HAAD JUNE 13

33) Ameloblastoma whts nt true?

Ameloblastoma is a rare, benign tumor of odontogenic epithelium (ameloblasts, or outside

portion, of the teeth during development) much more commonly appearing in the lower jaw than
the upper jaw.[2] It is the most common type of Odontogenic Epithelial Tumor.

While these tumors are rarely malignant or metastatic ), , wide surgical excision is required to
treat this disorder.

There are three main clinical subtypes of ameloblastoma: unicystic, multicystic, peripheral. [7] The
peripheral subtype composes 2% of all ameloblastomas. [2] Of all ameloblastomas in younger patients,
unicystic ameloblastomas represent 6% of the cases

Ameloblastomas are often associated with the presence of unerupted teeth. Symptoms include
painless swelling, facial deformity if severe enough, pain if the swelling impinges on other
structures, loose teeth, ulcers, and periodontal (gum) disease. Lesions will occur in the mandible
and maxilla,although 75% occur in the ascending ramus. In the maxilla it can extend into the
maxillary sinus and floor of the nose. The lesion has a tendency to expand the bony cortices
because slow growth rate of the lesion allows time for periosteum to develop thin shell of bone
ahead of the expanding lesion. This shell of bone cracks when palpated and this phenomenon is
referred to as "Egg Shell Cracking" or crepitus, an important diagnostic feature. Ameloblastoma
is tentatively diagnosed through radiographic examination and must be confirmed by histological
examination (e.g., biopsy). Radiographically, it appears as a radiolucency in the bone of varying
size and features—sometimes it is a single, well-demarcated lesion whereas it often demonstrates
as a multiloculated "soap bubble" appearance.. Resorption of roots of involved teeth can be seen
in some cases, but is not unique to ameloblastoma. The disease is most often found in the
posterior body and angle of the mandible, but can occur anywhere in either the maxilla or
mandible.

Ameloblastoma is often associated with bony-impacted wisdom teeth—one of the many reasons
some dentists recommend having them extracted.

Histopathology will show cells that have the tendency to move the nucleus away from the basement
membrane. This process is referred to as "Reverse Polarization". The follicular type will have outer
arrangement of columnar or palisaded ameloblast like cells and inner zone of triangular shaped cells
resembling stellate reticulum in bell stage. The central cells sometimes degenerate to form central
microcysts. The plexiform type has epithelium that proliferates in a "Fish Net Pattern". The plexiform
ameloblastoma shows epithelium proliferating in a 'cord like fashion', hence the name 'plexiform'. There
are layers of cells in between the proliferating epithelium with a well-formed desmosomal junctions,
simulating spindle cell layers
The six different histopathological variants of ameloblastoma are desmoplastic, granular cell,
basal cell, plexiform, follicular, and acanthomatous.[8]

The acanthomatous variant is extremely rare.[9]

One-third of ameloblastomas are plexiform, one-third are follicular

ameloblastoma is suspected to spread to adjacent areas of the jaw bone via marrow space. Thus,
wide surgical margins that are clear of disease are required for a good prognosis. This is very
much like surgical treatment of cancer. Often, treatment requires excision of entire portions of
the jaw. Recurrence is common Recurrence is common, although the recurrence rates for block
resection followed by bone graft are lower than those of enucleation and curettage.solid forms
high recurresnce (75%) unless tx by recesction..unicstic has 20 recurrence if tx by curretage

37)patient has throbbing pain, increased by heat and relieved by cold and pain on
percussion..diagnosis is ;

