FEB 2014 NDBE II

1. least likely periapical pathology in children-any chronic pathology.

2. BBB (blood-brain barrier) know the meds that pass through:
• minocycline does pass through,
• aminoglycosides nor macrolides do not pass through,
• chlorophenicol does pass through
• clindamycin does not pass through
• only 3rd generation of cephalosporins can pass through (i.e. cefriaxone)
• Penicillin G only passes through when the meninges are inflamed
• Sulfonamides do pass through
• Trimethoprim does pass penetrate BBB
3. Conscious sedation-NO2

4. Ectodermal dysplasia-thin hair, supernumary teeth

Ectodermal Dysplasia
A group of inherited conditions where 2 or more ectodermally derived anatomic
structures fail to develop. Hypoplasia or aplasia of tissues may be seen. Best known is
hypohidrotic ectodermal dysplasia.

Etiology: Various types of the disorder may be inherited through a genetic problem such
as autosomal dominant, autosomal recessive and X linked.
Clinical Features:

heat intolerance due to reduced number of sweat glands

fine, sparse blond hair
reduced density of eyebrow and eyelash hair
periocular skin may show wrinkling with hyperpigmentation
midface hypoplasia often observed
xerostomia
reduced number of teeth
crown shape abnormal
females show partial expression
male predominance is usually seen due to X-linked variable

Histological Features:

decreased amount of sweat glands and hair follicles

adnexal structures are hypoplastic and malformed

Treatment:
genetic counseling
dental problems are best managed by prosthetic replacement of the dentition with
complete dentures, overdentures or fixed dentures
endoosseous dental implants a possibility

5. Albright syndrome

McCune-Albright Syndrome (Albright Syndrome)

A syndrome characterized by polyostotic fibrous dysplasia of the skeletal
system, cafe-au-lait spots, and endocrine dysfunction.

Clinical Features:

early childhood
multiple, slow-growing, painless expansile bone lesions confined
to the craniofacial area or throughout the skeleton
endrocrine manifestations; in females often sexual precocity
 irregular shaped Café Au Lait Spots on the torso and may be
intraorally
disfiguring
increased level of serum alkaline phosphattase
Radiographic Features:

multilocular radiolucency or mixed radiolucent and radiopaque

appearance (ground glass)
lamina dura is usually obscured and the cortical plates thinned

Differential Diagnosis:
McCune-Albright syndrome
monostotic fibrous dysplasia
polyostotic fibrous dysplasia
Jaffe syndrome
ossifying fibroma
cherubism
neurofibromatosis

Etiology:
unknown
possible gene mutation
Histologic
Features:
 abundant cellular fibrous connective tissue in a whorled pattern
proliferating fibroblasts form spicules of bone and cementum

Main Pathologic Process:

benign dysplasia

Treatment:
surgery for cosmetic or functional problems
hormonal medications

Prognosis:
no accurate prediction of severity
life expectancy at or near normal

6.Glass ionomer- Fl release and acid base reaction …

• Polyacrylic acid and aluminosilicate glass

.
7. imp monomer in cement?

8. retard zinc phosphate add powder to water ration…add more water to powder

9. indexes DMFS (decayed missing filled surfaces)

10. practice mangment

11. hand over mouth not used in children

12. band and loop
a. used as a space maintainer for premature exfoliation of primary second
molar
b. A band-and-loop maintainer is made of stainless steel wire. The maintainer is
held in place by an orthodontic-type band around an adjacent tooth or a crown
on the tooth. A wire loop attached to the band or crown extends into the space
and touches the tooth on the other side of the space to hold both teeth in
place.
c. A lower lingual holding arch is used when teeth are lost on both sides of the
lower jaw. Lingual refers to the inside or tongue side of the teeth. This type of
space maintainer also uses bands wrapped around a tooth on either side of the
mouth behind the missing teeth. A wire connected to the bands runs along the
inside of the bottom teeth. It distributes the biting and chewing forces
throughout the entire jaw, which makes a lower lingual holding arch more
stable than two separate band-and-loop maintainers.
d. Another type of fixed space maintainer, called a distal shoe appliance, is
inserted under the gum. It's used when a primary tooth is lost but there is no
tooth behind it for the wire arm of a band-and-loop maintainer to touch. In
this case, the end of the metal arm is inserted under the gum instead, and
keeps the space from closing.

Nance Appliance

The Nance appliance is available with either straight or recurved arms. It can be
removable or soldered to the bands. The Nance is effective in preventing mesial molar
drift, and facilitates expansion or rotation of the molars.

13. perf sinus 2mm what to do not to do??

a. Close w/ partial thickness flap
b. Prescribe antibiotics
c. May pack w/ a dresssing
14. separate file in apical 1/3 leave it
15. fracture in the middle 1/3 vs apical 1/3 which has better prognosis? Apical 1/3 has a
better prognosis
16. avulsed teeth: place in milk, saliva. Complications include ankylosis and external
root resorption
17. horizontal fracture middle and apical 1/3. Observation, splint
18. intrude a tooth? Let it erupt on it’s own if the kid is young.
19. sc/rp recall? Reeval 1mo 3mo recall
20. best irrigation in AIDS pt. Chlorohexidine
21. widman flap
Objective
To gain access to the deeper periodontal structures using a flap
reflected from the root and alveolar surfaces.

Indications
• Active pockets over 4mm deep which are not responding to
initial treatment
• Pockets beyond the muco-gingival line with bone loss
• Pockets with marginal deformity.

Contraindications
Gingival enlargement by hyperplasia.

Method 1: Modified Widman

1. Use a reverse bevel incision at
approximately 10 degrees to the long
axis of the tooth. Incise around the
tooth (teeth) approximately 1mm from
the gingival margin. Scallop between
teeth to preserve the interdental
papilla.

2. Make releasing incisions at the line

angle (imaginary line of roots) of the
adjacent healthy teeth.
3. Reflect full gingival flap with
periosteal elevator. A collar of tissue,
which includes the sulcus epithelium,
should remain attached to the tooth
at this time.

4. Remove remaining collar of tissue

with a curette.

5. Systematically plane the root and

correct osseous defects.

6. Close labial or palatal flaps with

interrupted sutures.
Method 2: Apically Repositioned
Flap
1. Proceed as above, or via a sulcus
incision, without leaving a collar of
gingival attached to the tooth.

2. Make releasing incisions at the line

angle (imaginary line of roots) of the
adjacent healthy teeth.

3. Reflect full gingival flap with

periosteal elevator beyond the
mucogingival junction (MGJ).

4. Root plane and curette exposed

surface. Any diseased bone is
recontoured with a diamond bur in a
high speed handpiece or with a
Weidelstead chisel.

5. Replace the flap further down the

long axis of the root to eliminate
pocket depth. This is known as apical
repositioning. Note that the MGJ line
will not be continuous with the
adjacent teeth. The redundant tissue
can be left to fibrose naturally. A
barrier material can be employed to
eliminate pockets within the bone
before the flap is replaced.

22. distal wedge

a. A modified distal wedge procedure has been developed for use adjacent to
edentulous areas. The purpose of this procedure is to eliminate pockets,
 yet retain keratinized tissue. Ease of flap design, the creation of access to
the underlying osseous structures, and ease of closure are demonstrated by
illustrations and Kodachromes.
23. gowgates vs, akinosi

GowgatesThe mandibular block is perhaps the most commonly delivered major

nerve block injection in all of dentistry. Every dentist is an expert in
administration of mandibular blocks since we have all delivered thousands of
them. On the other hand, we have all run into patients for whom we could not
produce the desired anesthesia using the standard technique. It happens rarely,
but when it does, it is very, very frustrating.

Fortunately, an Australian dentist named Dr. George A.E. Gow-Gates invented an

alternative to the standard mandibular block in the mid 1970's. This block is
appropriately named the Gow-Gates and is delivered at the neck of the condyle
just under the insertion of the lateral pterygoid muscle. The Gow-Gates has a
number of advantages over it's more traditional alternative.

Unlike the mandibular block, the path the needle traverses during a Gow
Gates block contains much less muscle tissue than is traversed by the
needle in a standard mandibular block, and thus there is little release of
bradykinins which are the chemicals which cause the aching that patients
feel when receiving a mandibular block. Furthermore, the tissue through
which the needle passes contains no nerve receptors, and thus there is
little direct pain during the injection. It is not uncommon for patients to
remark that they felt nothing during the injection.
The area where the Gow-Gates is delivered is less vascularized. Studies
indicate that there is an 89-90% lower liklihood of giving an inter-vascular
injection using this technique. In addition, because of the lower
vascularization in the area, the action of the anesthetic is prolonged which
means that mepivicaine without vasorconstrictor may be used to greater
and longer lasting effect using the Gow-Gates. Some users of this
technique recommend that no vasoconstrictor be used at all.
Finally, the Gow-Gates anesthetizes the nerve trunk before it splits into its
three main branches; the lingual branch, the buccal branch and the
alveolar branch. Thus the Gow Gates delivers three shots in one. A single
shot does the work of three separate injections.

