lefort1 -floating palate
 guerin sign
 cracked pot sound


 lefort 2-moon face ,paresthesia of check
 bilateral

ecchymosis
 cracked pot and CSF rhinnioria


lefort 3-racoons eyes
 panda facies
 battles sign
 Sunken eyes

(also seen in blow out fractures - fractures of orbit)

GENERAL RESORPTION PATTERN
 the maxillary teeth generally flare

downward and outward so resorption takes place as upward and inward ,the
outer cortical plate is thinner than the inner cortical plate so resorption is rapid in
outer ,as resorption takes place in maxilla it becomes smaller

IN MANDIBLE
 the anterior teeth generally incline upward and forward to the
occlusal plane so resorption in ,the outer cortex is thicker than the lingual cortex
and width of the mand is greatest in inferior border so it will resorb lingually
(inward) and inferiorly (downward )ans as a result the mand becomes wider
posteriorly

The alpha particle is the heaviest. It is produced when the heaviest elements
decay. Alpha and beta rays are not waves. They are high-energy particles that
are expelled from unstable nuclei. In the case of alpha radiation, the energy The
particles leave the nucleus .

The Stephan Curve is something we learnt about at dental school- it shows the
effect of eating and drinking in your mouth clearly in a graphical form and is
crucial in helping you understand dental decay.

red complex-last colonizers,associated with chronic periodontitis with deep

pokects and recession

purple,green,yellow-primary colonizers of sub gingival sulcus

orange-secondary colonizers -gingivitis n presence of bleeding

Fatal disease - cohort study
 Rare disease - case control study
 Cohort study
measures incidence and exposure
 Can find out history of the disease
 Cross-
sectional for prevalence and rate
 can study multiple exposures or multiple
outcomes

By most common odontogenic cyst is radicular
 most common non odontogenic

cyst is nasopalatine cyst
 Most common epithelial odontogenic tumour is
ameloblastoma
 most common odontogenic tumor is odontoma
 non
odontogenic tumors is osteosarcoma and metastatic carcinoma

1.Most common impacted anterior tooth--- maxillary canine


2. Most common supernumerary tooth—mesiodens


3. Most common ectopically erupted tooth—maxillary permanent first molar


4. Most common malignancy of oral cavity—squamous cell carcinoma


5. Most common benign tumour of oral cavity—fibroma


6. Most common retained tooth – primary mandibular second molar


7. Most common recurring cyst— odontogenic keratocyst


8. Most common cyst in oral cavity— periapical cyst
 9. Most common lichen
planus- reticular lichen planus.


10. Most common dermatosis to affect oral cavity- lichen planus


11. Most common chemical burn in oral cavity –aspirin burn


12. Most common topical fluoride in adults – stannous fluoride


13. Most common topical fluoride in children—1.23 APF gel.


14. Most common burshing technique-scrub technique


15. Most common developments cyst-nasopalati ne cyst


16. Most common S/E of GA (op)-nausea


17. Most common used drug for petitmal epilepsy-ethosu ximide


18. Most common used drug for grand mal-phenytoil


19. Most common drug used for temporal epilepsy- carbomezepine


20. Most common treatment for cyst – enucleation


 21. Most common used clasp-simple circlet clasp


22. Most common used face bow in fpd- kinematic


23. Most common complication of RA involves TMJ-fibrous ankylosis


24. Most common salivary malignancy in children – mucoepidermoid

carcinoma.


