INTRODUCTION OF NDEB CANADA EXAM BY AHEAD ACADEMY

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National Dental Examining Board of Canada
The National Dental Examining Board of Canada, also known as the NDEB (French: Le Bureau national d'examen dentaire du Canada) is the organization is responsible for granting approval for dentists to practice in Canada through standardized examinations. Its headquarters are in Ottawa.
According to the Act of Parliament, the NDEB is responsible for the establishment of qualifying conditions for a national standard of dental competence for general practitioners, for establishing and maintaining an examination facility to test for this national standard of dental competence and for issuing certificates to dentists who successfully meet this national standard. The NDEB, in cooperation with the Royal College of Dentists of Canada, is also responsible for the establishment of qualifying conditions for a single standard national certificate for dental specialties.

History
In 1906 under the auspices of The Canadian Dental Association (CDA) the Dominion Dental Council was formed to conduct national written examinations, the successful completion of which would grant the candidate a Dominion Dental Council certificate. The National Certificate could then be presented to the Provincial Dental Regulatory Authorities (DRA’s) as evidence of the candidate's ability to meet a basic national standard of competence. Some DRA’s were prepared to grant licenses to practice on the basis of the certificate, however, others chose to accept the certificate as an academic base only and required the candidate to pass provincial practical tests in addition.
The Dominion Dental Council proved to be rather ineffective. A name change to The Dental Council of Canada in 1950 along with attempts to improve the efficiency of the examination mechanism still failed to attract strong support from the DRA’s. This was in spite of the fact that the DRA’s agreed with the general concept. They had indicated a desire to be free of provincial licensing examinations, providing that a strong competent national examination system could be introduced, which they could support.
The following year (1951) the CDA encouraged the ten DRA’s to meet in an attempt to develop a satisfactory plan for a National Examining Board. Its purpose was to provide a facility by which members of the profession could become eligible, on a national basis, to apply for practice privileges in the province of their choice. This meeting resulted in the incorporation of The National Dental Examining Board of Canada (NDEB) in 1952 by an Act of Parliament of Canada. The Act was supported by all ten DRA’s and by the CDA and this support continues today.
Since 1952, the NDEB has issued 21,907 certificates.

Structure
The National Dental Examining Board of Canada is composed of twelve members. Each DRA appoints one member and two members are appointed by the Commission on Dental Accreditation of Canada.
In 1994, the Board designated representatives from the Royal College of Dentists of Canada, the Commission on Dental Accreditation of Canada, the Canadian Dental Association and the CDA Committee on Student Affairs as official observers. In 2004, the Board designated a representative from the Canadian Dental Regulatory Authorities Federation (CDRAF)as an official observer and appointed a Public Representative.
The Executive Committee of the Board, consisting of the President, President-Elect, Past-President and two other members, meets two or three times a year. The full Board meets annually. The NDEB also has standing committees dealing with examinations, appeals, finances and by-laws.
The NDEB appoints a Chief Examiner for the examinations. Examiners are appointed by the Board from lists submitted by the DRA’s and lists submitted by the Deans of Canadian dental faculties. The NDEB is a non-profit organization supported financially by fees charged to candidates for examination certification.

Certification
Prior to 1971, a graduate of an undergraduate dental program in Canada was required to successfully complete the NDEB examination (written essay-type) in order to be certified. This policy was changed in 1971, when the NDEB decided to recognize the examinations and evaluation administered by Canadian faculties of dentistry and issue certificates to current graduates of these faculties without further examination. The conditions for certification of current graduates were established at this time to be proper application and graduation from an undergraduate dental program approved by the Commission on Dental Accreditation of Canada.
The NDEB, through its representatives on the Commission on Dental Accreditation of Canada and an appointee on each undergraduate program survey team actively participates in the accreditation process. In addition, the NDEB gives an annual grant to the Commission to be applied to accreditation costs of undergraduate dental programs in Canada and the United States.
In 1988 concern was expressed by several DRA’s about the validity of establishing clinical competence solely by accreditation. This concern was further intensified by the extension of the accreditation cycle from five to seven years. The NDEB, therefore, in 1989 established a committee "to explore whether the granting of a certificate on the basis of accreditation alone continues to be acceptable." This committee (Certification Review Committee or CRC) presented its report at the 1990 NDEB Annual Meeting. The report stated that certification based on accreditation alone was no longer acceptable, a finding which was further supported in the Parker Report.
As a result, the NDEB authorized two pilot projects which introduced and tested the use of NDEB external examiners/observers. In 1991 this involved the University of British Columbia, l’Université de Montréal and the University of Toronto. In 1992, the Universities of Alberta, Manitoba, McGill, Western Ontario and l’Université de Montréal participated in this pilot project. The pilot projects were deemed highly satisfactory by the NDEB. In 1993, certification for graduates of accredited Canadian Faculties of dentistry was based on present requirements and a successful report on the faculties’ participation in the NDEB External Examiner System.
In 1994, at the request of the DRA’s, the NDEB abandoned the External Examiner System and required that Canadian graduates pass the Written Examination. The NDEB committed to develop and implement an Objective Structured Clinical Examination (OSCE).
As a result of changes adopted at the 1993 Annual Meeting, in 1995 and onwards, graduates of dental programs accredited by the Commission on Dental Accreditation of Canada were required to pass both the NDEB Written Examination and the NDEB Objective Structured Clinical Examination (OSCE) in order to be certified.
In 1995 and 1996 an intense and lengthy consultation process with the DRA’s, the Commission on Dental Accreditation of Canada (CDAC), the Association of Canadian Faculties of Dentistry (ACFD), the American Association of Dental Schools (AADS) and the Commission on Dental Accreditation of the American Dental Association (ADA) was held. As a result a Notice of Motion was presented to the 1995 Annual Meeting that would significantly change the Board’s certification process. This Notice of Motion was circulated to the communities of interest and as a result, was revised, outlining conditions that required action by the ADA, the ACFD and the CDAC. In addition, to preserve national portability, the motion had to be ratified by all ten DRA’s.
During 1996, the ADA, CDAC and ACFD confirmed that the required changes would be made. The motion was subsequently passed by the NDEB at the November 1996 Annual Meeting and was ratified by all ten DRA’s.
As a result of the ADA Commission on Dental Accreditation making requested changes to their accreditation procedures, including the addition of state and national licensing board representatives to all site survey teams, the codification of the relationship between the ADA Commission on Dental Accreditation and the CDAC that ensures formal representation and involvement in each other’s process, the identification of the requested outcome measurement similar to the CDAC’s the Clinical Outcomes Review (CORE) Process. The NDEB was able to verify that the CDAC and the ADA accreditation processes were equivalent. Therefore, as of January 1, 1997, graduates of both US and Canadian accredited undergraduate dental programs were considered “accredited graduates”. To be certified, these graduates must pass the Written and OSCE Examinations within a specified period of time.
Until December 31, 1999, graduates of accredited programs who did not successfully complete the Written and OSCE Examinations within 7 years of graduation were granted a certificate by the Board following successful completion of the Examination for Certification of graduates of non-accredited dental programs established by the Board.
After January 1, 2000, graduates of accredited dental programs who do not successfully complete the Written and OSCE Examinations within 7 years of graduation were eligible to receive the Board’s certificate by successfully completing a Qualifying Program and then successfully completing the Written and OSCE Examinations.
As a result of wide consultation during a Strategic Planning process in 2003, the Board revised the “7 year rule” and allowed graduates of accredited programs who were more than 60 months past the date of their graduation to apply for special consideration to participate in the Board’s certification process. Also, in 2003, the Board placed a limit on the number of times a candidate could take an examination and added a public official observer.
Since the changes to the certification process for graduates of non-accredited dental programs in 1996, the Executive Committee of the National Dental Examining Board of Canada (NDEB) has been continually monitoring the results.
The 1996 changes introduced the 2 year Qualifying/Degree Completion Programs. The Commission on Dental Accreditation of Canada’s (CDAC) Standards for the Qualifying/Degree Completion Programs initially required that these programs be two academic years in length. Presently, these are approximately 80 students accepted into these programs each year. These programs work extremely well, faculties report that virtually every student requires the full 2 years in the programs to meet the national standard. However, it has been reported that there have been a few students who may not have needed the full 2 years.
In 2001, to provide more flexibility, the NDEB and the Canadian Dental Regulatory Authority Federation (CDRAF) requested the CDAC change the standards to allow a student to demonstrate competence in a shorter time. Although CDAC modified the standards, the Qualifying Programs find it difficult to satisfactorily evaluate students until they have almost completed the programs. In addition, as of 2006, all Faculties of Dentistry in Canada have moved to Degree Completion Programs which, due to university regulation, have 2 year residency requirements.
Currently, the CDRAF has initiated a certification process for graduates of non-accredited dental specialty programs, and several Provincial Dental Regulatory Authorities (DRA’s) have indicated the need to develop an alternative process for certification of general dentists.
Structure of Examination
Written Examination
The Written Examination consists of 2 papers, each with 150 multiple choice type questions. Each paper is given in a 2 hours and thirty minutes examination session. The sessions are held in the morning and afternoon of one day. One part of the written examination tests the basic sciences while the other tests the clinical sciences.