Irreversible pulpitis

Reversible

Acute periapical periodontitis

B&C

Refer to watsap…irreversible pulpitis

38) gauge of adams clasp wire

0.7mm\21 gauge molars and premolars S.S wire

For deciduous canine and pm …0.6\22

39) excessive orthodontic force

Hyulanization

Undermined resorption

Crushes PDL

All

40) which bur produces more rough surface

Carbide at low speed

Carbide at high speed

Diamond at high speed

Operative, or cavity preparation burs, have deep and wide flutes which allow for more aggressive enamel
cutting with higher speed and efficiency. These operative burs are usually either straight-bladed (plain) or
crosscut. Straight-bladed burs cut smoothly but more slowly, especially with harder materials. Crosscut burs
have additional cuts across the blades (these are the crosscuts) to

create increased cutting efficiency. While the benefit of these extra blades has been minimized in recent years
with the advent of high-speed handpieces (which cut more efficiently), crosscut burs can generally cut more
quickly because debris does not build up on the bur. Trimming and finishing burs have more blades than
operative burs, and the blades are closer together and shallower, which makes these burs ideal for the fine
finishing and polishing of dental materials. Each type of bur shape has a number designation, with the head
of the bur generally increasing in size as the number gets larger within a particular shape series. For example,
round burs come in sizes from 1⁄4 to 8, with 8 having a much larger head than 1⁄4.

Carbides and diamonds also produce different outcomes: carbide burs slice or chip away at material,
leaving the tooth surface smooth and more aesthetically pleasing. Diamond burs grind away at material,
leaving a rough tooth surface which requires more polishing in the end.

Restorative tooth preparation requires complete removal of enamel, existing restorative materials, and caries.
Diamond burs will safely accomplish this and are unlikely to cause enamel fracture. However, while cutting
through porcelain is best accomplished with diamonds, they are slow to cut

enamel and slower at cutting metal-based restorations or sectioning cast metal copings or crowns. Diamond
surfaces can also fill with debris and clog, wear smooth, and cause burnishing and overheating. Therefore,
carbide burs are more often used to easily accomplish these tasks. Carbide burs should be used to trim and
finish macro-filled composites and hybrid composites.

prepared with the diamond bur exhibited an irregular and rough surface, with deep and
irregular grooves (Figure 1A1). The diamond bur produced a thick smear layer occluding the
dentinal tubules (Figure 1A2). When prepared with the carbide bur, dentin surfaces showed
narrow and short grooves

Carbide burs can be used for deburring, finishing, smoothing, shaping, and carving many types of materials.
Carbide slices or chips away at material leaving a smooth surface. But they can still be effective on harder
metals. It is best to use these at high speeds with light pressure.

Diamond burs are best for grinding, carving, and sculpting—great for stones and glass. They grind away at
material and can leave a rough surface that requires some polishing afterward. Diamond burs won’t chip but
they do have a shorter lifespan than the carbide burs.
41) furcation involvement on upper 7 distally bcz of enamel pearl

Scaling and polishing every 6 month

Resection of palatal root

Flap and enameloplasty

Although, bacterial plaque is a primary cause of the initiation and progression of periodontal disease, anatomic
factors such as enamel pearls are often associated with advanced localized periodontal destruction. Both
enamel pearls and cervical enamel projection in furcations predispose to attachmet loss

enamel pearls occurred more commonly on the roots of maxillary 2nd and 3rd molars

surgical removal is necessary but if removal expose pulp…endo tx necessary

nt all pearl are consistent of eneamel but can contain dentine and pulp horn

treatment of multirooted teeth with furcation involvements associated with prominent enamel
projections. One of the techniques is the incorporation of projection flattening or removal, into surgical
procedures such as the modified Widman flap or the exicisional new attachment procedure combined
with furcationplasty. This would contribute to the promotion of collagen fiber attachment in grade I and
shallow grade II furcal lesions. In addition, opening the furca for access to plaque control with special
brushes or cleaners is another adjunctive approach for the management of grade III and grade IV furcal
lesions.