25. Most common salivary malignancy in palate area-ACC


26. Most common type of haemophilia--- haemophilia A


27. Most common type of gingivitis in children--- eruption gingivitis


28. Most common type of cerebral palsy is –athetoid/ spastic.


29. Most common nerve involved in C sinus thrombosis – abducent nerve


30. Most common type of impaction ---mesoangular


 31. Most common benign epithelial tumour---- papilloma


32. Most common complication of surgical extraction of lower third
 molar—loss

of blood clot 


33. Most common used instrument grasp—pen grasp


34. Most common susceptible tooth for caries—mandibul ar first molar


35. Most common contrast media - iodine in oil


36. Most common cause of light radiographs — exhausted developer


 37. Most common cause of failure of RCT— incomplete debridement


38. Most common isolated yeast strain from RCT— Candida


40. Most common part of oral cavity affected by L planus –buccal mucosa.

Periapical and radicualr cyst r one and the same thing

1-Ground Glass appearance--> Fibrous dysplasia
 2-Punched out

radiolucencies-->Multiple Myeloma
 3-Cotton Wool Appearance-->Paget's Dz
 4-
Tooth Floating in Air-->Eiosinophilic Granuloma
 5-Snow Appearance-->
Calcifying Epithelial Odontogenic Tumor(CEOT)
 6-Honey Comb Appearance-->
Odontogentic Myxoma
 7-Soap Bubble Appearance--> Aneurysmal Bone Cyst,
Cherubism
 8-Scooped out radiolucencies at mid root level--> Histiocytosis X
 9-
Scalloped radiolucencies around the roots of teeth--> Simple bone cyst aka
traumatic bone cyst
 10-Beaten Metal appearance on the skull-->Crouzon
Syndrome
 11-Enlarged marrow spaces--> Sickle cell Anemia
 13-Widened PDL
with dissolving bone--> Non-Hodgkin lymphoma
 14-Moth-Eaten radiolucency-->
external resorption
 salt and pepper appearance radio-graphically-COC

1. cemento-osseous dysplasia---lower anterior

2. traumatic bone cyst--- mandiular.. between canine and molar region

3.primordial cyst--- mandiular 3rd 4th molar region

4. dentigerous --- mostly mandibular 3rd molar and maxi canine region

5.stafne bone cyst--- below mandibular canal

6. lateal periodaontal cyst--- mandiular canine premolar area

7.bohn nodule---- newborn gingiva

8.epstein pearl--- midline of palate of newborn

9.cementoblastoma--- mandible molar area,grows on roots

10. OKC--- mandiular molar and ramus

11. nasopalatine duct cyst-- between roots of maxi central incisors

12. globulomaxi cyst--- between maxi lateral and canine

13.thyroglossal duct cyst-- midline of neck

14.demoid cyst--- FOM or upper neck

15.brachial cyst--- anterior to sternocleidomastoid

16.ossyfiying fibroma--- premolar area

Highest DMFT = White (caucasian) (highest amount of restored teeth)
 Highest

untreated primary teeth = Hispanic
 Highest untreated perm teeth = Black
(African American)
 Moderate periodontitis = Black males ( African
American)
 Class II caries = Whites (caucasian)
 Class III caries = Blacks
(African American)
 Cleft lip/palate w/ Class III occlusion = Native
American
 Cleft lip alone = Asian
 Cleft lip in USA = 1:700 to 1:800
 class 2
malocclusion : whites of northern European descent
 class 3 malocclusion :
Asian
 Caucasians have more lip cancer while African american have more
oropharyngeal carcinoma.
 Anterior open bite: African American(blacks)
 Deep
bite: cuacasian( whites)
 , cemento osseous dysplasia - black middle aged
women

* reverse overjet.....> Cl III MO
 *reverse polarity....> ameloblastoma
 *reverse

bevel.....> Cl II gold inlay
 *reverse bevel incision.....> in undisplaced flap when
the incision is done coronal to the sulcus
 *reverse occlusal plane.....> in
panoramic radiograph when pt chin is tipped upward

Waters view--->Maxillary sinus
 Bite wing------>Interproximally caries
 Periapical-

---->Periapical tissue&Periodontal disease
 Submentovertex--->Zygomatic
fracture
 Lateral Cephalometric--->Face growth
 Posterior-Anterior of skull---
>Skull vault
 Reveres Towns---->Condylar necks
 MRI------->TMJ
 CBCT-----
>Implant&Endo

Drug overdoses
 Diazepam treats Lidocaine overdose
 .Flumanzil treats

Diazepam overdose
 .Neostigmine treats cholinestrase inhibitors
overdose
 .Nalaxone treats opoid overdose
 .Milk & Calcium for fluoride
overdose
 .Antidotes for different drug overdose...1.Heparin- protamine
sulfate
 .TCA overdose- Physostigmine
 . Warfarin- Vit K
 .Opioids -
Naloxane/Naltrexone
 .Beta blocker- glucagon
 . Benzodiazepene- Flumazenil
 .
Theophylline- beta blocker
 . organohosphate poisoning- atropine,
pralidoxime
 .Acetaminophen- N acetylcysteine 
 .aspirin- Potassium salt and
sodium bicarbonate
 calcium sodium ( EDTA) -lead
poisng
 Dimercaprol,Penicillamine, edta-mercury poising

Types of studies:
 1)Case Series:study some clinical cases of jaw

necrosis.
 2)Cross Sectional:Interview All patients at the school for jaw necrosis
and use of biophosphate at one time.
 3)Case Control Study:Identify patients
with and without jaw necrosis,follow them for use of biophospate.
 4)Cohort
Study:Enroll all patients at the school and follow them for years to see who
develops jaw necrosis.