Written Examination Basic Sciences Clinical Sciences Tooth Morphology Oral Physiology Microbiology/Immunology Pain Pharmacology Biological effects of Radiation Human Anatomy Human Physiology Human Histology Human Biochemistry Nutrition Neurological Sciences General Medicine/Pathology Oral Medicine/Pathhology Radiology Periodontics Preventive Dentistry Operative Dentistry Endodontics Prosthodontics Dental Materials Orthodontics Pediatric Dentistry Geriatric Dentistry Oral & Maxillofacial Surgery Therapeutics Dental Biomaterials Behavioural Sciences Dental Public Health and Epidemiology Ethics

The basic sciences portion resembles Part I of the National Board Dental Examination in the United States, while the clinical portion is similar to Part II.
Objective Structured Clinical Examination (OSCE)
The OSCE is a station type examination (also known as "bell-ringer" type).
The majority of the stations have 2 questions and require the candidate to review the information supplied (e.g. case history, photographs, radiographs, casts, models) and answer extended match type questions. Each extended match type question has up to 15 answer options and one or more correct answer(s). A few stations may require the candidate to review the information supplied and write an acceptable prescription for a medication commonly prescribed by general dentists in Canada.
Candidates have 5 minutes at each station to answer the questions, after which they move on to the next station.
Current Exam
The dates of the current exam cycle are a Saturday and a Sunday in March, June and December. The examination is administered on two consecutive days; the written section on Saturday and the OSCE on Sunday. Accommodations can usually be made for candidates who have conflicting religious observations. For candidates who observe the Sabbath on Saturday, the written exam may be taken on Friday. The current fee for the exam is CDN $2000. Once graduation from an accredited dental school is confirmed, the NDEB sends successful candidates an official certificate, which in turn is used to apply to individual provinces and territories for licensure.

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NDEB EXAM COACHING : Course options at AHEAD Academy

Name of Course	Course Content	Course Duration	Charges	Study Material	Course Schedule
1. NDEB Simulated Online Test Series for Part – I Exam (Fundamental Knowledge Test)	Sunday Tests with Explanatory Answers & Combined Rankings. Tests are repeated Online on Weekdays also	10 Months	US $ 1100	· AHEAD Review Booklets in all basic & clinical subjects. · Books recommended for NDEB. · SimulatedTests with Answers	Check Schedule on Page 7
2. Regular Classes with NDEB Simulated Tests for Part – I Exam Sat : 2pm to 8pm Sun : 8am to 5pm	Weekend Classes, Tests & Discussions, Explanatory Answers, Combined Rankings, Doubt solving sessions with the expert faculties in all subjects Tests are available Online on Weekdays for practice	10 Months	US $ 2500	· AHEAD Review Booklets in all basic & clinical subjects. · Books recommended for NDEB. · SimulatedTests with Class Notes, New Mcqs, Assignments with saqs	Check Schedule on Page 7

