Ideal time for repair of a cleft lip is:

 # The ideal time for repair of a cleft lip is:

A. Immediately after birth

B. 3 weeks to 3 months

C. 3 months to 3 years

D. After puberty

The correct answer is B. 3 weeks to 3 months.

Variations occur in timing of the first lip surgery; however, the most usual time occurs at approximately three months of age. Pediatricians used to strictly follow a rule of ‘three 10s’ as a necessary requirement for identifying the child’s status as suitable for surgery (i.e. 10 lb, 10 mg/L of hemoglobin, and age 10 weeks). Although pediatricians are presently much more flexible, and some surgeons may well justify a neonatal lip closure, the rule of three 10s is still very useful.

Ref: Shafer's Textbook of Oral pathology, 7th Edition, Page no. 21

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Severe pain in an extraction socket after 3 days of extraction

 # A patient comes with severe pain in an extraction socket after 3 days of extraction. Which of the following drugs would you prescribe?

A. Amoxicillin

B. Metronidazole

C. Diclofenac

D. Tramadol

The correct answer is B. Metronidazole.

Dry socket or alveolar osteitis is delayed healing but is not associated with an infection. This postoperative complication causes moderate to severe pain but is without the usual signs and symptoms of infection such as fever, swelling, and erythema. The term dry socket describes the appearance of the tooth extraction socket when the pain begins. In the usual clinical course, pain develops on the third or fourth day after removal of the tooth. Almost all dry sockets occur after the removal of lower molars.

The occurrence of a dry socket after a routine tooth extraction is rare (2% of extractions), but it is frequent after the removal of impacted mandibular third molars and other lower molars (20% of extractions in some series).

The treatment of alveolar osteitis is dictated by the single therapeutic goal of relieving the patient’s pain during the period of healing. If the patient receives no treatment, no sequela other than continued pain exists (treatment does not hasten healing). Both Tramadol and Diclofenac can be used for pain but as this is a single response type of question, B. Metronidazole should be the correct answer.

Treatment consists of irrigation of the socket and placement of an obtundent dressing. This may be supplemented with metronidazole 200–400 mg three times a day for 3 days to eradicate any secondary anaerobic infection that is present.

Ref: An Introduction to Oral and Maxillofacial Surgery David A. Mitchell,   SECOND EDITION Page 137

The goal of treatment of dry socket is to relieve the patient’s pain during the delayed healing process. This is usually accomplished by irrigation of the involved socket, gentle mechanical débridement, and placement of an obtundent dressing, which usually contains eugenol. The dressing may need to be changed on a daily basis for several days and then less frequently after that. The pain syndrome usually resolves within 3 to 5 days, although it may take as long as 10 to 14 days in some patients. There is some evidence that topical antibiotics such as metronidazole may hasten resolution of the dry socket.

Ref: Peterson's 3rd edition, page 115

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Medication required preoperatively for a patient with mitral valve replacement

 # Which of the following medication is required preoperatively for a patient with mitral valve replacement?

A. Ampicillin

B. Cloxacillin

C. Benzathine penicillin

D. Procaine penicillin

The correct answer is: A. Ampicillin. 

Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures Is Recommended

• Prosthetic cardiac valve

• Previous infective endocarditis

• Congenital heart disease (CHD)*

-Unrepaired cyanotic CHD, including palliative shunts and conduits

- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†

- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

• Cardiac transplant recipients who have cardiac valvulopathy

*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.

†Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure.

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The CAT in pediatric dentistry is:

 # The CAT in pediatric dentistry is:

A. Caries activity test

B. Caries Advancement Test

C. Caries risk assessment tool

D. Child Aptitude Test

The correct answer is: C. Caries risk assessment tool.

The American Academy of Pediatric Dentistry (AAPD) recognizes that caries-risk assessment and management protocols, also called care pathways, can assist clinicians with decisions regarding treatment based upon child’s age, caries risk, and patient compliance and are essential elements of contemporary clinical care for infants, children, and adolescents. These recommendations are intended to educate healthcare providers and other interested parties on the assessment of caries risk in contemporary pediatric dentistry and aid in clinical decision-making regarding evidence- and risk-based diagnostic, fluoride, dietary, and restorative protocols.

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A stone present in salivary duct leads to:

 # A stone present in salivary duct leads to:

A. Hyperplasia of salivary gland

B. Hyperplasia of salivary duct

C. Dysplasia of salivary gland

D. Metaplasia of salivary duct

The correct answer is D. Metaplasia of salivary duct.

The duct associated with sialolithiasis exhibits squamous, oncocytic or mucus cell metaplasia.

- Periductal inflammation may also be seen. 

Sialolith is most common in submandibular glands. The main composition of sialoliths found in salivary glands is Calcium phosphate - 75%.

The higher rate of sialolith formation (80-90% of cases) occur in submandibular gland due to:

- Tortuous course of Wharton's duct.

- Higher calcium and phosphate levels

- The saliva from this gland is secreted into oral cavity through ducts against gravity that make them more prone to stasis

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Treatment of recurrent ranula is:

 # Treatment of recurrent ranula is:

A. Incision

B. Excision

C. Excision with adjacent glands

D. Marsupialization

The correct answer is: C. Excision with adjacent glands.

Treatment for recurrent ranula is enucleation of mucocele involving mucous gland and surrounding tissue.

Large ranulas can be best treated by marsupialization whereas the recurrent ranulas are best treated by sublingual gland excision. 

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Most common cause of mucocele is:

 # Most common cause of mucocele is:

A. Rupture of a salivary duct

B. Partial or complete compression of the salivary acini

C. Inflammatory changes in the glandular interstitial tissue

D. Partial or complete obstruction of the salivary duct by calculus

The correct answer is: A. Rupture of a salivary duct

Mucoceles often have been classified as:

(1) an extravasation mucocele, - mostly originates due to rupture of salivary duct following trauma that results in pooling of saliva and consequent swelling.

(2) a retention mucocele (or true retention cyst) - true retention cyst, arises due to obstruction of the duct by sialoliths (salivary duct stones)

The extravasation type is far more common than the retention type.

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