Important Diseases according to "Age":

*Fibrous Dysplasia---->Children
 *Paget's Disease------>Adults over

50
 *Aneursmal Bone Cyst---->Teenagers
 *Cherubism-----
>Children
 *Periapical Cemeno osseous Dsysplasia---->Middle aged black
women
 *Capillary Hemangioma---->1st week after Birth till 9 years
old
 *Cavernous Hemangioma---->Old Adults

Deterministic: dosage dependent, in deterministic there a limit only after it

reaches that limit effect will occur. It will increase with increase in dose.

Stochastic: it is not dose dependent any amount will cause effect

o UNBUNDLING: "the separating of a dental procedure into component parts

with each part having a charge so that the cumulative charge of the components
is greater than the total charge to patients who are not beneficiaries of a dental
benefit plan for the same procedure."

o BUNDLING "the systematic combining of distinct dental procedures by third-

party payers that results in a reduced benefit for the patient/beneficiary."

o UPCODING or overcoding: "reporting a more complex and/or higher cost

procedure than was actually performed."

o DOWNCODING: "a practice of third-party payers in which the benefit code has
been changed to a less complex and/or lower cost procedure than was reported
except where delineated in contract agreements."

In Epidemiology a confounder is: not part of the real association between

exposure and disease
 o predicts disease unequally distributed between
exposure groups
 o A researcher can only control a study or analysis for
confounders that are: known, measurable
 Example: Grey hair predicts heart
disease if it is put into a multiple regression model because it is unequally
distributed
 between people who do have heart disease (the elderly) and those
who don't (the young). Grey hair confounds thinking
 about heart disease
because it is not a cause of heart disease.
 Strategies to reduce confounding
are:
 o randomization (aim is random distribution of confounders between study
groups)
 o restriction (restrict entry to study of individuals with confounding
factors - risks bias in itself)
 o matching (of individuals or groups, aim for equal
distribution of confounders)
 o stratification (confounders are distributed evenly
within each stratum)
 o adjustment (usually distorted by choice of standard)
 o
multivariate analysis (only works if you can identify and measure the
confounders)

Primary Teeth :
 Largest : Mandibular 2nd Molar
 Smallest: Mandibular Lateral

incisor

Permanent tooth:
 Largest: Maxillary 2nd Molar
 Smallest: Mandibular Central

Inc

Pulpal and Periradicular/Periapical Conditions
 Pulpal Conditions:
 Normal Pulp -

