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.

PGCEE MDS 2022: Preventive and therapeutic measures for dealing with the periodontal problems during fixed appliance therapy

 # Which of the following are typical and acceptable preventive and therapeutic measures for dealing with the periodontal problems during fixed appliance therapy?

a) Elimination of gingivitis prior to placing orthodontic appliances

b) Home care instruction regarding the use of the toothbrush and water pik during orthodontic treatment

c) Megavitamin therapy

d) Scaling and curettage immediately after appliance removal

The correct answer is A. Elimination of gingivitis prior to placing orthodontic appliances

Maintaining oral hygiene becomes more challenging once the fixed orthodontic brackets are placed. Pre-existing gingivitis should be treated and eliminated before placing the brackets. 

PGCEE MDS 2022: The common site for necrotizing sialometaplasia:

 # The common site for necrotizing sialometaplasia:

a) cheeks 

b) dorsum of tongue

c) palate 

d) gingival

The correct answer is C. Palate.

Necrotising sialometaplasia is a benign, inflammatory reaction of salivary gland that mimics a salivary gland malignancy. Etiology is mostly due to local ischemia. Most common intraoral site is palate followed by buccal mucosa and the type of necrosis is coagulative necrosis. Similar type of lesions in skin are called as syringometaplasia. 

PGCEE MDS 2022: The preferred gingival finish line for veneer is:

 # The preferred gingival finish line for veneer is:

a) Shoulder 

b) Chamfer

c) Shoulder with bevel 

d) Radial shoulder

The correct answer is B. Chamfer.

The preferred gingival finish line for veneer metal restorations is the chamfer. This finish line has been

shown experimentally to exhibit the least stress, so the cement underlying it will have less likelihood of failure. It can be cut with the tip of a round-end diamond while the axial reduction is being done with the side of that instrument.

PGCEE MDS 2022: Vasoconstrictor in local anesthetic (LA) solution:

 # Vasoconstrictor in local anesthetic (LA) solution:

a) Reduces toxic effects of LA solution. 

b) Decreases depth & duration of LA. 

c) Increases bleeding. 

d) Has no effect on efficacy of LA solution.

The correct answer is A. Reduces toxic effects of LA solution.

Vasoconstrictors are drugs that constrict blood vessels and thereby control tissue perfusion. They are added to local anesthetic solutions to oppose the inherent vasodilatory actions of the local anesthetics. Vasoconstrictors are important additions to a local anesthetic solution for the following

reasons:

1. By constricting blood vessels, vasoconstrictors decrease blood flow (perfusion) to the site of drug administration.

2. Absorption of the local anesthetic into the cardiovascular system is slowed, resulting in lower

anesthetic blood levels.

3. Local anesthetic blood levels are lowered, thereby decreasing the risk of local anesthetic toxicity.

4. More local anesthetic enters into the nerve, where it remains for longer periods, thereby increasing (in some cases significantly, in others minimally) the duration of action of most local anesthetics.

5. Vasoconstrictors decrease bleeding at the site of administration; therefore they are useful when increased bleeding is anticipated (e.g., during a surgical procedure).

PGCEE MDS 2022: In winter's WAR line, Amber line represents the:

 # In winter's WAR line, Amber line represents the:

a) Relative depth of the III molar

b) Point of application of the elevator

c) Bone level covering the impacted tooth

d) Axial inclination of the impacted tooth relative to Second molar

The correct answer is C. Bone level covering the impacted tooth.

Winter's lines include 3 imaginary lines that are drawn on the radiographs.

• White line

• Amber line

• Red line

White Line: It is drawn touching the occlusal surfaces of 1st and 2nd molars and is extended posteriorly over the 3rd molar region. It indicates the difference in occlusal level of 2nd and 3rd molars.

Amber Line: It is drawn from the crest of interdental bone between 1st and 2nd molars and extends posteriorly distal to 3rd molar or to the ascending ramus. It indicates the amount of alveolar bone covering the impacted tooth and the portion of tooth that is not covered by the bone.

Red line: It is drawn perpendicular from the amber line to an imaginary point of application of elevator.

It indicates the depth of the tooth in the bone and the difficulty encountered in removing of the tooth.

PGCEE MDS 2022: Gracey’s curette no 15/16 is used for:

 # Gracey’s curette no 15/16 is used for:

A. Anterior teeth

B. Premolars

C. Mesial surface of posterior teeth

D. Distal surface of posterior teeth

The correct answer is C. Mesial surface of posterior teeth. 

Double-ended Gracey curettes are paired in the following manner:

Gracey #1-2 and 3-4: Anterior teeth

Gracey #5-6: Anterior teeth and premolars

Gracey #7-8 and 9-10: Posterior teeth: facial and lingual

Gracey #11-12: Posterior teeth: mesial

Gracey #13-14: Posterior teeth: distal 

Recent additions to the Gracey curette set have been the Gracey #15-16 and 17-18. The Gracey #15-16 is a modification of the standard #11-12 and is designed for the mesial surfaces of posterior teeth. It consists of a Gracey #11-12 blade combined with the more acutely angled #13-14 shank. When the clinician is using an intraoral finger rest, it is often difficult to position the lower shank of the Gracey #11-12 so that it is parallel with the mesial surfaces of the posterior teeth, especially on the mandibular molars. The new shank angulation of the Gracey #15-16 allows better adaptation to posterior mesial surfaces from a front position with intraoral rests. If alternative fulcrums, such as extraoral or opposite-arch rests, are used, the Gracey #11-12 works well and the new #15-16 is not essential.