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PGCEE MDS 2022: Hesitation cuts are seen in a case of:

 # Hesitation cuts are seen in a case of:
A. Homicide 
B. Suicide
C. Accident 
D. Fall from height


The correct answer is B. Suicide.

Hesitation cuts/marks or tentative cuts or trial wounds: These cuts are multiple, small, and superficial often involving only the skin, and are seen at the beginning of the incised wound, presumably hesitating while gaining the courage to make a final decisive cut.

- A person who commits suicide exposes his body by opening his clothes and then inflicts the wounds.

- When a safety razor blade is used, unintentional cuts are found on the fingers where the blade has been gripped.

- Most people have a vague knowledge of anatomy and do not know where to cut a major blood vessel, and may cut their forearms vertically, rather than horizontally.

PGCEE MDS 2022: Radiographic investigation for multiple implant screening is:

 # Radiographic investigation for multiple implant screening is: 
A. Intraoral periapical radiograph
B. Panoramic radiograph
C. CBCT
D. Magnetic resonance imaging


The correct answer is B. Panoramic radiograph.

The primary advantage of the panoramic radiograph is that it is a screening tool to evaluate for pathology within the hard tissues. It may also be beneficial to ensure that root tips and other structures are not in the surgical site. As a general rule, sinus pathology is difficult to observe on this film, and other tools are usually necessary (e.g., CT scans).

When the 25% average magnification is accounted for on the film, it may categorize the patient into three different groups:
(1) there is obviously enough vertical bone to place and implant,
(2) there is obviously not enough vertical bone to place an implant, or 
(3) the amount of vertical bone necessary to place an implant is not obvious.

Advantages of panoramic radiograph
• Easy identification of opposing landmarks
• Initial assessment of vertical height of bone
• Convenience, ease, and speed in performance in most dental offices
• Evaluation of gross anatomy of the jaws and any related pathologic findings*


Limitations
• Distortions inherent in the panoramic system
• Errors in patient positioning
• Does not demonstrate bone quality
• Misleading measurements because of magnification and no third dimension
• No spatial relationship between structures

PGCEE MDS 2022: Most common mode of transmission in nosocomial infections is by:

 # Most common mode of transmission in nosocomial infections is by:
A. Contact transmission
B. Droplet transmission
C. Airborne transmission
D. Vector borne transmission




The correct answer is A. Contact transmission.

A hospital-acquired infection, also known as a nosocomial infection (from the Greek nosokomeion, meaning "hospital"), is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare–associated infection. Such an infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. 

Main Roots of Transmission

I) Contact Transmission: The most important and frequent mode of transmission of nosocomial infections is by direct contact.

II) Droplet transmission: Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the patient's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy.

III) Airborne transmission: Dissemination can be either airborne droplet nuclei (small-particle residue {5 ┬Ám or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air-handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.

IV) Common vehicle transmission: This applies to microorganisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment.

V) Vector borne transmission: This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

PGCEE MDS 2022: Provision for good housing conditions comes under:

 # Provision for good housing conditions comes under:
A. Rehabilitation
B. Specific protection
C. Disability limitation
D. Health promotion


The correct answer is D. Health Promotion.

The relation between the residential environment and health is multidimensional and complex. It is possible not only to determine whether housing promotes or hinders health and quality of life, but also how the health of an individual can influence her/his housing conditions. Housing conditions, and homelessness in particular, are key components in the chain of explanatory factors linking poverty and inequality to health status. Housing is an important determinant of quality of life. It can influence health promotion. The multiple components of housing units and their surroundings need to be considered in terms of their potential and effective contribution to the physical, social and mental well-being.

PGCEE MDS 2022: Punched out lesions on the alveolar ridge is due to:

 # Punched out lesions on the alveolar ridge is due to:
a) acrylic nodules on tissue facing surface of denture
b) disturbed occlusion
c) overextended borders of denture
d) narrow occlusal table



The correct answer is A. Acrylic nodules on tissue facing surface of denture.

Acrylic nodules and spicules: These are produced by acrylic resin being processed into indentations or porosity in the cast. These areas of roughness can be detected by observation of the dried denture surface and by passing a gauze napkin or cotton wool roll over the surface so that the threads catch on the offending areas. They should be carefully removed with a stone without modifying the fit of the denture. Acrylic nodules on tissue facing surface of denture cause punched out lesions on the alveolar ridge or mucosa.

Mixed dentition growth spurt for boys occurs at the age of: PGCEE MDS 2022

 # Mixed dentition growth spurt for boys occurs at the age of:
A. 8-11 years
B. 7-9 years
C. 14-16 years
D. 11-13 years


The correct answer is A. 8-11 years.

Growth spurts do not take place uniformly at all times. The periods of sudden acceleration of growth spurts are known as growth spurts.

The following are the timings of growth spurts:
• Just before birth.
• One year after birth.
• Mixed dentition growth spurt
- Boys : 8-11 years
- Girls : 7-9 years
• Adolescent growth spurt
- Boys : 14-16 years
- Girls : 11-13 years

Perineural invasion in head and neck cancer is most commonly seen in: PGCEE MDS 2022

 # Perineural invasion in head and neck cancer is most commonly seen in:
a) Adenocarcinoma 
b) Cylindroma
c) Basal cell adenoma 
d) Squamous cell carcinoma


The correct answer is B. Cylindroma.

Adenoid cystic carcinoma (Cylindroma): 
The basal cells are arranged in anastomosing cords or a duct-like pattern, the central portion of may
contain a mucoid material , producing the typical cibriform or Swiss cheese or honey comb pattern. Peri neural spread of tumor cells is seen.

