Major salivary buffer is:

 # Major salivary buffer is:

A. Protein buffer

B. Carbonic acid and bicarbonate

C. Phosphate buffer

D. Albumin

The correct answer is B. Carbonic acid and bicarbonate.

The maintenance of the physiologic hydrogen ion concentration (pH) at the mucosal epithelial cell surface and the tooth surface is an important function of salivary buffers. The primary effect of these buffers has been studied in relationship to dental caries. In saliva, the most important salivary buffer is the bicarbonate– carbonic acid system. Saliva also contains coagulation factors (i.e., factors VIII, IX,

and X; plasma thromboplastin antecedent; and Hageman factor) that hasten blood coagulation and that protect wounds from bacterial invasion. An active fibrinolytic enzyme may also be present. 

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Gingival enlargement can be expected in all of the following patients EXCEPT:

 # Gingival enlargement can be expected in all of the following patients EXCEPT:

A. A patient who has undergone kidney transplant

B. A patient with COPD

C. An epileptic patient

D. Patient on antihypertensive therapy

The correct answer is B. A patient with COPD.

Gingival enlargement is a well-known consequence of the administration of some anticonvulsants (epileptic patient), immunosuppressants (organ transplant recipient), and calcium channel blockers (antihypertensive). The condition may create speech, mastication, tooth eruption, and aesthetic problems.  

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Which of the following cytokeratin is not found in orthokeratinized epithelium?

 # Which of the following cytokeratin is not found in orthokeratinized epithelium?

A. K9

B. K10

C. K11

D. K19

The correct answer is D. K19

Keratins K1, K2, and K10 through K12, which are specific to epidermal-type differentiation, are immunohistochemically expressed with high intensity in orthokeratinized areas and with less intensity in parakeratinized areas. K6 and K16, which are characteristic of highly proliferative epithelia, and K5 and K14, which are stratification-specific cytokeratins, also are present. Parakeratinized areas express K19, which is usually absent from orthokeratinized normal epithelia.

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PDL fibers that prevent extrusion are:

 # PDL fibers that prevent extrusion are: 

A. Horizontal

B. Oblique

C. Transseptal

D. Alveolar crest fibers

The correct answer is D. Alveolar crest fibers.

Alveolar crest fibers extend obliquely from the cementum just beneath the junctional epithelium to the alveolar crest. Fibers also run from the cementum over the alveolar crest and to the fibrous layer of the periosteum that covers the alveolar bone. The alveolar crest fibers prevent the extrusion of the tooth and resist lateral tooth movements. The incision of these fibers during periodontal surgery does not increase tooth mobility unless significant attachment loss has occurred.

Reference: Carranza's

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Elastic fiber component of periodontal ligament with age:

 # Elastic fiber component of periodontal ligament with age:

A. Remains same

B. Increases

C. Decreases

D. Either increases or decreases with age

The correct answer is B. Increases. 

Changes in the periodontal ligament that have been reported with aging include decreased numbers of fibroblasts and a more irregular structure, thus paralleling the changes seen in the gingival connective tissues. Other findings include decreased organic matrix production, epithelial cell rests, and increased amounts of elastic fiber.

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All of the following conditions affect oral and perioral tissues and are self-limiting EXCEPT:

 # All of the following conditions affect oral and perioral tissues and are self-limiting EXCEPT:

A. Varicella

B. Herpangina

C. Erythema multiforme

D. Hand, foot and mouth disease

E. Lupus erythematosus

The correct answer is E. Lupus erythematosus.

Lupus erythematosus (LE) may be seen in one of two well recognized forms: systemic (acute) lupus erythematosus (SLE) and discoid (chronic) lupus erythematosus (DLE), both of which may have oral manifestations. A third form, known as subacute lupus, has also been described. In the spectrum of LE, SLE is of particular importance because of the profound impact it has on many organs. DLE is the less aggressive form, predominantly affecting the skin and rarely progressing to the systemic form. It may, however, be of great cosmetic significance because of its predilection for the face. Subacute cutaneous LE, described as lying intermediate between SLE and DLE, results in skin lesions of mild to moderate severity. It is marked by mild systemic involvement and the appearance of some abnormal autoantibodies.

DLE is usually treated with topical corticosteroids. Highpotency corticosteroid ointments can be used intraorally. In refractory cases, antimalarials or sulfones may be used. Systemic steroids may be used in the treatment of SLE. The prednisone dose is generally dependent on the severity of the disease, and prednisone may be combined with immunosuppressive agents for their therapeutic and steroid-sparing effects. Antimalarials and nonsteroidal antiinflammatory drugs may help control this disease.

Reference: Oral Pathology Clinical Pathologic Correlations, Regezi, Sciubba, Jordan (2016)

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Microscopic feature responsible for the clinical appearance of Wickham striae

 # Which of the following microscopic features is responsible for the clinical appearance of Wickham striae?

A. Fibrin deposition

B. Reduced vascularity

C. Acantholysis

D. Hyperkeratosis

E. Intracellular keratinocyte edema

The correct answer is D. Hyperkeratosis.

Several types of lichen planus within the oral cavity have been described. The most common type is the reticular form, which is characterized by numerous interlacing white keratotic lines or striae (so-called Wickham’s striae) that produce an annular or lacy pattern. The buccal mucosa is the site most commonly involved. 

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