A normal pulp is symptom free and will normally be responsive to the electric
pulp tester (EPT). When evaluated by thermal testing, the normal pulp produces
a positive response that is mild and subsides immediately when the stimulus is
removed.
 Reversible Pulpitis - Caries, cracks, restorative procedures or trauma
may cause a pulp to become inflamed. The patient’s chief complaint is usually of
an exaggerated response to thermal stimulus but once the stimulus is removed,
the discomfort does not linger. EPT results are responsive.
 Irreversible Pulpitis
- If the inflammatory process progresses, irreversible pulpitis can
develop. Patients may have a history of spontaneous pain and complain of an
exaggerated response to hot or cold that lingers after the stimulus is
removed. EPT results are usually responsive. The involved tooth will often
present with a history of an extensive restoration and/or caries.
 In certain cases
of irreversible pulpitis, the patient may arrive at the dental clinic sipping a glass of
ice water or applying ice to the affected area. In these cases, cold actually
alleviates the patient’s pain as the dental pulp has developed allodynia and is
hyperalgesic. Normal body temperature is now causing the nociceptors in the
pulp to discharge.10 Removal of the cold causes return of symptoms and can be
used as a diagnostic test.
 Irreversible pulpitis can also present as an
asymptomatic condition. Internal resorption and hyperplastic pulpitis (pulp polyp)
are examples of asymptomatic irreversible pulpitis.
 Pulpal Necrosis - Necrosis is
a histologic term that denotes death of the pulp. Teeth with total pulpal necrosis
are usually asymptomatic unless inflammation has progressed to the
periradicular tissues. The pulp will not respond to the EPT and if using a digital
EPT, this result should be reported as no response (NR) over 80. The pulp will
not respond to thermal tests. The dental record entry for this pulpal diagnosis
should be pulpal necrosis.
 Pulpless Tooth - A tooth from which the pulp has
been removed. For example, a tooth with previous pulpotomy/pulpectomy/root
canal debridement or previous root canal therapy should be recorded as a
pulpless tooth for the pulpal diagnosis.
 Previously Treated - A clinical diagnostic
category indicating that the tooth has been endodontically treated and the canals
are obturated with various filling materials, other that intracanal
medicaments.
 Previously Initiated Therapy - A clinical diagnostic category
indicating that the tooth has been previously treated by partial endodontic
therapy (e.g. pulpotomy, pulpectomy).
 Periradicular/Periapical
Conditions:
 Normal Periradicular Tissues - Normal periradicular tissues will be
non-sensitive to percussion and palpation testing. Radiographically, periradicular
tissues are normal with an intact lamina dura and a uniform periodontal ligament
(PDL) space.
 Acute Periradicular Periodontitis - Acute periradicular periodontitis
occurs when pulpal disease extends into the surrounding periradicular tissues
and causes inflammation. However, acute periradicular periodontitis may also
occur as the result of occlusal traumatism. The patient will generally complain of
discomfort to biting or chewing. Sensitivity to percussion is a hallmark diagnostic
test result of acute periradicular periodontitis. Palpation testing may or may not
produce a sensitive response. The PDL space may appear normal, widened, or
there may be a distinct radiolucency.
 Acute Periradicular Abscess - In this
situation, bacteria have progressed into the periradicular tissues and the patient’s
immune response cannot defend against the invasion. It is characterized by
rapid onset, spontaneous pain, pus formation, and often swelling of the
associated tissues. Depending upon the location of the apices of the tooth and
muscle attachments, a swelling will usually develop in the buccal vestibule, on
the lingual/palatal, or as a fascial space infection. Percussion testing produces a
response that is usually exquisitely sensitive. This exaggerated response can
help differentiate between acute periradicular periodontitis and the early stages
of acute periradicular abscess. Palpation testing produces a sensitive
response. Radiographically, the PDL space may be normal, slightly widened, or
demonstrate a distinct radiolucency. This periradicular pathosis can occur with a
necrotic pulp or a pulpless tooth that has been partially or definitely
endodontically treated if continued bacterial contamination and/or leakage
occurs.
 Chronic Periradicular Periodontitis - When bacteria or bacterial products
from a necrotic pulp or pulpless tooth slowly ingress into the periradicular tissues,
the patient’s immune system may become involved in a chronic conflict. The
resultant inflammatory process causes periradicular bone resorption that
manifests as a periradicular radiolucency on the radiograph. Clinically, the
patient is asymptomatic. Percussion and palpation testing produce non-sensitive
responses.
 Subacute Periradicular Periodontitis - The patient will present with
mild to moderate symptoms that may include spontaneous pain or discomfort on
biting or chewing. The tooth may present with any pulpal diagnosis. Percussion
testing produces a mild sensitive response and palpation testing may or may not
be sensitive. Clinical symptoms are not as severe as acute periradicular
periodontitis. Radiographically, the tooth will present anywhere from a normal
periradicular appearance to a distinct radiolucency. These patients must receive
endodontic treatment in a timely manner because the condition can quickly
progress into acute periradicular periodontitis or an acute periradicular
abscess.
 Chronic Periradicular Abscess - An inflammatory reaction to pulpal
infection and necrosis characterized by gradual onset, little or no discomfort and
intermittent discharge of pus through an associated sinus tract. Clinically, the
patient is usually asymptomatic because the sinus tract allows drainage of any
exudate from the periradicular tissues. EPT and thermal testing are non-
responsive. Percussion and palpation testing usually produce non-sensitive
responses. Radiographically, a periradicular lesion is associated with the
involved tooth. This entity can also occur with a pulpless tooth that has been
partially or definitely endodontically treated if continued bacterial contamination
and/or leakage occurs.
 Focal Sclerosing Osteomeylitis (condensing osteitis) -
This entity may be considered a true lesion of endodontic origin (LEO). The
involved tooth will have an etiologic factor for low-grade, chronic inflammation
such as a necrotic pulp, extensive restorative history or a crack. The patient may
be asymptomatic or demonstrate a wide range of pulpal symptoms. EPT and
thermal tests may or may not be responsive. Percussion and palpation testing
may or may not be sensitive. Radiographically, the involved tooth will present
with increased radiodensity and opacity around one or more of the
roots. Evidence supporting consideration as a LEO is that 85% of these
periradicular radiodensities resolve after endodontic therapy if they have a pulpal
diagnosis of irreversible pulpitis.
 Focal Osteopetrosis - This entity is not a
LEO. The patient will be asymptomatic. EPT and thermal testing are responsive
and normal. Percussion and palpation testing will typically be non-sensitive. The
involved tooth is usually a virgin tooth or has a normal pulp. Radiographically,
the tooth will present with increased radiodensity and opacity around one or more
of the roots. No treatment is necessary and the tooth should simply be
monitored at periodic recall.