Case Report: Surgical Management of Oral Leukoplakia: A Case of Laser Excision

 Surgical Management of Oral Leukoplakia: A Case of Laser Excision
Dr. Soni Bista,1
 Dr. Rebicca Ranjit,2
 Dr. Suraksha Subedi3
1,3Department of Periodontology and Oral Implantology, Gandaki Medical College, Kaski, Nepal
Correspondence : Dr. Soni Bista. Email: sonibista1234@gmail.com

ABSTRACT
Oral leukoplakia is the most frequent potentially malignant disorder of the oral mucosa which requires
definite treatment. A wide variety of medical and surgical treatment modalities have been endeavoured
with varying degrees of success. Among various surgical treatments, laser techniques have helped
improve surgical approaches and ultimate control of leukoplakia. The present case reports homogenous
leukoplakia in an adult male treated successfully with diode laser and followed up for six months without any complications and recurrence. Thus, the application of diode laser is safe and can be effectively used as a good substitute for the management of oral leukoplakia.

Keywords: Diode lasers; laser therapy; oral mucosa; oral leukoplakia.

INTRODUCTION
The term leukoplakia is recognized as white patches of questionable risk having excluded known diseases or disorders that carry no increased risk for cancer.1 The cause is multifactorial including tobacco or areca nut use, alcohol abuse, human papilloma virus, fungal infections, chronic
trauma, and nutritional deficiency.2
 
Different modalities for its management includes medical therapy (antioxidants, Vitamin A), surgical therapy using scalpel, electrocautery, and laser.3 Surgical excision done by soft tissue diode laser have shown beneficial role in the treatment of the lesion.4 This paper reports a case of oral leukoplakia treated successfully with the application of diode laser.

CASE REPORT
An adult male aged 60 years reported to the Department of Periodontology and Oral Implantology of Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal with a chief complaint of white patches on his right lower back gum region for two years. The patient’s medical history and family history were non-contributory. He had the habit of smoking tobacco, one pack of bidi (25 bidis) per day for 10 years. On extraoral examination, there were no significant findings.
On intraoral examination, white plaques were appreciated on right lower buccal gingiva of the posterior teeth extending from the first premolar to the second molar involving their marginal, attached and papillary gingiva (Figure 1). The lesion was non-scrappable, had firm consistency, diffused margins, wrinkled surface, crack-mud appearance measuring approximately 7x4 cm2 with normal surrounding mucosa. Class II Gingival recession was observed in relation to #46 (according to two-digit numbering system). Furthermore, stain and calculus were present in all teeth. The provisional diagnosis was made as homologous leukoplakia on right buccal gingiva in relation to #45, #46, and #47 because at clinical examination a predominantly white lesion was appreciated which cannot be clearly diagnosed as any other disease or disorder of the oral mucosa. 
Following an initial examination and treatment planning discussion, the patient underwent nonsurgical periodontal therapy including scaling and root planing with oral hygiene instructions. He was given strict advice for complete cessation of the habit of smoking tobacco and prescribed with Tablet BNM forte (Lycopene, Meobalamin, Omega three with multivitamin) twice daily for a month. Meanwhile, a punch biopsy with a diameter of 0.5 cm (involved and normal tissue) of the lesion from marginal and attached gingiva in relation to #45 was sent for histopathological examination as it is mandatory to rule out any malignancy (Figure 2). The histopathological analysis revealed a hyperkeratinised stratified squamous epithelium with mild dysplasia (Figure 3). On the basis of clinical presentation and histopathological reports, a definite diagnosis of Homogenous Leukoplakia with mild dysplasia on buccal gingiva in relation to #45, #46, and #47 was made. The patient did not respond to conservative medical management with multivitamins, multiminerals, and antioxidants (Tablet BNM forte) even after a month of followups, so he was advised for complete excision of the lesion using a diode laser. A complete haemogram was done which depicted values within normal limits. Written informed consent was taken from patient. 



On the day of surgery, a complete protocol for surgical preparation was followed. The patient was asked to do a presurgical mouthrinse using 2 ml of 0.2% chlorhexidine diluted solution, and 5% povidone-iodine solution (Betadine) was used to perform extraoral antisepsis. Right inferior alveolar nerve block using 2% lignocaine with adrenaline 1:200,000 was administered. Safety measures were taken for the operator, patient, and assistants by wearing the recommended laser protective eyewear. High-speed suction and surgical masks were used to prevent infection from the laser plume. Diode laser (iLase™) emitting 940 nm was used for excision where a preset value was adjusted: power of 3.00 W, pulsed contact mode, continuous pulse duration, and pulse interval of 1.00 ms. Blunt end of the probe was used to check for objective symptoms. After the area was anaesthetised, the excision of the lesion in the right lower posterior gingiva and buccal mucosa was carried out using a bendable laser tip with a diameter of 300 mm (Figure 4). After excision, the surgical site was wiped off with a cotton pellets soaked in normal saline. The operated site was then protected with periodontal dressing (COE–PAKTM GC America) (Figure 5, 6). The entire procedure was painless with no bleeding and lesser intraoperative time.

Post-surgical instructions were given with the prescription of analgesics (Ibuprofen 200 mg, if needed) and warm saline rinse (three to four times/day for two weeks). To minimise traumatic injury to the wound, mechanical tooth cleaning was restricted to the surgical site for the first week. The patient was recalled immediately after a week for removal of periodontal dressing then after two weeks and six months for revaluation (Figure 7, 8). No complication without recurrence was observed at follow-ups.

