PGCEE MDS 2022: Extraoral Causes of Halitosis

 # A person has problem of bad odor of mouth. His gingiva is healthy. Other possible cause for this could be:

a) Indigestion 

b) Chronic sinusitis

c) Alcohol intake 

d) Diabetes mellitus

The correct answer is B. Chronic sinusitis.

ENT causes of halitosis include acute pharyngitis, chronic sinusitis and post nasal drip.

PGCEE MDS 2022: The ‘hanging drop appearance’ in the maxillary sinus radiograph indicates:

 # The ‘hanging drop appearance’ in the maxillary sinus radiograph indicates:

a) A nasal polyp 

b) A blow out fracture of the orbit

c) A radiograph artifact 

d) An antrolith

The correct answer is B. A blow-out fracture of the orbit.

Orbital blow out fracture occurs when a rounded object struck the protruding eyeball resulting in a fracture of the orbital floor. "Blow in" fracture is due to inward buckling of the orbital floor. It usually occurs in children and results from trauma to the inferior orbital rim.

Hanging drop sign is best seen in the Water's projection of the face.

Characteristics of blow out fracture:

• Rupture of infraorbital plate and herniation of orbital contents into the maxillary antrum

• Fracture of the orbital floor into the maxillary antrum without the involvement of the orbital rim

• Restriction of lateral and upward movement of the eyeball

• Enophthalmos and profound diplopia

• Hanging drop appearance in the radiograph

PGCEE MDS 2022: Microabrasion is a procedure in clinical orthodontics performed to:

 # Microabrasion is a procedure in clinical orthodontics performed to:

a) Clean the bracket base

b) Clean the arch wire

c) Polishing the bracket

d) Removal of white spot lesions.

The correct answer is D. Removal of white spot lesions.

Microabrasion is a method used to remove surface stains or defects. Enamel microabrasion is a minimally invasive technique for improving the appearance of teeth with superficial enamel irregularities and discoloration defects.  Tooth enamel defects amenable to microabrasion are brown or white stains or spots associated with conditions such as enamel fluorosis, hypomineralisation, decalcified areas around orthodontic brackets, or other intrinsic factors that do not respond to bleaching alone. In fact, microabrasion may be used either prior to and/or after dental bleaching to achieve uniform tooth color for these types of difficult-to-treat teeth.

PGCEE MDS 2022: Best route of heparin administration when IV line cannot be established is:

 # Best route of heparin administration when IV line cannot be established is:

A. Oral

B. Subcutaneous

C. Intramuscular

D. Sublingual

The correct answer is B. Subcutaneous.

Dosage: Heparin is conventionally given i.v. in a bolus dose of 5,000–10,000 U (children 50–100 U/kg), followed by continuous infusion of 750–1000 U/hr. Intermittent i.v. bolus doses of UFH are no longer recommended. The rate of infusion is controlled by aPTT measurement which is kept at 50–80 sec. or 1.5–2.5 times the patient’s pretreatment value. If this test is not available, whole blood clotting time should be measured and kept at ~2 times the normal value.

Deep s.c. injection of 10,000–20,000 U every 8–12 hrs can be given if i.v. infusion is not possible. The needle used should be fine and trauma should be minimum to avoid hematoma formation. Hematomas are more common with i.m. injection—this route should not be used.

Low dose (s.c.) regimen 5000 U is injected s.c. every 8–12 hours, started before surgery and continued for 7–10 days or till the patient starts moving about. This regimen has been found to prevent postoperative deep vein thrombosis without increasing surgical bleeding. It also does not prolong aPTT or clotting time. However, it should not be used in the case of neurosurgery or when spinal anesthesia is to be given. The patients should not be receiving aspirin or oral anticoagulants. It is ineffective in high-risk situations, e.g. hip joint or pelvic surgery.

PGCEE MDS 2022: When using a supplemental fluoride, which is the most important factor to be taken into consideration:

 # When using supplemental fluoride, which is the most important factor to be taken into consideration:

a) Mean climatic temperature

b) Number of topical fluoride treatments to be given

c) Amount of supplemental fluoride given by the physician

and the dentist

d) Age of the child and level of fluoride in drinking water

The correct answer is D. Age of the child and level of fluoride in drinking water.