The Target
The image above shows the medial aspect of the right condyle and the relative
position of the nerve trunk. The shaded oval indicates the area of the condyle
where the tip of the needle should be placed. Note the proximity of the nerve
trunk with respect to the general target.

The External Landmarks

In the image of the ear above, the little prominence in the front is called the
tragus. The tragus is a useful landmark since it lies just distal to the
temporomandibular joint. The little notch just above it is called the intertragal
notch. Both of these landmarks are easily identified, and, more importantly felt
with the finger. It is this external landmark that is used as the "aiming point" of
the needle when giving the Gow-Gates injection.

This intra-oral image shows the entry point of the needle. The patient's mouth
must be WIDE open so that the condyle is fully translated over the articular
eminence. The entry point of the needle is high and behind the tuberosity, well
distal and apical to the upper second molar.

The technique
With the patient lying fully reclined in the chair, have the patient open
his/her mouth as wide as possible. This technique is not possible if the
patient is not able to open wide enough to allow the condyles to translate
fully over the articular eminences.
Place your thumb in the patient's mouth retracting the cheek. The thumb
should be relatively close to the site of the entry point of the needle noted
in the image above.
Place the middle finger of the same hand over the intertragal notch. This
landmark is easily felt with the finger. Thus the hand is held in a "C" with
the thumb inside the mouth retracting the cheek and the middle finger
outside the mouth placed firmly over the intertragal notch.
Using a long needle, and holding the handle of the syringe at about the
level of the lower premolars, allow the needle to enter the buccal mucosa
just distal and apical to the tuberosity. (See the arrow in the intra-oral
image above.)
Now aim the tip of the needle toward the the intertragal notch.
This is fairly easy because you can feel the notch under your
middle finger, so in effect, you are simply aiming for your
finger! Keeping the middle finger in this position, and using it as the
aiming point makes giving the Gow-Gates block easy and predictable.
Proceed until the needle hits bone. The needle will enter about two-thirds
to three-quarters of its length before hitting bone. If the needle does not
hit bone, then you have missed the target and should withdraw and try
again, aiming slightly laterally, or medially. It should be noted that this
technique seems to produce very few misses. In any case, multiple tries do
not lead to post operative pain since the needle has penetrated little or no
muscle. Once you become familliar with the technique, missing the target
becomes a rare event.
Once the needle hits bone, aspirate and then inject the entire carpule
slowly.
After withdrawing the needle, ask the patient to remain open wide for
about one minute after the shot.

a. Akinosi: closed mouth technique. Used for patients w/ trismus,

handicapped, fractured mandible, children. Area of insertion: medial
border of the mandibular ramus directly adjacent to the maxillary
tuberosisty
b. Faculte de Chirurgie Dentaire, Paris.

The anesthesia technique described by AKINOSI in 1977, in Nigeria,

shows certain advantages: According to the author, it has a percentage of
efficacy, of about 95%. It permits an effective anesthesia of the inferior
alveolar, lingual and buccal nerves to be obtained with a single injection.
It has a psychological aspect which is of interest to the degree that it is
carried out with the mouth closed, the patient thus being in a position of
muscular and aponeurotic relaxation, which permits a nearly painless
injection to be made. This technique has disadvantages which lead to a
 preference for the "Spix spinal" technique, each time that it is indicated;
the onset is longer than the one at the Spix an average of 6 minutes (for all
nerves) as seen in this study, but above all, it is a high vascular risk
technic that can be conceived only if perfect knowledge of the pterygo-
mandibular region has been gained so as to evaluate the vascular
proximities, essentially the maxillary artery and the pterygoid veinous
plexas.
24. howlong for mature plaque to form?24 hrs
25. cravicular fluid tells you what? Amount of Ig G levels, microflora.

How do I use the Periotron to measure GCF?

GCF gingival crevice is a transudate that becomes an exudate when its flow increases
in response to progressive accumulation of bacterial plaque. Plaque build-up results
in formation of bacterial products which are able to stimulate inflammation of the
gingiva (gums) and destruction of the periodontium (supporting structures
surrounding the teeth). The former is called gingivitis and the latter is called
periodontitis. A truly healthy gum condition shows little or no GCF and the marginal
gingival tissues are firm and pink in color. However, with poor oral hygiene and
difficulty in reaching poorly accessible regions of the mouth such as between the
teeth, bacterial accumulations result in a thicker plaque and conditions that favor
growth of the Gram negative anaerobic bacteria. These are the microbes that favor
onset of gingivitis and development of periodontitis as well as bad breath. Since the
oral microbiota is a continuous culture of mixed bacteria, oral hygiene is a necessary
measure to counter this tendency towards accumulation of bacteria. Done
effectively, this helps achieve and maintain a healthy gingival condition and prevent
or retard the dev .

The Periotron has been been designed to permit the use for a variety of paper strips
for the collection of gingival crevice (GCF) and periodontal pocket (PPF) fluids,
salivary flow and saliva thickness measurements. elopment of periodontitis. The
Periotron has two electrodes that is used to measure moisture. The upper electrode
is moveable, controlled by a lever, and the lower electrode is stationary. Closing the
lever brings the two electrodes together and begins a measurement cycle. After a
reset time (15 seconds), the Periotron will display a number. This number is
referred to as a Periotron Score and represents the amount of fluid on the paper
strip. Periotron Scores may be converted to volume and thickness.

Why measure GCF and what is the significance?

Inflammation of the gingiva, usually referred to as gingivitis, arises in the
region of the crevicular epithelium well before any inflammation is
clinically visible.
This is sometimes referred to as clinically invisible gingivitis. As the
severity of inflammation rises so does the level of GCF. In most cases,
the inflammation spreads to the marginal gingiva and the gingivitis
becomes clinically evident. Visual and tactile methods are used almost
universally by periodontists, hygienists and general practitioners alike to assess
visible gingivitis on a severity scale. The most common scale is that of Loe-Silness
(Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontologica
 Scandinavica 21: 533, 1963). Usually referred to as the Loe-Silness Index, this
ranges from 0 to 3 where zero is no visible gingivitis, and one is mild, two is
moderate and three is severe gingivitis.

Gingival inflammation can now be measured electronically and as a result, assessed

more accurately (see below). Because of the high correlation between gingival
inflammation and GCF flow (Borden et al., The effect of age and sex on the
relationship between crevicular fluid flow and gingival inflammation in humans.
Journal of Periodontal Research 12: 160, 1977), this provides a diagnostic method
that has several advantages. One is that measurements are objective, and a patient
has a number or numbers which they can relate to, just like the blood sugar levels in
a diabetic patient. Second, values obtained are not different for different examiners.
Third and most importantly, one can measure invisible gingivitis. Fourth, one can
assess when the gingivitis and bacterial activity is of sufficient severity that
periodontitis (loss of epithelial attachment, pocket development and loss of
supporting bone) is likely to ensue.

Research has established that gingivitis without periodontitis is the condition that is
evident at a lower range of GCF production but when the GCF is above this
threshold, this signals a level of bacterial activity that heralds arrival of periodontitis
(Lee et al., Alpha 1-Proteinase inhibitor in gingival crevicular fluid of humans with
adult periodontitis: serpinolytic inhibition by doxycycline. Journal of Periodontal
Research 32: 9, 1997). At that point, collagenase, a key degradative protease
appears in the GCF and rises within the crevice or pocket to levels where destruction
of epithelial attachment and other periodontal structures readily occurs.

Leforte 1 osteotomy Introduction

The Le Fort I osteotomy is a versatile procedure used to correct a variety of dentofacial

deformities of the maxilla. It was first described by von Langenbeck in 1859 (3). The
most frequent complications include intraoperative hemorrhage, infection, nerve injury,
oronasal fistula formation, relapse, dental injury, and rarely, avascular nacrosis (4). The
surgical goal in repositioning the maxilla is to establish a harmonious maxillomandibular
dentoskeletal relationship and to achieve esthetic soft-tissue changes. It results also in
alterations in the form and function of the nose (1,2).