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40 MCQS CANADA for sample

ORTHODONTICS

1. A removable orthodontic appliance, producing a light force on the labial of a proclined maxillary central incisor will cause
A. lingual movement of the crown and lingual movement of the root apex.
B. intrusion of the central incisor and lingual movement of the crown.
C. lingual movement of the crown and labial movement of the root apex.
D. intrusion of the central incisor.
Ans C (Ref : page no. 374 proffit 4/e)
Consider a proclined maxillary central incisor. If a single force of 50gm is applied against the crown of this tooth, as might happen with a spring on a maxillary removable appliance, a force system will be created that includes a 750gm-mm moment . The result will be that the crown will be retracted more than the root apex, which might actually move slightly in the opposite direction. (Remember that a force will tend to displace the entire object, despite the fact that its orientation will change via simultaneous rotation around the center of resistance).
2. Maxillary incisor protrusion can be treated by
1. premolar extraction with orthodontic retraction of the incisors.
2. premolar extraction with surgical repositioning of the anterior dentoalveolar segment.
3. extraction of the incisors, alveoloplasty and prosthodontic replacement.
4. reduction and genioplasty.
A. (1)(2) (3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans A (Ref : page no. 204 and 701 proffit 4/e)
Orthodontic treatment of maxillary incisor protrusion:
Excessive protrusion of incisors( bimaxillary protrusion,(not excessive overjet) usually is an indication for premolar extraction and retraction of the protruding incisors.
Surgical treatment of maxillary incisor protrusion:
Segments of the dentoalveolar process can be repositioned surgically in all three planes of space. Genioplasty is the surgical repositioning of the chin. It can not be used for maxillary incisor protrusion.
3. The mandible grows primarily at the
A. symphysis and condyles.
B. posterior border of the ramus and the alveolar crest.
C. condyles and lateral border of the body.
D. condyles and posterior border of the ramus.
E. symphysis and posterior border of the ramus.
Ans D (Ref : page no. 46 proffit 4/e)
If data from vital staining experiments are examined, it becomes apparent that the principal sites of growth of the mandible are the posterior surface of the ramus and the condylar and coronoid processes.There is little change along the anterior part of the mandible.
As a growth site, the chin is almost inactive. It is transIated downward and forward, as the actual growth occurs at the mandibular condyle and along the posterior surface of the ramus. The body of the mandible grows longer by periosteal appositiono f bone on its posteriors urface,while the ramus grows longer by endochondralr eplacemenat the condyle accompanied by surface remodeling.
4. Which of the following are mechanisms of growth of the naso-maxillary complex?
A. Sutural.
B. Cartilaginous.
C. Appositional.
D. All of the above.
Ans D (Ref : page no. 51 proffit 4/e & Graber pg 43 3/ed)
Proponents of the cartilage theory hypothesize that the cartilaginous nasal septum serves as a pacemaker for other aspects of maxillary growth. growth. Note in Figure that the cartilage is located so that its growth could easily lead to a downward and forward translation of the maxilla. If the sutures of the maxilla served as reactive areas,as they seem to do, then they would respond to this translation by forming new bone when the sutures were pulled apart by forces from the growing cartilage. Although the amount of nasal septal cartilage reduces as growth continues, cartilage persists in this area throughout life, and the pacemaker role is certainly possible.
Fig. Diagrammatic representation of the chondrocranium at an early stage of development showing the large amount of cartilage in the anterior region that eventually becomes the cartilaginous nasal septum.
5. Wolffs Law states that bone elements
A. rearrange themselves in the direction of functional pressures.
B. increase their mass to reflect functional stress.
C. decrease their mass to reflect functional stress.
D. All of the above.
Ans A (Ref : page no.276 proffit 4/e & Graber pg 631 3/ed & Julius Wolff’s original book, das Gesetz der Transformation der Knochen )
In the early 1900s,t he German physiologist Wolff demonstrated that bone trabeculae were arranged in response to the stress lines on the bone.
A, Bone trabeculae in the head of the femur follow the calculated stress lines.This observation by the German physiologist Wolff at the end of the 19th century lead to "Wolff's law of bone" that the internal architecture of bones represents the stress pattern on them.
B, Frontal section through the head of the mandibular condyle.
C, Sagittal section through the head of the condyle.Note the arrangement of bony trabeculae in dicating a similar arrangement for resistance to stress as seen in the head of the femur.
6. In clinical dentistry, stiffness of wire is a function of
A. length of the wire segment.
B. diameter of the wire segment.
C. alloy composition.
D. All of the above.
E. None of the above.
Ans D (Ref : page no 361, 366 Proffit 4/e)
In orthodontics, there are three major elastic properties: Strength, Stiffness and Range and these three major properties have an important relationship:
Strength = Stiffness x Range
Each of the major elastic properties-strength, stiffness, and range-is substantially affected by a change in the geometry of a beam. Both the cross-section(whether the beam is circular, rectangular, or square) and the length of a beam are of great significance in determining its properties
NOTE : Keep in mind that the performance of a beam, whether beneath a highway bridge or between two teeth in an orthodontic appliance,is determined by the combination of material properties and geometric factors.
7. There is a differential between girls and boys with respect to the age at which the growth velocity reaches its peak. That difference is
A. boys six months ahead of girls.
B. girls six months ahead of boys.
C. girls one year ahead of boys.
D. girls two years ahead of boys.
Ans D (Ref : page no 578 Proffit 4/e)
Girls mature considerably earlier than boys and are often beyond the peak of the adolescent growth spurt before the full permanent dentition is available and comprehensive orthodontic treatment can begin. Boys, who mature more slowly and have a more prolonged period of adolescent growth, are much more likely to have a clinically useful amount of anteroposterior growth.
8. Excessive orthodontic force used to move a tooth may
1. cause hyalinization.
2. cause root resorption.
3. crush the periodontal ligament.
4. impair tooth movement.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans E (Ref : page no 331, 348 Proffit 4/e)
Deleterious effects of Orthodontic Force :

Effects on the pdl	Causes hyalinization.
Effects on the Height of Alveolar Bone	Height of Alveolar Bone decreases
Effects on the Pulp	There are occasional reports of loss of tooth vitality during orthodontic treatment.
Effects on Root Structure	Heavy continuous orthodontic force can lead to severe root resorption.

9. Which of the following is/are correct?
A. There is no histological difference between basal and alveolar bone.
B. There is no difference in the response of basal and alveolar bone to pressure.
C. Osteoid is a highly mineralized bundle bone.
D. All of the above.
Ans C (Ref : page no 331, 348 Graber Vanarsdall 3/e)
Lamellar bone
Lamellar bone, a strong, highly organized, well-mineralized tissue, makes up more than 99% of the adult human skeleton. When new lamellar bone is formed, a portion of the mineral component (hydroxylapatite) is deposited by osteoblasts during primary mineralization.
Secondary mineralization, which completes the mineral component, is a physical process (crystal growth) that requires many months. Within physiologic limits the strength of bone is directly related to its mineral content. 17,43 The relative strengths of different histologic types of osseous tissue can be stated thus: woven bone is weaker than new lamellar bone, which is weaker than mature lamellar bone.Adult human bone is almost entirely of the remodeled variety: secondary osteons and spongiosa. The full strength of lamellar bone that supports an orthodontically moved tooth is not achieved until approximately 1 year after completion of active treatment. This is an important consideration in planning orthodontic retention, as well as in the postoperative maturation period that follows orthognathic surgery.
Composite bone
Composite bone is an osseous tissue formed by the deposition of lamellar bone within a woven bone lattice, a process called cancellous compaction.This process is the quickest means of producing relatively strong bone." Composite bone is an important intermediary type of bone in the physiologic response to orthodontic loading , and it usually is the predominant osseous tissue for stabilization during the early process of retention or postoperative healing. When the bone is formed in the fine compaction configuration, the resulting composite of woven and lamellar bone forms structures known as primary osteons. Although composite bone may be high-quality, load-bearing osseous tissue, it eventually is remodeled into secondary osteons.
Bundle bone
Bundle bone is a functional adaptation of lamellar structure to allow attachment of tendons and ligaments. Perpendicular striations, called Sharpey's fibers, are the major distinguishing characteristics of bundle bone. Distinct layers of bundle bone usually are seen adjacent to the PDL along physiologic bone-forming surfaces. Bundle bone is the mechanism of ligament and tendon attachment throughout the body.
10. The predominant type of movement produced by a finger spring on a removable appliance is
A. torque.
B. tipping.
C. rotation.
D. translation.
Ans B (Ref : page no 339 Proffit 4/e)
The simplest form of orthodontic movement is tipping. Tipping movements are produced when a single force (e.g. a spring extending from a removable appliance) is applied against the crown of a tooth. In tipping, only one-half the PDL area that could be loaded actually is. As shown in Figure, the "loading diagram" consists of two triangles, covering half the total PDL area.