How to remove tonsil stones or tonsilloliths?

 Tonsil stones, also known as tonsilloliths, are small, white or yellowish formations that can form on or in the tonsils. They are caused by debris, including bacteria and food particles, getting trapped in the tonsils' crevices and hardening over time.

There are several ways to remove tonsil stones, and the best method for you will depend on the size and location of the stones, as well as your overall health and any other symptoms you may be experiencing.

Here are a few methods to remove tonsil stones:

• Gently cough: This method is effective for small tonsil stones that are located near the surface of the tonsils. Try to gently cough up the stones using a deep, hacking cough.
• Use a water pick or oral irrigator: A water pick or oral irrigator can be used to gently flush out tonsil stones. The water pressure can help to loosen the stones and wash them out of the tonsils.
• Use a cotton swab: Gently press a clean cotton swab against the tonsil stone to push it out of the tonsil crevice.
• Use a toothbrush: You can use a toothbrush to gently brush the surface of the tonsil and dislodge the tonsil stones.
• Surgery: If your tonsil stones are recurring or large, a procedure called tonsillectomy (removal of tonsils) can be done.

It's important to note that, home remedies are effective when the tonsil stones are small and accessible. If the stones are large, recurrent or cause difficulty in swallowing or breathing, it's best to seek professional medical help. A doctor or an ear, nose, and throat (ENT) specialist can help diagnose and remove the tonsil stones and also check for any underlying condition that may be causing them.

What is Ludwig's angina?

 Ludwig's angina is a serious and potentially life-threatening infection that affects the tissues of the floor of the mouth. It is a type of cellulitis, which is a spreading infection of the skin and subcutaneous tissues. The condition is named after Carl Friedrich Wilhelm Ludwig, a German physician who described the condition in 1836.

The infection usually starts with inflammation and infection of the submandibular salivary glands, which are located just below the jawbone but can quickly spread to the surrounding tissues, including the tongue, the floor of the mouth, and the neck.

Symptoms of Ludwig's angina can include:

• severe pain and swelling in the jaw, tongue, and neck
• difficulty swallowing and speaking
• drooling
• fever and chills
• swollen lymph nodes in the neck
• difficulty breathing (due to the swelling in the neck)

Ludwig's angina is considered a medical emergency, and prompt treatment is essential to prevent potentially life-threatening complications, such as airway obstruction or sepsis. Treatment typically includes antibiotics to fight the infection, along with surgical drainage of any abscesses that may have formed.

Ludwig's angina typically starts as an infection in the submandibular salivary glands, which are located just below the jawbone. However, it can also be caused by an infection in the teeth, gums, or other oral structures that spreads to the floor of the mouth.

A common cause of Ludwig's angina is a dental abscess, which is a pocket of pus that forms at the tip of a tooth's root due to a bacterial infection. Dental abscesses can be caused by untreated tooth decay, a broken or cracked tooth, or gum disease. The bacteria can spread through the bone and soft tissues of the jaw and into the submandibular space, leading to Ludwig's angina.

Another oral infection that can cause Ludwig's angina is a peritonsillar abscess (quinsy) which is a collection of pus in the tonsils caused by a bacterial infection. This abscess may spread to the floor of the mouth and also cause Ludwig's angina.

In general, Ludwig's angina is considered a rare but serious condition, and if left untreated, it can be life-threatening due to the potential for airway obstruction and sepsis (systemic infection).

The mortality rate associated with Ludwig's angina varies depending on the studies, but it ranges between 2-15%. Early recognition and intervention are critical to improve the outcome. Early identification and appropriate intervention along with the necessary care, will lower the mortality rate.

It's essential to seek professional dental help if you suspect you have a tooth infection or an abscess, or if you experience any of the symptoms associated with Ludwig's angina, such as severe pain and swelling in the jaw, tongue, and neck, difficulty swallowing and speaking, fever, and difficulty breathing.