42) class II amalgam in primary teeth..the proximal box;

Diverge occlusally

Converge occlusally

Parallel

Converge…refer to watsap and email

43) MTA is;

Bacteriostatic

Combined with bisphosphonate to increase success

Combined with …(?!nt sure)... to produce irritatant material

Refer to watsap
Gray MTA has higher conc of aluminium oxide , magnisuim and iron..both white and gray perform same
in furcal sealing and antimicrobial effectiveness.in vitro the grey version more favourable behavoiur in
terms of development of odontoblast..wheres the white more in the development of cementoblast and
keratinocytes. The white version gives final better appearance than the original gray.

Nothing I found about bacteriostatic or bisphosphonate nt even in books…ca hydroxide and zo

euogenol r bacteriostatic

44) white and gray

Same effect

Gray bcz of its material

Refer to q 43 and watsap

GMTA expanded significantly more than WMTA in either water or HBSS immersion.

45) apexogenesis whts false;

Ca doesn’t come from calcium hydroxide

Calcific barrier is porous

Caoh has high PH tht promotes antibacterial effect

Ca Oh has high alkanitity PH 12 that its when placed on vital pulp tissue it induces necrosis in superficial
pulp tissues

The caoh has some limitations…might require 6-24 months for barrier formation..the barrier formed is
often porous and not continous

CA oH has bactericidal effect…the antimicrobial effect has been contributed to the high PH.the
antimicrobial effect related to the release of hydroxyle group in the aqueous solution..the hydroxyl ions
are extremely oxidant which has effect on the bacteria. They damage the cytoblasmic membrane , protein
denaturation and DNA damage.

The calcium ions and the high alkinity has been proposed to act seperatly or serengically in promoting ca

The false tht Ca doesn’t come from ca oh according to my reading

46) contact stomatitis

Contact with denture material

Contact with cinnamon and pepper ment

Contact with tooth paste material

Contact stomatitis is a delayed hypersensitivity (Type IV) reaction to a chemical in contact with the
lining of the mouth. It occurs in people already sensitized to the allergen

Contact stomatitis is an uncommon allergic reaction affecting the inside of the mouth caused by
contact with an allergen, usually flavourings, metals or other components in oral hygiene products,
foods, dental restorations and medications. It may also be called allergic contact stomatitis to
distinguish this form from intraoral irritant reactions.

All the above true

47) washing hands with soup before and after gloves why ?

Kill all bacteria

Reduce bacterial count that can leak from microholes in the gloves

Reduce bacteria that can be transmitted

I believe third option

48) ANB in sever overjet

More than normal

Normal

less

I guess more bcz its in class 2 ANB more

ANB (A point, Nasion, B point)- indicates whether ... is a normal (skeletal class I relationship (+
2 degrees), a skeletal Class II (+4 degrees

49) frankfort plan

The Frankfort plane (also called the auriculo-orbital plane) It was decided that a plane passing through
the inferior margin of the left orbit (the point called the left orbitale) and the upper margin of each ear
canal or external auditory meatus, a point called the porion,

50) upper wax rim should be parallel to

Interpupillary line

Camper line
To interpupillary line

Refer to watsap

51) infection to lower posterior tooth moves directly to ?

Submental

Submandibular

Sublingual

Bucaal

Refer to watsap

52) class 1 amalgam why to make bevel

Thin amalgam may fracture

53) nitrous oxide is contraindicated in

Angina pectoris

History of MI

Epilepsy

None of the above

It is important that the COPD patient not receive nitrous oxide during dental treatment due to their impaired
breathing

HF patients are usually taking one or more diuretic medications to remove fluid, as well as digitalis to
strengthen their heart contractions. Supplemental oxygen may be needed for these patients and use of
nitrous oxide analgesia is contraindicated.

Its most appropriate for patients with history of cadiovascular diseaases to minimize stress

Patient with broncial asma can use nitrous

Can be used with patients with epilepsy to reducess stress but its important to avoid hypoxia, therefore
higher concentration of n2o should be avoided.