ORAL MEDICINE & RADIOLOGY
11. A Vitamin B₂ (Riboflavin) deficiency usually arises in patients
1. who are elderly.
2. with acute infection.
3. consuming a high protein or fat diet.
4. taking systemic antibiotics.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- C
Assessment of riboflavin status
Biochemical tests are essential for confirming clinical cases of riboflavin deficiency and for establishing subclinical deficiencies. Among these tests:
· Erythrocyte glutathione reductase activity:
Glutathione reductase is a nicotinamide adenine dinucleotide phosphate (NADPH), a FAD-dependent enzyme, and the major flavoproteins in erythrocyte. The measurement of the activity coefficient of erythrocyte glutathione reductase (EGR) is the preferred method for assessing riboflavin status. It provides a measure of tissue saturation and long-term riboflavin status. In vitro enzyme activity in terms of activity coefficients (AC) is determined both with and without the addition of FAD to the medium. ACs represent a ratio of the enzyme’s activity with FAD to the enzyme’s activity without FAD. An AC of 1.2 to 1.4, riboflavin status is considered low when FAD is added to stimulate enzyme activity. An AC > 1.4 suggests riboflavin deficiency. On the other hand, if FAD is added and AC is < 1.2, then riboflavin status is considered acceptable.^[8] Tillotson and Bashor reported that a decrease in the intakes of riboflavin was associated with increase in EGR AC. In the U.K. study of Norwich elderly, initial EGR AC values for both males and females were significantly correlated with those measured 2 years later, suggesting that EGR AC may be a reliable measure of long-term biochemical riboflavin status of individuals. These findings are consistent with earlier studies.
· Urinary riboflavin excretion:
Experimental balance studies indicate that urinary riboflavin excretion rates increase slowly with increasing intakes, until intake level approach 1.0 mg/d, when tissue saturation occurs. At higher intakes, the rate of excretion increases dramatically. Once intakes of 2.5 mg/d are reached, excretion becomes approximately equal to the rate of absorption (Horwitt et al., 1950)(18). At such high intake a significant proportion of the riboflavin intake is not absorbed.If urinary riboflavin excretion is <19 µg/g creatinine (without recent riboflavin intake) or < 40 µg per day are indicative of deficiency.
Ref:- Oral Pathology. Regezi . 4^th edition.page no- 122.
12. All of the following are well documented initiating factors of hairy tongue EXCEPT
A. candidiasis.
B. mouth rinses.
C. antibiotics.
D. systemic corticosteroids (Prednisone).
E. radiotherapy to the head and neck.
Answer:- A
Hairy tongue is a clinical term referring to a condition of filiform papillae overgrowth on the dorsal surface
of the tongue.
Etiology. There are numerous initiating or predisposing factors for hairy tongue. Broad-spectrum antibiotics, such as penicillin, and systemic corticosteroids are often identified in the clinical history of patients with this condition. In addition, oxygenating mouthrinses containing hydrogen peroxide, sodium perborate, and carbamide peroxide have been cited as possible etiologic agents in this condition. Hairy tongue may also be seen in individuals who are intense smokers and in individuals who have undergone radiotherapy to the head and neck region for malignant disease. The basic problem is believed to be related to an alteration in microbial flora, with attendant proliferation of fungi and chromogenic bacteria, and papillae overgrowth.
Clinical Features. The clinical alteration translates to hyperplasia of the filiform papillae, with concomitant retardation of the normal rate of desquamation. The result is a thick, matted surface that serves to trap bacteria, fungi, cellular debris, and foreign material. Hairy tongue is predominantly a cosmetic problem, since symptoms are generally minimal. However, when extensive elongation of the papillae occurs, a gagging or a tickling sensation may be felt. The color may range from white to tan to deep brown or black, depending on diet, oral hygiene, and the composition of the bacteria inhabiting the papillary surface.
Histopathology. Microscopic examination of a biopsy specimen confirms the presence of elongated filiform papillae, with surface contamination by clusters of microorganisms and fungi. The underlying lamina propria is generally mildly inflamed.
Diagnosis. Because the clinical features of this lesion is usually quite characteristic, confirmation by biopsy
is not necessary. Cytologic or culture studies are of little value.
Treatment and Prognosis. Identification of a possible etiologic factor, such as antibiotics or oxygenating mouthrinses, is helpful. Discontinuing one of these agents should result in improvement within a few weeks. In others there may be benefit to brushing the dorsum of the tongue with a slurry of sodium bicarbonate in water. In cases of individuals who have undergone radiotherapy, with resultant xerostomia and altered bacterial flora, management is more difficult. Brushing the tongue and maintaining fastidious oral hygiene should be of some benefit (application of a 1 % solution of podophyllum resin with thorough rinsing has also been described as a useful treatment). It is important to emphasize to patients that this process is entirely benign and self-limiting and that the tongue should return to normal after institution of physical debridement and proper oral hygiene.
Ref:- Oral Pathology. Regezi . 4^th edition.page no- 84-85.
12. A patient has a history of shortness of breath and ankle edema. You would suspect
A. asthma.
B. emphysema.
C. rhinophyma.
D. cardiac insufficiency.
Answer:- D
Chronic heart failure (CHF) is a progressive syndrome that results in a poor quality of life for the patient and places an economic burden on the health care system. Despite advances in the control of cardiovascular diseases such as myocardial infarction (MI), the incidence and prevalence of CHF continue to increase. An accurate estimate of disease burden is difficult to gather because of the vast number of patients with asymptomatic left ventricular (LV) dysfunction. As the population ages, there is an epidemiological shift toward a greater prevalence of clinical heart failure with preserved LV function, the so-called stiff-heart syndrome. In fact, heart failure with preserved systolic function may account for up to two-thirds of cases in patients older than 70 years.2 Regardless of age, the lifetime risk of developing heart failure is approximately 20% for all patients older than 40 years.
Despite the growing prevalence, novel screening techniques and therapeutic directions have improved the outlook for patients with heart failure by focusing not only on symptom control but also on ameliorating the pathophysiology toward a corrective phenotype. This review discusses accepted and emerging therapeutic directions, with an emphasis on practical implications. In light of the available literature and clinical trials, the primary emphasis will be on systolic dysfunction, with a separate brief discussion of heart failure with preserved systolic function.
DIAGNOSIS
No single test can be used to establish the clinical diagnosis of heart failure. Instead, history and physical examination findings showing signs and symptoms of congestion and/or end-organ hypoperfusion are used to make the diagnosis. Imaging studies documenting systolic or diastolic dysfunction and biomarkers are helpful adjuncts. Physical examination is not helpful in discriminating between systolic and diastolic heart failure because similar findings, including cardiomegaly and an S3 gallop, can be seen in both conditions. Pulmonary rales, often considered a sign of pulmonary venous congestion, are often absent in CHF despite elevated left-sided filling pressures. This absence is due to chronic lymphatic hypertrophy, which prevents alveolar edema despite elevated interstitial pressures. Framingham criteria, widely used in clinical research, comprise a series of major and minor criteria that aid in the diagnosis of heart failure and emphasize the importance of jugular venous pressure elevation, an S3 gallop, and a positive hepatojugular reflex in establishing a diagnosis, while minimizing the importance of lower extremity edema. The use of brain-type natriuretic peptides, in their active or inactive circulating forms, has evolved during the past decade, but the most well-established use remains in discriminating between causes of dyspnea when the diagnosis is in doubt. Comorbid conditions must be taken into account because renal insufficiency increases these levels and obesity lowers them.
The etiology of systolic heart failure dramatically affects prognosis and treatment. Coronary artery disease (CAD) accounts for the vast majority of cases of systolic heart failure in the United States, followed by hypertensive and dilated cardiomyopathies. In the acute setting of newly diagnosed cardiomyopathy, the exclusion of underlying CAD and potential “at-risk” myocardium that might benefit from revascularization is critical. Patients with CAD and concomitant heart failure have a worse prognosis than those with nonischemic cardiomyopathy, but myocardial function may substantially improve after revascularization in selected cases, highlighting the importance of making the appropriate diagnosis early and accurately.
Ref:- 16th Edition of Harrison’s Principles of Internal Medicine by Harrison. Page no- 2581.
14. A 34 year old male patient complains of night sweats, weight loss, malaise, anorexia and low-grade fever. Clinical examination shows a nodular, ulcerated lesion on the palate. The most likely diagnosis is
A. viral hepatitis.
B. infectious mononucleosis.
C. tuberculosis.
D. actinomycosis.
Answer:- C
· Tuberculosis (TB) is an infection, primarily in the lungs (a pneumonia), caused by bacteria called Mycobacterium tuberculosis. It is spread usually from person to person by breathing infected air during close contact. TB can remain in an inactive (dormant) state for years without causing symptoms or spreading to other people.When the immune system of a patient with dormant TB is weakened, the TB can become active (reactivate) and cause infection in the lungs or other parts of the body.
· The risk factors for acquiring TB include close-contact situations, alcohol and IV drug abuse, and certain diseases (for example, diabetes, cancer, and HIV) and occupations (for example, health-care workers). The most common symptoms and signs of TB are fatigue, fever, weight loss, coughing, and night sweats. The diagnosis of TB involves skin tests, chest X-rays, sputum analysis (smear and culture), and PCR tests to detect the genetic material of the causative bacteria. Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active. Active TB is treated, usually successfully, with INH in combination with one or more of several drugs, including rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide, and streptomycin.
· Drug-resistant TB is a serious, as yet unsolved, public-health problem, especially in Southeast Asia, the countries of the former Soviet Union, Africa, and in prison populations. Poor patient compliance, lack of detection of resistant strains, and unavailable therapy are key reasons for the development of drug-resistant TB. The occurrence of HIV has been responsible for an increased frequency of tuberculosis. Control of HIV in the future, however, should substantially decrease the frequency of TB
Ref:- 16th Edition of Harrison’s Principles of Internal Medicine by Harrison. Page no- 2087.
15. Myxedema is associated with
A. insufficient parathyroid hormone.
B. excessive parathyroid hormone.
C. insufficient thyroid hormone.
D. excessive thyroid hormone.
Answer:- C
· Myxedema is also used to describe the clinical syndrome secondary to hypothyroidism. Symptoms can include depression, mental slowness, weakness, bradycardia, fatigue, hypothermia, alopecia, and many others (see symptoms of severe hypothyroidism). Used in this way, myxedema can be considered the adult counterpart of cretinism.
· Myxedema coma is rare and establishing the diagnosis requires a high index of suspicion. Myxedema coma represents the severest form of hypothyroidism and has an associated mortality rate of 30 percent to 40 percent. It can occur due to long-standing, untreated hypothyroidism, but is often linked to a precipitant, such as acute infection, myocardial infarction, congestive heart failure, cerebral vascular accident, trauma, or drug toxicity. Several medications can cause hypothyroidism, and patients taking them must be carefully monitored. These medications include amiodarone, lithium, and sedatives. No consensus exists on specific thyroid hormone replacement regimens for myxedema coma. Most experts agree that a large intravenous bolus of levothyroxine should be administered (200 to 400 mcg), followed by daily doses of 50 to 100 mcg, based on the patient's weight and comorbidities. Other experts advocate the use of triiodothyronine (T3) or a combination of both T3 and T4. In addition to thyroid replacement therapy, it is important to detect coexisting adrenal insufficiency and treat patients with stress-dose steroids to avoid precipitating adrenal crisis.
· Cause- The increased deposition of glycosaminoglycan is not fully understood, however two mechanisms predominate.
· Exophthalmos in particular results from TSH receptor stimulation on fibroblasts behind the eyes which leads to increased glycosaminoglycan deposition. It is thought that many cells responsible for forming connective tissue react to increases in TSH levels.
· Secondarily, in autoimmune thyroid diseases lymphocytes react to the TSH receptor. Thus, in addition to the inflammation within the thyroid, any cell that expresses the TSH receptor will likely experience lymphocytic infiltrates as well. The inflammation can cause tissue damage and scar tissue formation, explaining the deposition of glycosaminoglycans.
· The increased deposition of glycosaminoglycans causes an osmotic edema and fluid collection. Hashimoto's thyroiditis is the most common cause of myxedema in the United States
Ref:- 16th Edition of Harrison’s Principles of Internal Medicine by Harrison. Page no- 1041.