Classification of benign fibro-osseous lesions of the craniofacial complex

I. Bone dysplasias
 a. Fibrous dysplasia
 i. Monostotic
 ii.

Polyostotic
 iii. Polyostotic with endocrinopathy (McCune-Albright)
 iv
Osteofibrous dysplasiaa
 b. Osteitis deformans
 c. Pagetoid heritable bone
dysplasias of childhood
 d. Segmental odontomaxillary dysplasia
 II.
Cemento-osseous dysplasias
 a. Focal cemento-osseous dysplasia
 b.
Florid cemento-osseous dysplasia
 III. Inflammatory/reactive processes
 a.
Focal sclerosing osteomyelitis
 b. Diffuse sclerosing osteomyelitis
 c.
Proliferative periostitis
 IV. Metabolic Disease: hyperparathyroidism
 V.
Neoplastic lesions (Ossifying fibromas)
 a. Ossifying fibroma NOS
 b.
Hyperparathyroidism jaw lesion syndrome
 c. Juvenile ossifying
fibroma
 i. Trabecular type
 ii. Psammomatoid type
 c. Gigantiform
cementomas

Immune granulomas can have a few different appearances, depending on their

cause. Here’s a summary:
 1. Tuberculosis. Granulomas in TB are sometimes
called tubercles. They are caseating, meaning they are ―cheesy‖ in gross
appearance. Histologically, there is a bunch of amorphous, granular, necrotic
debris in the center of the granuloma. You should see some acid-fast bacilli in
there too.
2. Leprosy. These granulomas are non-caseating, and an acid-fast stain should
reveal bacilli.

3. Syphilis. Granulomas in syphilis are called gummas; they have central

necrosis (but not really caseating, because you can still see cell outlines) and a
plasma cell infiltrate.

4. Cat-scratch disease. These granulomas may be stellate in appearance. They

contain neutrophils and some granular debris, but giant cells are rare.

5. Sarcoidosis. Granulomas in sarcoidosis are non-caseating, with a lot of

activated macrophages.

6. Crohn disease. Sometimes you see non-caseating granulomas in the intestinal

wall in patients with Crohn disease.

Age at which children develop dexterity and speech. (5 yrs speech 8 yrs
dexterity).

Skirt preparation in gold only - it is a surface extention feature for secondary

retention. the preparation is extended over to facial/lingual external wall of tooth
in cases of short axial walls or tilted teeth (there r few other indications as well).
the finish line over the external facial/lingual surafce extends at the mid third of
surface n doesnt extend all the way down as in crown preps.

iseally INR should be between 2 and 3.5
 it should not be higher than 4 and
lower than 3 before extractions which mat indicate or fuse bleeding
 for simple
extractions pt shoi=uld be lower than 4
 moderate bleeding, included and
impacted third molar surgeries or multiple extractions- it should be less than 3
 if
over 5 no surgical treatment

adult periodontitis-P.gingivalis
 ANUG-spirochetes
 juvinile periodontitis-A.A