DISCUSSION 
The management protocol for leukoplakia should be based on grade of dysplasia, size, and location of the lesion; however, local factors such as trauma and adverse habits such as using tobacco should be controlled. Both non-surgical and surgical treatment modalities can be applied with varying success. In non-surgical methods, anti-inflammatory agents, carotenoids, retinoids, antimycotic agents, and cytotoxic agents can be used topically. Chemopreventive agents such as vitamins (A, C, E), fenretinide (Vitamin A analogue), carotenoids (beta carotene, lycopene), green tea, curcumin are also beneficial. They play a vital role during the early healing of the lesion but they will appear once the patient stops taking the supplements. Researchers have found it to be less convincing and possessing a longer duration of treatment. In the present case, combination of multivitamins, multiminerals, and antioxidants drug was prescribed to the patient for a month, but it did not show any effect. Thus, surgical excision was opted as an appropriate treatment for the case. Surgical treatment can be carried out using scalpel, cryotherapy, electrocautery, and laser, but will not prevent all premalignant lesions from undergoing malignant transformation, which can be explained by the genetic defects even in the normal appearing mucosa surrounding the excised lesion (field cancerisation).4 Surgical excision of lesions using laser offers several advantages over scalpel excision which includes bloodless surgical and postsurgical events; the ability to precisely coagulate, vaporise, or cut tissue; minimal swelling and scarring; reduction of surgical time, postsurgical pain with high patient acceptance.5 Previous study has evidenced promising results using lasers in the excision of oral leukoplakia.6 The diode laser is not indicated as the main laser for soft tissue surgery, but its versatility of use led us to choose it for the study. In the present case, the patient reported minimal intraoperative and post-operative pain and discomfort. These results are similar to the findings of Mohan et al., who reported minimal post-operative pain and discomfort.7 The wound healing was also satisfactory similar to the previous study.7 Histologically, laser-created wounds heal more quickly and produce less scar tissue than conventional scalpel surgery,8 although contrary evidence also exists.9 In the present case, the patient did not show any signs of recurrence in six months’ follow-up. This was similar to the findings of a study conducted in Natekar et al.,10 the patients in their study showed no sign of recurrence on six months’ follow-up. Although laser has many advantages, it requires some precautions during and after irradiation such as using protective eyewear, high-speed evacuation, and a properly trained operator as an important part of laser safety. Thus, the main purpose of treating oral leukoplakia is to prevent transformation into a malignant form as the patients are mostly asymptomatic. Diode laser provides an effective technique with marked clinical improvement and high degree of patient acceptance in the management of oral leukoplakia. 

Conflict of interest: None.

REFERENCES
1. Warnakulasuriya S, Johnson NW, Van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. 2007;36(10):575-80. [PubMed | Full Text | DOI]
2. Goyal D, Goyal P, Singh HP, Verma C. An update on precancerous lesions of oral cavity. Int J Med Dent Sci. 2013;2(1):70-5. [Full Text | DOI
3. Lodi G, Franchini R, Warnakulasuriya S, Varoni EM, Sardella A, Kerr AR, et al. Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database Syst Rev. 2016;7:CD001829.[PubMed | Full Text | DOI]
4. Tatu R, Shah K, Palan S, Brahmakshatriy H, Patel R. Laser excision of labial leukoplakia with diode laser: A case report. Indian Journal of Research and Reports in Medical Sciences. 2013;3(4):64-6. [Full Text]
5. Bista S, Adhikari K, Saimbi CS, Agrahari B. Comparison of patient perceptions with diode laser and scalpel technique for frenectomy. J Nepal Soc Periodontol. 2018;2(1):6-8. [Full Text]
6. Gupta P, Thakur J, David CM. Excision of oral leukoplakia using 970 nm diode laser. Int J Adv Integ Med Sci. 2017;13(8):208-11. [Full Text]
7. Mohan R, Sunil MK, Raina A, Krishna K, Basu M, Khan T. Diode laser therapy of homogenous leukoplakia- A clinical study. TMU J Dent. 2017;4(3):90-2. [Full Text]
8. Bista S, Adhikari K, Saimbi CS, Agrahari B. Diode laser for lingual frenectomy. J Dent Lasers. 2018;12:74-6. [Full Text | DOI]
9. Buell BR, Schuller DE. Comparison of tensile strength in CO2 laser and scalpel skin incisions. Arch Otolaryngol. 1983;109:4657. [PubMed | DOI]
10. Natekar M, Raghuveer HP, Rayapati DK, Shobha ES, Prashanth NT, Rangan V, et al. A comparative evaluation: Oral leukoplakia surgical management using diode laser, CO2 laser, and cryosurgery. J Clin Exp Dent. 2017;9(6):e779-84. [PubMed | Full Text | DOI]


Published in: JNDA | Vol. 22 No. 1 Issue 34 Jan-Jun 2022

Simple Dental Clinic Design - Must have areas

 When designing a dental clinic, it's important to consider factors such as accessibility, efficiency, and patient comfort. Here are a few key elements to consider:

Reception and waiting area: This should be located near the entrance of the clinic and be designed to be welcoming and comfortable for patients. The number of seats should be made based on the estimated number of patients that typically visit your clinic every day.



Treatment rooms: These should be designed to optimize workflow and efficiency, with ample space for dental equipment and easy access to supplies. 

Sterilization and lab area: These areas should be designed to ensure that instruments and equipment are properly sterilized and stored. Should be separate and not easily accessible, spacious enough to accommodate an autoclave machine.

Patient amenities: Consider adding amenities such as televisions, Wi-Fi, and reading materials to help patients feel more comfortable during their visit. Proper toilets and hand-washing basins with mirrors are desirable.

Accessibility: The clinic should be accessible to the elderly and to people with disabilities and comply with relevant regulations.

It is also important to work with a professional architect and dental equipment supplier to ensure that your clinic meets all necessary regulations and has the right layout and equipment for your needs.


How to handle bargaining dental patients?

 Dealing with patients who haggle or bargain over the cost of their treatment can be challenging. Here are a few strategies you can use to handle this situation:

Be transparent: Clearly communicate the cost of treatment to the patient before any work is done. Provide them with a detailed treatment plan that includes the cost of each procedure. This can help prevent any surprises or misunderstandings after the treatment is complete.

Explain your policy: Make sure your patients are aware of your payment policy, including any fees for late payment or missed appointments.




Be empathetic: Listen to the patient's concerns and try to understand their situation. They may be facing financial difficulties or have other reasons for wanting to negotiate the price.

Offer options: If the patient is unable to pay the full cost of treatment, consider offering financing options or a payment plan.

Stand your ground: Be firm but respectful when discussing payment with the patient. If necessary, remind the patient of the value of the treatment they received and the cost of running your business.

Follow up: Make sure to follow up with the patient after the treatment to ensure that they are satisfied with the service and to remind them of the outstanding balance.

Be Professional: Be Professional at all times and avoid getting into personal arguments or confrontations with the patient.

It's important to remember that while you need to be mindful of your own financial needs, you should also strive to provide quality care and maintain positive relationships with your patients. 

