How to Correct an Overbite in Children?


When 30-50% of the upper teeth protrude over the lower teeth, an overbite occurs.

Many reasons contribute to overbite problems in children. In this article, let’s first understand the types of overbite problems that exist, what are their causes and how they can be treated.  


Types of Overbites

They are of two types:

Vertical overbite: The top teeth significantly overlap the bottom teeth


   Horizontal overbite: The top teeth protrude over the bottom teeth


Overbites are also categorized as dental or skeletal in nature.


·         In dental overbites, the teeth cause the overbite to form.

·         In skeletal overbites, the jaw is responsible for the overbite to occur.


The overbite teeth problem is the most common type of bite problem and occurs due to a lot of reasons. Let us delve into some:


Causes of Overbite Teeth Problem


·           Improper jaw development


This is the most common cause of overbites. Overbites can occur if there is too much room in the jaw area or if there is too little room to accommodate the teeth size.


·           Thumb sucking and tongue thrusting


Habits like thumb-sucking and tongue thrusting in infants and children push the tongue against the back of the teeth, which can produce an overbite.


·           Genetics


Overbites can even occur because of hereditary or genetics as the genes have a role to play in the natural eruption of teeth.


The earlier you treat your child’s overbite, the better their jaw and teeth will be able to develop. If left untreated, your child’soverbite problem may worsen over time, and he/she may have to undergo extensive treatments later on.


Based on the severity of the problem, here are some issues your child may face due to an overbite:


If an overbite goes untreated, it could alter the face structure dramatically and lead to self-esteem issues in your child.


Other problems include:

  • Speech problems
  • Jaw pain
  • Low self-esteem
  • Discomfort while eating
  • Severe headaches
  • Trouble in opening and closing the mouth
  • Sleep apnea


How Can Overbite be Fixed in Children? 

 Your orthodontist will tell you that overbite correction in children is easy as their jaw is still in the developmental stage. They will take an x-ray and prescribe a treatment plan for your child. 


  • In case your child is very young, the orthodontist may remove their baby teeth to create room for the permanent teeth to grow straight. 


  • If your child is old enough, the orthodontist may recommend dental braces. These braces will help to move the teeth slowly to correct the overbite as well as the jaw.


Timely and early orthodontic evaluation will best determine how to prevent dental issues from occurring in your child. If your child shows signs of an overbite coming in, make sure to spot the signs early and consult your orthodontist.


If your child is seven years old and above, you should start making regular visits to the dentist. If a treatment plan to fix an overbite is given to your child, it is essential that they receive your full support as it will be a challenging time for them.


Make sure that your child practices good oral hygiene habits so that further dental problems don’t take place. 


Author Bio:

Dr. Satish Pai is an orthodontist and an Ivy League trained dentist who has and has served as a faculty at Columbia University. He believes that a perfect smile not only makes a person look great but feel great.  As the founder of Putnam Orthodontics and Rome Orthodontics, he is dedicated to providing the best orthodontic treatments to his patients. He also writes to educate people about everything orthodontics and the importance of correctly aligned teeth along with good oral health. In his free time, you can find him golfing, doing yoga or surfing, and spending time with his family. 

Root surface typically not totally cleaned with standard floss

# When using only standard floss, the mesial root surface of which of the following teeth
is typically NOT totally cleaned?
A. Mandibular central incisor
B. Mandibular 1st premolar
C. Mandibular 1st molar
D. Maxillary 1st premolar
E. Maxillary central incisor

The correct answer is D. Maxillary first premolar.

The mesial root surface of the maxillary 1st
premolar is typically NOT thoroughly cleaned using ONLY dental floss due to the mesial root concavity.

Because of the lack cleansibility of the
mesial of this tooth, It is advised to use
inter dental brushes, end tuft brushes, tooth
pick in holders, rubber tips, and powered
floss to clean these interproximal areas.

This is because of the type of gingival
embrasure space on the mesial aspect off
maxillary 1st premolar. The three types of
gingival embrasures are:
Type I: Having NO inter dental papilla loss
Type II: Partial loss of inter dental papilla
Type lIl: Complete loss of inter dental papilla

The mesial surface of the maxillary 1st premolar typically has a type ll or ll gingival embrasure, resulting in moderate to severe recession with exposure of the root concavity. Interdental brushes clean the root concavity better than dental floss.

Acute Necrotizing Ulcerative Gingivitis

 # Which of the following is not found in acute necrotizing ulcerative gingivitis?
A. Pocket formation
B. Tooth loss
C. Bone loss
D. Gingival recession

The correct answer is A. Pocket formation.