Contraindication

Nasal obstruction
Chronic obstructive pulmonary disease (emphysema , tb)

Debilitating cardiovascular or cerebrovascular disease

Pregnancy ( it croses the placenta)

Patients wit hpsychaitric disorders

Children with difficult behaviour

Diazipams barbiturates morphines mepiredine cause CNS depression so better nt to use n2o with them

54)psedumembranous colitis ;

Only in large intestine

Clindamycina nd ampicilin can cause it

Pseudomembranous colitis, a cause of antibiotic-associated diarrhea (AAD), is an inflammation of the

colon. It is often, but not always, caused by the bacterium Clostridium difficile

The use of clindamycin, broad-spectrum antibiotics such as cephalosporins, or any penicillin-based

antibiotic such as amoxicillin causes the normal bacterial flora of the bowel to be altered. In particular,
when the antibiotic kills off other competing bacteria in the intestine, any bacteria remaining will have
less competition for space and nutrients. The net effect is to permit more extensive growth than normal
of certain bacteria. Clostridium difficile is one such type of bacterium. In addition to proliferating in the
bowel, C. difficile also produces toxins. Without either toxin A or toxin B, C. difficile may colonize the gut,
but is unlikely to cause pseudomembranous colitis. [1]

The disease is treated either with oral vancomycin or with intravenous metronidazole. Oral
metronidazole at doses of 500 mg three times a day for 10 to 14 days can be used for mild to moderate
cases of C. difficile. Choice of drug depends on severity of disease and the ability to tolerate and absorb
oral medications. Vancomycin treatment does present the risk of the development of vancomycin-
resistant Enterococcus, though it is only minimally absorbed into the bloodstream from the
gastrointestinal tract. Metronidazole has on occasion been associated with the development of
pseudomembranous colitis. In these cases, metronidazole is still an effective treatment, since the cause
of the colitis is not the antibiotic, but rather the change in bacterial flora from a previous round of
antibiotics. C. difficile infections that do not respond to vancomycin or metronidazole are sometimes
treated with oral rifaximin. Fidaxomicin, a new alternative, has been approved for treatment as of mid-
2011.
In most cases, a patient presenting with pseudomembranous colitis has recently been on antibiotics.
Antibiotics disturb the normal bowel bacterial flora. Certain antibiotics, such as ampicillin,[8] have a
higher propensity to create an environment where the bacteria causing pseudomembranous colitis can
outcompete the normal gut flora. Clindamycin is the antibiotic classically associated with this disorder,
but any antibiotic can cause the condition

The answer both are right

55) what antagonize comarin ;

Barbiturates

Aspirin

Barbiturate antagonize

Aspirin potentiate

Refere to watsaap

56) what should be investigated in patient taking warfarin sodium ?

Serium n2 ( I geuss sodium )

Serum warfarin

INR

A&C

INR searched a lot only INR was mentioned

57) usefull irrigation with sodium hypochlorite;

Sodium is the active component

Using Gp is more usefull more than …?

Last several hrs after irrigation

None ?1

Sabstantivity is for CHX

Hypochlorous acid is responsible for most of the effective antimicrobial action, although
hypochlorite ion may also contribute to it. Antiseptic/disinfectant action is due to
chlorination of microbial plasma proteins/enzymatic systems.
Vianna et al. (3) and Estrela et al. (4,5) showed that sodium hypochlorite is more
bactericidal than chlorhexidine gel. In terms of tissue dissolution, efficiency is proportional
to hypochlorite concentration in the solution (6,7).

