APC gene is mutated in:

 # APC gene is mutated in:

A. Hereditary intestinal polyposis syndrome

B. Gardner’s syndrome

C. Gorham stout syndrome

D. Caffey Silverman Syndrome

The correct answer is B. Gardner's syndrome.

Gardner syndrome, inherited as an autosomal-dominant disorder, is characterized by intestinal polyposis, multiple osteomas, fibromas of the skin, epidermal and trichilemmal cysts, impacted permanent and supernumerary teeth, and odontomas. The genetic defect is found in a small region on the long arm of chromosome 5 (5q21), where the familial adenomatous polyposis (APC) gene resides. Most patients with Gardner’s syndrome do not exhibit the complete spectrum of clinical disease expression. Osteomas associated with this syndrome may be found in the jaws (especially the mandibular angle) and in facial and long bones. Intestinal polyps associated with Gardner syndrome are commonly located in the colon and rectum. Significantly, these polyps, found microscopically to be adenomas, exhibit a very high rate of malignant transformation to invasive colorectal carcinoma.

Reference: ORAL PATHOLOGY: CLINICAL PATHOLOGIC CORRELATIONS, SEVENTH EDITION, Joseph A. Regezi, DDS, MS, James J. Sciubba, DMD, PhD, Richard C.K. Jordan, DDS, MSc, PhD, FRCD(C), FRCPath

Obstructive sleep apnea syndrome (OSAS) often results in all of the following except:

 # Obstructive sleep apnea syndrome (OSAS) often results in all of the following except: 

A. Excessive daytime sleepiness 

B. Aggressive behavior 

C. Personality changes 

D. Depression 

The correct answer is B. Aggressive behavior.

Signs and symptoms

Generally, symptoms of OSA begin insidiously and are often present for years before the patient is referred for evaluation.

Nocturnal symptoms may include the following:

• Snoring, usually loud, habitual, and bothersome to others
• Witnessed apneas, which often interrupt the snoring and end with a snort
• Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience
• Nocturia
• Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night

Daytime symptoms may include the following:

• Nonrestorative sleep (ie, “waking up as tired as when they went to bed”)
• Morning headache, dry or sore throat
• Excessive daytime sleepiness that usually begins during quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving)
• Daytime fatigue/tiredness
• Cognitive deficits; memory and intellectual impairment (short-term memory, concentration)
• Decreased vigilance
• Morning confusion
• Personality and mood changes, including depression and anxiety
• Sexual dysfunction, including impotence and decreased libido
• Gastroesophageal reflux
• Hypertension

Reference: https://emedicine.medscape.com/article/295807-overview

The most common mandibular surgical osteotomy to advance the mandible is:

 # The most common mandibular surgical osteotomy to advance the mandible is ____. 

A. Le Fort I osteotomy 

B. Segmental maxillary osteotomy 

C. Bilateral sagittal split osteotomy 

D. Intraoral vertical ramus osteotomy 

The correct answer is C. Bilateral sagittal split osteotomy.

Bilateral sagittal split osteotomy (BSSO) is one of the most commonly performed and versatile mandibular procedures. It can be used for backward or forward correction of the mandible in isolation or in combination with a maxillary osteotomy. It is usually performed while the patient is under general anaesthesia. It was originally described by Trauner and Obwegeser in 1957. The procedure has since undergone numerous modifications, including those by Dalpont, Hunsuck, Bell and Epker.

Even when there are large advancements, bone grafting is rarely required because of the long bony interface between the two fragments. Indications for BSSO include mandibular advancement, setback and correction of asymmetry. It is contraindicated in ramus hypoplasia, narrow lateral to medial ramus thickness and severe asymmetries.

Ref: An Introduction to Oral and Maxillofacial Surgery SECOND EDITION, David A. Mitchell, Page 306

Distraction osteogenesis is preferred over a traditional osteotomy:

 # Distraction osteogenesis is preferred over a traditional osteotomy: 

A. When a large advancement is needed 

B. When a small advancement is needed 

C. When exacted interdigitation of the occlusion is needed 

D. When the treatment needs to be done in a very short period of time 

The correct answer is A.  When a large advancement is needed.