NUG or NUP does not usually lead to periodontal pocket formation, because the necrotic changes involve the junctional epithelium, a viable junctional epithelium is needed for pocket deepening.

Cone Cut in Radiograph

 # Which of the following describes the etiology of cone-cutting?
A. Inadequate exposure time
B. Excessive mA
C. Excessive kVp
D. Incorrect source-object distance
E. Incorrect placement of X-ray machine

The correct answer is E. Incorrect placement of X Ray machine.

Cone-cutting occurs when the X-ray machine is not lined up properly with the X-ray sensor or film.

The film or sensor should be placed perpendicular to the X-ray
collimator to ensure that all of the necessary information is picked

External devices are often used to ensure that the film/sensor are
perpendicular to the X-ray collimator.

SLOB technique

  # A periapical radiograph suggests an opaque mass Over the apex of the maxillary right 2nd molar. A second periapical radiograph is made with the X-ray head adjusted in a more mesial direction. The second periapical suggests that the object in question has moved distally compared to the 1st radiograph. Which of the following directions describes the location of the object?
A.In-between the roots
B. Buccal to the tooth
C. Lingual to the tooth
D. Not enough information is provided

The correct answer is B. Buccal to the tooth.

The SLOB (Same Lingual, Opposite Buccal) rule suggests that the
object is buccal to the tooth.

Because the object moved opposite to the positioning of the X-ray
device for the 2nd radiograph it demonstrates buccal positioning
If the object moved mesially with the head of the X-ray head being
moved mesially, it would have demonstrated lingual/palatal

Difficulty in pronouncing T

 # A person wearing complete denture has difficulty in pronouncing T. The reason may be:
A. Too thick palatal area
B. Incorrect position of upper incisor teeth
C. Too thick mandibular bone
D. Reduced salivary flow

The correct answer is B. Incorrect position of upper incisor teeth. 

- Sounds like t, d, n, etc. are alveolar sounds. These sounds are produced with tip of tongue touching anterior palate.

- If maxillary anterior teeth are placed too far anteriorly, 'd' will sound like 't'.

- If they are placed too palatally, 't' will sound like 'd'. 

Lentulo spiral uses

 # Lentulo spirals are used for:
A. Locating canal orifice
B. Pulp extirpation
C. Enlarging coronal third of the root canal
D. Application of root canal sealer

The correct answer is D. Application of root canal sealer. 

- Finger pluggers are used for vertical compaction of gutta percha. 
- Finger spreaders are used for  lateral compaction of gutta percha.
- Lentulo spiral is used to deliver sealer or triple antibiotic paste to the root canal.

BPKIHS Online OPD Registration


B.P. Koirala Institute of Health Sciences (BPKIHS) has initiated an innovative service of Online registration and ticketing for providing OPD services from 2077-06-26. For this, the patients have to get themselves registered from the Android App BPKIHS  

Patients have to:
- register their personal details
- select the desired department and register the ticket / pay the stipulated amount via Khalti or eSewa or IMEPay
- If registered before 8:00 AM, the patients will be registered for the same day, and those registering after 8:00 AM will be registered for the next day. Patients have to collect their OPD cards from the counter in the respective departments and enter the doctor's chamber. 

At present, this service is available only for routine OPD (daily regular OPD). In the upcoming days, Institutional based private practice (Private OPD) registration will also be incorporated in the app.

Staffs from respective departments working in the OPD should collect the OPD cards of the patients registered through online within 9:00 AM on the same day. 

Age related gingival recession

# Age-related gingival recession can be best treated by:
A. Gingivoplasty
B. Pedicle graft
C. Free gingival graft
D. No treatment

The correct answer is D. No treatment.

Gingival recession increases with age, the incidence varies from 8% in children to 100% after the age of 50 years. This has led to some investigators to assume that recession may be a physiologic process related to ageing. 

Tooth most affected by gingivitis

 # Facial surface of which tooth is most affected by gingivitis?
 A. Upper first molar
 B. Lower first molar
 C. Lower central incisor
 D. Lower premolar

The correct answer is A. Upper first molar.

Facial surface of upper first molar and lingual surface of lower central incisors is most affected by gingivitis. This is due to close proximity to opening of salivary ducts.

Life saver shaped gingival enlargement of Marginal Gingiva

 # Life saver shaped gingival enlargement of marginal gingiva is called:
 A. Stillman's cleft
 B. McCall's festoons
 C. Widow peaks
 D. Craters

The correct answer is B. McCall's festoons.

The term McCall's festoons has been used to describe a rolled, thickened band of gingiva that is usually seen adjacent to the cuspids when recession approaches the mucogingival junction.