16. Radiographically, the opening of the incisive canal may be misdiagnosed as a
1. branchial cyst.
2. nasopalatine cyst.
3. nasolabial cyst.
4. periradicular cyst.
A. (1)(2) (3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- C
The incisive foramen (also called the nasopalatine or Anterior palatine foramen in the maxilla is the oral terminus of the nasopalatine canal. It transmits the nasopalatine vessels and nerves (which may participate in the innervation of the maxillary central incisors) and lies in the midline of the palate behind the central incisors at approximately the junction of the median palatine and incisive sutures. Its radiographic image is usually projected between the roots and in the region of the middle and apical thirds of the central incisors. The foramen varies markedly in its radiographic shape, size, and sharpness. It may appear smoothly symmetric, with numerous forms, or very irregular, with a well demarcated or ill-defined border. The position of the foramen is also variable and may be recognized at the apices of the central incisor roots, near the alveolarcrest, anywhere in between, or extending over the entire distance. The great variability of its radiographic image is primarily the result of (1) the differing angles at which the x-ray beam is directed for the maxillary central incisors and (2) some variability in its anatomic size. Familiarity with the incisive foramen is important because it is a potential site of cyst formation. An incisive canal cyst is radiographically discernible: it frequently causes a readily perceived enlargement of the foramen and canal. The presence of a cyst is presumed if the width of the foramen exceeds 1 cm or if enlargement can be demonstrated on successive radiographs. Also, if the radiolucency of the normal foramen is projected over the apex of one central incisor, it may suggest a pathologic periapical condition. The absence of pathosis is indicated by a lack of clinical symptoms and an intact lamina dura around the central incisor in question. The lateral walls of the nasopalatine canal are not usually seen but on occasion can be visualized on a projection of the central incisors as a pair of radiopaque lines running vertically from the superior foramina of the nasopalatine canal to the incisive foramen
Ref:- Oral Radiology- Principles And Interpretation. 5^th Edition . White & Ferro. Page No- 174.
17. Which of the following bone lesions of the mandible is/are malignant?
1. Osteosarcoma.
2. Osteochondroma.
3. Ewing's tumor.
4. Fibrous dysplasia.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- B
Conventional osteosarcomas involving the mandible and maxilla display a slight predilection for males (60%). Although the peak incidence of osteosarcomas of the skeleton occurs in the second decade, those arising in the jaws present 1 to 2 decades later, with a mean age of 35 years (range 8 to 85 years). The mandible is more commonly affected than the maxilla by a ratio of 1.7 to 1.
Ewing's sarcoma has been a highly lethal round cell sarcoma that was first described by James Ewing in 1921. The cause is unknown, the cell of origin uncertain, and even the multipotentiality of antigenic expression controversial. Ninety percent of Ewing's sarcomas occur between the ages of 5 and 30 years, and more than 60% affect males (Figure 14-14). The mean age of occurrence for primary tumors involving the bones of the head and neck is 11 years. Pain and swelling are the most common presenting symptoms. Involvement of the mandible or maxilla may result in facial deformity, destruction of alveolar bone with loosening of teeth, and mucosal ulcers. Radiographic findings in the jaws are nonspecific and may simulate an infectious process, as well as a malignant process. The most characteristic appearance is that of a moth-eaten destructive radiolucency of the medullary bone and erosion of the cortex with expansion. A variable periosteal onionskin reaction may also be seen. A significant number of patients also have a soft tissue mass.
Ref:- Oral Pathology. Regezi . 4^th edition.page no-321 & 330.
18. Radiolucent lesions of the jaws can be seen in
1. hyperparathyroidism.
2. multiple myeloma.
3. fibrous dysplasia.
4. hyperthyroidism.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- A
Fibrous dysplasia has available radiographic appearance that ranges from a radiolucent lesion to a uniformly radiopaque mass. The classic lesion has been described as having a radiopaque change that imparts a "ground glass" or "peau d'orange" effect. This characteristic image, which is most identifiable on intraoral radiographs, is not, however, pathognomonic. Lesions of fibrous dysplasia may also present as unilocular or multilocular radiolucencies, especially in long bones. A third pattern, most commonly seen in patients with long-standing disease, is a mottled radiolucent and radiopaque appearance. Additional radiographic features that have been described include a fingerprint bone pattern and superior displacement of the mandibular canal in mandibular lesions.
An important distinguishing feature of fibrous dysplasia is the poorly defined radiographic and clinical margins of the lesion. The process appears to blend into the surrounding normal bone without evidence of a circumscribed border. In addition, these lesions are often elliptic as opposed to spheric.
Ref:- Oral Pathology. Regezi . 4^th edition.page no-292-293.
19. Which of the following sites for squamous cell carcinoma has the best prognosis?
A. Lower lip.
B. Retromolar area.
C. Gingiva.
D. Buccal mucosa.
E. Hard palate.
Answer:- A
Carcinoma of the Lips- From a biologic viewpoint, carcinomas of the lower lip are separated from carcinomas of the upper lip. Carcinomas of the lower lip are far more common than upper lip lesions. UV light and pipe smoking are much more important in the cause of lower lip cancer than in the cause of upper lip cancer. The growth rate is slower for lower lip cancers than for upper lip cancers. The prognosis for lower lip lesions is generally very favorable, with over 90% of patients alive after 5 years. By contrast, the prognosis for upper lip lesions is considerably worse. Lip carcinomas account for 25% to 30% of all oral cancers. They appear most commonly in patients between 50 and 70 years of age and affect men much more often than women. Some components of lipstick may have sunscreen properties and account, in part, for this finding. Lesions arise on the vermilion and typically appear as a chronic nonhealing ulcer or as an exophytic lesion that is occasionally verrucous in nature. Deep invasion generally appears later in the course of the disease. Metastasis to local submental or submandibular lymph nodes is uncommon but is more likely with larger, more poorly differentiated lesions.
Ref:- Oral Pathology. Regezi . 4^th edition.page no- 57.
20. In hyperparathyroidism, typical features of bone involvement are
1. subperiosteal erosion of the phalanges.
2. osteopetrosis.
3. pathological fractures.
4. renal stones.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. All of the above.
Answer:- D
The disease spectrum of primary hyperparathyroidism ranges from asymptomatic cases (diagnosed by routine serum calcium determinations) to severe cases manifesting as lethargy and occasionally coma. The incidence increases with age and is greater in postmenopausal women. Early symptoms include fatigue, weakness, nausea, anorexia, arrhythmias, polyuria, thirst, depression, and constipation. Bone pain and headaches are often reported.
Several clinical features are associated with the primary form of this disease, classically described as "stones, bones, groans, and moans." Lesions of the kidneys, skeletal system, gastrointestinal tract, and nervous system are responsible for this syndrome complex. The renal component includes the presence of renal calculi or, more rarely, nephrocalcinosis associated with hypercalcemia.
Gastrointestinal manifestations include peptic ulcer secondary to the increase in gastric acid, pepsin, and serum gastrin levels. Rarely, pancreatitis may develop secondary to obstruction of the smaller pancreatic ducts by calcium deposits.
Neurologic manifestations may become evident when serum calcium levels are very high, exceeding 16 to 17 mg/dl. In such instances coma or parathyroid crisis may occur. Loss of memory and depression are common, and rarely, true psychosis may appear. Some of the neurologic findings may be attributed to calcium deposits in the brain. Severe osseous changes (called, in the past, osteitis fibrosa cystica) are the result of significant bone demineralization, with fibrous replacement producing radiographic changes that appear cyst like. In the jaws these lesions resemble central giant cell granuloma microscopically. Less obvious radiographic changes may include an osteoporotic appearance of the mandible and maxilla, reflecting a more generalized resorption. Loosening of the teeth may also occur, as well as corresponding obfuscation of trabecular detail and overall cortical thinning. Partial loss of lamina dura is seen in a minority of patients with hyperparathyroidism. Pulpal obliteration, with complete calcification of the pulp chamber and canals, has been reported in association with secondary hyperparathyroidism.
The bone lesions of hyperparathyroidism, although not specific, are important in establishing the diagnosis. The bony trabeculae exhibit osteoclastic resorption, as well as the formation of osteoid trabeculae by large numbers of osteoblasts. In these areas a delicate fibrocellular stroma contains numerous multinucleated giant cells. Accumulations of hemosiderin and extravasated red blood cells also are noted. As a result, the tissues may appear reddish brown, accounting for the term brown tumor. The lesions are microscopically identical to central giant cell granulomas.
Ref:- Oral Pathology. Regezi . 4^th edition.page no- 342-343.
CONSERVATIVE DENTISTRY & ENDODONTICS
21. The primary retention of a Class II gold inlay is achieved by
1. adding an occlusal dovetail.
2. increasing the parallelism of walls.
3. lengthening the axial walls.
4. placing a gingival bevel.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans. A [Ref. Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 307]
Cast metal intracoronal restorations rely primarily on almost parallel vertical walls to provide retention of the casting. The preparation walls must be designed maintaining parallelism with small angle of divergence (2-5 degrees per wall) that would enhance retention form. The degree of divergence needed primarily depends on the length of the prepared walls: greater the vertical height of the walls, the more divergence is permitted & recommended, but within the range described. Having sufficient length of these almost parallel walls allows enough frictional resistance & mechanical locking of the luting agent into minute irregularities of the casting & the preparation walls to counteract the pull of sticky foods.
In class II preparations involving only one of the two proximal surfaces, an occlusal dovetail may aid in preventing the tipping of the restoration by occlusal forces. When an unusually large amount of retention form is required, occlusal dovetail may be placed whether or not caries is on the occlusal surface.
Fig A shows primary retention form in class II tooth preparation for amalgam with vertical external walls of proximal & occlusal portios converging occlusally while fig B shows primary retention form for an inlay with similar walls slightly diverging occlusally.
22. A vertical cross-section of a smooth surface carious lesion in enamel appears as a triangle with the
A. base at the dentino-enamel junction.
B. base facing toward the pulp.
C. apex pointing to the enamel surface
D. apex pointing to the dentino-enamel junction.
Ans. D [Ref.Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 165,166]
Smooth-surface caries does not begin in an enamel defect, but rather in a smooth area of the enamel surface that is habitually unclean & is continually or usually covered by plaque. The disintegration in the enamel in smooth-surface caries may be pictured as a cone with its base on enamel surface & the apex directed towards DEJ.
In contrast, caries cone in pit & fissure caries may be pictured with its apex on enamel surface & base towards DEJ. Thus, caries in this case forms a small area of penetration in the enamel & does not spread laterally to a great extent until DEJ is reached.
23. For an acid-etched Class III composite resin, the cavosurface margin of the cavity can be bevelled to
A. eliminate the need for internal retention.
B. improve convenience form.
C. aid in finishing.
D. increase the surface area for etching.
Ans. D [Ref. Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 313, 530]
Bevelling the cavosurface margin of composite restorations increasese the surface area of etchable enamel by increasing the number of exposed enamel rods thus maximising the effectiveness of bond. Most class III composite restorations are retained only by the micromechanical bond from acid etching & resin bonding, so no additional retention form is required. Also, bevel brings the margins into more accessible areas thus improving the convenience form & allowing better blending and finishing of the margins.
24. The tooth preparation for a porcelain veneer must have a
1. rough surface.
2. space for the veneer material.
3. definite finish line.
4. margin at least 1mm supragingivally
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above
Ans. E [Ref.Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 650]
Intraenamel preparation before placing a veneer is strongly recommended for following reasons:
1. to provide space for opaque, bonding or veneering materials for maximal esthetics without overcontouring
2. to remove the outer, fluoride-rich layer of enamel that may be more resistant to acid-etching
3. to create a rough surface for improved bonding
4. to establish a definite finish line.
Whenever possible, margins should be placed supragingivally.
25. In order to achieve a proper interproximal contact when using a spherical alloy, which of the following is/are essential?

