Oral pain, erythematous gingival tissues, blunted papillae spontaneous gingival bleeding, and no attachment loss

 # A 19 year old patient presents with oral pain, erythematous gingival tissues, blunted papillae spontaneous gingival bleeding, and no attachment loss. There is also a pseudomembrane covering the gingiva. Which of the following is the diagnosis for this patient?

A. Plaque associated gingivitis

B. Necrotizing ulcerative gingivitis

C. Aggressive periodontitis

D. Chronic periodontitis

E. Necrotizing ulcerative periodontitis

The correct answer is B. Necrotozing ulcerative gingivitis.

Necrotizing ulcerative gingivitis and periodontitis usually occurs

because of the predominance of the anaerobic fusobacteria and

spirochetes within the oral cavity, specifically underneath the gingiva.

This is a case of Necrotizing ulcerative gingivitis (NUG) NOT

necrotizing ulcerative periodontitis (NUP) because the patient is not

experiencing bone loss.

Debridement of the affected gingiva with an adjunctive prescription

of chlorhexidine 0.12 % rise will help stop the progression of

necrotizing ulcerative disease.

Acute necrotizing gingivitis signs/ symptoms:

1. Pain
2. Interproximal necrosis of the papilla (Blunting of papilla)
3. Bleeding gingiva
4. Fetid odor
5. Low-grade fever
6. Pseudomembrane

Acute necrotizing gingivitis risk factors:

1. Poor oral hygiene
2. Smoking
3. Malnutrition
4. Fatigue
5. Stress
6. Immunocompromised patients

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Strongest indication for splinting

 # Which of the following patient conditions is the strongest indication for splinting?

A. Mobility with a unilateral shift from centric relation to centric occlusion

B. Mobility with discomfort

C. Presence of diastemas

D. Primary occlusal trauma

The correct answer is B. Mobility with discomfort.

Unstable teeth that cannot maintain normal position during centric occlusion need additional support to maintain position and therefore must be splinted to the adjacent teeth.

Presence of a diastema does not necessarily require splinting except when the diastema is caused by the movement of teeth due a periodontally compromised status.

Primary occlusal trauma can be resolved once the cause of trauma

is removed.

Discomfort associated with tooth mobility may:

• Be due to other periodontal conditions

• Be due to pulpal conditions

• NOT be a direct indication alone for splinting therapy

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Peace Dental Care Pvt. Ltd., Bharatpur -10, Chitwan

 Name of Dental Clinic: Peace Dental Care Pvt. Ltd.

Address: Bharatpur-10, Hospital Road, Chitwan

Year of Establishment: 2076

Name of the chief Dental Surgeon: Dr. Binaya Subedi

CONTACT NUMBER: 056593325

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Baishdhara Dental Clinic, Balaju, Kathmandu

 Name of Dental Clinic: Baishdhara Dental Clinic

Address : Near Tarun Ma Vi, Balaju, Kathmandu, Nepal

Year of Establishment: 2021

Name of the chief Dental Surgeon: Dr Bishwo Prachanda Sedhain

CONTACT NUMBER: 9851157949

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Interruption of transmission of disease is called:

 # Interruption of transmission of disease is called:

A. Disease control 

B. Disease eradication

C. Disease elimination

D. Disability limitation

The correct answer is C. Disease elimination.

Concept of Control

A. Disease control : The term 'disease control' describes (ongoing) operations aimed at reducing incidence, duration, decrease effects of disease, etc. Control activities may focus on primary prevention or secondary prevention. The concept of tertiary prevention is comparatively less relevant to control efforts. In disease control, the disease agent is permitted to persist in the community at a level where it ceases to be a public health problem according to the tolerance level of local population.

B. Disease elimination: Between control and eradication, an intermediate goal has been described, called 'regional elimination'. The term elimination is used to describe interruption of transmission of disease, eg. elimination of measles, polio and diphtheria from large geographic region or areas. Regional elimination is now seen as an important precursor of eradication.

C. Disease eradication: Eradication literally means to 'tear out by roots'. It is the termination of all transmission of infection by extermination of the infectious agent through surveillance and containment. As the name implies, eradication is an absolute process, and not a relative goal. It is an all or none phenomenon. 

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Phases of Public Health - Concept of risk factor

 # The new concept of risk factor came into existence during which phase?

A. Disease control phase

B. Health promotional phase

C. Social engineering phase

D. Health for all phase

The correct answer is C. Social engineering phase.