Stillman clefts are apostrophe shaped indentations extending to marginal gingiva. They are usually present on facial surface. 

Craters are bony defects or concavities found in interdental areas.

Widow peaks are pseudo piling up of gingiva when failed to remove bony discrepancies at gingival line angles during osteotomy procedures. These are peaks of residual cortical bone left out during horizontal grooving at the facial/palatal/lingual line angles. 

Radiographic finding of Aggressive periodontitis

 # One of the radiographic finding of Aggressive periodontitis is arc shaped bone loss extending from:
A. Distal surface of the second premolar to mesial surface of second molar
B. Distal surface of the first premolar to mesial surface of first molar
C. Mesial surface of the second molar to distal surface of the first premolar
D. Mesial surface of the first premolar to distal surface of the second premolar

The correct answer is A. Distal surface of the second premolar to mesial surface of second molar

- Localized Juvenile Periodontitis is characterized by distribution of lesions in the first molars and incisors with least destruction in the cuspid-premolar area whereas in Generalized Juvenile periodontitis, there is generalized involvement of teeth.

- Vertical bone loss around incisors and molars in otherwise healthy teenagers is diagnostic of Localized juvenile periodontits.

- There is an arc shaped bone loss extending from distal surface of second premolar to mesial surface of second molar creating a mirror image type of bone loss which is characteristic of Juvenile periodontitis. 

Malignant involvement of lymph nodes

# Which  is  the  preferred  method  of  biopsy  in  case  of  a  malignant  involvement  of  lymph  node? 
a. Fine needle  aspiration 
b. Incisional  biopsy
c. Excisional biopsy 
d. No  biopsy

The correct answer is A. Fine needle aspiration.

Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, after being stained, are examined under a microscope (biopsy). The sampling and biopsy considered together are called fine-needle aspiration biopsy (FNAB) or fine-needle aspiration cytology (FNAC) (the latter to emphasize that any aspiration biopsy involves cytopathology, not histopathology). Fine-needle aspiration biopsies are very safe minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead, eliminating the need for hospitalization. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center. Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions.

Aspiration is safer and far less traumatic than an open biopsy; complications beyond bruising and soreness are rare. However, the few problematic cells can be too few (inconclusive) or missed entirely (a false negative).

This type of sampling is performed for one of two reasons:
- A biopsy is performed on a lump or a tissue mass when its nature is in question.
- For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies.

When the lump can be felt, the biopsy is usually performed by a cytopathologist or a surgeon. In this case, the procedure is usually short and simple. Otherwise, it may be performed by an interventional radiologist, a doctor with training in performing such biopsies under x-ray or ultrasound guidance. In this case, the procedure may require more extensive preparation and take more time to perform.

Also, fine-needle aspiration is the main method used for chorionic villus sampling, as well as for many types of body fluid sampling.

It is also used for ultrasound-guided aspiration of breast abscess, of breast cysts, and of seromas.

Pulp stem cells are:

 # The pulp stem cells are:
A. Pluripotent in nature
B. Totipotent in nature
C. Multipotent in nature
D. None of the above

The correct answer is A. Pluripotent in nature.

Pulpal stem cells are pluripotent in nature.
The stem cells were shown to undergo proliferation and migrate to the site of injured odontoblasts and produce dentin.

Generalized Anxiety Disorder Treatment

 # A young man of 24 years is suffering from Generalized Anxiety Disorder; which drug may be preferred for his problem?
a. Zolpidem
b. Buspirone
c. Midazolam
d. Triazolam
e. Phenobarbital

The correct answer is B. Buspirone.

Buspirone is the first azapirone, a new class of antianxiety drugs, distinctly different from

• Does not produce significant sedation or cognitive/functional impairment.
• Does not interact with BZD receptor or modify GABAergic transmission.
• Does not produce tolerance or physical dependence.
• Does not suppress BZD or barbiturate withdrawal syndrome.
• Has no muscle relaxant or anticonvulsant activity.

Buspirone relieves mild-to-moderate generalized anxiety, but is ineffective in severe cases, in those showing panic reaction and in OCD.

Though most patients on buspirone remain alert, those operating machinery/motor vehicles should be cautioned.
Dose: 5–15 mg OD–TDS:

Anemia of chronic disease

# Which of the following is a feature of anemia of chronic disease ?
A.Increased red cell protoporphyrin
B.Hypoproliferative marrow
C.Normal or increased serum ferritin
D.All of the above

The correct answer is D. All of the above. 

Features of anemia of chronic disease are a low serum iron, increased red cell protoporphyrin, hypoproliferative marrow, transferrin saturation of 15 - 20%, & normal or increased serum ferritin.