26. safe distance for talking to pt. 18 inches 1ft 4 inches

27. active listening -look in to eyes
28. hazardous waste is waste that can cause disease
29. toxic waste has poisonous effect
30. infectious waste cause disease
31. mercury toxicity is tremors and vision hearing loss lose teeth
a. oral manifestations include metallic taste, ulcerative stomatitis, salivary
gland enlargement, macroglossia and gingival becomes blue/gray to black
32. flor of the mouth do biopsy
33. which anesthsis causes methoglobunoria, prilocaine
34. diff cross bite functional vs non functional
35. 3mm max disclusion
36. I+D submand space: attachment of the mylohyoid: above submandibular below
sublingual
37. undercut in anterior tuberosity: reduce both posterior and anterior tuberosities
38. max ridge resorbs how? Teeth are extracted, non supported edentulous dentures,
force from opposing
39. indirect retainers
40. VDO whisteling: decreased VDO whisteling, Increased VDO clickling
41. sessitivity test on tooth with crown-does not work
42. amalgam replace with gold inlay diverge bevel
43. bevel fn cusp bulk of material
44. optimum Fluoride PPM 0.7ppm
45. HUE(basic color) value(brigthness) chroma(strength/saturation) most imp is? value
46. Diff wavelength with hue value chroma? Chroma deals w/ wavelength saturations
47. healing in leukemia pt? delayed
48. Diab mellitus sussiptible to ??/ periodontitis, blindness, polydispia, succeptible to
infection. Clotting/bleeding time is not affected
49. anaph drugs least sedation? Second generation histamines produce the least
drowsiness.claratin and clavinex First generation histamine blockers produce more
drowsiness

50. alpha and beta receptors:

a. alpha 1-peripheral vasoconstriction, increased bp, increased peripheral

resistance, mydriasis, increased closure of the internal sphincter of the
bladder
b. alpha 2 – inhibition of ne release, and inhibition of insulin release
c. Beta 1: tachycardia, increased lipolysis, increased myocardial
contractility, increased rennin release,
d. Beta 2: vasodilation, slightly decreased peripheral resistance,
bronchodilation, increased muscle and lever glycogenolysis, increased
release of glucagon, and relaxed uterine smooth muscle
51. least extensive in plaque removal
52. most susiptible to caries in prim molars
53. apical pathology primary molar- furcation
54. specificity = #of true neg / false pos + true neg
55. sensitivity true positive /true positive +false negative
56. papilloma
57. tongue pic
58. erythma migrans = geographic tongue
59. varience
1. The state of being variable, different, divergent, or deviate; a degree of deviation.
2. A measure of the variation shown by a set of observations, defined as the sum of
squares of deviations from the mean, divided by the number of degrees of freedom in
the set of observations.
measure of the dispersion of a set of data points around their mean value. It is a mathematical expectation of the
average squared deviations from the mean.

Variance measures
the variability
(volatility) from an
average. Volatility
is a measure of
risk, so this statistic
can help determine
the risk an investor
might take on
when purchasing a
specific security.

59. 6 months 4 cases = case study

60. A case study is a particular method of qualitative research. Rather than using large
samples and following a rigid protocol to examine a limited number of variables,
case study methods involve an in-depth, longitudinal examination of a single
instance or event: a case. They provide a systematic way of looking at events,
collecting data, analyzing information, and reporting the results. As a result the
researcher may gain a sharpened understanding of why the instance happened as it
did, and what might become important to look at more extensively in future
research. Case studies lend themselves especially to generating (rather than testing)
hypotheses.
61. all cases in 1 month = cross sectional
Cross Sectional Studies
Cross sectional studies, as their name suggests, involve the collection of data from multiple patients at a
single point in time.

Cross sectional studies represent a cheaper and quicker way to obtain data than prospective research. They
offer a reasonable degree of control over question design and a reasonable expectation of data completeness
that cannot be achieved with a retrospective approach. Cross sectional study designs can be used to identify
possible associations without a long trial but are limited in their ability to confirm causality. For example, drug
X’s mechanism of action may suggest gastrointestinal benefits. A cross sectional study of patients receiving
drug X and drug Y may reveal a much higher incidence of gastric pain in patients receiving drug Y. While this
finding is no way conclusive, the proven association may be sufficient to change clinical behavior.

62. filter x-ray low wavelength least pent most destructive

63. scatter radiation- pt or off wall
64. CaOH
65. Apexification
66. Visualize fracture horizontal
67. minralcorticoids
Mineralocorticoids, principally aldosterone, regulate renal retention of sodium and
thus profoundly influence electrolyte balance, intravascular volume, and blood
pressure. Glucocorticoids, principally cortisol, are named for their carbohydrate-
mobilizing activity but are ubiquitous physiological regulators that influence a wide
variety of bodily functions. Adrenal androgens serve no known physiological role but
do mediate some secondary sexual characteristics among women, and overproduction
may result in virilism.
68. leukoplakia non wipable
Leukoplakia (Leukokeratosis, Erythroleukoplakia)
A clinical term used to denote mucosal conditions that produce a whiter than
normal coloration of the mucous membranes; a white patch on the oral mucosa
that can neither be scraaped off nor classified as any other diagnosable disease.

Clinical Features:

white patch varies from flat, smooth and slightly translucent

macular areas to thick, firm, rough-surfaced and fissured, raised
plaques
bucal mucosa, floor of the mouth, labial commissures, lateral
borders of the tongue and mandibular and maxillary alveolar ridges
strong male predilection
usually over the age of 40

Differential Diagnosis:
lichen planus
morsicatio buccarum (cheek biting)
frictional keratosis
keratosis
leukoplakia
nicotine stomatitis
candidiasis
leukoedema
white sponge nevus
tobacco pouch

Etiology:
 tobacco
alcohol
ultraviolet radiation
microorganisms
trauma

Tissue of Origin:
epithelium
Histologic
Features:

thickened surface keratin layer a thickened spinous layer

chronic inflammatory cells in the connective tissue
keratin layer may contain parakeratin, orthokeratin or both

Main Pathologic Process:

dysplasia

Treatment:
a biopsy is mandatory
based on the exact nature of the lesion

Prognosis:
considered to be a precancerous or premalignant lesion
dependent on the exact nature of the lesion
Oral & Maxiollofacial Pathology List
 69. bump on tongue
70. tx for herpes labialis. Antivirals
71. caries ph 5.5
72. bacterias in caries lactobacillus
73. high noble metal = gold pal plat
74. radilucent lesion no teeth ?primordial cyst, residual cyst aspiration biopsy
75. taurodontism

Taurodontism
A malformed multirooted tooth characterized by an altered crown-to-root ratio,
the crown being of normal length, the roots being abnormally short, and the pulp
chamber being abnormally large.

Clinical Features:
molar with an elongated crown, apically placed furcation, rectangular
pulpal chamber
may be unilateral or bilateral
affects permanent teeth more frequently than deciduous teeth
no sex predilection
may occur in patients with amelogenesis imperfecta, Down syndrome,
andd Klinefelter syndrome
Radiographic
Features:

multilocular

Etiology:
developmental

Tissue of Origin:
 root sheath

Main Pathologic Process:

variant of normal

Treatment:
no treatment but can be a complicating factor in root canal procedures

Prognosis:
good

76. why use porc inlay esthetic or dentin bonding

77. anti fungals systemic vaginal candiditis fluconozole, amphotericin B, ketokanozole
78. class 5 sensitivity
79. best antibiotic for kids penicillin 50mg/kg 1 hr prior
80. hardest tooth move to maintain rotation supracrestal fibers
81. PA of max 3rd molars hammulus tuberosity humular process
82. what carc invades and follow nerves: Adenoid cystic carcinoma

Adenoid Cystic Carcinoma

A relatively common malignant neoplasm arising from minor or majorsalivary gland

epithelium manifesting as a submucosal "bump";nerve invasion is common and lung
metastasis may occur; adenoid cystic carcinomas have a high mortality rate.

Adenoid cystic carcinomas have a distinctive histology.

There are two microscopic features that distinguish this malignancy from other salivary
gland neoplasms. First, it is composed largely of malignant epithelial cells arranged in
sheets of dilated duct cross-sections resembling a honeycomb or Swiss cheese. Second, it
is common to find malignant epithelial cells invading the sheaths of nearby nerves
(perineural invasion) a feature not commonly seen in other malignancies. While adenoid
cystic carcinoma may produce distant metastases, particularly to the lungs; paradoxically
spread to regional lymph nodes is less common.

Surgical excision is possible; mortality rates are high.

As primary radiation is ineffective for these lesions, surgical excision is the treatment of
choice for eradication of adenoid cystic carcinoma. As with other malignancies, long-
term prognosis of this disease, depends on the stage in which is treated. Fifteen-year
survival rates may be as low as 10%

83. litium used for manic depression

84. tx of reoccurring ranula excise
85. mucocele
86. pin placement
87. lesions on gingivae = draining fistula
88. URQ which tx in indicated/ gign graft/ OHI/ conn tissue graft
89. tissue guided regeneration-

GTR (guided tissue regeneration)

Your teeth are at risk because of periodontal disease. Plaque and tartar on your teeth,
resulting from insufficient brushing and flossing, can build up over time, and lead to the
loss of the supporting tissue around some of your teeth.

When plaque builds up on a tooth, bacteria in the plaque attack the bone around the tooth
as well as the fibers that connect the tooth to the bone. As the fibers and bone are
destroyed, a pocket, or space, forms between the gum and the tooth. Without proper
hygiene the process may continue, sometimes without symptoms, until the tooth is
endangered.

Guided Tissue Regeneration (GTR) is a procedure that enables bone and tissue to re-
grow around an endangered tooth or if the tooth is lost, to increase the amount of bone for
implant placement.

Prior to GTR therapy, your dental professional will recommend an appropriate oral
hygiene program. It is essential that you follow this program, otherwise, GTR therapy has
less chance of success and may be ruled out as a treatment option.

During GTR therapy (for teeth), the soft (gum) tissue is surgically separated from the
endangered tooth and the tooth surface is thoroughly cleaned and infected tissues are
removed from the area. After cleaning a small piece of material called a GTR membrane
is placed against the tooth. This GTR membrane serves as a barrier that separates fast-
growing soft (gum) tissue from the newly cleaned surface of the tooth root. The
membrane enables slower-growing fibers and bone cells to migrate into the protected
area.