Sodium hypochlorite solutions have low cost, and are very efficient as tissue solvents (8)
and in the reduction of endodontic microbiota (9) even at low concentrations

I guess none

58) failure of RCT in lower incisors

2 canals

Accessory canal

Its generally accepted that mandibular incisors have 2 canals, which merge in one canal
before reaching the apex..in rare cases separate foramina may present

The main reason for failure in endo tx in mand incisors due to inability to detrect presence
of 2dn canal

59)To remove lower torus ..flap position;

On the torus for max view

On the torus with extension to floor of the mouth

On crest of ridge or cervical of teeth

Mandibualr torus are bening growth asymptomatic usually and bilateral, of dense cortical
bone avascular in nature, grow with pts life time and mucosa over them is this

Sulcular incision extended mesially and distally..full thikness flap to avoid tearing of the
thin tissue

60) post to lower denture

Ptyregomandibualr raphe

Vibrating line

Hamular notch

Fovae
61) greater palatine foramen located

Junction at soft and hard palate

Btw 1st and 2nd m

Btw 2nd and 3rd m

small opening of the hard palate located near the second and third molars in which the palatine vessels
and greater palatine nerve travel

The greater palatine foramen (GPF) is related to the upper 3rd molar tooth in most of the skulls (55%),
2nd molar in (12%), between the 2nd & 3rd molar in (19%) and retromolar in (14%). The shape of the
foramen is elongated antero-posteriorly; however, an unusually crescent shaped foramen is rare

62) not cause of rampant caries in geriatric patients

Decreased salivary flow

Medication

Poor oral hygein

Altered microflora

Altered microflora according to my reading…they can be more susceptible to infection due to

altered immune function and denture hygiene

63) epinephrine what wrong

Can initiate asmatic attach

The most common side effects may include increase in heart rate, stronger or irregular heartbeat,
sweating, nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness,
headache, apprehension, nervousness or anxiety. These side effects usually go away quickly, especially if
you rest

Side effects of epinephrine include increased heart rate, palpitations, sweating, ... Also
approved for emergency treatment of asthma

64) tachyphylaxis

Increase tolerance to a drug

Peripheral sensitivity when drug given iv or im

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Tachyphylaxis (Greek ταχύς, tachys, "rapid", and φύλαξις, phylaxis, "protection") is a medical
term describing an acute (sudden) decrease in the response to a drug after its administration.[1]
Tachyphylaxis can occur both after an initial dose of medication or after an inoculation with a
series of small doses. Increasing the dose of the drug may be able to restore the original
response.[2] This can sometimes be caused by depletion or marked reduction of the amount of
neurotransmitter responsible for creating the drug's effect, or by the depletion of receptors
available to which the drug or neurotransmitter can bind

65) during balanced occlusion ..non working side;

Maxillary lingual cusp contact ?

Lingual inclination of facial cusp of lower

Refere watsap

Nothing usefull I found

66)non working condyle moves

Downward forward medially

If mandible moves right the right congyle moves lat and the left moves downword forward and
medially

67) fracture in the angle of the mandible, proximal segment moves;

Ant.

Inferior

Ant and sup

And and inf

Body fractures often are unfavorable because of the actions of the masseter, temporalis, and
medial pterygoid muscles, which distract the proximal segment superomedially

Ant superior..refer to watsap

68)class 2 div 1
Mostly susceptible to fracture in ant teeth

69) ortho class 111

Mesiobucall cusp of lower 6 contact mesialy to upper 6

70 occulomotor nerve ?

Nothing else written

The oculomotor nerve is the third cranial nerve. It enters the orbit via the superior orbital fissure
and controls most of the eye's movements, including constriction of the pupil and maintaining an
open eyelid by innervating the levator palpebrae superioris muscle. The oculomotor nerve is
derived from the basal plate of the embryonic midbrain. Cranial nerves IV and VI also
participate in control of eye movement.

71)nystatin

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Nystatin (originally named Fungicidin) is a polyene antifungal medication to which many

molds and yeast infections are sensitive, including Candida. Due to its toxicity profile, there are
currently no injectable formulations of this drug on the US market.[1] However, nystatin may be
safely given orally as well as applied topically due to its minimal absorption through
mucocutaneous membranes such as the gut and the skin

72) clicking during speech is caused by

Increased OVD
Perio collagene matrix