1. A larger sized condenser. 2. A thinner matrix band. 3. A properly placed wedge. 4. Use of mechanical condensation. A. (1) (2) (3) B. (l)and(3) C. (2) and (4) D. (4) only E. All of the above.

Ans. A [Ref.Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 206]
Condensers should be chosen that are best suited for use in each part of the tooth preparation & that can be used without binding. Condensation of amalgam with spherical particles requires larger condensers than are commonly used for admixed because spherical amalgam is initially easier to condense & admixed requires more pressure.
26. A bitewing radiograph of tooth 1.4 reveals caries penetrating one third into the mesial enamel. The correct management of tooth 1.4 is to
A. place an amalgam restoration.
B. place a porcelain inlay.
C. place a direct composite restoration.
D. apply fluoride and improve oral hygiene.
Ans D [Ref.Nairn H Wilson, Textbook: Minimally Invasive Dentistry. Pg 66-70]
Following the philosophy of minimal invasive dentistry, perform the least amount of dentistry needed in any situation. As depicted by iceberg of dental caries, lesions limited to enamel can be managed by preventive care only. Thus, attempts should be made towards remineralization using fluoride & improving oral hygiene.
27. As a dentist in Canada, it is ethical to refuse to treat a patient on the basis of
1. religious beliefs.
2. infectious disease.
3. physical handicap.
4. recognition of lack of skill or knowledge.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.

