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#MCQ 13: Which of the following is the best treatment plan to control rampant caries?

#MCQ 13:  Which of the following is the best treatment plan to control rampant caries (many proximal caries that undermine enamel) ?

A. Restore all teeth with amalgam as soon as possible
B. Prescribe high fluoride tooth paste, give oral hygiene instruction, and wait until effectiveness has been appraised
C. Restore all teeth with crowns
D. Remove caries and place glass ionomer restorations then complete the treatment plan after the vitality of the teeth has been established

Answer: D. Remove caries and place glass ionomer restorations then complete the treatment plan after the vitality of the teeth has been established

Rampant caries control protocols suggest that caries should be removed and glass ionomer cement restorations should be placed until the true pulp status can be assessed.

Removing the caries allows the clinician to see if caries have extended to the pulp cavity.
Placing glass ionomer restorations allows for the affected dentin to be remineralized.

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#Mnemonics - Steps in Planning and Evaluation - Public Health Dentistry

The steps involved in the Planning Process are:
1. Identifying the Problem
2. Determining Priorities
3. Development of Program goals, objectives, and activities
4. Resources Identification
5. Constraints Identification
6. Alternative Strategies
7. Developing Implementation Strategies
8. Implementation
9. Monitoring
10. Evaluation

These steps can be memorized with the help of an expression mnemonics - @  Identifying Determined Girl/Guy Requires Conscious Strategies Implementing IME ( Ingenuity, Morality and Emotions)

Identifying - 1. Identifying the Problem
Determined - 2. Determining Priorities
Girl /Guy - 3. Development of Program goals, objectives, and activities
Requires - 4. Resources Identification
Conscious - 5. Constraints Identification
Strategies - 6. Alternative Strategies
Implementing - 7. Developing Implementation Strategies
I - 8. Implementation
M - 9. Monitoring
E -10. Evaluation

#MCQ 12 - Which of the following tooth has the highest endodontic failure rate?

#MCQ 12 - Which of the following tooth has the highest endodontic failure rate?
A. Maxillary First Molar
B. Maxillary First Premolar
C. Mandibular First Molar
D. Mandibular Second Premolar

Answer: A. Maxillary First Molar

The pulp chamber of the maxillary first molar is the largest in the dental arch.

The maxillary first molars are three rooted, two buccal and one palatal. The tooth usually has four root canals, the additional canal being located in the mesiobuccal root. The pulp chamber floor has a quadrilateral shape, although it is sometimes described as triangular.  All the canal orifices lie mesial to the oblique ridge which makes it possible to preserve it (oblique ridge) during access preparation.

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#MCQ 11 - Regarding Electric Pulp Test for tooth vitality assessment, all of the following statements are true EXCEPT:

#MCQ 11 - Regarding Electric Pulp Test (EPT) for tooth vitality assessment, all of the following statements are true EXCEPT:
A. The objective is to stimulate a pulpal response by subjecting the tooth to an increasing degree of electric current
B. Any restorations in the tooth or the adjacent gingival tissue should not be contacted with the electrolyte or the electrode
C. The test is always performed on the tooth in question prior to testing on a control tooth
D. Gloves should not be worn while performing EPT because it may cause false negative responses

Answer:
C. The test is always performed on the tooth in question prior to testing on a control tooth

This statement is a false statement because, the test is always performed on a control tooth first, and then only on the tooth in question.

EPT checks the sensibility of a tooth by stimulating nerve endings with a low current and high potential difference in voltage. Although manufacturers of this device give normal reference values of current, the best way to check "normal/baseline" values is to use it on adjacent (nonpathological) teeth. This is then compared with the values obtained on the tooth being questioned. The EPT uses electrical excitation to stimulate the A-delta sensory fibers in the pulp.

Any restorations in the tooth or the adjacent gingival tissue should not be contacted with the electrolyte or the electrode because this may give a misleading response.