Ref: Harrison’s 18th edition, Page 849.

Pediatric Dentistry MCQs - Child Behavior Management

# The main areas of concern in diagnosis and treatment planning for the child are:

A. Oral medical problems
B. Dental caries and restorative dentistry
C. Occlusion and craniofacial growth and development
D. All of the above

# Pedodontic triangle is given by:
A. Mischer
B. McDonanld
C. Finn
D. Wright

# Place of the child in the pedodontic treatment triangle is:
A. At the base
B. In the centre
C. At the apex
D. None of the above 

Paradoxical excitement in children

 # Which of the following can result in paradoxical excitement in children?
 A. Morphine
 B. Phenobarbitone
 C. Nitrous oxide
 D. Amphetamine

The correct answer is B. Phenobarbitone.

A paradoxical reaction or paradoxical effect is an effect of medical treatment,usually a drug, opposite to the effect which would normally be expected. Paradoxical excitement is caused by barbiturates which also includes secobarbital. 

Reported to occur in approximately 3% of patients. In susceptible individuals,benzodiazepine treatment might increase anxiety,aggressiveness, agitation, loss of  impulse control, talkativeness, violent behavior, and even convulsions. 

Before sedating a child

 # Before sedating a child:
A. Not essential to take the consent
B. Essential to take the written consent
C. Needed to consult the pediatrician
D. Essential for the parents to be present

The correct answer is D. Essential for the parents to be present.

Before sedating a normal child it is important to take informed consent, and have the parents present during procedure.

A child with previous medical history however requires consulting with the child's physician.

Altered state of consciousness

 # Altered state of consciousness characterized by a heightened suggestibility to produce desirable behavioral and psychological changes is called:
A. Coping
B. Hypnosis
C. Biofeedback
D. Implosion therapy

The correct answer is B. Hypnosis.

It is also called psychomatic or suggestion therapy. 
Hypnosis is a state of  human consciousness involving focused attention and reduced peripheral awareness and an enhanced capacity to respond to suggestion.

Capsid Shapes

 # One of the principal capsid shapes is a 20-sided figure with 12 evenly spaced corners referred to as a(n) _____ capsid. 
A. Spiked
B. Complex
C. Icosahedral
D. Helical
E. Buckeyball

The correct answer is C. Icosahedral.

In geometry, an icosahedron (/ˌaɪkɒsəˈhiːdrən, -kə-, -koʊ-/ or /aɪˌkɒsəˈhiːdrən/) is a polyhedron with 20 faces. The name comes from Ancient Greek εἴκοσι (eíkosi) meaning "twenty" and from Ancient Greek ἕδρα (hédra) meaning "seat". The plural can be either "icosahedra" (/-drə/) or "icosahedrons".


 # Viruses have all the following except :
A. Definite shape
B. Metabolism
C. Genes
D. Ability to infect host cells
E. Ultramicroscopic size

The correct answer is B. Metabolism.

Viruses are non-living entities and as such do not inherently have their own metabolism. However, within the last decade, it has become clear that viruses dramatically modify cellular metabolism upon entry into a cell.

Viruses consist of nucleic acid (genetic material) surrounded by a capsid (protein coat). Most scientists consider viruses to be nonliving because they can't carry out the most basic processes of life. Viruses can't metabolize (break down) food to release energy (carry out respiration) or grow.

Endodontic Surgery should be avoided in

 # Endodontic Surgery should be avoided in:
A. Short rooted teeth
B. Teeth with periodontal disease
C. Lingual surface of mandibular molars
D. All of the above

The correct answer is D. All of the above.

Because of inaccessibility and difficulty to gain access to the surgical site through dense layers of bone, endodontic surgery should be avoided on lingual surfaces of molars or external oblique ridge of mandible. 

Immunoglobulin most commmon in Periodontitis

#Which immunoglobulin is most common in patients with periodontal disease?
A. IgA
B. IgD
C. lgG
D. lgE
E. IgM 

The correct answer is C. IgG. 

The presence of IgG in gingival crevicular
fluid is a product of actively secreting plasma cells stimulated by chronic plaque/calculus accumulation. 

The next abundant type is IgA, There is a negligible amount of lgM.

lg A predominates in saliva to agglutinate
bacteria so they are more easily swallowed
and evacuated from the oral cavity.

Lingual holding arch

# A mandibular lingual holding arch with loops mesial to each molar band is used in children for:
A. Correction
B. Regaining space
C. Space maintenance only
D. Correction of distally tilted molars 

The correct answer is B. Regaining space.

Normal passive mandibular lingual holding arch is used for space maintenance in mandible. This is  a preventive procedure.

