Al-Assaf NOTES (PART 5), 5 December 2021

1. Which material should be used carefully:

• Formocresol - MTA – CaOH

•
• McDonald pediatric dentistry

2. Material used for vital tooth bleaching is: (NOTE: Frequent MCQs about bleaching material & techniques)
• 10% carbamide peroxide
• 15% carbamide peroxide
• Nonvital Bleaching Procedures
i. In-Office Nonvital Bleaching Technique
1. Thermo-catalytic technique:
a. 35% hydrogen peroxide liquid into the debrided pulp chamber and
acceleration of the oxidation process by placement of a heating instrument
into the pulp chamber.
b. Not recommended because of the potential for cervical resorption.
2. Preferred in-office technique for bleaching nonvital teeth:
a. 30% to 35% hydrogen peroxide pastes or gels that require no heat.
b. This technique is frequently the preferred in-office technique for bleaching
nonvital teeth.
ii. Walking Bleach Technique
1. The dentist removes gutta-percha (to approximately 1-2 mm apical of the clinical
crown) and enlarges the endodontic access opening sufficiently to ensure complete
debridement of the pulp chamber.
2. Next, the dentist places a resin-modified glass-ionomer liner to seal the gutta-percha
of the root canal filling from the coronal portion of the pulp chamber.
3. Sodium perborate is used with this technique because it is deemed extremely safe.
4. A cotton pellet to blot the mixture and places a temporary sealing material.
5. The area should remain isolated for approximately 5 minutes after closure to
evaluate the adequacy of the seal of the temporary restoration. If bubbles appear
around the margins of the temporary material indicating leakage, the temporary
restoration must be replaced.
6. The sodium perborate should be changed weekly.

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

• Vital Bleaching Procedures

i. In-Office Vital Bleaching Technique:
1. Most commonly contain 30% to 35% hydrogen peroxide.
2. Addition of light during the bleaching procedure does not improve the whitening
result beyond what the bleach alone can achieve.
3. A nonsteroidal analgesic and anti-inflammatory drug may be administered if
sensitivity is anticipated.
4. Bleaching treatments generally are rendered weekly for two to six treatments, with
each treatment lasting 30 to 45 minutes.
5. There is no need to polish the teeth after treatment.
6. It is not essential to provide a fluoride treatment.
7. Advantages:
a. Totally under the dentist’s control,
b. The soft tissue is generally protected from the process,
c. Potential for bleaching teeth more rapidly.
8. Disadvantages:
a. Primarily relate to the cost,
b. Unpredictable outcome,
c. Unknown duration of the treatment.
ii. Dentist-Prescribed, Home-Applied Technique:
1. 10-15% carbamide peroxide
2. The advantages are:
a. The use of a lower concentration of peroxide
b. The ease of application,
c. Minimal side effects,
d. Lower cost because of the reduced chair time required for treatment.
3. The disadvantages are
a. Reliance on patient compliance,
b. Longer treatment time,
c. Potential for soft tissue changes with excessively extended use
• Sturdevant’s Art and Science of Operative Dentistry

3. When to use prophylactic antibiotic

• Prosthetic heart valve

•
• Dental Management of the Medically Compromised Patient

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

4. A 3-year-old patient came to the clinic, you examined the patient and apply fluoride, then at the end of
the appointment the patient vomited, what should you do to prevent this in the next visit?
• Advise to drink milk
• Monitor the vital sign for 24 h
• NOTE: could not clear answer in textbooks, but generally it is recommended to use suction and
keeping patient in upright position.

•
• McDonald and Avery's Dentistry for the Child and Adolescent

5. The definition of metamerism

•
• Contemporary Fixed Prosthodontics

6. 4 years old patient lower anterior tooth is large, the tooth has 2 pulp chamber and 2 pulp canals:
• Fusion - Gemination
• Gemination is defined as a single enlarged tooth or joined (i.e., double) tooth in which the tooth
count is normal when the anomalous tooth is counted as one.
• Fusion is defined as a single enlarged tooth or joined (i.e., double) tooth in which the tooth count
reveals a missing tooth when the anomalous tooth is counted as one.
• Concrescence is union of two adjacent teeth by cementum alone, without confluence of the
underlying dentin.