How referral program could skyrocket your dental practice?

A referral program is a way to encourage current patients to refer friends and family to your clinic. Here are a few examples of how you could implement a referral program:

Offer a discount: Provide a discount on future services for patients who refer a new patient to your clinic. For example, offer $50 off their next cleaning for every new patient they refer.

Giveaway: Give a prize to patients who refer the most new patients within a certain period of time. For example, offer a gift card to a local restaurant to the patient who refers the most new patients in a month.

Loyalty rewards: Create a loyalty program that rewards patients for each referral they make. For example, offer a free cleaning for every five referrals a patient makes.

Send a thank you note: Show appreciation for patient referrals by sending a personal thank you note or a small gift.

Make it easy: Make it easy for patients to refer friends and family by providing referral cards or an online referral form.



Remember that the goal of a referral program is to make it as simple and rewarding as possible for your current patients to refer their friends and family to your clinic. These could help you to skyrocket your dental practice with a large proportion of your new patients coming through referrals. 

How to increase patients' flow in a dental clinic?

 


There are several strategies you can use to try to increase the number of patients visiting your dental clinic:

Marketing: Increase your visibility through online and offline marketing campaigns. Utilize social media, email campaigns, and local advertising to reach potential patients.

Referral program: Encourage current patients to refer friends and family to your clinic by offering incentives for successful referrals.

Special promotions: Offer special promotions, such as discounts or free consultations, to attract new patients.

Networking: Attend local networking events and conferences to connect with other dental professionals and potential patients.

Online reviews: Encourage satisfied patients to leave positive reviews on sites like Google and Yelp.

Collaboration: Partner with other medical or dental professionals in your area to cross-promote each other's services.

Improving services: Make sure that your services are up to date, with well-trained staff, clean and comfortable facilities, and cutting-edge technology.

Expand services: Offer additional services, such as cosmetic dentistry, orthodontics, or implant surgery to attract more patients.

Remember, it's important to track your progress, so you can measure the effectiveness of your efforts and make adjustments as needed.

It's also important to note that you should be compliant with the laws and regulations of your area and consult with experts to help you with the legal and financial aspects of expanding your business.

PGCEE MDS 2022: Inflammation and bleeding on probing around an implant are usually less than with natural teeth because:

 # Inflammation and bleeding on probing around an implant are usually less than with natural teeth because:
A. less plaque accumulation
B. less blood vessels
C. dense connective tissue with type III collagen
D. sulcus lining by keratinized mucosa


The correct answer is B. Less blood vessels.

Compared with an implant, the support system of a natural tooth is better designed to reduce the biomechanical forces distributed to the tooth/restoration and the crestal bone region. The periodontal membrane, biomechanical design of the tooth root and material, nerve and blood vessel complex, occlusal material (enamel) and surrounding type of bone blend to decrease the risk of occlusal overload to the natural tooth system.

Regardless of whether gingival health is relative to success, all dentists agree that the ideal soft tissue condition around an implant is an absence of inflammation. Radiographic bone loss and increased pocket depth have been correlated with sulcular bleeding. Therefore, the gingival status around an implant should be recorded and used to monitor the patient’s daily oral hygiene. However, surrounding soft tissues around implants have fewer blood vessels than teeth; therefore, inflammation is typically less around implants than around teeth.

Ref: DENTAL IMPLANT PROSTHETICS, SECOND EDITION, Carl E. Misch

PGCEE MDS 2022: Caries risk status for a DMFT score of 4 is:

 # Caries risk status for a DMFT score of 4 is:
A. Very low
B. Low
C. Moderate
D. High


The correct answer is C. Moderate.

The World Health Organization Global Data Bank (1995) shows that out of 178 countries for which data is available 25 percent were categorized as having very low levels of dental caries (DMFT 0.0 to 1.1), 42 percent as low (DMFT 1.2 to 2.6), 30 percent as moderate (DMFT 2.7 to 4.4) and 13 percent
as high (DMFT 4.5 to 6.5) and 2.1 percent countries as very high, i.e. 6.6.

Ref: A Textbook of  Public Health Dentistry, CM Marya

PGCEE MDS 2022: Parent child relationship has been described as:

 # Parent child relationship has been described as:
A. One tailed
B. Two tailed
C. Three tailed
D. Multi tailed


The correct answer is A. One tailed.

The home is the first school where a child learns to behave. All the home individuals influence the child’s behavio£ but none so much as the mother, e.g. in case of a broken home, the child may feel insecure, inferior, apathic and depressed. Mother child relation- ship has been described as one-tailed.

Ref: Shobha Tandon



Mallampati Classification : PGCEE MDS 2022

 # If base of uvula and soft palate are visualized on maximal mouth opening it is referred to as Mallampati  classification:
A. Class I
B. Class II
C. Class III
D. Class IV



The correct answer is C. Class III.

Visualization of the amount of posterior pharynx is important and correlates with the difficulty of intubation. Visualization of the pharynx can be obscured by the tongue, which also interferes with visualization of the larynx on laryngoscopy. 

The Mallampati classification is based on the structures visualized with maximal mouth opening and tongue protrusion in a sitting position.
Class I: Soft palate, fauces, uvula, and pillars are visualized
Class II: Soft palate, fauces, and a portion of uvula are visualized
Class III: Soft palate, the base of the uvula is visualized.
Class IV: Only the hard palate is visualized

PGCEE MDS 2022: Behavior modification is based on the principle of:

 # Behavior modification is based on the principle of:
A. Cognitive theory
B. Classical conditioning theory
C. Social learning theory
D. Operant conditioning theory


The correct answer is C. Social learning theory.

Behavior shaping is a form of behavior modification technique based on principles of social learning. It is the procedure that slowly develops desired behavior. The behavior-shaping techniques are:
• Desensitization (TSD)
• Modelling
• Contingency management

PGCEE MDS 2022: 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


The correct answer is B. Zinc oxide.

Composition of gutta percha cones:
(Constituent - Percentage of constituent - Function)
Gutta percha - 20% - Matrix
Zinc oxide - 66% - Filler
Heavy metal sulfates (Bismuth sulphates) - 11% - Radio opacifier
Waxes or resins - 3% - Plasticizer

PGCEE MDS 2022: CSF rhinorrhea is due to:

 # CSF rhinorrhea is due to:
A. Nasal fracture
B. Guerin’s fracture
C. Dural tear
D. Condylar fracture


The correct answer is C. Dural tear.

CSF rhinorrhoea is the result of a dural tear associated with a fracture of the cribriform plate of the ethmoid in Lefort II and III fractures. Cerebrospinal Otorrhoea is due to a fracture of the petrous part of the temporal bone.

CSF mixed with blood produces a double ring (Tramline effect) if dropped on a hospital sheet or pillow.

PGCEE MDS 2022: Extraoral Causes of Halitosis

 # A person has problem of bad odor of mouth. His gingiva is healthy. Other possible cause for this could be:
a) Indigestion 
b) Chronic sinusitis
c) Alcohol intake 
d) Diabetes mellitus


The correct answer is B. Chronic sinusitis.

ENT causes of halitosis include acute pharyngitis, chronic sinusitis and post nasal drip.


PGCEE MDS 2022: The ‘hanging drop appearance’ in the maxillary sinus radiograph indicates:

 # The ‘hanging drop appearance’ in the maxillary sinus radiograph indicates:
a) A nasal polyp 
b) A blow out fracture of the orbit
c) A radiograph artifact 
d) An antrolith


The correct answer is B. A blow-out fracture of the orbit.

Orbital blow out fracture occurs when a rounded object struck the protruding eyeball resulting in a fracture of the orbital floor. "Blow in" fracture is due to inward buckling of the orbital floor. It usually occurs in children and results from trauma to the inferior orbital rim.

Hanging drop sign is best seen in the Water's projection of the face.

Characteristics of blow out fracture:
• Rupture of infraorbital plate and herniation of orbital contents into the maxillary antrum
• Fracture of the orbital floor into the maxillary antrum without the involvement of the orbital rim
• Restriction of lateral and upward movement of the eyeball
• Enophthalmos and profound diplopia
• Hanging drop appearance in the radiograph

PGCEE MDS 2022: Microabrasion is a procedure in clinical orthodontics performed to:

 # Microabrasion is a procedure in clinical orthodontics performed to:
a) Clean the bracket base
b) Clean the arch wire
c) Polishing the bracket
d) Removal of white spot lesions.


The correct answer is D. Removal of white spot lesions.

Microabrasion is a method used to remove surface stains or defects. Enamel microabrasion is a minimally invasive technique for improving the appearance of teeth with superficial enamel irregularities and discoloration defects.  Tooth enamel defects amenable to microabrasion are brown or white stains or spots associated with conditions such as enamel fluorosis, hypomineralisation, decalcified areas around orthodontic brackets, or other intrinsic factors that do not respond to bleaching alone. In fact, microabrasion may be used either prior to and/or after dental bleaching to achieve uniform tooth color for these types of difficult-to-treat teeth.

PGCEE MDS 2022: Best route of heparin administration when IV line cannot be established is:

 # Best route of heparin administration when IV line cannot be established is:
A. Oral
B. Subcutaneous
C. Intramuscular
D. Sublingual


The correct answer is B. Subcutaneous.

Dosage: Heparin is conventionally given i.v. in a bolus dose of 5,000–10,000 U (children 50–100 U/kg), followed by continuous infusion of 750–1000 U/hr. Intermittent i.v. bolus doses of UFH are no longer recommended. The rate of infusion is controlled by aPTT measurement which is kept at 50–80 sec. or 1.5–2.5 times the patient’s pretreatment value. If this test is not available, whole blood clotting time should be measured and kept at ~2 times the normal value.

Deep s.c. injection of 10,000–20,000 U every 8–12 hrs can be given if i.v. infusion is not possible. The needle used should be fine and trauma should be minimum to avoid hematoma formation. Hematomas are more common with i.m. injection—this route should not be used.

Low dose (s.c.) regimen 5000 U is injected s.c. every 8–12 hours, started before surgery and continued for 7–10 days or till the patient starts moving about. This regimen has been found to prevent postoperative deep vein thrombosis without increasing surgical bleeding. It also does not prolong aPTT or clotting time. However, it should not be used in the case of neurosurgery or when spinal anesthesia is to be given. The patients should not be receiving aspirin or oral anticoagulants. It is ineffective in high-risk situations, e.g. hip joint or pelvic surgery.

PGCEE MDS 2022: When using a supplemental fluoride, which is the most important factor to be taken into consideration:

 # When using supplemental fluoride, which is the most important factor to be taken into consideration:
a) Mean climatic temperature
b) Number of topical fluoride treatments to be given
c) Amount of supplemental fluoride given by the physician
and the dentist
d) Age of the child and level of fluoride in drinking water



The correct answer is D. Age of the child and level of fluoride in drinking water.





How to remove tonsil stones or tonsilloliths?

 Tonsil stones, also known as tonsilloliths, are small, white or yellowish formations that can form on or in the tonsils. They are caused by debris, including bacteria and food particles, getting trapped in the tonsils' crevices and hardening over time.

There are several ways to remove tonsil stones, and the best method for you will depend on the size and location of the stones, as well as your overall health and any other symptoms you may be experiencing.

Here are a few methods to remove tonsil stones:

  • Gently cough: This method is effective for small tonsil stones that are located near the surface of the tonsils. Try to gently cough up the stones using a deep, hacking cough.
  • Use a water pick or oral irrigator: A water pick or oral irrigator can be used to gently flush out tonsil stones. The water pressure can help to loosen the stones and wash them out of the tonsils.
  • Use a cotton swab: Gently press a clean cotton swab against the tonsil stone to push it out of the tonsil crevice.
  • Use a toothbrush: You can use a toothbrush to gently brush the surface of the tonsil and dislodge the tonsil stones.
  • Surgery: If your tonsil stones are recurring or large, a procedure called tonsillectomy (removal of tonsils) can be done.

It's important to note that, home remedies are effective when the tonsil stones are small and accessible. If the stones are large, recurrent or cause difficulty in swallowing or breathing, it's best to seek professional medical help. A doctor or an ear, nose, and throat (ENT) specialist can help diagnose and remove the tonsil stones and also check for any underlying condition that may be causing them.

What is Ludwig's angina?

 Ludwig's angina is a serious and potentially life-threatening infection that affects the tissues of the floor of the mouth. It is a type of cellulitis, which is a spreading infection of the skin and subcutaneous tissues. The condition is named after Carl Friedrich Wilhelm Ludwig, a German physician who described the condition in 1836.

The infection usually starts with inflammation and infection of the submandibular salivary glands, which are located just below the jawbone but can quickly spread to the surrounding tissues, including the tongue, the floor of the mouth, and the neck.

Symptoms of Ludwig's angina can include:

  • severe pain and swelling in the jaw, tongue, and neck
  • difficulty swallowing and speaking
  • drooling
  • fever and chills
  • swollen lymph nodes in the neck
  • difficulty breathing (due to the swelling in the neck)
Ludwig's angina is considered a medical emergency, and prompt treatment is essential to prevent potentially life-threatening complications, such as airway obstruction or sepsis. Treatment typically includes antibiotics to fight the infection, along with surgical drainage of any abscesses that may have formed.

Ludwig's angina typically starts as an infection in the submandibular salivary glands, which are located just below the jawbone. However, it can also be caused by an infection in the teeth, gums, or other oral structures that spreads to the floor of the mouth.

A common cause of Ludwig's angina is a dental abscess, which is a pocket of pus that forms at the tip of a tooth's root due to a bacterial infection. Dental abscesses can be caused by untreated tooth decay, a broken or cracked tooth, or gum disease. The bacteria can spread through the bone and soft tissues of the jaw and into the submandibular space, leading to Ludwig's angina.

Another oral infection that can cause Ludwig's angina is a peritonsillar abscess (quinsy) which is a collection of pus in the tonsils caused by a bacterial infection. This abscess may spread to the floor of the mouth and also cause Ludwig's angina.

In general, Ludwig's angina is considered a rare but serious condition, and if left untreated, it can be life-threatening due to the potential for airway obstruction and sepsis (systemic infection).

The mortality rate associated with Ludwig's angina varies depending on the studies, but it ranges between 2-15%. Early recognition and intervention are critical to improve the outcome. Early identification and appropriate intervention along with the necessary care, will lower the mortality rate.

It's essential to seek professional dental help if you suspect you have a tooth infection or an abscess, or if you experience any of the symptoms associated with Ludwig's angina, such as severe pain and swelling in the jaw, tongue, and neck, difficulty swallowing and speaking, fever, and difficulty breathing.





Signs and symptoms of Anemia and leukemia related to oral cavity

 Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin, the protein in red blood cells that binds to oxygen and carries it to the body's tissues. One of the common signs of anemia is fatigue and weakness, as the body's tissues are not getting enough oxygen. Other signs of anemia can include pale skin, shortness of breath, and a rapid or irregular heartbeat.

Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells.

Oral symptoms associated with anemia can include dry mouth, sore tongue, and a burning or tingling sensation in the tongue and mouth. The gums may appear pale, and there may be small, shallow ulcers or sores on the tongue and inside of the cheeks. Anemia can also cause difficulty swallowing and a loss of taste.

In the case of leukemia, oral symptoms can include the following:
  • Petechiae: Tiny red or purple spots on the gums, the roof of the mouth, and the buccal mucosa caused by bleeding under the surface of the skin.
  • Gum hypertrophy: Enlarged or swollen gums
  • Oral infections: Leukemia can impair the body's ability to fight infections, leading to frequent mouth sores, ulcers, and infections in the gums, tongue, and other parts of the mouth.
  • Taste changes: Some people with leukemia may experience changes in their sense of taste.
  • Excessive bleeding from the oral cavity
  • Mouth pain
  • Loose teeth

In addition to these symptoms, individuals with anemia or leukemia may also experience difficulty swallowing, sore mouth or tongue, and unexplained weight loss.

It is important to remember that these symptoms may also be caused by other conditions and to seek professional medical help to diagnose and treat them. A thorough examination of the oral cavity, together with laboratory and imaging tests, will be done by a dentist or oral surgeon to establish the diagnosis.

PGCEE MDS 2022: The dentin desensitizing agents that acts by precipitating proteins in the dentinal tubular fluid is:

 # The dentin desensitizing agent that acts by precipitating proteins in the dentinal tubular fluid is:
a) Strontium Chloride 
b) Potassium oxalate
c) Fluoride 
d) Hydroxyethyl methacrylate


The correct answer is A. Strontium chloride.

Dentin Desensitizers act by:
i) Desensitization of intradental nerves or inhibit or prevent transmission of the stimulus itself.
Eg: Potassium salts like nitrate, chloride and citrate.
ii) Occlusion of the dentinal tubules

a) Precipitation of proteins:
• Silver nitrate
• Zinc chloride
• Strontium chloride

b) Plugging of dentinal tubules
• Salts of fluorides and oxalates
• Bioglass

c) Dentin adhesive sealers
• Varnish
• GIC
• Composites
• Dentin bonding agents

iii) Lasers:
• Nd-YAG-act by occlusion of tubules
• GaAlA (Gallium Aluminium Arsenide laser act by affecting the neural transmission)

PGCEE MDS 2022: Bald tongue due to vitamin B12 deficiency is called as:

 # Bald tongue due to vitamin B12 deficiency is called as:
A. Moeller’s glossitis
B. Benign migratory glossitis
C. Strawberry tongue
D. Gingivostomatitis



The correct answer is A. Moeller's glossitis.


Pernicious Anemia, or Addison's anemia or Biermer's anemia
• Seen due to deficiency of Vit. B12 or Erythrocyte maturation factor or extrinsic factor.
• Peripheral neuropathy due to degeneration of posterior and lateral tracts of the spinal cord with loss of nerve fibers and degeneration of myelin sheath is seen.
• Tongue is "beefy red" in color and characteristically shows glossitis, glossodynia, and glossopyrosis.
• There is gradual atrophy of papillae of the tongue resulting in a "bald" tongue which is often referred to as Hunter's glossitis or Moeller's glossitis which is similar to the "bald tongue of sandwith" seen in pellagra.
 • RBC count of < 1 million, macrocytosis, poikilocytosis, polychromatophilic cells, stippled cells, nucleated cells, Howell-Jolloy bodies, and Cabot's ring are the laboratory findings.
• Bone marrow studies reveal immature red cells or MEGALOBLASTS. Polymacrocytes (macropolyps) are large polymorphonuclear leukocytes with large poly-lobed nuclei are also found.
• Achlorhydria or lack of HCL secretion is a constant feature of the disease.
• The oral and general manifestations of "sprue" are closely related to pernicious anemia.


PGCEE MDS 2022: Enzyme responsible for breakdown of ground substance is:

 # Enzyme responsible for breakdown of ground substance is:
a) Hyaluronidase 
b) Coagulase
c) Phosphorylase 
d) Acid phosphatase



The correct answer is A. Hyaluronidase.

Collagenase is responsible for the breakdown of periodontal fibers in periodontitis. It is released by bacteria (P. gingivalis mostly), polymorpho-nuclear leukocytes, and some populations of fibroblasts. Hyaluronidase causes the breakdown of ground substances and helps in the spread of inflammation (cellulitis).

PGCEE MDS 2022: Rapid maxillary expansion is not indicated after:

 # Rapid maxillary expansion is not indicated after:
a) 6 years 
b) 9 years
c) 12 years 
d) 15 years



The correct answer is D. 15 years.

Rapid maxillary expansion should be initiated prior to the ossification of the mid-palatal suture. The time of ossification of the mid-palatal suture is about 16 years in girls and 18 years in boys with a broad range of 15-27 years.

Contraindications of Rapid maxillary expansion:
• Single tooth crossbites
• In adults with severe anteroposterior skeletal discrepancies.
• Vertical growers
• Periodontally weak conditions

The retention period following rapid maxillary expansion should be at least 3 - 6 months.
In slow expansion, the maxillary arch is expanded at a rate of 0.5 - l mm per week.
The forces generated in slow expansion procedures are 2-4 pounds while it is 10-20 pounds (1 pound = 450 gms) in RME.
In rapid maxillary expansion, the treatment is completed in 1-2 weeks whereas in the slow expansion it may take as much as 2-5 months.


PGCEE MDS 2022: Gubernacular canal guides the eruption of:

 # Gubernacular canal guides the eruption of:
a) Primary teeth 
b) Permanent teeth
c) First molar
d) Third molar



The correct answer is B. Permanent teeth. 

Actually the correct answer is Succedaneous teeth. Because, not all permanent teeth have a gubernacular canal. The gubernacular canal and cord help in guiding the permanent teeth during the process of eruption. Except molars, all the permanent teeth (incisors, canines, and premolars) are known as succedaneous teeth because they take the place of their primary predecessors.

Permanent molars are not succedaneous teeth, as they develop from the distal extension of the dental lamina. Successional lamina, which is present on the lingual side of primary dental lamina, is absent for permanent molars.


PGCEE MDS 2022: Chronic burrowing ulcer is caused by:

 # Chronic burrowing ulcer is caused by:
a) Microaerophilic streptococci
b) Peptostreptococcus
c) Streptococcus viridans 
d) Streptococcus pyogenes


The correct answer is A. Microaerophilic Streptococci.

Chronic burrowing type of ulcer is due to symbiotic action of microaerophilic non-haemolytic streptococci and hemolytic Staphylococcus aureus. Clinically it is undermined ulcer with lot of granulation tissue in the floor. This condition is painful, toxaemic and the general condition of the patient deteriorates without treatment. Radical drainage is necessary for cure, antibiotics alone being useless. 

Dhangadi Sanjeevani Dental, Dhangadi, Kailali

 Name of Dental Clinic: Dhangadi Sanjeevani Dental
Address (Full): Dhangadi Kailali
Year of Establishment: 2079
Name of the chief Dental Surgeon: Dr. Amrit Raj Jaishi
CONTACT NUMBER: 9860644282
NMC Number of Dental Surgeon: 30037

PGCEE MDS 2022: Histochemical demonstration of glycogen in the cells can help in the diagnosis of:

 # Histochemical demonstration of glycogen in the cells can help in the diagnosis of:
a) Malignant melanoma 
b) Squamous cell carcinoma
c) Kaposi's sarcoma 
d) Ewing's sarcoma


The correct answer is D. Ewing's sarcoma.

Ewing's sarcoma also called round cell sarcoma, seen in children and young adults, is characterized by painful swelling of the involved bone, facial neuralgia and lip paresthesia. It produces an irregular diffuse radiolucency, onion-skin and sun ray appearance of bone. Histologically, the neoplasm is composed of solid sheets of round cells, arranged in Filigree pattern. Intracytoplasmic glycogen of these cells helps in the differentiation from reticulum cell sarcoma.

PGCEE MDS 2022: Degree of color saturation is called:

PGCEE MDS 2022 
# Degree of color saturation is called:
A. Hue
B. Value
C. Chroma
D. Translucency

The correct answer is C. Chroma.

Hue is the specific color produced by a specific wavelength of light. It describes the dominant color of an object, for example, red, green, or blue.

Value (Brilliance) is the lightness or darkness of an object. Lighter-shaded objects are with the highest value and dark-shaded objects are with a lower value.

Saturation (Chroma) is the amount of color per unit area of an object. Chroma represents the degree of saturation of a particular hue. For example, some teeth appear more yellow than others.

Translucency is the property of an object that permits the passage of light through it but does not give any distinguishable image.

Metamerism: Objects that appear to be color matched under one type of light may appear different
under another light source. This phenomenon is called metamerism.

PGCEE MDS 2022: Poor accessibility is the main disadvantage of which flap?