Lingual arch with U loops mesial to each molar band is a modification of mandibular lingual arch. The loops are opened periodically and this can bring about distalization of molars by 1 to 2 mm. This is an interceptive procedure.

Primary source of anaerobic bacteria in diseased periodontal tissue

 # Which of the following is the primary source of anaerobic bacteria in diseased periodontal tissue?
A. Supragingival plaque
B. Blood
C. Subgingival plaque
D. Calculus

The correct answer is C. Subgingival plaque. 
Subgingival plaque is most likely to contain the anaerobic bacteria that cause periodontal disease.

Remember that although calculus is a secondary etiologic factor, the primary etiologic factor of periodontal disease is dental plaque.

All Ceramic Restorations

 # Which of the following is the BEST way to avoid porcelain failure in all-ceramic restorations?
A. Rounded angles of the preparation
B. Minimal occlusal forces
C. Porcelain is 3.5mm thick
D. Porcelain is not more than 0.5mm thick 

The correct answer is A. Rounded angles of the preparation.

All ceramic restorations should include rounded angles in the tooth preparation in order to reduce stress concentration along these areas. Sharp angles within tooth preparations are areas where stress is concentrated, and may cause fracturing.

Porcelain thickness is also an important factor in its fracture toughness. All porcelain crowns should have a minimum thickness of 1mm circumferentially and about 1.5mm along the occlusal/ incisal to
achieve strength (Not including the framework of the restoration).

Proper case selection and occlusal load analysis is also an important factor in preventing failure of an all ceramic restoration. 

Abutment teeth in a fixed partial denture

 # What is the primary reason why dentists splint adjacent abutment teeth in a fixed partial denture?
A. Improve spacing mesiodistally
B. Stabilize abutment teeth
C. Improve embrasure contours
D. Improve the distribution of the occlusal load 

The correct answer is D. Improve the distribution of the occlusal load 

Abutment teeth are included in fixed partial dentures to provide retention and help disperse the occlusal load placed on the restoration.

Abutment teeth provides support and stability to the pontic.

Abutment teeth allows better distribution of the occlusal forces acting on all teeth and pontic in the fixed partial denture.

Packing acrylic resin into the denture flasks

# After packing acrylic resin into the denture flasks, one should wait to cure the resin to:
A. Assure full flow of acrylic into the denture mold
B. Allow the monomer to reach all acrylic polymer
C. Allow for pressure to be equalized between the acrylic and flask
D. Make sure temperature equilibrium exists between the flask and acrylic 

The correct answer is D. Make sure temperature equilibrium exists between the flask and acrylic

Allowing the dental flask packed with acrylic to remain under the bench press until equilibrium in temperature is achieved will give enough time for the acrylic to achieve better monomer-polymer interaction and create stronger chemical bond.

The curing of resin should be uniformly completed to lessen any chances of distortion before and during the time the flask is immersed in a water bath.


Packing the acrylic during the rubbery stage

# When fabricating dentures, what would be the most likely outcome if the lab compressed/packed the acrylic during the rubbery stage?
A. Higher porosity than normal
B. A lot of extra resin being attached to the denture that will take a long time to trim
C. Incomplete picking up of anatomical details
D. The denture would have an increased VDO 

The correct answer is C. Incomplete picking up of anatomical details

Packing and compressing acrylic during denture fabrication should be done in its doughy stage.

The doughy stage is the ideal for packing acrylic resin because it is the moment when acrylic is most packable and workable.

The rubbery stage of acrylic denotes the start of the setting when heat is released from the setting acrylic.

Rubbery acrylic also has a tendency to revert back to its original position regardless of the forces applied to it during packing, resulting in incomplete packing.

VDO (Vertical Dimension of Occlusion) is synonymous with OVD (Occlusal Vertical Dimension) and is the relationship of the maxilla and mandible when the teeth are in maximum intercuspation. 

Excess height of the posterior palatal seal

 # Excess height of the posterior palatal seal of a complete maxillary denture will usually result in which of the following?
A. Gagging
B. Increased retention
C. A tingling or tickling sensation
D. Unseating of the denture

The correct answer is D. Unseating of the denture.

Over contouring or excessive beading of the posterior palatal seal causes too much pressure to be exerted on the palatal tissues resulting in the unseating of upper dentures.

The posterior palatal seal is typically placed approximately on the vibrating line between the hard and soft palate and provides a physiologically acceptable tissue pressure within the compressible portion of the soft palate to attain retention and peripheral seal.

Over extending the coverage of seal will cause gaggling and painful swallowing for the part of the patient. 