Distraction osteogenesis is preferred over traditional osteotomies when large skeletal movements are required and the associated soft tissue cannot adapt to the acute changes and stretching that results. Larger movements may be at increased risk of some relapse; this is particularly true in a patient with a cleft palate, where there is significant soft tissue scarring from previous surgeries.

At which of the following locations are perikymata usually found?

 # At which of the following locations are perikymata usually found?

a. Cervix of the crown.

b. Apex of the root.

c. Cusp tips.

d. Deposited throughout the crown.

The correct answer is A. Cervix of the crown.

Perikymata are transverse, wave-like grooves, believed to be the external manifestations of the striae of Retzius. They are continuous around a tooth and usually lie parallel to each other and to the cementoenamel junction. Ordinarily there are about 30 perikymata per millimeter in the region of the cementoenamel junction, and their concentration gradually decreases to about 10 per millimeter near the occlusal or incisal edge of a surface. Their course usually is fairly regular, but in the cervical region it may be quite irregular. The terms perikymata and imbrication lines are used without distinction to the surface structures of ridges or grooves. To avoid confusion in the usage of these terms it has been suggested that the terms perikymata or imbrication lines be suffixed by the words ridge or crest to denote elevations and the terms groove or furrow to denote depressions, as for example, perikymata ridge.

Reference: Orban's 13th Edition Page no 58

Bones that are small, irregularly shaped, and found along sutures are called

 # Bones that are small, irregularly shaped, and found along sutures are called 

a. Parietal. 

b. Wormian. 

c. Temporal. 

d. Zygomatic. 

The correct answer is B. Wormian bone.

Wormian bones, also known as intrasutural bones or sutural bones, are extra bone pieces that can occur within a suture (joint) in the skull. These are irregular isolated bones that can appear in addition to the usual centres of ossification of the skull and, although unusual, are not rare. They occur most frequently in the course of the lambdoid suture, which is more tortuous than other sutures. They are also occasionally seen within the sagittal and coronal sutures. A large wormian bone at lambda is often called an Inca bone (Os Incae), due to the relatively high frequency of occurrence in Peruvian mummies. Another specific Wormian bone, the pterion ossicle, sometimes exists between the sphenoidal angle of the parietal bone and the great wing of the sphenoid bone. They tend to vary in size and can be found on either side of the skull. Usually, not more than several are found in a single individual, but more than one hundred have been once found in the skull of a hydrocephalic adult.

Wormian bones are a marker for some diseases and important in the primary diagnosis of brittle bone disease: osteogenesis imperfecta.

Wormian bones may also be seen in:

• Pycnodysostosis
• Osteogenesis imperfecta
• Rickets
• "Kinky-hair" Menke's syndrome
• Cleidocranial dysostosis
• Hypothyroidism and hypophosphatasia
• Otopalatodigital syndrome
• Primary acro-osteolysis
• Down syndrome

Which certification is required for dentists that provide general anesthesia?

 # Which certification is required for dentists that provide general anesthesia? 

a. Basic life support (BLS). 

b. Emergency medical training (EMT). 

c. Cardiopulmonary resuscitation (CPR). 

d. Advanced cardiac life support (ACLS). 

The correct answer is D. Advanced cardiac life support (ACLS).

Dentists that provide general anesthesia must be certifed in ACLS for their licensure; BLS certifcation is inadequate. Many states mandate, and the current standard of care necessitates, certifcation in ACLS training for dentists providing general anesthesia. 

ACLS:

For healthcare professionals who either direct or participate in the management of cardiopulmonary arrest or other cardiovascular emergencies and for personnel in emergency response

What does this course teach?

• Basic life support skills, including effective chest compressions, use of a bag-mask device, and use of an AED
• Recognition and early management of respiratory and cardiac arrest
• Recognition and early management of peri-arrest conditions such as symptomatic bradycardia
• Airway management
• Related pharmacology
• Management of ACS and stroke
• Effective communication as a member and leader of a resuscitation team