Following GTR therapy, your doctor will provide specific instructions for proper oral
hygiene and care of the area under treatment. These may include the following:

• Your doctor may ask you to refrain from brushing or flossing the treated area for some
time following the procedure so as not to disturb the GTR membrane or the tissue that
covers it.

• Specific mouthwashes may be recommended to reduce plaque buildup.

• Your doctor may prescribe an antibiotic to reduce the possibility of a bacterial infection
in the surgical area.

It is important to keep in mind that proper hygiene is essential to prevent a serious

recurrence of periodontal disease.

\
90. apical reposition flap
The Apically Displaced Flap

Apically displaced flaps have the important advantage of preserving the outer portion of
the pocket wall and transforming it into attached gingiva. Therefore they accomplish the
double objective of eliminating the pocket and increasing the width of the attached
gingiva.

The apically positioned flap procedure is the most commonly used surgical approach to
pocket elimination and osseous recontouring. Its advantages include its wide spectrum of
usefulness, retention of most existing gingiva, and ability to solve both mucogingival-
osseous and pure mucogingival problems. Because the flaps are fully reflected, the
access and vision requirements for osseous procedures are achieved. The major
disadvantages of the apically positioned flap procedure include possible unacceptable
esthetic results in areas in which esthetics may be important and the greater likelihood of
root sensitivity because of root exposure. Guided tissue regeneration (GTR) better
resolves these problems with less esthetic compromise

If adequate attached gingiva will remain if the flap is positioned at the crest of the bone,
the incision for the flap is made with an internal bevel to the crest of the alveolus on the
facial and lingual surfaces. It is scalloped interdentally to retain additional gingiva to
fit interproximally when the flap is sutured. It should be filleted so that its thickness is
similar over the tooth root and interdentally. If additional attached gingiva is needed, it
may be created by leaving several millimeters of coronal bone denuded when the flap is
positioned apically. This denuded area will granulate and heal as gingiva, which, when
added to the apically positioned old gingiva, will create a band of attached gingiva 2 to 5
mm high. Such a flap need not be scalloped to fulfill this need.
In the apically positioned flap approach, the flap is fully reflected into alveolar mucosa
(in contrast to the modified Widman flap approach). Because the palate does not have
alveolar mucosa, a gingival flap in that area cannot be apically positioned and is created
differently. Next the remaining interdental and marginal tissue is removed with curets
and chisels, exposing the bone and any osseous defects. These may be treated by osseous
recontouring or bone fill. If any defects are amenable to GTR, this technique should be
employed preferentially to pocket elimination because it provides greater support, better
esthetics, and easier cleansing of the area when healed.

When the flap is positioned and sutured, if no additional gingiva is to be created by

denudation, it may be sutured tightly at the level of the crest of bone and the pack placed
(Figure 90-1).

Figure 90-1 A, The internal bevelled, scalloped incision is used for pocket elimination through
apical repositioning of the flap. B, The flap positioned apically for pocket elimination.

If more attached gingiva is needed, the flap may be positioned so that some bone is
exposed, and it may be sutured loosely with suspensory sutures to establish its position
before pack placement. Healing is more rapid if the only bone left exposed is between
teeth. Ideally performed, the apically positioned flap should result in pocket elimination
with improved gingival form, facilitating plaque removal by the patient.

91. loc of inverse bevel- widman flap

The Modified Widman Flap

The modified Widman flap has been described for exposing the root surfaces for
meticulous instrumentation and for removal of the pocket lining; it is not intended to
eliminate or reduce pocket depth, except for the reduction that occurs in healing by tissue
shrinkage.

The modified Widman flap does not intend to remove the pocket wall, but it does
eliminate the pocket lining. Therefore the internal bevel incision starts close (no more
than 1 to 2 mm apically) to the gingival margin and follows the normal scalloping of
the gingival margin (Figs. 61-1 and 61-2).

This technique offers the possibility of establishing an intimate postoperative adaptation

of healthy collagenous connective tissue to tooth surfaces and provides access for
adequate instrumentation of the root surfaces and immediate closure of the area.

In full thickness flaps, all the soft tissue, including the periosteum, is reflected to expose
the underlying bone. This complete exposure of, and access to, the underlying bone is
indicated when resective osseous surgery is contemplated.

The partial thickness flap includes only the epithelium and a layer of the underlying
connective tissue. The bone remains covered by a layer of connective tissue, including
the periosteum. This type of flap is also called the split thickness flap. The partial
thicknesss flap is indicated when the flap is to be positioned apically or when the
operator does not desire to expose bone.

92. full tickness

93. partial tickness 3 walled defect
94. 5 tumors which one not hard tissue= nasolabial
95. mass in tail of parotid for 7 years = bening mixed tumorn

Benign Mixed Tumor (Pleomorphic Adenoma) most common benigh

neoplasm

A relatively common benign neoplasm arising from the

parenchyma and stroma of major or minor salivary glands manifesting as a
submucosal "bump"; complete surgical excision will cure mixed tumors.

They are neoplasms of both epithelium and connective tissue.

Mixed tumors (as the name implies) is composed of neoplastic parenchyma (epithelium)
and stroma (connective tissue). The epithelial component consists of countless duct-like
structures that may be empty or filled with salivary secretions. It is varied appearance of
the stroma, however, that is most helpful in making the diagnosis of mixed tumor. The
stroma may be a mixture of dense fibrous c.t., loose mesenchymal c.t., and cartilage. The
neoplasm is invariably well-demarcated by a fibrous c.t. capsule.

Complete surgical excision of mixed tumors may be difficult.

Mixed tumors must be surgically excised. Because the neoplasm is encapsulated, simple
enucleation should suffice. In cases of parotid mixed tumors, however, the nearness of
the facial nerve (cranial nerve VII) may cause the surgeon to be tentative about complete
removal leading to recurrences.

A rare malignant variant of mixed tumor exists.

If these lesions are not detected, there is a remote possibility that they may transform into
the malignant mixed tumor summarized below.

96. distal most PA which one can you not see\

97. purpose of collimator and PID (pos indicating device)

Collimator: A collimator is a device used to filter a stream of rays (such as X-rays) so

that only those travelling parallel to each other in a certain direction are allowed through.
The illustration below (top section) shows a lead collimator used in X-ray machines. The
image will be recorded on the plate at the left of the picture. Without a collimator (top
picture) rays from all directions will be recorded; for example, a ray that has passed
through the top of the specimen but happens to be travelling in a downwards direction
may be recorded at the bottom of the plate. This will not produce a readable image.

How a lead collimator filters a stream of rays. Top: without a collimator. Bottom: with a
collimator.
In the illustration to the left, (bottom section}, a lead collimator has been added.
Effectively, this is a thick sheet of lead with many tiny holes bored through it. Only rays
travelling at nearly 90° will pass through - any others will be absorbed by hitting the side
of a passage. This ensures that rays are recorded in their proper place on the plate,
producing a clear image. Although collimators improve the signal to noise ratio, they also
reduce the intensity of the signal--most lead collimators let less than 1% of incident
photons through. For this reason, attempts have been made to replace collimators with
electronic analysis.

Collimators may be used with laser diodes.

Collimating lenses may also be used in optical systems to make rays of light parallel by
(see also Collimating lens).

Proper collimation of a laser source with long enough coherence length can be verified
with a shearing interferometer.

Collimators are also used with radiation detectors in nuclear power stations for
monitoring sources of radioactivity.

a. Positive Indicating Device

98. nerve is missed with gowgates: V3
99. digital xray is more or less radiation: less
100. digital xray
101. pt has brown spots on neck and back is which erythromatic oral disease:Albright
syndrome (café-au-lait spots on skin)
102. dilacerated root
The treatment of three cases of dilacerated incisors are reported with long-
term follow-ups. Impacted incisor with dilaceration refers to a dental deformity
characterized by an angulation between the crown and root preventing the
incisor from eruption. Surgical extraction used to be the first choice in treating
the severely dilacerated incisor. After a brief review of the literature, the
surgical and orthodontic treatment of these patients are described. By
combining two stages of the crown exposure surgery with light force
orthodontic traction, the impacted dilacerated incisors were successfully
moved into proper position.
103. Which imp material least likely to have bubbles poured in gypsum : Polyether
(because. polyether absorbs water from the gypsum and. swells with each
successive pour.)
104. Multiple myeloma: IgG

This is a cancer of the plasma cells, usually beginning in the bone marrow. These
neoplastic plasma cells produce immunoglobulins and evolve from B lymphocytes. The
disease typically involves the bones and kidneys and may lead to kidney failure. Patients
may complain of back pain, weakness, and fatigue. However, rarely patients may be
 diagnosed during a serum protein electrophoresis. The immunoglobulins which are
produced by the plasma cells may be detected in both the blood serum and urine by
sophisticated electrophoresis testing.

