MCQs on Medication effect upon orthodontic tooth movement

MDS Orthodontics Assessment

Topic: Medication Effects on Orthodontic Tooth Movement

Interactive Assessment

This assessment covers the physiological and pharmacological effects of various drug classes on orthodontic tooth movement (OTM), including NSAIDs, Bisphosphonates, Hormones, and Monoclonal Antibodies.

Level: MDS Orthodontics
Questions: 10

Question 1 of 10 Score: 0

Physiology

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Review the physiology of bone turnover.

Key Takeaway

Drug half-lives and mechanism of action (ranking bone vs extracellular) are critical for orthodontic planning.

Generated based on "Medication effect upon orthodontic tooth movement" (Zahrowski, 2025)

Alveolectomy for prosthetic reasons should be performed:

 # Alveolectomy for prosthetic reasons should be performed:

A. During the time of extraction of teeth

B. One month after the extraction

C. 2 months after the extraction

D. At the time when the complete dentures are to be constructed

The correct answer is A. During the time of extraction of teeth.

Clinical Rationale

Performing an alveolectomy (or alveoloplasty) at the same time as the tooth extraction is widely considered the standard of care for prosthetic preparation. This is often referred to as a primary alveoloplasty.

• Accessibility: Since the alveolar bone is already exposed during the extraction, it is the most convenient time to smooth sharp bony edges, reduce undercuts, and contour the ridge.

• Patient Comfort: It prevents the need for a second surgical procedure later, reducing overall trauma and recovery time for the patient.

• Prosthetic Readiness: Smoothing the bone immediately allows the ridge to heal in a shape that is optimized for the future denture, facilitating a better fit and retention. It also helps prevent "sharp spots" that would cause pain under a denture base.

Why Other Options Are Less Ideal

• B & C (1–2 months after): Waiting this long requires a secondary surgical procedure (secondary alveoloplasty). This means raising a new mucoperiosteal flap after the initial extraction site has likely already closed, causing unnecessary additional trauma and delaying the final prosthetic construction.

• D (At the time of denture construction): If you wait until the denture is ready to be made to discover bony irregularities, you will have to perform surgery then. This forces a delay in the fabrication of the denture while the tissue heals again (usually 4–6 weeks).

Note: A secondary alveolectomy is only performed if irregularities are found after the initial healing is complete, but the goal is always to address these issues during the initial extraction whenever possible.

What portion of the trough area of the tray is filled during application of APF gel or foam?

 # What portion of the trough area of the tray is filled during application of APF gel or foam?

A. One third of the trough area of the tray

B. One half of the trough area of the tray

C. Three fourths of the trough area of the tray

D. Trough area of the tray is filled completely

The correct answer is A. One third of the trough area of the tray.

Clinical Rationale

When applying Acidulated Phosphate Fluoride (APF) gel or foam, the primary goal is to ensure the teeth are coated while minimizing the risk of the patient swallowing the excess material.

• Displacement: When the tray is inserted into the mouth, the patient's teeth will displace the gel or foam, pushing the level up to cover the cervical areas of the teeth.

• Safety: Filling the tray more than one-third full significantly increases the risk of the material overflowing. This can lead to:

  • Gagging: Due to excess material running down the throat.

  • Ingestion: Swallowing high concentrations of fluoride can cause nausea or gastric distress.

Application Guidelines

To ensure a safe and effective treatment:

• Quantity: Fill the tray only about 1/3 full (or approximately 2 ml to 2.5 ml of gel per tray).

• Foam: If using foam, be aware that it expands; however, the 1/3 guideline remains a standard conservative measure to prevent overflow.

• Suction: Always use a saliva ejector during the procedure to evacuate excess saliva and fluoride.

• Positioning: Keep the patient in an upright position with the head tilted slightly forward to prevent flow into the throat.

The apex of the maxillary sinus faces the:

 # The apex of the maxillary sinus faces the:

A. Nasal bone

B. Floor of the orbit

C. Palate

D. Zygomatic process of the maxilla

The apex of the maxillary sinus faces the D. Zygomatic process of the maxilla.

Anatomical Explanation
The maxillary sinus (also known as the Antrum of Highmore) is the largest of the paranasal sinuses and is roughly shaped like a pyramid lying on its side. Its orientation is as follows:

• Apex: Points laterally towards the zygomatic process of the maxilla. In some individuals, it may even extend into the zygomatic bone.
• Base: Faces medially and is formed by the lateral wall of the nose.
• Roof: Formed by the floor of the orbit (containing the infraorbital nerve and vessels).
• Floor: Formed by the alveolar process of the maxilla (often very close to the roots of the molar and premolar teeth).

Summary of Incorrect Options
A. Nasal bone: This area relates to the medial wall (base) of the sinus, not the apex.
B. Floor of the orbit: This forms the superior wall (roof) of the sinus.
C. Palate: This relates to the inferior aspect; the hard palate and alveolar process form the floor of the sinus.