Flabby maxillary anterior ridge

# Which of the following is associated with a flabby maxillary anterior ridge under a complete denture?
A. Retained mandibular anterior teeth
B. A "V" shaped ridge
C. A "U" shaped ridge
D. A patient with Class Il occlusion
E. Osteoporosis 

The correct answer is A. Retained mandibular anterior teeth.

Combination syndrome is a condition that usually occurs when retained mandibular
anterior teeth opposes a maxillary complete denture.

In combination syndrome, the anterior aspect of upper maxillary ridge becomes highly resorbed and flabby due to the biting force against its natural tooth antagonist.

Since the occlusal force of a natural tooth is stronger than the force of a denture supported by an alveolar ridge, the area under pressure will exhibit higher resorption pattern than the rest of the denture.

Pterygomandibular raphe is a tendon between

# Pterygomandibular raphe is a tendon between which of the following muscles?
A. Masseter and medial pterygoid
B. Anterior belly of the digastric and Buccinator
C. Buccinator and Superior constrictor
D. Buccinator and Masseter

The correct answer is C. Buccinator and Superior constrictor.

Pterygomandibular raphe acts as a tendon between the buccinator and superior Constrictor muscle. It is a landmark used often for the identification of the pterygomandibular space for the administration of an inferior alveolar nerve block.

The injecting needle pierces the buccinator muscle to inject the local anesthetic solution in the pterygomandibular space.


Number of lobes in a tooth

 # The minimum number of lobes from which any tooth may develop is:
A. Two
B. Three
C. Four
D. Five

The correct answer is: C. Four.

Tooth development begins with increased cell activity in growth centers in the tooth germ. A growth center (lobe) is an area of the tooth germ where the cells are particularly active. These lobes are primary centers of calcification and are primary sections of formation in the development of the crown of a tooth. They are represented by a cusp on posterior teeth and mamelons and cingula on anterior teeth. They are always separated by developmental grooves, which are very prominent in the posterior teeth and form specific patterns. With anterior teeth, their presence is much less noticeable and these lobes are separated by what are known as developmental depressions.

Summary of number of lobes:
•All anterior teeth: three labial and one lingual (cingulum)
• Premolars: three buccal and one lingual.
Exception: The mandibular second premolar has three buccal and two lingual lobes.

• First molars (maxillary and mandibular): five lobes, represented by five cusps - one lobe for each cusp
•Second molars (maxillary and mandibular): four lobes, one for each cusp
• Third molars: at least four lobes. one for each cusp ***variations arc seen

Lethal dose of Fluoride

# The lethal dose of fluoride for a typical three-year-old child is approximately :
A. 100 mg
B. 200 mg
C. 350 mg
D. 500 mg

The correct answer is D. 500 mg.

The studies and surveys link fluorosis to three factors:
• Fluorosis is more common in geographic areas where the endemic levels of fluoride in the drinking water is higher than three parts per million
• Fluorosis is associated with fluoride supplementation at inappropriately high levels
• The use of fluoridated toothpaste has been implicated in fluorosis

In acute fluoride toxicity, the goal is to minimize the amount of fluoride absorbed. Therefore, syrup of ipecac is administered to induce vomiting. Calcium-binding products, such as milk or milk of magnesia, decrease the acidity of the stomach, forming insoluble complexes with the fluoride and thereby decrease its absorption. Note: Emergency Medical Service should be activated.

In acute fluoride toxicity, symptoms may appear within 30 minutes of ingestion and persist for up to 24 hours. Patients may experience some nausea, vomiting, diarrhea, and abdominal cramping. This may be due to the fact that 90-95% of ingested fluoride is absorbed through the stomach and small intestines. Fluorides are primarily eliminated from the body by way of the kidneys. However, the fluoride that does remain in the body is found mostly in skeletal tissue. In acute fluoride poisoning (which is rare), the most common causes of death are cardiac failure and respiratory paralysis. Fluoride toxicity shows up in the bones as osteosclerosis.

Important: The lethal dose of fluoride for a typical 3-year-old child is approximately 500 mg and would be proportionately less for a younger child and smaller child. To avoid the possibility of ingestion of large amounts of fluoride it is recommended that no more than 120 mg of supplemental fluoride be prescribed at any one time.

Note: If a six-year old child were receiving fluoridated water in the amount of 3 ppm, the result would most likely be fluorosis but not systemic toxicity. On the other hand, if a child in the same age range (6-7) were receiving 8 ppm of fluoridated water, there would be a good chance of systemic toxicity and moderate to severe fluorosis occurring.