The bone marrow aspiration and biopsy, usually performed by the pathologist, is one of
the most important tests that can be performed to establish the diagnosis. If possible, the
biopsy should be directed at a site of a lytic bone lesion. The pathologist can use
immunohistochemistry upon the tissue sample to identify these abnormal
immunoglobulins and establish the diagnos

105. best careis detection,: explore catch, brown stain, open fissure, white
decalcification
106. how does caries indicator work degenerative
107. condylar hyperplasia
108. TMJ joint disfunction depression
109. Psudomembranous colitis
110. which one is contraindicated methodone (substance abuse)
111. which is prescribed for mod pain: tylonol 3
112. lingual tori radiograph
113. systemic drug for vaginal candida: fluconozole(diflucan),ketokanozole(nizoral)
Anphotericin B(fungizone), Itraconazole (Sporanox)
Topical therapy
Topical therapy includes mouth rinses or lozenges, vaginal tablets, suppositories and
creams. Topical drugs include amphotericin B suspension (Fungizone), clotrimazole
(Lotrimin), econazole (Spectazole), ketoconazole (Nizoral), miconazole (Monistat) or
nystatin (Mycostatin).

114. these drugs bind to estrogol except

115. to tx xerostomia pilocarpine
116. drugs for asthma cromolyn albuterol
117. which one is the least sedative :anti histamine
118. slowest acting drugs used to tx anaphylactic shock: Epinephrine (subcutanea)
119. least likely cancer of oral- basal cell carcinoma: Oral squamous cell carcinoma
least common in buccal mucosa and dorsum of tongue.
120. tooth bleaching
121. taking bite registrarion for denture do you want cusp tips to pierce
122. occ index preserve face bow clinical remount
123. direcr retainers retentive arm
124. purpose of direct retainers: provide tetention
indirect retainers: fuction: to prevent vertical dislodgement of the
distal extension base of a removable partial denture.
125. optimum reduction for PFM : 1.5-2mm overall tooth, supporting cusp 2mm
126. wrought wire is stiff or flexible?? Flexible
127. transillumination used to diagnose what tumor? Salivery gland
 128. after sc/rp get abcess
129. HIV protected by ADA
130. Koplik spots measles reubella
Typical Measles. The prodrome of measles lasts 2 to 4 days (range up to 8 days) and is
characterized by fever up to 105 F (40.5 C), malaise, anorexia, cough, coryza, and
conjunctivitis with photophobia and excess lacrimation. Koplik's spots, red-based lesions
with central bluish gray specks, appear on the buccal or labial mucosa, typically opposite
the second molars, toward the end of the prodromal period and last for several days. The
enanthem may involve the soft
131. syphilis mulberry molars
---------

Mulberry Molars
Berry-like molars seen in congenital syphilis.

132. Amitryptiline red palate.. tricyclics cause dry mouth atropine side affects
ANTIDEPRESSANTS
• Most commonly used meds for depression → TCA’s
• Examples of TCA: imipramine, amitriptyline
• MAO inhibitors: tranylcypromine, phenylene
• 2nd generation drugs: fluoxetine, trazodone

Mechanism of action: block amine reuptake OR alteration of receptor number

Side effect: anticholinergic or atropine side effects

133. ph of plaque lumen

134. studies; cohort vs cross sectional, mean, median, error

Cross-sectional studies (also known as Cross-sectional analysis) form a class of

research methods that involve observation of some subset of a population of items all at
the same time.

The alternative is longitudinal studies.

A cross-sectional study is a study in which disease and exposure status are measured
simultaneously in a given population. Cross-sectional studies can be thought of as
providing a "snapshot" of the frequency and characteristics of a disease in a population at
a particular point in time.

A cohort study is a form of longitudinal study used in medicine and social science. It is
one type of study design. In medicine, it is usually undertaken to obtain evidence to try to
refute the existence of a suspected association between cause and disease; failure to
refute an hypothesis strengthens confidence in it. Crucially, the cohort is identified before
the appearance of the disease under investigation. A cohort is a group of people who
share a common characteristic or experience within a defined time period (e.g., are born,
leave school, lose their job, are exposed to a drug or a vaccine, etc.)

135. cerebral palsy; ataxia vs other dental aspects

BASICS

DESCRIPTION
A term used to describe a group of patients with a non-progressive but not unchanging
disorder of movement or posture that is a result of a central nervous system insult that
occurred prenatally, perinatally, or during the first three years of life

System(s) affected: Nervous, Musculoskeletal

Genetics: Rarely inherited. Small percentage of cases with symmetric signs are
associated with autosomal recessive transmission. Symmetric and idiopathic spastic CP
(4% of cases) has 1:8 recurrence risk.

Incidence/Prevalence in USA: 1 to 2 per 1,000 live births. Up to 10% of infants with

birthweight less than 1500 grams.

Predominant age: Causative CNS insult during period of rapid brain growth but effects
are life long and evolve with time.

Predominant sex: Male  Female (1.3:1)

SIGNS AND SYMPTOMS

By classification
• Spastic 40%
 Spasticity
 Hemiplegia, quadriplegia or diplegia
 Triplegia, monoplegia are rare
 Contractures
  Mental retardation with quadriplegia and mixed forms
 Normal intelligence with hemiplegia or paraplegia
 Scissors gate, toe walking
 Tremors with hemiplegia
 Aphonia with quadriplegia
 Seizures
• Athetotic (dyskinetic) 30%
 Usually normal intelligence
 Choreoathetoid type is the most common with jerky motions of proximal muscle
groups and slow writhing of extremities face neck and trunk
 Dystonic type due to simultaneous contraction of opposing muscle groups
 Speech difficulties
 Muscular hypertrophy
 Deafness common with athetosis caused by kernicterus
• Ataxic 10%
 Normal intelligence
 Clumsy disposition with wide based gate and difficulty with fine movements
 Best prognosis for functional improvement
• Mixed 20%
 Spasticity and choreoathetosis most common
 Athetosis and ataxia can occur
 Mental retardation common.

CAUSES
• 70% of the time, neither causes nor risk factors can be identified
• In utero bacterial infections (chorioamnionitis), viral infections (e.g. rubella), CNS
malformations, chromosomal abnormalities, coagulation disorders, kernicterus, CNS
trauma and intraventricular hemorrhage
• While most cases are due to prenatal events and prematurity, 10% or less of cases are
due to intrapartum events. Such cases are almost always of spastic quadriplegic type or
dyskinetic type and are associated with evidence of severe metabolic acidosis at birth (pH
 7.00) and early onset neonatal encephalopathy at birth. Criteria which individually are
nonspecific but which together suggest intrapartum cause include a sentinel hypoxic
event immediately before or during labor (e.g. cord prolapse, abruption or uterine
rupture); sudden, rapid and sustained deterioration of the fetal heart rate pattern which
was previously normal; Apgar scores of  6 for greater than five minutes; early evidence
of multisystem involvement and early imaging showing acute cerebral abnormality.

136. slow infusion of epi low dose what happens

137. retention of pits and fissure sealant meachnaical
138. source of scatter of xray to operate pt and walls
139. taurodontism asso with denti. Imperfecta/ cleinicrad may occur in patients with
amelogenesis imperfecta, Down syndrome, andd Klinefelter syndrome
140. pagets
141. erythema Multiforme: young adults, + M Skin- target lesions. Oral: hemorrhagic
crust of the lips, painful ulcerations of the tongue, bucal mucosa. Attached gingica
rarely affected. Headache, low grade fever and previous respiratory infection often
precedes lesions. Tx: topical analgesics, antipyretic, fluids, corticosteroids,
antibiotics to prevent secondary infect.
142. geographic tongue
143. porc finish lines, bevels, chamfer . sholder bevel
144. res of ant esthtics reason why to do it after bleaching; inability to etch, shade,
asked which one is the reason
145. what is not part of band and loop
146. tooth next to edontolous area; what is is most important to prevent mesial drift (
occlusal contact)
147. Qs about articulator: incisal guidance, protrusive record with bite registration
148. drainage track fistula or prima molar; furca or apecies
149. what is not vertical relation of teeth; open bite vs ant cross bite/ ankylosis/
overbite, super eruption
150. after LA on kid; 3 min get jittery (nervous) what the reason : epi
151. kid swallows 5 mg NaFl what is effect? Nausea ,death, loss of consc
152. #30 has necrotic pulp, what do you do with 7 year old pt –apexification
153. Cerebral palsy( oral findings) Baclofen is most commonly used drug

• Children with cerebral palsy may demonstrate self injurious behavior, including:
tongue, cheek, and lip biting;
finger, arm, and hand chewing.
• Protective oral appliances may be useful in combating self-injurious behavior.
• Children who are affected by cognitive disability or mental retardation often
practice damaging oral habits, including:
bruxism, rumination, pouching, and pica.