Four phases of public health have been recognized:

A. Phase one: Disease Control Phase (1880-1920)

The 19th century Public Health- matter of sanitary legislation and sanitary reform, safe water supply and waste disposal. 

B. Phase Two: Health promotional phase (1920-1960)

At the beginning of the 20th century, the concept of health promotion emerged. As a result, in addition to disease control activities, one more goal was initiated. e.g. Maternal and child health, School health, mental health, occupational health and rehabilitation services.

C. Phase Three: Social Engineering phase (1960-1980)

Chronic conditions such as cancer, Diabetes mellitus (DM), cardiovascular diseases (CVD), and alcoholism, drug addiction occurred. These chronic health problems could not be tackled by the traditional approaches to public health i.e. isolation, immunization, and disinfection) nor they can be explained on the basis of germ theory (biomedical) of disease. The concept of risk factors (social, environmental, genetic and lifestyle) came into action as determinants of disease. 

D. Phase four: Health for all phase (1980-2000)

Primary Health care, Health for all (HFA)- Health for all meant that every individual should have access to Primary Health Care 

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Bhatbhateni Dental Care Pvt. Ltd., Thirbum Sadak, Bhatbhateni, Naxal

 Name of Dental Clinic: Bhatbhateni Dental Care Pvt. Ltd.

Address: Thirbum Sadak, Bhatbhateni, Naxal

Year of Establishment: 2017

Name of the chief Dental Surgeon: Dr. Sanjay Kumar Tiwari 

CONTACT NUMBER: 9863028098 

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Dent Inn the Dental Clinic, Sherpa Mall, Third Floor, Durbar Marg, Kathmandu

 Name of Dental Clinic: Dent Inn the Dental Clinic

Address: Sherpa Mall, Third Floor, Durbar Marg, Kathmandu

Year of Establishment: 2006

Name of the chief Dental Surgeon: Dr. Rima Shrestha 

CONTACT NUMBER: 9843050990

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King's Dental Care Centre Pvt. Ltd, Bharatpur, Chitwan

 Name of Dental Clinic: King's Dental Care Centre Pvt. Ltd

Address: Bharatpur-9 central bus terminal, Chitwan

Year of Establishment: 2074 BS

Name of the chief Dental Surgeon: Dr.  Avishek Adhikari Sharma

CONTACT NUMBER: 056595401, 9845150787

NMC Number of Dental Surgeon: 22608

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Quality smile dental care, Lagankhel (opposite patan hospital)

 Name of Dental Clinic: Quality smile dental care

Address: Lagankhel (opposite patan hospital)

Year of Establishment: 2077

Name of the chief Dental Surgeon: Dr Rabin Gyawali

CONTACT NUMBER: 9851310253

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Mandala Dental Clinic, Kanti Marg, Basundhara Chowki, Kathmandu

 Name of Dental Clinic: Mandala Dental Clinic

Address: Kanti Marg, Basundhara Chowki, Kathmandu 

Year of Establishment: 2021

Name of the chief Dental Surgeon: Dr Sabin Paudel

CONTACT NUMBER: 9849717709

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ARS Dental Clinic, Lokanthali Bhaktapur, Lazimpat, Kathmandu

 Name of Dental Clinic: ARS Dental Clinic

Address: Lokanthali, Bhaktapur and Lazimpat, Kathmandu

Year of Establishment: 2015

Name of the chief Dental Surgeon: Dr. Shyam K. Maharjan 

CONTACT NUMBER: 9851039240 

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Smerata Dental Care, Ratnanagar-2, Chitwan

 Name of Dental Clinic: Smerata Dental Care

Address : Tandi chowk,  Ratnanagar-2, Chitwan

Year of Establishment: 2076

Name of the chief Dental Surgeon: Dr Anjula Thapa

CONTACT NUMBER: 9855085545

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SWASTIK DENTAL CARE AND IMPLANT CENTRE, Biratnagar

 Name of Dental Clinic: SWASTIK DENTAL CARE AND IMPLANT CENTRE

Address: Rani path, Roadcess chowk, Biratnagar-12

Year of Establishment: 2021

Name of the chief Dental Surgeon: Dr. Aditya Shah

CONTACT NUMBER: 9803050871

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First person to define public health

# Who was the first person to define public health?

A. Rutherford

B. Winslow

C. Freud

D. Erikeson

The correct answer is B. Winslow.

Winslow (1920): 'Public Health' is the art and science of preventing disease.

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Dhulikhel Dental Care, Dhulikhel

 Name of Dental Clinic: Dhulikhel Dental Care

Address: Dhulikhel bus station, next to Century commercial bank

Year of Establishment: 2019

Name of the chief Dental Surgeon: Amir Hamal

CONTACT NUMBER: 9851172359

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Family dental home pvt. Ltd., Lagankhel, Lalitpur

 Name of Dental Clinic: Family dental home pvt. Ltd.

Address: Lagankhel buspark, lalitpur (near everest bank)

Year of Establishment: 2075/76

Name of the chief Dental Surgeon: DR. BIJAY TAJA

CONTACT NUMBER: 9849688648

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Attachment loss and probing depth

 # A patient has a 5 mm probing depth on the distal of their maxillary second premolar, 2 mm of recession was also charted in that area. What is the attachment loss in that area?

A. 7 mm

B. 10 mm

C. 5 mm

D. 3 mm

The correct answer is A. 7 mm.

Periodontal health is assessed by determining how much attachment a tooth has lost. A healthy periodontium demonstrates a sulcular depth of 1-3 mm.

Recession is the distance from the CEJ to the marginal gingiva.

Probing depth is the distance betweeen the marginal gingiva and the floor of sulcus. 

Loss of attachment is measured as the distance of CEJ from the sulcular depth. 

So, Loss of Attachment (LOA) = Recession+Probing depth

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A mature dental plaque is formed after:

 # How many hours after mechanical debridement with a toothbrush is a mature dental plaque found?

A. 24-48 hours

B. 3-5 hours

C. 6-10 hours

D. 12-24 hours

E. 1-2 hours

The correct answer is A. 24-48 hours.

Mature dental plaque is usually formed on the teeth within 24-48 hours after plaque removal.

The bacterial biofilm first attach to the tooth via a pellicle, consisting of glycoproteins.

The first bacteria to attach to the pellicle glycoproteins are gram positive aerobic cocci such as Streptococcus sanguinis. 

After 24 hours, anaerobic gram negative cocci, rods, and filaments begin to colonize the plaque. 

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Artery supplying the buccal flap in an oroantral communication associated with maxillary third molar

 # A buccal flap used to cover an oroantral communication associated with maxillary third molar would receive nourishment from which of the following arteries?

A. Posterior superior alveolar

B. Nasopalatine

C. Greater palatine

D. Facial

The correct answer is A. Posterior superior alveolar.

The buccal flap will receive its nourishment from the blood vessel that supplies the maxillary third molar, which is the posterior superior alveolar artery.

Posterior superior alveolar artery is the blood vessel that provides blood supply to the lining of maxillary sinus, the alveolar bone, the molars and premolars of the maxilla and the gingiva.

Facial artery branches out and supplies blood to several parts of the face which includes the lips, portions of the nose, submental area and some portions of the tonsils.

Nasopalatine artery (sphenopalatine artery) branches off to the walls of nasal septum.

Greater palatine artery gives off blood supply to the nasal septum and the hard palate.

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Classification of Malocclusion

# In Angle's classification for malocclusion, the key tooth is:
A. Mesiobuccal cusp of permanent maxillary forst molar
B. Distobuccal cusp of permanent maxillary first molar
C. Mesiobuccal cusp of permanent maxillary second molar
D. Mesiobuccal cusp of permanent mandibular first molar

# Andrew's 5th Key of occlusion is:
A. Curve of Spee
B. Rotation absent
C. Tight contact
D. Bolton's ratio

# Zygoma or Key ridge corresponds to:
A. Mesiobuccal root of upper first molar
B. Mesiobuccal root of upper second molar
C. Distobuccal cusp of upper first molar
D. Distobuccal cusp of second molar

  

# Angles line of occlusion are seen in which plane?
A. Sagittal
B. Vertical
C. Transverse
D. Transverse and vertical

# When Angle's classification system is used then displacement occurs in which direction?
A. Vertical
B. Transverse
C. Sagittal
D. Sagittal and transverse

# The following features are noted in a patient. The mesiobuccal cusp of right upper first molar is aligning in the mesiobuccal groove of right lower first molar. The distobuccal cusp of left upper first molar is aligning in the mesiobuccal groove of left lower first molar. The upper incisors are retroclined. You would like to classify it as:
A. Angle's class I div I subdivision
B. Angle's class II div I subdivision
C. Angle's class II div II subdivision
D. Angle's class III div I subdivision

# A patient is having edge to edge or end on relation of first molar in permanent dentition with retroclination of incisors. The malocclusion according to Angle's classification is:
A. Class I
B. Class II Div I
C. Class II Div II
D. Class III

# Anterior crossbites according to Dewey are classified in Angle's class I as:
A. Type I
B. Type II
C. Type III
D. Type IV

# Who has classified malocclusion based on etiology?
A. Angle
B. Lischer
C. Benett
D. Dewey

# Classification for skeletal malocclusion was given by:
A. Kartz
B. Salzman
C. Angle
D. Kingsley

# Transposition of teeth refers to:
A. Buccorotation of 120 degrees
B. Hypodontia
C. Teeth erupted in unusual position
D. Inverted supernumerary teeth

# Transposition of teeth is most commonly seen in the region of:
A. Maxillary central and lateral incisors
B. Mandibular canine and first premolar
C. Maxillary lateral incisor, canine and premolar
D. Mandibular first and second premolars

# The term torsiversion refers to the:
A. Impaction of the maxillary canines
B. Interchange of position of teeth
C. Rotation of teeth in their long axis
D. None of the above

# Postnormal occlusion is:
A. Class I with anterior crowding
B. Class II malocclusion
C. Class III malocclusion
D. Bimaxillary protrusion

# If the tooth has not erupted to the line of occlusion, it is called:
A. Supraversion
B. Torsiversion
C. Rotated
D. Infraversion

# The skeletal classification of malocclusion is given by:
A. Calvin Case
B. Martin Dewey
C. Paul Simon
D. Edward H. Angle

# If maxillary canines are placed forward to orbital plane, they are said to be in:
A. Protraction
B. Retraction
C. Abstraction
D. Contraction

# Which of the following system of classification gives a complete picture of malocclusion in a patient?
A. Simon
B. Ackerman
C. Dewey
D. Angle

# In Ackerman-Profitt classification, outer envelope represents:
A. Alignment
B. Profile
C. Transverse relation
D. Vertical relation

# In classifying molar relation in patient with premature loss of molar, additional relation to be noted is:
A. Incisor relation
B. Canine relation
C. Midline relation
D. Premolar relation

# Canine class I relation is:
A. Distal inclines of lower cuspid contact with mesial inclines of upper cuspid
B. Distal inclines of lower cuspid in line with distal inclines of upper cuspid
C. Mesial inclines of lower cuspid in contact with distal inclines of upper cuspid
D. Mesial inclines of lower cuspid in line with mesial inclines of upper cuspid

# Katz classification is based on:
A. Incisor
B. Canine
C. Premolar
D. Molar

# A bimax protrusion is:
A. Splitting and protrusion of maxilla into two halves
B. Forward placed upper and lower dental arches on normal skeletal bases
C. Forward placed upper dental arch and skeletal base
D. Forward placed lower dental arch and skeletal base

# The term surtrusion refers to the:
A. Backward movement of the condyle
B. Downward movement of the centric position
C. Lateral movement away from the midline
D. Upward movement of the working condyle as it moves away

Pioneer in the treatment of cleft palate

# Who among the following is named as the pioneer in the treatment of cleft palate and related problems?

A. Norman Kingsley

B. Edward H. Angle

C. Graber

D. Nance

The correct answer is A. Norman Kingsley.

Kingsley, was among the first to use extraoral force to correct protruding teeth. He was also a pioneer in the treatment of cleft palate and related problems. 

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First Orthodontic Appliance was developed by:

 # Who among the following developed the first orthodontic appliance?

A. Pierre Fauchard

B. Norman Kingsley

C. Emerson C. Angell

D. Edward H. Angle

The correct answer is A. Pierre Fauchard.

Orthodontics truly began developing in the 18th and 19th centuries. In 1728, French dentist Pierre Fauchard, who is often credited with inventing modern orthodontics, published a book entitled "The Surgeon Dentist" on methods of straightening teeth. Fauchard, in his practice, used a device called a "Bandeau", a horseshoe-shaped piece of iron that helped expand the palate. In 1754, another French dentist, Louis Bourdet, dentist to the King of France, followed Fauchard's book with The Dentist's Art, which also dedicated a chapter to tooth alignment and application. He perfected the "Bandeau" and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and to improve jaw growth.

Pierre Fauchard, 'Father of modern dentistry', as early as 1723, developed first orthodontic appliance.

Norman Kingsley, the first to use extraoral force on teeth. He is also considered to be the first person to use orthopedic force to correct protruding teeth.

Bunon- first to use the term 'orthopedic appliances'

Emerson C. Angell - founder of 'rapid maxillary expansion'

William E. Magill - First person to band teeth for active tooth movement. 

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Jackson's Triad in Orthodontics

 # Which of the following is a component of Jackson’s triad?

A. Functional efficiency

B. Structural balance

C. Aesthetic harmony

D. All of the above

The correct answer is D. All of the above.

The aims and objectives of orthodontic treatment have been summarized by Jackson as the 'Jackson's triad'. The three main objectives of orthodontic treatment are:

- Functional efficiency

- Structural balance

- Aesthetic harmony

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# The term ‘Orthodontics’ was coined by:

 # The term ‘Orthodontics’ was coined by:

A. Le Foulon

B. Hunter

C. Carabelli

D. Norman Kingsley

The correct answer is A. Le Foulon.

The term orthodontics was apparently used first by the Frenchman Le Foulon in 1839.

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The occipital condyle is represented by the following cephalometric point:

 # The occipital condyle is represented by the following cephalometric point:

A. Bolton’s point

B. Broadbent registration point

C. Basion

D. Articulare

The correct answer is A. Bolton's point.

Bolton's point: The highest point at the post-condylar notch of occipital bone

Few other cephalometric landmarks are:

1. Glabella: It is the most prominent point on the forehead in the mid-sagittal plane.

2. Nasion: The most anterior point midway between the frontal and nasal bone on the frontonasal suture.

3. Orbitale: The lowest point on the inferior bony margin of the orbit.

4. Porion: The highest bony point on the upper margin of external auditory meatus.

5. Sella: This point represents the mid point of the pituitary fossa or sella-turcica.

6. Basion: It is median point of the anterior margin of the foramen magnum

7. Anterior nasal spine: It is the anterior tip of the sharp bony process of the maxilla in the midline of the lower margin of anterior nasal spine.

8. Point A: It is a deepest point in the midline between the anterior nasal spine and alveolar crest between the two central incisors. It is also called as " subspinale".

9. Prosthion: The lowest and the most anterior point on the alveolar bone in the midline between the upper central incisors. It is also called as " supradentale".

.

10. The key ridge: The lower most point on the contour of anterior wall of the infra-temporal fossa.

11. Posterior nasal spine: The intersection of a continuation of the the anterior wall of the pterygopalatine fossa and the floor of the nose, marking the distal limit of the maxilla.

12. Broadbent registration point: It is the midpoint of the perpendicular from the centre of the sella turcica to the Bolton point. 

.

13 PTM point: It is the intersection of the inferior border of foramen rotundum with posterior wall of the pterygo maxillary fissure.

14. Chelion: It is the lateral terminus of the oral slit on the slit on the outer corner of the mouth.

15. Subnasal: The point where the lowest border of the nose meets the outer contour of the upper lip. 

16. Point B: It is the deepest point in the midline between the alveolar crest of mandible and the mental process. Also called as " submentale".

17. Gonion: It is a constructed point at the junction of ramal plane and the mandibular plane.

18. Pogonion: It is the most anterior point of the bony chin in the median plane.

19. Menton: It is the most inferior midline point on the mandibular symphysis.

20. Gnathion: It is the most antero-inferior point on the symphysis of the chin. It is constructed on the symphysis of the chin, by intersecting a line drawn perpendicular to the line connecting menton and pogonion.

21. Articulare: It is a point at the junction of the posterior border of ramus and the inferior border of the basilar part of the occipital bone.

22. Condylion: The most superior point on the head of the condyles.

23. Infradentale: The highest and the most anterior point on the alveolar process, in the median plane between the mandibular incisors.

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Termination of skeletal maturity - Indicator

 # Which of the following bone indicates the termination of skeletal maturity?

A. Presence of Sesamoid

B. Appearance of pisiformis

C. Appearance of calcification of hook of hamate

D. Union of diaphysis and epiphysis on radius

The correct answer is D. Union of diaphysis and epiphysis on radius.

Some other important tips:

 * Absence of hamate and pisiform - Still 1 year for prepubertal growth spurt

* Presence of hamular process of the hamate, pisiform and sesamoid- Beginning of  growth spurt

* Initial ossification of  sesamoid - Peak pubertal growth spurt

* The epiphysis and diaphysis fusion/ ossification of sesamoid completed - Prepubertal growth spurt completed

* The epiphysis and diaphysis fusion on radius and ulna- Active growth completed

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