Koplik's Spots are seen in

# "Koplik's spots" are associated with:
A. Smallpox (Variola)
B. German measles (Rubella)
C. Mumps
D. (Rubeola)

The correct answer is. D. Measles (Rubeola)

Before immunization, measles was very common during childhood so that 90% of the population had been infected by age 20.

Measles (also called Rubeola) is a highly contagious viral illness characterized by a fever, cough, and a spreading rash. It is caused by a paramyxovirus. The incubation period is 1 to 2 weeks before symptoms generally appear. The oral lesions are pathognomonic of this disease. These characteristic "Koplik's spots" usually occur on the buccal mucosa. They are 1-2 mm, yellow-white necrotic ulcers that are surrounded by a bright red margin.

Rubella (or German measles) is a fairly benign viral disease. The symptoms usually include
a red, bumpy rash, swollen lymph nodes (most often around the ears and neck), and a mild fever. Some people will feel a little achy. The virus can manifest in the oral cavity as small petechiae-like spots of the soft palate. The defects of congenital infection from an infected mother are more severe -enamel defects, hypoplasia, pitting, and abnormal tooth morphology.

Smallpox (Variola) is an acute viral disease, it manifests itself clinically by the occurrence of a high fever, nausea, vomiting, chills, and headache. The skin lesions begin as small macules and papules which first appear on the face, but rapidly spread to cover much of the body. Oral manifestations include ulceration of the oral mucosa and pharynx. In some cases, the tongue is swollen and painful, making swallowing difficult.

Mumps is an acute contagious viral infection characterized chiefly by unilateral or bilateral swelling of the salivary glands, usually the parotid (parotitis). Although it is usually a disease of childhood, mumps may also affect adults. The papilla of the opening of the parotid duct on the buccal mucosa is often puffy and reddened.

3M Ketac Molar Easymix Glass Ionomer Cement

 This particular brand of Glass Ionomer Cement Ketac Molar Easymix by 3M Germany was available in the dental clinic where I work. The powder felt like wheat flour and even after mixing repeatedly, I couldn't get the required consistency. I had used exactly one scoop of powder by the scoop provided by the manufacturer with one drop of liquid. Have you experienced the same problem? Or is this a great GIC product What about its clinical success? Please leave your honest feedback.

Seizure in the dental clinic

# Which of the following is true concerning a young epileptic who has a grand mal seizure in the dental office?
A. It is generally fatal
B. It is best treated by injecting insulin
C. They generally recover if restrained from self-injury and oxygen is maintained
D. It can be prevented with antibiotics

 The correct answer is C. They generally recover if restrained from self-injury and oxygen is maintained

Of the multiple types of seizures, the tonic-clonic (grand mal) type is the most frightening and the one that most often requires treatment. Grand mal seizures are manifested in four phases: the prodromal phase, the aura, the convulsive (ictal) phase, and the postictal phase.

The prodromal phase consists of subtle changes that may occur over minutes to hours. It is usually not clinically evident to the clinician or the patient. The aura is a neurologic experience that the patient goes through immediately prior to the seizure. It is specifically related to trigger areas of the brain in which seizure activity begins. It may consist of a taste, a smell, a hallucination, motor activity, or other symptoms. As the CNS discharge becomes generalized, the ictal phase begins. The patient loses consciousness, falls to the floor, and tonic, rigid skeletal muscle contraction ensues. This usually lasts 1 to 3 minutes.

As this phase ends, the muscles relax and movement stops. A significant degree of CNS depression is usually present during this postictal phase, and it may result in respiratory depression. Management of the seizure consists of gentle restraint and positioning of the patient in order to prevent self-injury, ensuring adequate ventilation, and supportive care, as indicated, in the postictal phase, especially airway management. Single seizures do not require drug therapy because they are self-limiting.

Important: Should the ictal phase last longer than 5 minutes or if seizures continue to develop with little time between them, a condition called status epilepticus has developed. This may be a life-threatening medical emergency. This condition is best treated with intravenous diazepam, and transport should be arranged to take the patient to the hospital.

Oral manifestation of Achondroplasia

 # An outstanding oral manifestation of achondroplasia is:
A. Rampant caries
B. Periodontal disease
C. Overcrowding of teeth
D. Supernumerary teeth

The correct answer is C. Overcrowding of teeth.

Achondroplasia is the most common form of short-limb dwarfism. It occurs in all races and with equal frequency in males and females. An individual with achondroplasia has a disproportionate short stature -- the head is large and the arms and legs are short when compared to the trunk length. Other signs are a prominent forehead and a depressed bridge of the nose. Many of these children die during the first year of life. Deficient growth in the cranial base is evident in many children that survive.