The electric Pulp test cannot be solely depended on for testing pulp vitality, results should be confirmed by other vitality tests like cold test or test cavity.

The most ideal way of performing a pulp sensibility test is a combination of cold test and Electric Pulp Test (EPT).

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#MCQ 10 - In Orthodontics, Porcelain brackets have better esthetics as compared to stainless steel brackets. However, a major disadvantage is:

#MCQ 10 - In Orthodontics, Porcelain brackets have better esthetics as compared to stainless steel brackets. However, a major disadvantage is:
A. Stains over time
B. Require special debonding agents
C. Removing is difficult and causes enamel cracks
D. Channel microfraction while debonding

Answer: Removing is difficult and causes enamel cracks

"Ceramic brackets are more difficult to debond than steel brackets, and wing fractures may occur easily during debracketing." - Graber

Drawbacks of Ceramic Brackets:
1.  The frictional resistance between orthodontic wire and ceramic brackets is greater and less predictable than it is with steel brackets. This unpredictability makes determining optimal force levels and anchorage control difficult. Ceramic brackets with a steel slot insert to reduce friction are therefore more reliable for clinical purposes.

2. Ceramic brackets are not as durable as steel brackets and are brittle by nature. These brackets may break during orthodontic treatment, particularly when full size (or close to full size) stainless steel archwires are used for torquing purposes.

3. Ceramic brackets are harder than steel and rapidly induce enamel wear of any opposing teeth.

4. Ceramic brackets are more difficult to debond than steel brackets, and wing fractures may occur easily during debracketing. 

5. The added bulk required to provide adequate strength makes oral hygiene more difficult.

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#MCQ 9 - Treatment of Ludwig's Angina due to pericoronitis with respect to lower third molar?

#MCQ 9 - Treatment of Ludwig's Angina due to pericoronitis with respect to lower third molar :
A. Incision and Drainage, antibiotics and removal of third molar
B. Intubation prior to surgery
C. Incision and drainage, removal of third molar, antibiotics
D. Tracheostomy should be done before any treatment

Answer: D.  Tracheostomy should be done before any treatment

The dramatic reduction in the mortality of Ludwig's angina from 54% to 10% in only 3 years, afforded by Williams and Guralnick, was made possible by their changed surgical policy of immediate establishment of airway security by early intubation or tracheostomy, followed by aggressive and early surgical intervention. This dramatic reduction in mortality from 54 to 10 percent was not due to the first use of penicillin in the treatment of these infections.

Reference: Peterson's Principles of Oral and Maxillofacial Surgery, 3rd Edition, Page 841

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#MCQ 8 - A dental surgeon has recovered from Hepatitis B after a three months rest. His Laboratory Findings are Normal but he is not allowed to attend to the patients as per the medical board because he is:

#MCQ 8 - A dental surgeon has recovered from Hepatitis B after a three months rest. His Laboratory Findings are Normal but he is not allowed to attend to the patients as per the medical board because he is:
A. Healthy carrier
B. Active carrier
C. Convalescent carrier
D. Paradoxical carrier

Answer: C. Convalescent carrier

A carrier is a person who harbors the pathogenic microorganism without suffering from any ill effect because of it.

Healthy Carrier - One who harbors the pathogen but has never suffered from the disease caused by the pathogen
Convalescent carrier - One who has recovered from the disease and continue to harbor the pathogen in the body
Temporary carrier - This state lasts less than 6 months
Chronic carrier - This state lasts for several years and even rest of the life in some cases
Contact carrier - One who acquires pathogen from a patient
Paradoxical carrier - One who acquires pathogen from other carrier

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How to get rid of Toothache ?

Toothache is a lifetime experience for someone who has experienced the pain of acute pulpitis. Be it sharp, acute, transient pain for seconds or some dull aching, continuous vauge pain in the facial region, tooth pain is really intolerable to ignore. Getting rid of the toothache is the only  thing the sufferer thinks of at the time because, foods look painful, all parties are meaningless if you cannot eat anything, even water !