• Children with cerebral palsy frequently have gastroesophageal reflux, as well as

episodes of vomiting. Either problem can lead to dental erosion, or loss of tooth
structure.
• Gingival overgrowth, due to seizure medications, is a frequent problem in
children with cerebral palsy.
• Orofacial findings in spastic cerebral palsy:
The head is tensely reclined.
The mouth is open, and facial movements are tense.
The tongue is hypertonic and cigar-shaped.
There is tongue thrust during swallowing and speaking.
Since the upper lip is underdeveloped, it does not produce enough pressure on the
front teeth to align them correctly.
• Orofacial findings in athetotic cerebral palsy:
The tongue shows spontaneous wave-like movements.
There may be an abrupt and wide opening of the mouth, which can lead to jaw
dislocation.
There is an uncoordinated movement of tongue, jaw, and face muscles.
 • Orofacial findings in hypotonic cerebral palsy:
The tongue is large, flat, and protruded.
Facial movements are weak, and the upper lip is inactive.

154. tx for vaginal candida (oral tx) ?? fluconozole(diflucan),ketokanozole(nizoral)

Anphotericin B(fungizone), Itraconazole (Sporanox)
Topical therapy
Topical therapy includes mouth rinses or lozenges, vaginal tablets, suppositories and
creams. Topical drugs include amphotericin B suspension (Fungizone), clotrimazole
(Lotrimin), econazole (Spectazole), ketoconazole (Nizoral), miconazole (Monistat) or
nystatin (Mycostatin).

155. Kaposi sarcoma: All of these are associated w/ Kaposi except? +Hard palate,
gingival, caused hhv 8(herpes virus 8) (not caused by HIV)
156. Hydroxyzine (Atarax): antihistamine w/ antiemetic activity;
Antiemetics/antivertigo; Antihistamines, H1; Anxiolytics; Sedatives/hypnotics
Hydroxyzine has been shown clinically to be a rapid-acting true ataraxic with a wide
margin of safety. It induces a calming effect in anxious, tense, psychoneurotic adults and
also in anxious, hyperkinetic children without impairing mental alertness. It is not a
cortical depressant, but its action may be due to a suppression of activity in certain key
regions of the subcortical area of the central nervous system.
157. If your giving a kid chloral hydrate, what else are you going to give? Give w/
hydroxyzine-often used for sedation prior to dental procedure surgeries
• Cholral hydrate is irrating to GI tract and causes epigastric distress
158. Increased vertical dimension 4 mm? what do you do? Take a new centric
relation
159. Pemiphigus Vulgaris? Which test would you do? Immunofluoresence, is the test
that you would do. Nikolsky’ sign positive: epithelium will slide off simply by
rubbing of apparently inafected area.
160. multiple osteomas- associated w/ gardner’s syndrome
161. what gland is most involved salivary gland tumor? Parotid
162. lichen planus? Associated w/ disruption of basal cell layer-acantholysis
Hyperparakeratin
saw tooth appearance of rete pegs
band-like lymphocytic infiltrate in the basement membrane region
hydrophic degeneration of basal cell layer (vaculation of basal cells)

163. pemiphigus associated w/ hesdisomes

pempighiod basement membrane
164. Sturge-weber syndrome-associated w/ port wine stains

Sturge-Weber Syndrome
 (Encephalotrigeminal Angiomatosis, Sturge-Weber Angiomatosis)
A rare cevelopmental condition characterized by a vascular birthmark and
neurological abnormalities.

Clinical Features:

first year of life

epilepsy, hemiplegia (a weakness or stiffness affecting one side of
the body, glaucoma and learning difficulties.
port wine stain usually involving at least one upper eyelid and
the forehead
usually unilateral, but bilateral cases can occur

Etiology:
unknown

Tissue of Origin:
vascular and neurological tissue

Main Pathologic Process:

developmental

Treatment:
no cure
treat symptoms
laser for cosmetic reasons
Prognosis:
disease itself is not fatal
developmental delay
emotional and behavioral problems
special education requirements
employment problems

165. picture of a cauliflower on the lateral border of the tongue? Choices were
squamous cell carcinoma or papilloma (was the answer)
166. floor of the mouth lesion that does not scrape off what would you do? Biopsy
167. in the mandible there was a radiolucencie (pretty big)? What would be the first
thing you do? Choices were aspiration w/ excisional biopsy
168. Flap- when you do a flap which do you not do? Do not separate periosteum from
the mucosa of the flap was the answer
169. apically repositioned flap- flap was made were pockets were reduced originally
the flap had hyperplastic tissue and after the flap the tissue went below the cej

170. take a max 2 molar out and there as a 2 mm perforation in the maxillary sinus what
would you do? Choices were peddicle flap, packing in bone I think the answer is peddicle
flap NO!(7mm or larger use flap )A figure eight suture should be place over the tooth
socket (2-6mm)
171. which of these cysts would most likely turn into a tumor? Dentigerous cyst will
become an ameloblastoma
172. mercury poisoning? What is the side effect? Tremor?
173. all of the following are toxic effects of lidocaine except? Myocardial depression,
convulsions, nervousness, renal failure. I think the answer had to w/ a renal
problem
174. Which drug would give hypokalemia? Hydrochlorothiazide diuretics

175. pt is taking amtryptiline (antidepressant ) pic of edentulous denture pt? what is the
problem? Candidiasis

176. which one of these is most carcinogenic? Answer is erythroplakia is the worst
one leads to carcinoma in situ
177. kid has this thing on the tongue that has grown in proportion to the rest similar to
hemangioma or lymphangioma? Example of what type of tumor? Hamartoma-
largest growth of normal cells A hamartoma is a common benign tumor in an
organ composed of tissue elements normally found at that site but that are growing
in a disorganized mass.
178. the question says has sessile bumps, w/ café au-lait spots Answer is that the
neurofibromatosis (not Polyostotic fibrous dysplasia )
179. kid has an ANB of 80. probably were talking SNA 82 SNB 80
180. Papillary hyperplasia-red dots in the palate a little inflamed
 181. Fibromas vs calcifying fibroma.
182. Bump on the tongue what is it? Lipoma, neurofibroma
183. Bump on th gingival that is painless, compressible on the papilla what is it?
Fibroma (smooth surface, pink firm symmetric papule or nodule that arise at a site
of chronic irritation, such buccal mucosa, labial mucosa and tongue.) or peripherial
odontogenic fibroma (the gingival is the most common location for the POF)

fibromatosis hyperplasia-gingiva gets fibrotic and affects the eruption of teeth

(probably affecting the eruption of teeth
184. dentinal dysplasia

Dentin Dysplasia (Rootless Tooth)

A hereditary defect in dentin formation in which the coronal dentin and tooth
color is normal; the root dentin is abnormal with a gnarled pattern and associated
shortened and tapered roots.

Clinical Features:

normal eruption pattern

bluish in cervical region
types
type I radicular dysplasia
normal crowns of regular or slightly amber translucency
tendency toward complete obliteration of pulp cavities
abnormal spaces between the teeth, malignment, malpositon
and severe mobility
type II coronal dysplasia
semi-transparent opalescent primary teeth
normal appearance in the permanent teeth
incomplete obliteration of pulp cavities
pulp stones
Radiographic
Features:
 type I radicular dysplasia
extremely short roots
obliterated pulp chambers and root canals before eruption
periapical radiolucencies around the defective roots
type II coronal dysplasia
complete obliteration of pulp chambers and root canals after
eruption
pulp stones
absence of periapical radiolucencies

Etiology:
developmental autosomal dominant trait

Tissue of Origin:
tooth

Histologic Features:
normal enamel and coronal dentin
numerous areas of interglobular dentin near the pulp
radicular dentin is tubular, amorphous, and hypertrophic

Main Pathologic Process:

developmental

Treatment:
 meticulous oral hygiene
prosthetic rehabilitation

Prognosis:
good

185. odontodysplasia
186. ectodermal dysplasia
187. primary tooth w/deep carious lesion which site would be the most common?
Furcation
188. Prilocaine (Citanest)-methomoglobinemia
189. Which drug would give to reverse xerostomia? Pilocarpine (cholinergic agonist)
190. Lithium is given for? Lithium is used for the treatment of manic/depressive
(bipolar) and depressive disorders
191. pt is taking theophylline (broncholdilatador) for what? Asthma
192. if pt is taking an inhalant steroid
inhalant steroid medicines used widely to treat asthma. and chronic obstructive
pulmonary disease (COPD)
193. Methotrexate abbreviated MTX and formerly known as amethopterin, is an
antimetabolite drug used in treatment of cancer and autoimmune diseases. It acts by
inhibiting the metabolism of folic acid. Methotrexate replaced the more powerful
and toxic antifolate aminopterin

194. HIV pt –what is the worst therapy?

Multiple gingival grafts,
methotrexate,
antibiotic therapy (erythromycin). I think the antibiotics was the answer
195. ototoxicity-streptomycin( gentamycin)
196. mineralcorticoid? What is the main action? Reabsorption of sodium
197. Diabetes-all are possible complications, except?
More prone to vascular disease,
blindness,
periodontitis,
insufficient coagulation during extraction procedures (this is the only one that is
not a complication)
198. If you block prostaglandin synthesis, what happens?
Antipyretic,
decrease inflammation,
decrease in gastric mucosa.,
decrease renal blood flow,( It does not decrease renal blood flow or glomerular
filtration)
platelets go down (thromboxane gets inhibited

199. What is the side effect of acetominophin? Liver damage

 200. Tetracycline is in the crevicular fluid
201. what is the optimal conc of fluoride in water 0.7-1.0
202. ph where enamel demineralizes 5.5
203. Plaque ph is related to succeptibility to initiation of caries
204. What kind of caries develop in the last twenty years? Pit fissures (maybe the
answer, root surface
205. subacute bacterial endocarditis? streptococci (S. viridans, a cause of endocarditis
and dental abscesses. ) while acute bacterial endocarditis (ABE) is a fulminant
illness over days to weeks, and is more likely due to Staphylococcus aureus What
could it cause? Bacteremia.
206. what antibiotic works best in children? Penicillin
207. Thrombophlebitis is associated what? Diazepam
208. what is the mechanism of nitroglycerin? Works on vascular smooth muscle by
dilating them
209. Oral med for vaginal candidiasis? Monostat (topical), ketokanozole (systemic
probably the answer)
Sistemic: fluconozole(diflucan),ketokanozole(nizoral) Anphotericin B(fungizone),
Itraconazole (Sporanox)
Topical therapy
Topical therapy includes mouth rinses or lozenges, vaginal tablets, suppositories and
creams. Topical drugs include amphotericin B suspension (Fungizone), clotrimazole
(Lotrimin), econazole (Spectazole), ketoconazole (Nizoral), miconazole (Monistat) or
nystatin (Mycostatin).

210. The pt is taking amitryptilline and has an edentulous ridge w/red sore spots?
candidiasis
211. Denture pt opens mouth and lower denture pops out-triangularis
212. submand abscess how do you drain it extraorally? Skin then superficial fascia,
platysma, then deep fascia
213. Define cohort A cohort study is a form of longitudinal study used in medicine
and social science

Cohort Study is a study in which patients who presently have a certain condition and/or
receive a particular treatment are followed over time and compared with another group
who are not affected by the condition under investigation.

For instance, since a randomized controlled study to test the effect of smoking on health
would be unethical, a reasonable alternative would be a study that identifies two groups, a
group of people who smoke and a group of people who do not, and follows them forward
through time to see what health problems they develop.

Cohort studies are not as reliable as randomized controlled studies, since the two groups
may differ in ways other than in the variable under study. For example, if the subjects
who smoke tend to have less money than the non-smokers, and thus have less access to
health care, that would exaggerate the difference between the two groups.
 The main problem with cohort studies, however, is that they can end up taking a very
long time, since the researchers have to wait for the conditions of interest to develop.
Physicians are, of course, anxious to have meaningful results as soon as possible, but
another disadvantage with long studies is that things tend to change over the course of the
study. People die, move away, or develop other conditions, new and promising treatments
arise, and so on. Even so, cohort studies are generally preferred to case control studies,
since they involve far fewer statistical problems and generally produce more reliable
answers.

214. what muscle contracts when you protrude? Lateral ptyergoid

215. use a cryer to remove roots of a mandibular molar (mesial and distal roots)-east
and west
216. close oral antral fistula –which means you perforated the max sinus-what area
supplies the flap that you do to fix it? Greater palatine artery
217. modified widman flap-when you make the incision you place the blade at an
angle and go all the way until you penetrate the bone
218. Class 2 prep-what is the retention and resistance gained from? Retention: grooves
are placed in the axiobuccal and axiolingual.(also resistance of dislodgment)
Resistance: occlusal dovetail, axiopulpal line angle rounded or beveled
219. why would you bevel the working cusp (facial) for an onlay? Better marginal
adaptation (probably the answer)
220. what is the purpose of a bevel on a class 3? Esthetics
221. Direct vs indirect retainers
222. routine Class 5 composite comes back complaining of post operative pain what is
the problem? Polished off cementum
223. deep amalgam, placed calcium hydroxide, what do you put on top? Place a liner
(glass ionomer)
224. what adhesive component of GI? Polyacrilic acid
225. What sterilization ruins a carbide bur? Heat sterilation
226. which sterilization has the hightest temp? heat sterilization
227. what is the rule for pin? How many do you use for a molar? One for every cusp
your missing, one for every wall your missing don’t know the answer
228. wavelength is most important characteristic for what? Hue
229. what is the important for shade? Value
230. what is the scattered radiation? What is the greatest risk to the operators?
scattered radiation: secondary radiation arises from interaction of the primary
radiation beam with the antoms in the oject being imaged.

Generally, a wall made of two layers of 5/8" offset gypsum board can be assumed to
provide the minimum protection from scattered radiation if the following conditions
are met:

1. Areas occupied by patients are protected by this wall or a wall of equivalent

attenuating material, and there is at least a 6 feet distance between the dental x-ray
chairs.
2. Dental personnel should be careful not to aim the primary beam toward areas
adjacent to the x-ray room.

3. The use of dental x-ray equipment does not exceed the following operating
parameters:

• 60 seconds/week of actual beam "on-time" at 90 kVp, or

• 100 seconds/week of actual beam "on-time" at 65 kVp

231. what is the best way to do a vitality test for a full cast restoration? Cold or
palpation
232. tooth that had a large carious lesion w/ no apical pathology, All except give a
good indicaton.
233. band and loop appliance
234. kid presents w/ ulcer w/ one week duration how would you treat it? Topical
steroids (probably because it looked like an apthous ulcer)
235. recurrent herpes? Tx, how long it takes? Everything
cream 4 days ion 7 days
236. pic of posterior palate w/no vesicles red?
237. ulcer on the upper lip-look into chancre (primary syphilis)
238. geographic tongue what is the chief complaint? No complains

239. what is the last thing to go in local sedation to get anesthetized? Deep pressure
(answer), pain temp touch (other choices)
Clx the order of loss of fuction is: (first the small unmyelinated fibers.
1. pain
2. temperature
3. touch
4. propioception
5. skeletal muscle tone
240. why is nitrous oxide-not soluble in blood
241. fast acting barbituates why is it so fast? Redistribution
242. enzyme in mouth rinse-how does it break up plaque? Hyaluronidase, collagenase,
dextranase (probably the answer)
243. band and loop appliance –does not have a vertical stop
244. atropine-which one stops secretion?
245. fibromas-know the different types peripheral, ossifying, ..
246. occlussal trauma would affect? periodonto
247. sensititivy-true positive
248. kid gets jittery? Side effect of epinephrine into a vessel answer was intravascular
injection
249. which of the following pathologies doe not occur on the midline? Cleft lip
250. if preparing an fpd, if there is a lot of tissue, how would this affect your pontic
design?
 251. Function of EDTA? Chelating agent and debriding canal, naocl is only
antibacterial
252. which selective procedure would you do on a second trimester pregnant pt?
253. intensity is square of the distance differenc answer is 9
254. Teeth bleaching? Vita bleach.
255. Taurodontism associated w/ what? Amelogenisis imperfect
256. x –ray tube what is used for filtering? Aluminum
257. obturating Max 1st molar mb canal? Go from the distolingual approach
258. reason for inadequate obturation or leaving shavings in the canal? Inadequate
straight line access
259. after sc/rp you should use chlorohexidine for aids patients
260. optimal occlusal reduction for pfm is 2 mm
261. gold optimal reduction 1.5
262. cleft lip/palate what kind of malocclusion would you see? Class III
263. imbibition and syneresis? Irreversible and reversible hydrocolloid
264. anug what is the etiology? Spirochetes and gram - fusobactruim , ptertrppitala
265. long standing periodonitis what is the main chief immune cell? Neutrophil or
macrophage or plasma cell
266. etiology behind periodontitis? Decrease in neutrophils coming to the site to attack
neutrophil chemotactix response
267. dual cured resins? How are they cured? What are the two cures that happen?
Chemical and light cured
268. if a pt has bleeding problems, what other test do you beside PT? INR
269. cerebral palsy? Common oral findings/ fractured anterior teeth bc of ataxia
270. horizontal root fracture-mobilize and splint

Anatomical bony landmarks:

⚫ S- sella turcica. N- nasion.
⚫ ANS- anterior nasal spine. P- point
⚫ PNS- posterior nasal spine. Po- porion.
⚫ Or- orbitale. ME – menton
⚫ Pg – pogonion. Gn – genathion.
⚫ Ar- articulare. A- point
⚫ Co- condylon. B- point
⚫ PTM- pterygomaxillary fissure. Go-gonion

Vertical & Horizontal lines.

⚫ S-N ( anterior cranial base).
⚫ N-A .
⚫ N-B.
⚫ FH : frankfort plane( corrected FH).midface.
⚫ ANS- PNS ( maxillary plane).
⚫ Me-Go ( mandibular plane).
⚫ Occlusal plane.
Long axis of U&L incisors.

275.Non-working interferences usually occur on the inner aspects of the

A. facial cusps of maxillary molars.

B. facial cusps of mandibular molars.
C. lingual cusps of mandibular molars.
D. facial cusps of maxillary premolars.

276.Cross-sectional occlusal radiographs are useful for locating the

A. hyoid bone.
B. mandibular foramen.
C. maxillary sinus polyp.
D. sialoliths in Wharton's duct

277.Which of the following describes primary occlusal trauma?