# Poor accessibility is the main disadvantage of which flap?
a) Trapezoid
b) Envelope
c) Semilunar
d) Partial thickness flap


The correct answer is C. Semilunar flap.

Basic requirements of a flap:
• Flap must be designed to provide adequate exposure to the surgical area.
• Flap must have a broad base and good vascular supply.
• When placed back, the flap should rest on healthy bone.

Envelop flap: Incision along the free gingival margin with no vertical incision
A two-sided triangular flap is an envelop flap with a releasing incision on one side.
A three-sided rhomboid flap is a modification of a two-sided flap with the addition of a second vertical incision.
Semilunar flap: is designed when the periapical area is required to be exposed. It is always kept 5 mm away from the gingival margin.

PGCEE MDS 2022: Bimanual palpation technique is carried out for:

 # Bimanual palpation technique is carried out for:
a) Submandibular sialadenitis
b) Sublingual gland
c) Ranula
d) Cervical lymph nodes when they are enlarged due to inflammation




The correct answer is A. Submandibular sialadenitis.

During bimanual palpation of submandibular gland, one hand is placed intra orally on the floor of mouth and other extra orally below mandible.

PGCEE MDS 2022: Cherry-blossom appearance on a sialogram indicates:

 # Cherry-blossom appearance on a sialogram indicates:
a) Mucoepidermoid cell carcinoma
b) Acinar cell carcinoma
c) Sjogren's syndrome 
d) Pleomorphic adenoma


The correct answer is C. Sjogren's syndrome.

Sialographs of Sjogren's syndrome demonstrate punctuate, cavitary defects which produce a 'cherry blossom' or 'branchless fruit laden tree' effect.

PGCEE MDS 2022: Which of the following wires is the better choice if alignment is needed?

 # Which of the following wires is the better choice if alignment is needed?
a) Nitinol wire 
b) TMA wire
c) Elgiloy wire 
d) Stainless steel wire


The correct answer is A. Nitinol wire.

TMA wires or  beta titanium wires
• Used for space closure and finishing
 • Used for final adjustment in torquing

Nitinol 
• Used for initial alignment

PGCEE MDS 2022: Surgicel used as a hemostatic agent for post extraction bleeding is:

 # Surgicel used as a hemostatic agent for post extraction bleeding is: 
A. Commercially available thrombin
B. Russel viper's venom
C. Oxidised cellulose
D. Methyl cellulose




The correct answer is C. Oxidised cellulose.

Surgicel is a brand of absorbable hemostatic (blood-clotting) agents that are used during surgery to control bleeding. It is made from oxidized regenerated cellulose, a type of fiber derived from plants. Surgicel is used to stop bleeding from small blood vessels and is often used in conjunction with other methods of hemostasis, such as suture ligation and cauterization. It is commonly used during surgery to help control bleeding in areas that are difficult to access, such as the nose, throat, or inside the mouth. Surgicel is also used to help control bleeding in areas that are prone to bleeding, such as the liver or spleen.

In addition to its use as a hemostatic agent, Surgicel has also been used as a wound dressing to help promote healing and prevent infection. It is often used in conjunction with other wound dressings to provide additional absorbent capacity and absorb exudate (fluid produced by the wound). Surgicel is absorbed by the body over time and does not need to be removed. 

PGCEE MDS 2022: First order bends are:

 # First order bends are: 
a) Tipping bends. 
b) Torquing bends. 
c) In and out bends. 
d) Anchorage bends. 


The correct answer is C. In and out bends.

2nd order bends are Tipping bends while 3rd order bends are Torquing bends.

PGCEE MDS 2022: Papules, vesicles and macules all are seen in:

 # Papules, vesicles and macules all are seen in:
a) Measles 
b) Herpangina
c) Rubella 
d) Hand foot and mouth disease



The correct answer is D. Hand foot and mouth disease. 

Individuals with HFMD present with oral pain, often with accompanying fever and flu‐like symptoms (e.g., malaise, myalgia). As with herpangina, prodrome is usually absent. The oral ulcers resemble herpangina ulcers, but are more numerous. The location of the oral ulcers in HFMD also differs
from herpangina and they are located anterior to the faucial pillars, most commonly on the tongue, labial, and buccal mucosa. The hand lesions are located on the dorsum of the fingers, interdigital spaces, and palms. The foot lesions are typically on the dorsum of the toes, sole, heel, and lateral borders of the foot. In infants, toddlers, and preschool children, lesions may occur on the buttocks. The skin lesions may be macular, maculopapular, or vesicular. The skin vesicles contain a clear or turbid fluid surrounded by a halo of erythema. HFMD caused by enterovirus A71 and a novel coxsackievirus
A6 genotype are associated with more severe disease patterns (Enterovirus 71: CNS disease, heart failure; Coxsackievirus A6: wider distribution, longer duration).

Ref: Burket.

PGCEE MDS 2022: The host modulation therapy that may be used as adjunctive therapy for aggressive periodontitis is

 # The host modulation therapy that may be used as adjunctive therapy for aggressive periodontitis is:
a) Clindamycin
b) Metronidazole
c) Doxycycline
d) Ciprofloxacin


The correct answer is C. Doxycycline.

Host Modulatory Therapy (HMT) is a treatment concept that aims to reduce tissue destruction and stabilize or even regenerate the periodontium. Doxycycline hyclate is available as a 20mg capsule for use by patients twice daily. The mechanism of action is by suppression of the activity of collagenase, particularly that produced by PMNs. NSAIDs inhibit the formation of prostaglandins, including prostaglandin (PGE2). PGE2 is found to upregulate bone resorption by osteoclasts. Flurbiprofen, an NSAID, significantly inhibits radiographic alveolar bone loss compared to a placebo. A recent study suggested that concomitant administration of doxycycline and flurbiprofen may result in
enhancement of the anti collagenase effects of doxycycline. 

Subantimicrobial-dose doxycycline (SDD) may help to prevent the destruction of the periodontal attachment by controlling the activation of matrix metalloproteinases, primarily collagenase and gelatinase, from both infiltrating cells and resident cells of the periodontium, primarily the neutrophils.