The type of pain you have is very important to know the condition you might be suffering with. For example, continuous pain that lasts for minutes to hours even after removal of an offending stimulus ( cold, heat, air or some acidic foods) or spontaneous pain without any stimulus often represents irreversible pulpitis, which mandates that you should have a root canal treatment rather than a simple tooth filling. The tooth may seem perfectly fine from outside but there may be a large decay between two teeth which can be seen only on radiographs. Or, your teeth may be without any decay but the pain may be from some periodontal problems (problems arising from gums and other supporting structures of tooth)  The decision of treatment plan whether you should get a root canal treatment or a simple restoration will be okay must be done by your dentist after listening to your history of illness, clinical examination and radiographic evaluation. There's no point asking a dentist over the phone about whether you need an RCT or not.

There is no any medication to reverse your tooth decay once a clinically visible cavitated lesion is formed, the only treatment is to remove the caries and then restore it. But for the immediate pain relief, you can avoid the stimulus causing pain. Warm water can be helpful to relieve pain in some tooth sensitivity cases. Lying down or sleeping aggravates the pain in irreversible pulpitis due to increased blood pressure in the pulpal tissues while sleeping or lying down, so, upright positioning provides relief relatively. Avoid taking too cold or too hot foods and acidic foods and beverages like carbonated soda drinks, citric fruits, sweets, ice cream, etc.

 If you cannot tolerate the dental pain, you may take over the counter medications such as Paracetamol 500mg or Ibuprofen 400mg for immediate pain relief. But that does not mean you can defer the dental treatment any further. You do not feel the pain doesn't mean that the underlying problem is cured, the bacteria doesn't die itself. You wouldn't want the disease progress further and come back again larger and stronger which causes more pain, loss of time and loss of money.

A stitch in time saves nine is very much applicable in the field of dentistry.






# MCQ 7 - Which of the following tests for tooth vitality assessment has the highest diagnostic accuracy?

# MCQ 7
# Which of the following tests for tooth vitality assessment has the highest diagnostic accuracy?
A. Electric Pulp Test
B. Heat Test
C. Cold Test
D. Anesthetic Test

Answer: C. Cold Test
The diagnostic accuracy of cold test is 86%, the heat test is 71 % and Electric pulp test is 81%.
So, a combination of cold test followed by Electric Pulp Test (EPT) is recommended in a clinical setting. Anesthetic test is done only in patients who are in pain at the time of the test and other tests have failed to identify the tooth causing pain.

Reference: Grossman's Endodontic Practice, 13th Edition, Page 72

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# MCQ 6 - Maximum use of Computers in the field of Dentistry is in the field of:

# Maximum use of Computers in the field of Dentistry is in the field of:
A. Periodontology
B. Prosthodontics
C. Community Dentistry
D. Operative Dentistry

Answer:
C. Community Dentistry
Other branches of dentistry may optionally use computers, but Community Dentistry uses computers extensively for data analysis, storage, transfer and presentation.

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#MCQ 5 - First Water Fluoridation was done in:

# First Water Fluoridation was done in:

A. Sweden
B. Canada
C. Michigan (USA)
D. California

Answer:
C. Michigan (USA)

To test the hypothesis that adding fluoride would prevent cavities, Dean and his colleagues conducted a controlled experiment by fluoridating the water in Grand Rapids, Michigan, starting 25 January 1945. The results, published in 1950, showed significant reduction of cavities.