Ans. D [Ethics Handbook for Dentists,Introduction to Ethics, Professionalism, and Ethical Decision Making (CODE-1)]

There are several valid reasons for a dentist to refrain from providing treatment:

1. The dentist does not have the expertise or capability to provide competent treatment or to meet patient expectations. In such cases, the dentist has a responsibility to refer patients to suitable caregivers who can provide treatment appropriate to the circumstances;
2. The dentist’s professional ability is impaired from injury, illness, disability, medication, or addiction;
3. The patient requests treatment that is clearly contrary to the patient’s best interests.
28. In a post-endodontic restoration, the function of the post is to insure
A. distribution of forces along the long axis.
B. resistance of the tooth to fracture.
C. sealing of the root canal.
D. retention of the definitive restoration.
Ans. D [Ref. Ingle’s Endodontics 6^th Edition, Pg 1435]
Since clinical & laboratory data indicate that teeth are not strengthened by posts, their purpose is for retention of a core that will provide appropriate support for the definitive crown or prosthesis.
Types of posts:
A. According to fabrication:
(I) Prefabricated (II) Custom-made
1. Metal posts- gold, high platinum, Co-Cr-Mo, 1. Direct – pattern fabricated in patient’s mouth
stainless steel, Titanium 2. Indirect - pattern fabricated in the lab
2. Carbon fiber posts
3. Quartz fiber posts
4. Zirconia posts
5. Glass fiber posts
6. Plastic posts
B. According to retention:
1. Active- mechanically engage the wall. More retentive but generate higher stresses
2. Passive – do not engage the wall. Less retentive but produce low stresses
C. According to Post design:
1. Parallel
2. tapered
3.smooth
4. serrated
5. combination of the above
29. The major advantage of glass ionomer cement as a restorative material is that it is
A. highly translucent.
B. a fluoride releasing material.
C. highly esthetic.
D. unaffected by moisture during the setting reaction.
Ans. B [Ref. Phillips’ Science of Dental Materials, 11^th edition 474-5]
Glass ionomers release fluoride in amounts comparable to those released initially from silicate cement & continue to do so over an extended period. It has a radiopacity of 2.5mm of Al. water plays a critical role in the setting of GIC. Conventional GIC must be protected against desiccation and water changes in the structure during placement.
30. A 45 year old patient has 32 unrestored teeth. The only defects are deeply stained grooves in the posterior teeth. Clinical examination reveals no evidence of caries in the grooves. The treatment of choice is
A. application of pit and fissure sealants.
B. preventive resin restorations.
C. conservative Class I amalgams.
D. prophylactic odontotomy.
E. no treatment.
Ans. E [Ref.Sturdevant’s Art & Science of Operative Dentistry 5^th Edition, Pg 194-195]
The ideal time to apply sealants is soon after occlusal surfaces erupt into the oral environment. However, sealants also are a common strategy for managing older patients whose risk for caries is increasing as a result of reduced saliva flow & more difficulty in maintaining good oral hygiene. Since in this case, patient is not v. old & has a low caries index, it is not logical to place sealants and no treatment is required.

ORAL SURGERY
31. Which of the following nerves should be anesthetized for the removal of a maxillary first molar?
1. Greater palatine.
2. Naso palatine.
3. Middle superior alveolar.
4. Anterior superior alveolar.
5. Posterior superior alveolar.
A. (I) (2)(4)
B. (0(3) (4)
C. (1)(3) (5)
D. (2)(3)(5)
E. (2) (4) (5)
Ans. C (ref. malamed 5^th ed. Pg 193,196,203)
Middle superior alveolar nerve block anesthetize mesiobuccal root of maxillary first molar.
32. Antibiotic prophylaxis is recommended for patients with which of the following?
1. Mitral valve prolapse with regurgitation.
2. Cardiac pacemaker.
3. Prosthetic heart valves.
4. All heart murmurs.
A. (1) (2) (3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans. A (Peterson 2^nd ed. Pg. 23)
33. Post-immunization serological test results for a health care worker who has completed the series of vaccinations against hepatitis B reveals that their anti-HBsAg is less than the value required for immunity. The health care worker should
A. receive one additional vaccination followed by post-immunization testing.
B. repeat the full series of hepatitis B vaccinations followed by post- immunization testing.
C. refrain from performing any exposure-prone procedures for a period of 3-6 months followed by a full series of hepatitis B vaccinations.
D. have liver function tests performed to assess liver damage from a previous hepatitis B infection.
Ans. A
Hb s Ab titres should be obtained 6 months after 3 dose primary series. Those with non protective titres < 10mlU/ml should receive 1 dose monthly with subsequent Hb s Ab testing upto maximum of 3 doses.
34. Which of the following drugs is used for preoperative sedation?
A. Propoxyphene.
B. Phenylbutazone.
C. Diazepam.
D. Atropine.
Ans. D (ref. Petersons 2^nd ed. Ch. 5)
Drugs used for Pharmacologic Premedication before Inaction of Anesthesia
· Barbiturates: Secobarbital, Pentobarbital
· Narcotic / long acting NSAID’s: morphine, pethidine, fentanyl, ketoprofen, piroxicam
· Opioids: Morphine, Meperidine
· Benzodiazepine: Midazolam, Diazepam, Lorazepam, Temazepam
· Antihistamines: diphenhydramine, promethazine
· Alpha-2 agonists: Clonidine, Dexmedetomidine
· Anticholinergics: Atropine, Scopolamine, Glycopyrrolate
· H2 antagonists: Cimetidine, Ranitidine, Famotidine
· Antacids: Particulate, Nonparticulate
· Stimulates of gastric motility: Metoclopramide
35. Thiopentone sodium (Pentothal) provides all of the following advantages EXCEPT
A. smooth pleasant induction.
B. good sleep production.
C. adequate length of operating time.
D. acceptability for both young and old.
Ans. C
36. Patient nausea during nitrous oxide administration is an indication that the patient
A. is nervous.
B. has not eaten for some time.
C. is allergic to nitrous oxide.
D. has received the nitrous oxide too quickly
Ans. D (ref. Petersons 2^nd ed. Pg.96)
Depending on the concentration and length of administration of laughing gas, four levels of sedation can be experienced (after an initial feeling of light-headedness):
1. a tingling sensation, especially in the arms and legs, or a feeling of vibration (“parasthesia”), quickly followed by
2. warm sensations, and
3. a feeling of well-being, euphoria and/or floating. During heavier sedation, hearing may dissolve into a constant, electronic-like throbbing.
4. At a deeper level of sedation again, sleepiness, difficulty to keep one’s eyes open or speak (“dream”) can occur. Should nausea set in, it means you’re definitely oversedated!
37. Pain and difficulty on swallowing, trismus and a displaced uvula are signs and symptoms of infection of which one of the following spaces?
A. Submandibular.
B. Lateral parapharyngeal.
C. Sublingual.
D. Deep temporal.
Ans. B (ref. shafers 6^th ed. Pg 505) 
· Brawny induration of face above the angle of mandible
· Anterior part of lateral pharyngeal wall may be swollen; that pushes the soft palate & palatine tonsil towards midline.
· Marked trismus
· Severe pain & dysphagia
38. Which of the following is NOT a component of a dental cartridge containing 2% lidocaine with 1:100,000 epiniphrine?
A. Methylparaben.
B. Water.
C. Sodium metabisulphite.
D. Sodium chloride
Ans. D (ref. malamed 5^th ed.pg.320)
· Local anesthetic agent conducts blockade
· Vasoconstrictor: 1:100000 = 0.01mg/ml safe dose is 0.25 mg. so no more than 20 cc should be given.
Purpose:Vasoconstrictors are drugs that are added to LA to oppose vasodialatory actions of LA i.e.:
· Decrease blood flow to the site of administration
· Absorption of LA into CVS is slowed down
· Lowers blood levels of LA thereby minimizing risk of LA toxicity
· Increase duration of action
· Decrease bleeding at the site of administration
· Reducing agent: 0.5 mg/ml sodium metabisulfite.
· Preservative: 1mg/ml methyl paraben.
· Fungicide:thymol.
· Salts: 5-6 mg NaCl to make it isotonic
· Vehicle: distilled water.
39. The surgical removal of tooth 3.6 requires anesthesia of the inferior alveolar nerve as well as which of the following nerves?
A. Lingual, cervical plexus.
B. Cervical, long buccal.
C. Lingual, long buccal.
D. Mental, long buccal
Ans. C (ref. malamed 5^th ed.pg.235)
LINGUAL NERVE BLOCK
While giving inferior alveolar nerve block syringe is slowly withdrawn till half of the inserted depth & 0.5 ml of solution is inserted.
For anterior 2/3^rd of tongue & floor of mouth on side of injection
LONG BUCCAL NERVE BLOCK
Buccal nerve block also known as the (long buccal) is useful to anesthetize the soft tissues and periosteum buccal to the mandibular molars.
40. Which of the following hemostatic agents is most likely to create a systemic reaction?
A. Aluminum sulphate (Pascord®).
B. Aluminum chloride (Hemodent®).
C. Epinephrine (Racord®).
D. Ferric sulphate (Astringedent®).
Ans. C 
Extensive application or undiluted preparation can cause systemic effects.
Astringedent, Pascord & hemodent are for patients in which epinephrine is contraindicated.

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