Hyperplastic Tissue Management in Complete Dentures

# The most common reason why hyperplastic tissue is removed during the construction of a complete denture is that:
a) It interferes with the arrangement of the teeth
b) It is unaesthetic to construct a denture on a hyperplastic tissue
c) It interferes with the stability of the denture
d) All of the above

The correct answer is C. It interferes with the stability of the denture.

The most important reason for the treatment of hyperplastic tissue before the construction of complete or removable partial dentures is to provide a firm, stable base for the denture. 

Functional cusp reduction

# The amount of functional cusp reduction required for metal-ceramic crown is -
a) 1.0 - 2.5 mm
b) 1.5 - 2.0 mm
c) 2.0 - 2.25 mm
d) 1.85 - 2.10 mm

The correct answer is B. 1.5 -2.0 mm. 

Metal ceramic restorations require a 1.5 - 2 mm reduction in the functional cusp and 1.0 - 1.5mm reduction in the non-functional cusp. 

Gutta percha removal

# Best method to remove gutta-percha in retreatment procedures:
A. Hand instrumentation
B. Automated instrumentation
C. Rotatory instruments
D. Ultrasonic instruments

The correct answer is A. Hand instrumentation

The coronal portion of gutta-percha obturations should always be drilled out, preferably by means of endodontic drills such as the Gates-Glidden or Peeso. Gutta-percha may be dissolved (solvent technique) or removed in its solid form (Solid gutta-percha techniques). Dissolving avoids the use of excessive force in the negotiating of gutta-percha-obturated canals.

Extrusion of solvent into the periapical tissues should be prevented.

Solvents of gutta-percha: Gutta-percha is soluble in chloroform, ethyl chloroform, carbon disulfide, carbon tetrachloride, benzene, xylene, eucalyptol oil, halothane, and rectified white turpentine.

Retreatment of solid objects other than gutta-percha, either a silver point or a fragment of an instrument or post, cannot be easily grasped and pulled out. A readily accessible solid object may be withdrawn from the canal by a variety of instruments, including Stieglitz or Perry pliers, a modified Castroviejos needle holder, or a Caulfield silver point extractor. Ultrasonic Vibration, bypassing with hand instruments and Intermittent irrigation, alternating sodium hypochlorite with hydrogen peroxide or RC-Prep, may float the object coronally through the effervescence they create.

Special grasping devices. The Masserann technique- Masserann and alternative extractors. The Masserann kit consists of an extractor into which the object to be retrieved is locked. An assortment of end-cutting trepan burs are used in anticlockwise rotation, to provide access for the extractor. 

Endodontic retreatment

# Endodontic retreatment:
A. Is as technically challenging as original treatment
B. Has a poorer prognosis than original treatment
C. Is performed only on endodontic failures
D. Has different objectives than primary treatment

The correct answer is B. has a poorer prognosis than the original treatment

Post and Core in Endodontics

# In restoring an endodontically treated tooth for post core, an absolute minimum of apical fill of gutta percha to be left over to prevent leakage is:
A. 1 mm
B. 2 mm
C. 3 mm
D. 4 mm

The correct answer is D. 4mm

Since there is greater leakage when only 2-3 mm of Gutta-percha is present, 4-5 mm should be retained apically to ensure an adequate seal. Although studies indicate that 4 mm produce an adequate seal, stopping precisely at 4 mm is difficult, and radiographic angulation errors could lead to retention of less than 4 mm. Therefore, 5 mm of gutta-percha should be retained apically. 

Concentration of EDTA used during BMP:

# Concentration of EDTA used during biomechanical preparation (BMP) is:
A. 20% at pH 7.4
B. 15% at pH 5.0
C. 15% at pH 7.3
D. 25% at pH 7.4

The correct answer is C. 15% at pH 7.3

EDTA has a property of chelate formation with calcium salts. Disodium salt of EDTA is used in endodontic therapy for dissolving pulp stones. 

Length of a Peeso reamer is:

# Length of a Peeso reamer is:
A. 28-32 mm
B. 30-35 mm
C. 35-40 mm
D. 40-45 mm

The correct answer is A. 28-32 mm

- Standard Peeso reamer is of 32 mm length.
- Short Peeso reamer is of 28 mm length.

Cardiac glycosides:

# Which of the following is called cardiac glycosides?
A. Digitalin
B. Belladonna
C. Reserpine
D. Colchicum

Cardiac glycosides are a class of organic compounds that increase the output force of the heart and increase its rate of contractions by acting on the cellular sodium-potassium ATPase pump. Their beneficial medical uses are as treatments for congestive heart failure and cardiac arrhythmias; however, their relative toxicity prevents them from being widely used.

Cardiac glycosides can be more specifically categorized based on the plant they are derived from, as in the following list. For example, cardenolides have been primarily derived from the foxglove plants Digitalis purpurea and Digitalis lanata, while bufadienolides have been derived from the venom of the cane toad Bufo marinus, from which they receive the “bufo” portion of their name.

Cardiac glycosides have long served as the main medical treatment to congestive heart failure and cardiac arrhythmia, due to their effects of increasing the force of muscle contraction while reducing heart rate. Heart failure is characterized by an inability to pump enough blood to support the body, possibly due to a decrease in the volume of the blood or its contractile force. Treatments for the condition thus focus on lowering blood pressure, so that the heart does not have to exert as much force to pump the blood, or directly increasing the heart's contractile force, so that the heart can overcome the higher blood pressure. Cardiac glycosides, such as the commonly used digoxin and digitoxin, deal with the latter, due to their positive inotropic activity. On the other hand, cardiac arrhythmia are changes in heart rate, whether faster (tachycardia) or slower (bradycardia). Medicinal treatments for this condition work primarily to counteract tachycardia or atrial fibrillation by slowing down heart rate, as done by cardiac glycosides.

Nevertheless, due to questions of toxicity and dosage, cardiac glycosides have been replaced with synthetic drugs such as ACE inhibitors and beta blockers and are no longer used as the primary medical treatment for such conditions. Depending on the severity of the condition, though, they may still be used in conjunction with other treatments.

Middle meningeal artery:

# The middle meningeal artery: (MAN -95)
a) Enters the skull through the foramen ovale
b) Supplies the superolateral surface of the ipsilateral cerebral hemisphere
c) Runs a subdural course within the cranial cavity
d) Gives an interior branch which runs deep to the pterion

The correct answer is D. Gives an interior branch which runs deep to the pterion

The middle meningeal artery enters the middle cranial fossa through the foramen spinosum. In middle cranial fossa, it has an extradural course and divides into anterior frontal branch and posterior parietal branch.

The frontal branch is closely related to the motor area of the cerebral cortex. It is the commonest source of extradural hemorrhage and results in hemiplegia of the opposite side. The parietal branch is closely related to the cerebrum and its involvement result in contralateral deafness. 

AIIMS MDS MCQs Nov 2007 Part 1 with Answers

# Which one of the following is a junction of frontal, parietal, temporal and greater wing of sphenoid bone?
 A. Pterion
 B. Lambda
 C. Vertex
 D. Inion

# A non synovial joint with dense connective tissue between two bony surfaces is termed as:
 A. Synchondrosis
 B. Syndesmosis
 C. Symphysis
 D. Suture


14th MARCH 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal
5th year BDS
Paper - IV 

Time - 2 Hours
 Total Marks: 80
Maximum Marks - 40
1. Explain the pathophysiology of osteomyelitis of jaws.   (4)

2. Discuss the clinical features of trigeminal neuralgia and enlist different treatment options. (2+3=5)

3. Enlist FOUR clinical features of zygomatic arch fracture. Add a note on Gillies temporal approach to indirect reduction. (2+3=5)

4. Enlist the clinical test to diagnose oro-antral communication and add a note on management of oroantral communication. (2+4=6)

5. Discuss briefly on different types of dislocation and enumerate the surgical procedures for the management of chronic recurrent temporomandibular joint dislocation . (3+3=6)

6. Mention the difference between ridge extension and ridge augmentation procedure based on their indication. Describe any one ridge extension procedure. (1+4=5)

7. With the help of a well labeled diagram, discuss WAR lines. (4)

8. Mention different theories of the mechanism of action of local anesthetic and explain the most accepted theory. (2+3=5)


Maximum Marks: 40
I. A 50-year-old male weighing 70 kg, presented to the maxillofacial clinic for extraction of grossly decayed 16. He also gave a history of coronary artery bypass graft surgery, which was done at BPKIHS 3 years back.
Q.1 Will this patient require antibiotic prophylaxis prior to extraction?     1
Q.2 Enlist the cardiac conditions requiring antibiotic prophylaxis for infective endocarditis as per the latest guidelines.     4
Q.3 Calculate the maximum number of cartridges of lignocaine with vasoconstrictor that is recommended for this patient.    5
Q.4 Enlist contraindications for exodontia.    5

II. A 45-year-old male presented to the OMFS department with a complaint of swelling over the right side of face from the last 6 months. There is no history of trauma or toothache.
On examination there .was a bony hard swelling over the right angle region with buccal and lingual cortices expansion with clinically missing 48.

OPG of the patient revealed a multilocular radiolucent area extending from distal of 47 till the ramus of the mandible with a radio-opaque tooth-like structure resembling 48 on the inferior aspect of the radiolucent lesion.

Aspiration from the lesion revealed a creamy white viscoid fluid.

Q.5 Enlist the differential diagnosis for this case.    (1)
Q.6 Formulate a provisional diagnosis and briefly discuss about findings to support the diagnosis.   (1+2=3)
Q.7 Discuss the different treatment options for a jaw cyst and its indications.      (3+3=6)
Q.8 Name the agents used to reduce the recurrence. Write down its composition and advantages. (1+2+2-5)

III. 31-year-old Mr. Rupesh visited the department of oral and maxillofacial surgery with a complaint of reduced mouth opening for 3 days. He also reports having a toothache in right lower wisdom tooth which was on and off from the last 6 months which used to regress on medications.

On examination, there was no appreciable facial swelling extra orally. However, he had significant trismus to make intraoral examinations impossible. With little to be seen intra-orally the uvula seemed to be pushed towards the left side.

OPG was taken which revealed an impacted mesioangularly impacted 48. No other abnormalities were detected in the OPG.
Q.9 Mention your provisional diagnosis for this case.    2
Q.10 Enlist the principles for the management of facial space infection.    5
Q.11 Enlist the life-threatening complication if it is untreated.     3

Moth eaten appearance is seen in all except:

# Moth eaten appearance is seen in all except:
A. Osteomyelitis
B. Hemorrhagic cyst
D. Osteosarcoma

The correct answer is C. OKC

'Moth eaten appearance' is seen in lesions of bone which shows lytic activity. 
Seen in:
- Osteomyelitis - Acute suppurative and chronic both
- Osteosarcoma
- Osteoradionecrosis
- Ewing Sarcoma
- Langerhans cell histiocytosis
- Hemorrhagic cyst

Radiolucency between maxillary central incisors

# A radiolucency seen between the maxillary central incisors is most commonly due to:
A. Periapical cyst
B. Nasopalatine cyst
C. Globulomaxillary cyst
D. Nasoalveolar cyst

The correct answer is B. Nasopalatine cyst

Nasopalatine cyst (Incisive canal cyst) - Most common fissural cyst, usually asymptomatic, may complain of tender swelling of palate. Radiographic characteristics- well demarcated round, oval or heart shaped radiolucency between and above maxillary central incisors; rarely just lateral to the midline; lesion crosses midline, teeth are vital. 