A. It is the first incidence of trauma that a tooth experiences.

B. It is a trauma that produces irreversible damage to the periodontium.
C. Mobility is caused by excessive forces on a normal periodontium.
D. Mobility is caused by excessive forces on a reduced periodontium.

278. The maximal or "ceiling" effect of a drug is also correctly referred to as the drug's

A. agonism.
B. potency.
C. efficacy.
D. specificity.

279. In mg/kg body weight, the lethal dose of fluoride falls in the range of

A. 0.5-1.0.
B. 20-50.
C. 100-200.
D. 300-500.

280. The rate at which new disease occurs is classified as which of the following?
 A. Incidence
B. Prevalence
C. Extent
D. Attributable risk

281. Which of the following types of chemical bonding is the least likely to be involved
in a drug-receptor interaction?

E. Covalent bonding
F. Hydrogen bonding
G. Dipole-dipole bonding
H. Electrostatic bonding
I. van der Waal's forces

282.Secondary trauma from occlusion is seen in cases where

J. healthy gingival and osseous tissues are present.

K. traumatic changes are occurring in periodontal tissues of teeth with normal
supporting bone.
L. normal occlusal forces cause trauma to the attachment apparatus of teeth with
inadequate bone support.

A patient presents with malocclusion and a unilateral, slowly progressing elongation of

her face. This elongation has caused her chin to deviate away from the affected side. The
MOST probable diagnosis is which of the following?

A. Ankylosis
B. Osteoarthritis
C. Myofascial pain
D. Condylar hyperplasia

Incorporating additional moisture during mixing will accelerate the set of (a) plaster; (b)
polyether; (c) polysulfide impression material; (d) a zinc oxide-eugenol impression paste;
(e) an irreversible hydrocolloid impression. (a) and (c) (a) and (d) (b) and (c) (b) and (d)
(b) and (e) (c) and (d) (d) and (e)

On the basis of diagnostic test results, a dentist correctly classifies a group of patients as
being free from disease. These results possess high

A. sensitivity.
B. specificity.
C. generalizability.
D. repeatability.
Which of the following adverse conditions may arise if the occlusal vertical dimension is
increased?

A. The closing muscles may become strained.

B. The opening muscles may become strained.
C. The closing muscles may become too relaxed.
D. Soreness may occur at the corners of the mouth.

The nerve plexus of Rashkow is located in the

A. cell-rich layer.
B. cell-free layer.
C. central pulp core.
D. odontoblast layer.

Which of the following principles requires health professionals to inform their patients
about treatment and to protect their confidentiality?

A. Justice
B. Autonomy
C. Beneficence
D. Nonmaleficence

Through the Bloodborne Pathogen Standard, the Occupational Safety and Health
Administration (OSHA) directs activity for each of the following EXCEPT one. Which
one is this EXCEPTION?

A. Using barrier techniques

B. Using material safety data sheets (MSDS)
C. Obtaining hepatitis B vaccinations
D. Communicating hazards to employees
E. Performing housekeeping

diagnostic test failed to identify five cases of true disease. This type of failure is known
as a

F. false negative.
G. false positive.
H. positive predictive value.
I. negative predictive value.

What is the major difference between a Class V cavity preparation for amalgam and one
for composite resin by the acid-etch technique?
 A. Depth
B. Convenience form
C. Position of retention points
D. Angulation of the enamel cavosurface margins

A researcher establishes the following null hypothesis: "There is no difference in student

achievement between the programmed self -instructional strategy and a conventional
lecture-discussion format." In this study, the DEPENDENT variable will be the

A. type of instruction used.

B. number of students who participated.
C. relevance of course material.
D. examination scores obtained.

Which of the following represent(s) an early effect of primary traumatic occlusion?

A. Vertical pocket formation

B. Generalized alveolar bone loss
C. Undermining resorption of alveolar bone
D. Hemorrhage and thrombosis of blood vessels in the periodontal ligament

Which of the following is MOST appropriate for testing differences between the means
of two groups?

A. Chi-square test
B. Multiple regression analysis
C. Correlation coefficient analysis
D. Student's t-test

When a removable partial denture is terminally seated, the retentive clasp tips should

A. be invisible.
B. exert no force.
C. apply retentive force into the body of the teeth.
D. resist torque through the long axis of the teeth

Which of the following represents the variability about the mean-value of a group of
observations?

A. Sensitivity
B. Standard deviation
C. t-Statistic
D. Specificity
Which of the following most strongly suggest cause-and-effect relationships?

E. Correlational studies
F. Controlled clinical trials
G. Case reports
H. Epidemiologic surveys

An operator has chosen to use a shielded open-ended cone. Which of the following will
contribute the most to patient gonadal dose?

I. Leakage from the x-ray machine head

J. Scatter from the operatory walls
K. Scatter from the cone
L. Scatter from the patient's face

defect in neuromuscular transmission causes which of the following?

A. Bell's palsy
B. Myasthenia gravis
C. Muscular dystrophy
D. Multiple sclerosis
E. Trigeminal neuralgia

Use of a gold casting instead of dental amalgam should be considered in the restoration
of an MOD carious lesion on a maxillary second molar when

A. greater sealing of the cavity is desired.

B. the preparation is wider than a third of the intercuspal distance.
C. esthetics is the primary concern of the patient.
D. All of the above

denture set-up was balanced on the articulator with the condylar setting at 20 degrees.
This setting had been incorrectly recorded. When the correct setting of 45 degrees is
made on the articulator, and if a balanced occlusion is desired, it will be necessary to

A. decrease the plane of occlusion.

B. increase incisal guidance.
C. decrease the heights of cusps.
D. increase the compensating curve

Major connectors of a maxillary removable partial denture may be beaded to

A. produce a stronger framework.

B. aid in retention of the removable partial denture.
C. hold acrylic resin to the metal framework.
D. produce a positive contact with the tissue.
 E. form a finish line between the metal and acrylic resin.

A patient who wears complete dentures is having trouble pronouncing the letter "C". This
is probably caused by

A. too thick a palatal seal area.

B. too thick a base in the mandibular denture.
C. incorrect positioning of maxillary incisors.
D. improper positioning of mandibular incisors.

The setting time of zinc phosphate cement can be retarded by

A. increasing the ratio of powder to liquid.

B. diluting the liquid with a small amount of water.
C. accelerating the rate of addition of powder to liquid.
D. decreasing the rate of addition of powder to liquid.

Indirect retention is designed to

A. stabilize tooth-borne removable partial dentures.

B. engage an undercut area of an abutment tooth.
C. help resist tissueward movement of an extension base partial denture.
D. help resist dislodgment of an extension base partial denture in an occlusal
direction.

Protrusive jaw relation records are used to

A. give direction to the occlusal plane.

B. set the incisal guides of the articulator.
C. set the lateral posts of the articulator.
D. set the condylar inclinations of the articulator.

The primary purpose of a plaster index of the occlusal surfaces of a maxillary denture
before removing the denture from the articulator and cast is to

A. preserve the face-bow transfer.

B. maintain the patient's centric relation.
C. maintain the patient's vertical dimension.
D. maintain both the correct centric and vertical relation records.
Which of the following might be anticipated in a patient who is an uncontrolled diabetic?
(a) Impaired healing; (b) Poor tissue tolerance; (c) Rapid bone resorption; (d) Increased
salivary flow.

A. (a), (b) and (c)

B. (a), (b) and (d)
C. (a), (c) and (d)
D. (b), (c) and (d)
E. All of the above

Cross-sectional growth studies sample

A. different individuals at the same age intervals.

B. the same individuals, but different midsagittal sections.
C. different individuals and different sagittal sections.
D. the same individuals at different age intervals.
E. none of the above.

The first sensations usually lost after local anesthetic administration are (a) touch; (b)
pressure; (c) pain; (d) temperature; (e) skeletal muscle movement.

A. (a) and (b)

B. (a) and (c)
C. (b) and (c)
D. (c) and (d)
E. (c) and (e)

The principal therapeutic action of the glucocorticoids is

A. antidiuretic.
B. antianabolic.
C. anti-infective.
D. antihypertensive.
E. anti-inflammatory

Prolonged therapeutic administration of cortisone induces

A. hypoglycemia.
B. hypofunction of the adrenal cortex.
C. hypofunction of the adrenal medulla.
D. hyperfunction of the pituitary gland.
E. hyperfunction of the thyroid gland

Spironolactone diuresis is the result of

A. increased potassium excretion.

 B. direct aldosterone antagonism.
C. inhibition of carbonic anhydrase.
D. inhibition of antidiuretic hormone release.
E. increase in glomerular filtration rate.

314. The adrenal steroids may be used to treat (a) rheumatoid arthritis; (b) leukemia; (c)
tuberculosis; (d) collagen diseases; (e) Cushing disease.

A. (a), (b) and (c)

B. (a), (b) and (d)
C. (b), (c) and (d)
D. (c), (d) and (e)
E. (d) and (e) only