•
• To diffrentiate, count the teeth and take a radiograph.
• Neville Maxillofacial Pathology

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

7. Patient extracted tooth #25, patient is highly concerned about esthetics, what is the appropriate pontic?
• Ovate pontic

•
Sanitary pontic & Modified Sanitary pontic

• Contemporary Fixed Prosthodontics

8. HIV positive patient came you in the clinic, what investigation to ask for?
• CD4 count

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

• Diagnosis of HIV:
i. The enzyme-linked immunosorbent assay (ELISA) is the screening test for identification of
antibodies to HIV. It is 90% sensitive but has a high rate of false-positive results.
ii. If the results are positive, a second ELISA is performed. All positive results are then
confirmed with Western blot analysis.
• Management:
i. Both ART (Anti-Retroviral Therapy) and HAART (Highly Active Anti-Retroviral Therapy)
involve use of combinations of antiretroviral drugs; however, strictly speaking, HAART is
defined as the use of at least three active antiretroviral medications.

ii.

iii.

iv.
9. Vomit on floor and the nurse wipe it where to throw:
• Contaminated waste – hazardous waste

•
• Basic Guide to Infection Prevention and Control in Dentistry

10. Location of chemical indicator in the pouch?

• Chemical indicator strips inserted within sterilization pouches,
which are used to confirm that the pouch has been through a
sterilization cycle. They help to differentiate between
processed and unprocessed items, eliminating the possibility
of using instruments that have not been sterilized.

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

11. Patient with edentulous upper arch & with Kennedy class II lower arch, type of occlusion?
• Principles of Occlusal Contact Relationships for RPDs:
i. In centric occlusion: Simultaneous bilateral contacts of opposing posterior teeth.
ii. In eccentric:
1. Tooth-supported RPDs: arranged similar to occlusion seen in a natural.
2. Maxillary complete denture opposes RPD: Bilateral balanced occlusion.
3. Bilateral distal extension mandibular RPD opposed by natural: Working contacts.
4. Opposing Class I partially edentulous arches: working and balancing contacts.
5. Unilateral distal extension RPD (upper or lower): working contacts
iii. In Kennedy Class IV: contact of opposing anterior teeth in inter-cuspal position.
• McCracken's Removable Partial Prosthodontics
12. Digoxin drug interaction with?
• Epinephrine and Macrolide antibiotics (erythromycin, clarithromycin, azithromycin).

•
13. Maximum epinephrine dose for cardiac patient?
• 0.04 milliliters
• For healthy -> 200 micro-ml -> 0.2ml

•
• Handbook of Local Anesthesia by Stanley F. Malamed
14. Interincisal angel decreased and increased when?
• Increased in class II division 2
• Decreased in class II division 2
• Average value = 135 degree

•
• An Introduction to Orthodontics
15. Frankfort horizontal plane?
• Frankfort Horizontal Plane (in red). The Frankfort Plane is
actually measured on a lateral cephalogram (between porion
and orbital) but can be estimated clinically by palpation of the
lower border of the orbit.
• Camper’s line: ala-tragus line.

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

16. Cause of maxillary cross bite?

• Local causes:
i. Most common local cause is crowding where one or two teeth are displaced from the arch.
ii. Retention of a primary tooth can deflect the eruption of the permanent successor.
• Skeletal:
i. Generally, the greater the number of teeth in crossbite, the greater is the skeletal
component of the aetiology.
ii. Buccal crossbites are associated with Class III malocclusions.
iii. Lingual crossbites are associated with Class II malocclusions.
iv. Anterior crossbites are associated with Class III skeletal patterns.
• An Introduction to Orthodontics
17. Many Endodontic diagnosis?