Dentin Desensitizing Agent

# The dentin desensitizing agents that acts by precipitating proteins in dentinal tubular fluid is: (MHCET 2014)
A. Strontium chloride
B. Potassium oxalate
C. Fluoride
D. Hydroxyethyl methacrylate

The correct answer is A. Strontium chloride.

After professional diagnosis, dentinal hypersensitivity can be treated simply and inexpensively by home use of desensitizing dentifrices.

Strontium Chloride Dentifrices
Ten percent strontium chloride desensitizing dentifrices are found effective in relieving the pain of tooth hypersensitivity.

Potassium Nitrate Dentifrices
Five percent potassium nitrate dentifrices are found to alleviate pain related to tooth hypersensitivity.

Fluoride Dentifrices
Sodium monofluorophosphates dentifrices are effective mode of treating tooth hypersensitivity.

Strontium chloride is the most important constituent in home care dentifrices intended to be used for the treatment of dentinal hypersensitivity. Topical application of concentrated strontium chloride on an abraded dentin produces a deposit of strontium that penetrates dentin to a depth of approximately 10-20 micrometers and extend into dentinal tubules. 

Ref: Textbook of OPERATIVE DENTISTRY, Nisha Garg, 3rd Edition, Page 445

Direct Pulp Capping

# Which of the following are true about direct pulp capping?
A. Mechanically exposed teeth have a greater success rate than carious exposures
B. Final restorative materials do not affect success
C. Generally, individual teeth involved in a fixed prosthesis are candidates for direct pulp capping
D. All of the above

The correct answer is A.  Mechanically exposed teeth have greater success rate than carious exposures.

What is Fluoride bomb?

# The ‘FLUORIDE BOMBS’ is related to:
A. A fluoride  capsule with high ppm of fluoride varnish
B. A hypoplastic lesion on tooth seen in fluorosis areas
C. Undiagnosed hidden caries
D. Procedure to treat rampant caries

The correct answer is C. Undiagnosed hidden caries.

  • Occult or hidden caries is used to describe such lesion which is not clinically diagnosed but detected only on radiographs.
  • Occult lesions are seen with low caries rate which is suggestive of increased fluoride exposure.
  • It is believed that increased fluoride exposure encourages remineralization and slows down the progress of the caries in the pit and fissure enamel while the cavitation continues in dentin, and the lesions become masked by a relatively intact enamel surface.
  • These hidden lesions are called 'fluoride bombs' or fluoride syndrome.

# Calcium hydroxide is advocated as an inter appointment intracanal medication because of

# Calcium hydroxide is advocated as an inter appointment intracanal medication because of:
A. Its ability to dissolve necrotic tissue
B. Its antimicrobial property
C. Its ability to stimulate hard tissue formation
D. Its powerful bleaching effect

The correct  answer is B. Its antimicrobial property. 

Most studies report culture reversals during the interappointment period when active antibacterial dressing is not used in the root-canal system between appointments. The reversals are due to regrowth of residual bacteria or recontamination by bacterial leakage around the access cavity

Classical and well-controlled studies (Sundqvist’s group) evaluated the effect of various root-canal treatment procedures on the microbiota both qualitatively and quantitatively. They tested the effect of mechanical preparation, saline or sodium hypochlorite irrigation (0.5%, 5.0%, 5.0% with EDTA), the addition of ultrasonic activation to the irrigation and calcium hydroxide dressing; each addition to the chemical canal preparation improved the antibacterial effect, reducing residual bacteria further. They found the antibacterial action to reduce the number of bacteria from an initial range of 10^2–10^8 cells to 10^2–10^3 fewer cells after initial debridement, further reducing down to no recoverable cells (from the prepared part of the root-canal system) after interappointment dressing with calcium hydroxide.

Reference: Endodontics, 4th Edition, Kishor Gulabivala, Yuan-Ling Ng, Page no. 83