Important: The maxilla may be small with the resultant crowding of the teeth.

Note: A Class III malocclusion is very common.

Remember: The oral manifestations of the following disorders in children:

• Gigantism: enlarged tongue, mandibular prognathism, teeth are usually tipped to the buccal or lingual side, owing to enlargement of the tongue. Roots may be longer than normal.

• Pituitary dwarfism: the eruption rate and the shedding of the teeth are delayed, clinical crowns appear smaller as do the roots of the teeth, the dental arch as a whole is smaller causing malocclusion, and the mandible is underdeveloped.

Iron content in each ml of blood

 # Each milliliter of red cells contain how much elemental iron ?
A. 1 mg
B. 2 mg
C. 3 mg
D. 4 mg

The correct answer is A. 1 mg.

Each milliliter of red cells contains 1 mg of elemental iron.
Ref: Harrison’s 18th Ed. 845

Flexural strength

# The term "flexural strength" describes a material with the ability do which of the following?
A. Be visually detectable in radiographs
B. Sustain deformation without permanent change in
size or shape
C. Resist fracture during bending
D. Resist the propagation of a crack

The correct answer is C. Resist fracture during bending. 

Flexural strength is the ability of a material
to resist fracture while bending and is also
known as modulus of rupture, bend
strength, or fracture strength.

The transverse bending test is most
frequently employed to evaluate the flexural strength of a material using a 3-point flexural test technique.

The flexural strength gives the highest
stress experienced within the material at its
moment of rupture.

The significance of flexural strength is
commonly expressed in class V cervical

Low tensile and high compressive strength

# A material with a low tensile strength and high compressive strength can be described as which of the following?
A. Ductile
B. Malleable
C. Resilient
D. Brittle
E. Tough

The correct answer is D. Brittle. 

Brittle materials can be hard solid materials
that can withstand heavy compression but
not tension.

Brittle materials exhibit low tensile strength and may fracture or break instead of being deformed when under tensile stress.

Ductile materials exhibit high tensile
strength and low compressive strength,
making them capable of being drawn into

Excessive segmentation of nucleus of neutrophils

# Excessive segmentation of nucleus of neutrophils is a manifestation of ?
A. Folate or vitamin B12 deficiency
B. Iron deficiency
C. Thalassemia
D. Repeated blood transfusion

The correct answer is: A. Folate or vitamin B12 deficiency.

Nucleus of neutrophils normally contains up to four segments. Excessive segmentation (>5
nuclear lobes) is seen in folate or vitamin B12 deficiency & congenital neutropenia syndrome of
warts, hypogammaglobulinemia, infections & myelokathexis (WHIM).

Ref: Harrison’s 18th Ed. 473

Contraindication for splenectomy

# Which out of the following is a contraindication for splenectomy ?
A. Iatrogenic splenic rupture
B. Thrombocytopenia
C. Presence of bone marrow failure
D. Hairy cell leukemia

The correct answer is C. Presence of bone marrow failure.

The only contraindication to splenectomy is the presence of marrow failure, in which the
enlarged spleen is the only source of hematopoietic tissue.

Ref: Harrison’s 18th Ed. 471

Weight of Normal Spleen

# Weight of a normal spleen is ?
A. < 150 grams
B. < 250 grams
C. < 350 grams
D. < 450 grams

The correct answer is B. < 250 grams.

Normal spleen weighs <250 grams.
Ref: Harrison’s 18th Ed. 468

Enlarged, grayish yellow or orange tonsils are pathognomic of

# Enlarged, grayish yellow or orange tonsils are pathognomic of ?
A. Waldenström’s macroglobulinemia
B. Polycythemia vera
C. Wolman disease
D. Tangier disease

The correct answer is D. Tangier Disease.

Tangier disease is associated with cholesterol accumulation in reticuloendothelial system with
hepatosplenomegaly & enlarged, grayish yellow or orange tonsils.

Ref: Harrison’s 18th Ed. 3154

Preauricular lymphadenopathy

# Preauricular lymphadenopathy accompanies which of the following?
A. Scalp infection
B. Ear infection
C. Conjunctival infections
D. Tooth infection

The correct answer is: C. Conjunctival infections.

Preauricular adenopathy accompanies conjunctival infections and cat-scratch disease.

Ref: Harrison’s 18th Ed. 466

Occipital lymphadenopathy

# Occipital lymphadenopathy accompanies which of the following ?
A. Scalp infection
B. Ear infection
C. Conjunctival infections
D. Tooth infection

The correct answer is : A. Scalp infection.

Occipital adenopathy often reflects infection of the scalp.
Ref: Harrison’s 18th Ed. 466

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