehensive preventive program:
 Follow recommended guidelines[ no bending/ no breaking]
 Safe recapping procedure
 Effective disposal system
 Surveillance program
 Employee training
 Improved equipment design
67. Inferior alveolar nerve block

a. Symptoms of toxicity- lightheadedness, convulsions, paresthesia, respiratory

depression
b. How to prevent toxicity:
 Evaluation of patient with thorough history
 Accurate injection techniques
 Adequate anesthesia-do not cross limits
68. Unilateral cross bite in 3 year old
A. When to start treatment- The most appropriate timing of treatment occurs when the
patient is in the late deciduous or early mixed dentition stage as expansion modalities
are very successful in this age group and permanent incisors are given more space as a
result of the expansion.
B. Types of treatment: upper removable appliance with unilateral screw, fixed ortho
appliance
69. Anterior crossbite

a. Causes of crossbite:
 Habits
 Skeletal discrepancy
 Mismatch of the dental arches
 Crowding
 Retained deciduous teeth
 Early loss of primary 2nd molars
b. Treatment methods:
 if it’s a developmental crossbite:
 tongue blade
 lower inclined plane
 established:
 URA with Z spring/ disocclude posteriors by bite plane
 Telescopic expansion screws
 Segmental expansion with posterior bite plane
 Multi looped arch wire with fixed appliance
 2X4 fixed appliance
 facemask
c. Describe the gingiva: recession
 November
70. .

a. Origin and insertion of masseter muscle:

 Superficial head-
 origin: anterior 2/3rd of lower border of zygomatic arch
 Insertion: lower half of the lateral surface of ramus
 Orientation of fibres: downwards and backwards
 Deep head-
 origin: deep surface of zygomatic arch
 Insertion: upper half of the lateral surface of ramus particularly over coronoid process
 Orientation of fibres: vertically downwards
b. Blood supply: maxillary and facial artery
c. Nerve supply: masseteric branch of anterior division of mandibular branch of trigeminal nerve
d. Functions:
 Elevation of the mandible
 Posterior fibres of deep head may have some retrusive capability
 Mastication
71. Bilateral parotid swelling

a. Causes:
 Duct obstruction
 Infections
 Inflammatory conditions such as sjogrens, rheumatoid arthritis etc
 Systemic conditions like diabetes mellitus, hypothyroidism etc
 Alcohol abuse andheavy metals
b. Sialolithiasis: a condition in which salivary calculi form in salivary glands or ducts, blocking the
flow of saliva
Made up of calcium phosphate and hydroxyapatite
% of occurrence: parotid: 6-15%
Sublingual and minor: 2%
Submandibular:80%
Submandibular sialoliths are radiopaque
72. Silver diamine fluoride
a. Disadvantages:
 Discoloration of tooth colored filling
 Permanent staining of unhealthy tissues
 Brown stains on skin, if accidentally applied
 Metallic taste
 toxicity
 Stains doesn’t get removed from cloths
b. Contribution:
 Silver: kills carcinogenic bacteria by interacting with DNA and cellular proteins, which
leads to cessation of cellular metabolism preventing cell wall synthesis and DNA
synthesis and ATP production.
 Fluoride: binds to bacterial bacterial cell walls, inhibiting enzymatic processes
associated with sugar uptake and metabolism of carbohydrate, therefore producing a
surface more resistant to acid dissolution
 Ammonia: reduces oxidative potential of SDF, increase its stability and helps to
maintain a constant concentration over period of time.
c. % of remineralisation: 80
d. Concentration of fluoride in it: 44600ppm
73. Sjogren’s syndrome:
a. Types:
 primary:dry eyes and dry muth
 secondary: dry eyes and dry mouth along with auto immune conditions such as
rheumatoid arthritis or SLE and other diseases like polymyositis,scleroderma etc
b. tests: schrimer’s test, ESR.
immunoglobulin levels-elevated,
antisalivary duct antibodies levels-elevated
c. treatment: symptomatic treatment
artificial saliva, ocular lubricants.
74. Progression of gingivitis to periodontitis:

Systemic conditions associated with periodontitis:

 Diabetes
 Pregnancy
 Coronary artery disease
 Rheumatoid arthritis
 Respiratory diseases
75. Implants:
a. Difference between implant supported and implant retained denture:
Implant retained Implant supported
Retention from implants and support from Retention and support from implants
soft tissues
2 to 3 individual implants may be with a Long bar with 4 implants
short bar
b. Uses:
 Restore esthetics
 Function
 Support
 Reduces bone loss
 Preserves the health of surrounding bone and gums
 Helps keep adjacent teeth stable
 Improves quality of life
76. Direct pulp capping :
a. Materials used:
 Calcium hydroxide
 MTA
 Tricalcium phosphate
 Biodentine
 Bioaggregate
 Bonding systems
b. Advantages:
 Conservative
 No need for RCT
 Saves the tooth and preserves vitality
 Helps in formation ofsecondary dentine
c. Bacteria causing caries:
 Streptococcus mutans
 lactobacillus
d. Substances increase caries risk:
 Bacterial biofilm
 Carbohydrates
77. Anaphylactic reaction: severe allergic reaction

a. Symptoms:
 Abdominal pain, anxiety, confusion
 Coughing, rash, slurred speech
 Facial swelling, trouble breathing, low pulse
 Wheezing, difficult swallowing, blue skin
 Itchy skin, nausea, swelling in mouth and throat, shock
b. Treatment:
 Lie back with legs elevated
 Check in ABCDE approach and O2 administration[15L/min]
 Intramuscular injection of 1:1000adrenaline, repeat every 5 min until improved
 Other drugs: 200mg hydrocortisone IM/Slow IV,10mg chlorphenamine IM/slow IV
78. Oral hairy leukoplakia: most common disease associated with this is HIV

a. Causes: EBV virus

b. c/f:
 most commonly lateral border of tongue, but may involve ventral and dorsal
surfaces as well
 corrugated appearance,may have shaggy/frayed appearance as well
 often bilateral
c. d/d:
 lichenplanus
 hyperplastic candidiasis
 lupus erythematous
 WSN
 Idiopathic leukoplakia
d. Test:
 Biopsy
 PCR, immunohistochemistry, insitu hybridization
 SEM
e. Treatment:
 Removal
 If biopsy confirms EBV infection, no need to remove
 Antiviral medication –acyclovir,HAART
 Topical retinoic acid ointment,gentian violet,25% podophyllin resin
 Avoid any trigger agents-surgical excision.
79. Kaposi sarcoma:

 malignant mesenchymal neoplasm

 shows indolent protractive course
 characterized by proliferation of connective tissue and capillaries
a. etiology: HHV-8- induces angiogenesis and inflammatory cytokines
b. c/f:
 with or without cutaneous involvement
 locates on hard palate, gingiva, dorsum of tongue
 initial- flat red/purple discoloration, later-nodular and ulcerated
 solitary, multifocal[coalesce],multicentric macules,plaque/nodules
 variable sizes
 may cause resorption of underlying bone/tooth mobility
 1st indication of HIV
c. D/D: naevi, PGCG,pyogenic granuloma, low grade mucoepidermoid carcinoma,
hemangioma, lymphangioma, bacillary angiomatosis, melanoma, lymphoma.
d. Treatment:
 depends on immune status
 HAART
 Radiotherapy
 Chemotherapy[intralesional/systemic]
 Co2/ argan laser to minimize bleeding
e. Prognosis: depends on immune status,
Progressive malignancy
80. OPG of mixed dentition:
Dental age estimation chart: