Interesting / most difficult / most frightening / most challenging / unforgettable/ potentially fatal

Every dentist examines a number of  patients each day and gains more and more the clinical skills required for diagnosis and gains insight to distinguish between the conditions that appear very similar to each other clinically and are confusing to a neophyte in the field of dentistry.

You must have heard the saying "The eyes only see what the head knows" as a student which is true indeed. A good knowledge of the condition, its manifestations, signs and symptoms are vital to make a differential diagnosis pointing towards the correct direction. Even the general public these days believe that  older the doctor, the lesser the lab investigations he needs and demands before making a diagnosis. What are your opinions about that ?

Please Share your interesting / most difficult / most frightening / most challenging / unforgettable/ potentially fatal cases you've managed so far and share your feelings during the procedure, after completing it, and the lessons you learnt. You can share as many as you like. Have a nice time. Thank You !!!

Types of Dentitions

TYPES OF DENTITIONS

Monophyodont	Presence of only one set of dentition for entire life.
Diphyodont	• Presence of two sets of dentition  • Human beings are diphyodonts
Polyphyodont	Presence of more than two sets of dentition.
Homodont	All the teeth have same shape without distinction such as incisors, canines, premolars and molars.
Heterodont	Presence of different groups of teeth.
Bunodont	• Primitive type of teeth seen in primates like cats, dogs, etc.  • Contains simple conical cusps.
Haplodont	• Seen in reptiles like crocodiles.  • Simplest cone form of teeth with single root. • Only simple hinge movements of jaws are seen.
Triconodont	• Seen in early mammals.  • Three cusps are arranged in line with the largest cusp in the center.
Tritubercular stage	• Three cusps are arranged in triangle form.
Quadritubercular stage	• 4th cusp is formed and an occlusal contact relationship between the upper and lower  jaws is established.

Except molars, all the permanent teeth (incisors, canines and premolars) are known as succedaneous teeth because they take the place of their primary predecessors.

MCQs in Fixed Partial Dentures - Principles of Tooth Preparation

# The average root surface area of maxillary first molar is (in mm2):
A. 133
B. 233
C. 333
D. 433

# The average root surface area (mm2) of the maxillary second premolar is:
A. 234
B. 220
C. 273
D. 204

MCQs on Preventive and Interceptive Orthodontics - Orthodontics MCQs

# Space maintainers are usually needed in the:
A. Mandibular primary incisor teeth area
B. Mandibular primary canine teeth area
C. Mandibular primary second molar area
D. Maxillary primary incisor area

# The term space maintenance refers to:
A. the preservation of space for a permanent tooth in a child's mouth
B. the preservation of total arch length or of all the permanent teeth in the arch in a child's mouth
C. the preservation of mesial drift after the loss of a tooth
D. none of the above

Head and Neck Cancer : Risk Factors and Prevention

Due  to  widespread  screening services  more and more cases of the dreadful cancer are being recorded. Cancer represents Australia’s greatest disease burden, ahead of cardiovascular disease. Cancer is a disease associated with ageing. With the number of people aged over 65 years set to double by 2051, cancer incidence is projected to continue rising. (Ref : 1)

Current evidence indicates that approximately one-third of cancer deaths in Australia can be attributed to known and avoidable risk factors. Appropriate prevention strategies have the potential to reduce cancer incidence.

MCQs in Endodontics - Disinfection and Obturation

# Obturation of a root canal should achieve:
A. Tug back
B. Hermetic seal
C. Fluid free seal
D. All of the above

# The purpose of a root canal sealer is to:
A. seal the tubules of the dentine
B. stimulate healing in periapical region
C. prevent discoloration
D. fill the space between solid core material and pulp canal walls

MCQs in Endodontics - Diseases of the Pulp and Periradicular Tissues

# The treatment of acute periapical abscess is:
A. Endodontic therapy or extraction
B. Incision and drainage only
C. Pulp capping
D. None of the above

# Internal resorption in a tooth is seen as:
A. Ca(OH)2 pulpotomy
B. Replacement resorption
C. Non-proliferating lesion
D. Desensitizing tooth

# The initial pulpal response to any insult is:
A. Necrosis
B. Ulceration
C. Calcification
D. Inflammation

# Patient reports with severe throbbing pain in relation to mandibular second molar. The tooth is sensitive to both hot and cold food and elicits a painful response on percussion. What would be your treatment of choice?
A. Incision and drainage of periapical area
B. Endodontic therapy
C. Indirect pulp capping
D. Partial pulpectomy

# The most important aspect of emergency treatment for an acute apical abscess is to:
A. Produce sedation
B. Obturation
C. Establish drainage
D. None of the above

# In treating a tooth with a non vital pulp and sinus, the sinus should be treated as follows:
A. No special treatment
B. Cauterization
C. Curettage of sinus
D. Use of cautery to eliminate the sinus

# A pulp polyp may arise in connection with:
A. Chronic open pulpitis
B. Pulp necrosis
C. Acute pulpitis
D. Chronic periapical lesion

# Internal resorption is due to:
A. Pulp Necrosis
B. Acute inflammation of pulp
C. Chronic inflammation of pulp
D. None of the above

# Most common cause of pulp pathology is:
A. Microbes
B. Trauma
C. Leakage from filling materials
D. Pressure sensation from condensation of filling materials

# Phoenix abscess is:
A. Reversible pulpitis
B. Acute apical periodontitis
C. Acute exacerbation of an existing chronic inflammation
D. Chronic abscess

# Which of the following is the method of treating internal resorption?
A. Extirpation of pulp and calcium hydroxide dressing
B. Extirpation of pulp and formocresol dressing
C. Pulpotomy
D. Pulp capping

# Acute reversible pulpitis is treated by:
A. Sedative filling , Wait and Watch
B. Pulpectomy
C. Pulpotomy
D. Pulp capping

# Which one of the following is not seen in the acute pulpitis?
A. Pain disappears on removal of stimulus
B. Pain persists on removal of stimulus
C. Increased threshold for stimulus
D. Severe pain

# The treatment of acute pulpitis is:
A. Extraction
B. Pulpotomy
C. Pulpectomy
D. PA curettage

# Blood borne seeding of bacteria into an area of previously damaged or irritated pulp with a resultant inflammation is known as:
A. Bacterial endocarditis
B. Anachoretic pulpitis
C. Chronic hyperplastic pulpitis
D. Ulcerative pulpitis

# Pain due to acute "irreversible" pulpitis is:
A. Spontaneous
B. Sharp
C. Lasting for short time
D. Both A and B

# The periapical lesion that would most likely contain bacteria within the lesion is:
A. Periapical abscess
B. Periapical cyst
C. Periapical granuloma
D. Condensing osteitis

# Type of efferent nerve fibers of the pulp is:
A. Somatic motor
B. Sympathetic post ganglionic
C. Parasympathetic post ganglionic
D. Both somatic anf autonomic postganglionic fibers

# A patient feels that his molar is extruded from the socket and is tender to percussion. This can be due to:
A. Periapical cyst
B. Periapical granuloma
C. Periapical abscess
D. Furcation involvement

# Calcification of pulp:
A. is in response to ageing
B. does not relate to the periodontal condition
C. precedes internal resorption
D. indicates presence of additional canal

# Which one of the following does not commonly survive in a periapical lesion?
A. Pseudomonas
B. Streptococcus
C. Porphyromonas
D. Actinomyces

# Cholesterol crystals are occasionally present in which of the following zone?
A. Zone of contamination
B. Zone of irritation
C. Zone of necrosis
D. Zone of stimulation

# The following is not true about phoenix abscess:
A. Symptoms are similar to acute infection
B. Associated with non vital tooth
C. Radiographically does not show radiolucency in the periapical region
D. Tooth is tender on percussion

# Pulpal pain is most intense in:
A. Acute closed pulpitis
B. Acute open pulpitis
C. Pulp hyperaemia
D. Pulp necrosis


# Which one of the following conditions does not require any treatment unless it becomes symptomatic?
A. Subacute pulpitis
B. Chronic pulpitis
C. Pulp fibrosis
D. Apical cyst

# Odontogenic pain is:
A. Tooth and Periodontal ligament pain
B. Bone pain
C. Soft tissue pain
D. Jaw pain

# Condition in which a stimulus provokes pain easily :
A. Analgesia
B. Allodynia
C. Dysasthesia
D. Hyperpathia

# Pulp capillary pressure is:
A. 14cm of water
B. 25 cm of water
C. 80 cm of water
D. 120 cm of water

# Which of the following fibers are responsible for conduction of pain impulse?
A. Alpha
B. Beta
C. Delta
D. Gamma

# Which of the following is the most difficult pulpal or periapical pathosis to diagnose?
A. Necrotic pulp
B. Chronic pulpitis
C. Internal resorption
D. Acute alveolar abscess

# Enamel infarctions can be detected by:
A. Direct illumination with visible light
B. Ultraviolet light source
C. Magnetic resonance imaging
D. Fibre optic light source

# The stabbing nature of pain in trigeminal neuralgia mimics pain caused by:
A. a cracked tooth
B. acute reversible pulpitis
C. acute irreversible pulpitis
D. acute apical periodontitis

# Hall mark signs of neuropathic pain are mechanical hyperalgesia and:
A. Allodynia
B. Alopecia
C. Allocretia
D. Allogeusia

# Internal resorption:
A. will appear as lesion superimposed over an unaltered canal in a radiograph
B. is associated with a systemic disease
C. is frequently associated with trauma
D. requires deferment of treatment with 'careful watching'

# Which of the following may be used to fill the pathologic void of a non perforating internal resorption?
A. Silver amalgam
B. Gutta percha
C. Zinc oxide Eugenol
D. All of the above

# Pulpal inflammation is marked by:
A. Peripheral vasoconstriction
B. Strangulation of pulp
C. Increased vascular permeability
D. Decreased capillary pressure

# A tooth with a chronic alveolar abscess would have all of the following features EXCEPT:
A. Always symptomatic
B. Detected only during routine radiographic examination
C. Presence of a sinus tract
D. The sinus tract provides continual drainage of the periradicular lesion

# Normal intrapulpal pressure is:
A. 10 mm Hg
B. 5 mm Hg
C. 7 mm Hg
D. 15 mm Hg

# Which of the following can be used to diagnose a cracked tooth ?
A. Methylene blue staining
B. Tooth slooth
C. Transillumination
D. All of the above

# Immediate treatment of a cracked tooth involves:
A. Stabilization with orthodontic band
B. Extraction
C. Relief from occlusion
D. Full coverage crown

# Odontalgia that is occasionally typical in hypertensive patients is a result of:
A. Headache radiating to the teeth
B. Nervous tension and worry
C. Hyperaemia of pulp resulting from increased blood pressure
D. Abnormal stimulation of the systemic nerve system

# A 25 year old male comes with a complaint of throbbing pain in the upper part of the cheek or entire side of face, heavy feeling in the face, which exacerbates on bending down and associated with pyrexia. The most probable diagnosis is:
A. Acute dentoalveolar abscess in relation to upper first molar
B. Irreversible pulpitis in relation to upper second molar
C. Acute maxillary sinusitis
D. Acute periodontal abscess in relation to upper first molar

# Pain, temperature, touch from pulp are carried by which one of the following type of nerve fibers?
A. A alpha
B. A beta
C. A delta
D. A gamma

# Predisposing clinical condition for endodontic flare up:
A. Acute periapical abscess
B. Acute apical periodontitis
C. Asymptomatic necrotic pulp with periapical lesion
D. Pain and swelling since the treatment


# Nerve fibers in pulp are:
A. Sympathetic efferent postganglionic
B. Parasympathetic post ganglionic
C. Motor fibers
D. Both autonomic parasympathetic and sympathetic fibers

# Reactive oxygen metabolite in lysosomes is released by:
A. Peroxidase
B. NADPH oxidase
C. Superoxide dismutase
D. Catalase

# Halo effect surrounding the root of tooth on IOPA X ray is seen with:
A. Horizontal root fracture
B. Root caries
C. Widening of periodontal ligament space
D. Periapical periostitis

# Inflammation of the periapical tissue is sustained by which of the following?
A. Stagnant tissue fluid
B. Necrotic tissue
C. Microorganisms
D. Pus cells

# Pulp of involved teeth is vital in the following:
A. Apical cyst
B. Granuloma
C. Apical periodontitis
D. Phoenix abscess

# Which of the following is most susceptible to local anesthetics?
A. A alpha fibers
B. A beta fibers
C. A delta fibers
D. C fibers

# The most important diagnostic test to differentiate between an acute periapical abscess and a phoenix abscess is:
A. Pulp testing
B. Radiographs
C. History
D. Percussion

# Which of the following irrigant is used during opening of a tooth with acute pulpal abscess?
A. Normal saline
B. Hydrogen peroxide
C. Sodium hypochlorite
D. EDTA