• Endodontics PRINCIPLES AND PRACTICE

18. Ethics definitions:
• Autonomy: (mentioned in previous parts).
• Paternalism: (mentioned in previous parts).
• Consent: Consent is a decision of a competent patient to accept the medical procedures proposed.
The patient has the right to refuse the proposed treatment. Both consent and refusal must be
informed, i.e., based on full disclosure of the details of the proposed treatment, including its benefits
and risks.
• Professionalism and Ethics Handbook for Residents

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

19. Dentist convinced the patient to place amalgam rather than composite. Dentist violate which principle?
• Autonomy or Non-maleficence
20. Epoxy resin working time:
• 4 hours.
• Additional important INFO:
• AH-26: slow setting epoxy resin that was found to release formaldehyde when setting.
• AH Plus: modified formulation of AH-26 in which formaldehyde is not released & it exhibits a
working time of approximately 4 hours.

•
• Cohen's Pathways of the Pulp Expert Consult
21. Minimum time to pour alginate impression?
• Should be poured immediately, withing 10 minutes and maximum 1 hour.

•
• Textbook of Complete Dentures, 6th Edition

• NOTE: Disinfection technique.

•
• McCracken's Removable Partial Prosthodontics

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

22. Extraction of third molar have risk of injury to which nerve?

• Both lingual nerve or IAN could be injured during extraction of lower 3rd molar BUT:
i. Lingual nerve due to improper flap design.
ii. IAN due to improper extraction technique.

•
• Contemporary Oral and Maxillofacial Surgery
23. Radio-opacity in the anterior region of the maxilla?
• Mesiodens

•
• Oral Radiology, Principles and Interpretation
24. Patient with complete denture, has compromised occlusal relation and poor fitted denture, what to do?
• Reline, rebase, or fabricate new denture?

•
• When problem is with the fitting surface of the denture, Reline.
• If problem in denture base such porosity, crazing, staining, Rebase.
• Whenever there is a problem in denture teeth, New denture.
• Textbook of Complete Dentures, 6th Edition
25. If both upper and lower dentures require relining, which one should be done first?

•
• Textbook of Complete Dentures, 6th Edition
26. Mesiodistal distance is 7 mm. What is the minimum implant size can be placed?
• 4 mm implant diameter.
• A very helpful picture demonstrating this type of question was mentioned in previous parts
27. Implant restoring missing tooth #34 has risk of injury of which nerve?
• Mental nerve.
• Critical measurements specific to implant placement include the following:
i. At least 1 mm inferior to the floor of the maxillary and nasal sinuses
ii. Incisive canal (maxillary midline implant placement) to be avoided
iii. 5 mm anterior to the mental foramen
iv. 2 mm superior to the mandibular canal
v. 3 mm from adjacent implants
vi. 1.5 mm from roots of adjacent teeth
• Carranza’s Clinical Periodontology

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

28. Child with superficial injury in the tongue and well controlled bleeding what is the management?
• Repair in 1 layer - repair in 2 layers - leave it to heal with secondary intention

•
• Contemporary Oral and Maxillofacial Surgery

29. Patient with severe pain in lower molar did RCT. Cause of Post operative pain is related to:
• Tooth location, patient age or gender

•
• Endodontics: principles and practice
30. Severely autistic patient came with his nurse, & you need consent for surgery. You will get consent from?
• Patient, Nurse, Parent
• NO IDEA if it is the correct answer.

•
• McDonald and Avery's Dentistry for the Child and Adolescent
31. Most effective fluoride?
• Systemic water fluoridation

•
• McDonald and Avery's Dentistry for the Child and Adolescent
32. Which is resorbable root canal sealer?
• ZnOE – MTA – CaOH – AH2

•
• Endodontics: principles and practice

NOTES By: Moath Al-assaf Twitter: @mo3ath44

 Al-Assaf NOTES (PART 5), 5 December 2021

33. Which of the following is a manifestation of chronic fluoride toxicity?

• Dental fluorosis

•
• McDonald and Avery's Dentistry for the Child and Adolescent

•
• Pediatric Dentistry - Infancy Through Adolescence

NOTES By: Moath Al-assaf Twitter: @mo3ath44