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PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS - Oral and Maxillofacial Surgery

According to Contemporary Oral and Maxillofacial Surgery, 6th Edition, the PRINCIPLES OF THERAPY OF ODONTOGENIC INFECTIONS are:

Principle 1: Determine Severity of Infection
Principle 2: Evaluate State of Patient’s Host Defense Mechanisms

Compromised Host Defense States:

Uncontrolled Metabolic Diseases
• Poorly controlled diabetes
• Alcoholism
• Malnutrition
• End-stage renal disease

Immune System–Suppressing Diseases
• Human immunodeficiency virus/acquired immunodeficiency
syndrome
• Lymphomas and leukemias
• Other malignancies
• Congenital and acquired immunologic diseases

Immunosuppressive Therapies
• Cancer chemotherapy
• Corticosteroids
• Organ transplantation

Principle 3: Determine Whether Patient Should Be Treated by General Dentist or Oral-Maxillofacial Surgeon

Criteria for Referral to an Oral-Maxillofacial Surgeon

• Difficulty breathing
• Difficulty swallowing
• Dehydration
• Moderate to severe trismus (interincisal opening less than 20 mm)
• Swelling extending beyond the alveolar process
• Elevated temperature (greater than 101°F)
• Severe malaise and toxic appearance
• Compromised host defenses
• Need for general anesthesia
• Failed prior treatment

Principle 4: Treat Infection Surgically

Principle 5: Support Patient Medically

Principle 6: Choose and Prescribe Appropriate Antibiotic

Guidelines for consideration when choosing a specific antibiotic:

- Determine the need for antibiotic administration.
- Use empirical therapy routinely.
- Use the narrowest-spectrum antibiotic.
- Use the antibiotic with the lowest incidence of toxicity and
side effects.
- Use a bactericidal antibiotic, if possible. 
- Be aware of the cost of antibiotics.

Principle 7: Administer Antibiotic Properly

Principle 8: Evaluate Patient Frequently


Most Common Causes of Some Conditions : Contemporary Oral and Maxillofacial Surgery, 6th Edition, Mosby

Most Common Causes of Some Conditions:


1. The most common cause of adrenal insufficiency is chronic therapeutic corticosteroid administration (secondary adrenal insufficiency).

2. The most common cause of a transient loss of consciousness in the dental office is vasovagal syncope.

3. During normal development, the lower third molar begins in a horizontal angulation, and as the tooth develops and the jaw grows, the angulation changes from horizontal to mesioangular to vertical. Failure of rotation from the mesioangular to the vertical direction is the most common cause of lower third molars becoming impacted.

4. A complication that every dentist believes can never happen—but happens surprisingly often—is extraction of the wrong tooth. This is usually the most common cause of malpractice lawsuits against dentists.

5. The most common cause of delayed wound healing is infection. Infections are a rare complication after routine dental extraction and are primarily seen after oral surgery that involves the reflection of soft tissue flaps and bone removal.

6. The most common cause of treatment failure of odontogenic infections is inadequate surgery. Atooth  may have to be re-evaluated for extraction, or an extension of the infection into an area not detected during the first treatment may have to be incised and drained.

7. The most common cause of Ludwig’s angina is an odontogenic infection.

8. Oral Candidiasis: Candida rarely causes disease unless the patient’s health becomes compromised. The two most common causes of compromise are:
administration of antibiotics, especially penicillin, for prolonged periods,  and
immune system compromise, as occurs with acquired immunodeficiency syndrome (AIDS) or chemotherapy for leukemias and other forms of cancer.

9. One of the most common causes of true mucoceles is surgery on the sinus that results in separation of a portion of the sinus lining from the main portion of the sinus. This area can then become filled with mucus and walled off, forming a separate cystic lesion. These lesions are termed surgical ciliated cysts or postoperative maxillary cysts.

10. The most common causes of temporomandibular disorders (TMDs) are muscular disorders, which are commonly referred to as myofascial pain and dysfunction. These muscular disorders are generally managed with a variety of reversible nonsurgical treatment methods.

11. The most common cause of TMJ ankylosis involves macro-trauma, most frequently associated with condylar fractures. Other causes of ankylosis include previous surgical treatment that resulted in scarring and, in rare cases, infections.

# MCQ 4: Which of the following materials cannot be used as a base under composite restorations?

# Which of the following materials cannot be used as a base under composite restorations?
A. Zinc Phosphate
B. Zinc Polycarboxylate
C. Zinc Oxide Eugenol
D. Glass Ionomer Cement


Answer: C. Zinc Oxide Eugenol.
Reason: Residual free eugenol interferes with the proper setting of resin-based composites or resin cements. Therefore, various types of carboxylic acids have been used to replace eugenol and produce a ZOE-like material. These products are called zinc oxide-non eugenol cements.

Reference: Phillip's Science of Dental Materials, 12th Edition, Page No. 331

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#MCQ 3 # Which of the following materials could be used for cementing a bridge as well as restoring a cervical lesion?

# Which of the following materials could be used for cementing a bridge as well as restoring a cervical lesion?
A. Glass Ionomer cement
B. Zinc Polycarboxylate
C. Zinc Phosphate
D. Zinc Oxide Eugenol

Answer:
Correct Answer is: A. Glass Ionomer Cement

Only glass ionomer is used as a cement (luting agent) and a permanent restorative material.
Glass ionomer cement is often used for root surface carious lesions because of the potential advantage of fluoride release in helping to control the spread of caries.

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# MCQ 2 : Gutta Percha is Plasticized/Softened by:

# Gutta Percha is plasticized / softened by:
A. Alcohol
B. Chloroform
C. Eugenol
D. EDTA

Ans:

Reference: Grossman's Endodontic Practice, 13th Edition Page no. 366

Correct answer is B. Chloroform

Gutta Percha can be plasticized by chemical solvents such as Chloroform, Eucalyptol, or xylol  which enables the gutta percha to flow into small and curved wavy canals. 

MCQ 1: The Largest Component of Gutta Percha Cones is:

# The Largest Component of Gutta Percha Cones is:
A. Gutta Percha
B. Zinc Oxide
C. Resins and Waxes
D. Coloring Agents

Why dentists should charge higher?

Most Dentists and Dental Students assume that dental extraction is a relatively easy procedure which takes less time to perform and they need not charge much for extractions because all you need is few milliliters of Local anesthetic, a pair of gloves and some reusable instruments which need to be autoclaved. So, in the fear that their competitor could charge less for the dental extraction and acquire more customers because we all have realized that Nepal, India, and Asia in general, is a price-sensitive economy, dentists prefer to charge less than they actually should have charged for dental extractions. Non - Asian dental patients are price sensitive too because dental treatment is something the general public has envisioned as a costly treatment. But, it is to be noted that Dentists in Asia are actually charging very less for dental extractions as well as other dental treatments and they should charge many times higher for the treatment than they are currently charging. Here are some reasons to justify it.

1. Dental Treatment is a One-to-One Patient Care
You cannot treat three patients at once however easy the procedure is or however flooded with patients your dental clinic is. Each patient has to be given sufficient time and instruments and chair should be set up and customized as per the necessity for every patient. This will take time. So, you can do only a limited number of patients on any given day, you cannot work 18 hours a day!! But does that mean we should charge an outrageous amount to a patient if very few patients come to our clinic? Not actually. They just need to be charged sufficiently so that you would not have to worry a bit about how many patients you can do today.

2. The cost of saving a Tooth
As Miguel de Cervantes said, "Every tooth in a man's head is more valuable than a diamond." The value of the tooth is reflected by the cost needed to remove it from the socket. People don't have to pay for keeping the teeth in their mouth. They know its importance only when they are lost. And when you charge just Rs. 500 (5 USD) to extract a tooth because it's easy and takes no time, you're telling them by your actions that they are not valuable, and more importantly, they are given a choice of sacrificing the tooth for a petty sum of money, instead of preserving it (if restoration or root canal treatment were possible) by paying a bit more money. People insist to have their restorable teeth removed just because they think you are trying to extort their hard earned money. So, the cost of dental extraction should be invariably higher than any restorative treatment efforts.

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