NEET MDS 2021 RECALL + MERITERS STRIKES

NEET MDS 2021

RECALLS + MERITERS STRIKES
MERITERS FACULTY PANEL REVIEW

Dr Pavithra Dr Aaysha
Dr Roshna Ramaswamy Sheikh
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES
Arrange the following zones of the pulp from outer to inner layer in the correct
sequence:

1. Odontoblastic zone
2. Cell rich zone
3. Cell free zone
4. Central pulp

1) 1324
2) 1234
3) 3241
4) 3214

Ans Key : 1 (1324)

NEET MDS 2021 RECALL + MERITERS STRIKES
ZONES OF PULP

Starting at the periphery, the pulp is divided into four zones:

I. Odontoblastic zone, which surrounds the periphery of the pulp
II. Cell-free zone
III. Cell-rich zone
IV. Central zone

I. ODONTOBLASTIC ZONE

• The odontoblasts are specialized cells that generally last the entire life of the
tooth. They consist of cell bodies and their cytoplasmic processes.
• The odontoblastic cell bodies form the odontoblastic zone, whereas the
odontoblastic processes are located within the predentin matrix and the
dentinal tubules, extending into the dentin.
NEET MDS 2021 RECALL + MERITERS STRIKES

II. CELL-FREE ZONE

• The cell-free zone, or zone of Weil, is a relatively acellular zone of the pulp,
located centrally to the odontoblast zone. This zone, although called cell-
free, contains some fibroblasts, mesenchymal cells, and macrophages.
• Fibroblasts are involved in the production and maintenance of the
reticular fibers found in this zone.

III. CELL-RICH ZONE

• The cell-rich zone is located central to the cell-free zone.

• Its main components are ground substance, fibroblasts with their product, i.e.
the collagen fibers, undifferentiated mesenchymal cells, and macrophages.
NEET MDS 2021 RECALL + MERITERS STRIKES

IV. CENTRAL ZONE

• The central zone or pulp proper contains blood vessels and nerves that are
embedded in the pulp matrix together with fibroblasts.
• From their central location, the blood vessels and the nerves send branches
to the periphery of the pulp.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Zones of pulp
Zone Major component
Odontoblastic zone Odontoblast cells
Cell-free zone (Weil’s zone) Relatively acellular, accommodate odontoblast during
development and function of tooth
Cell-rich zone (primarily Fibroblasts, undifferentiated mesenchymal cells
coronal)
Pulp core Predominantly fibrous tissue, major vessels and nerves,
fibroblasts

Source Ref : ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY Edited by G S Kumar Fourteenth
Edition, page no 95
GROSSMAN’S ENDODONTIC PRACTICE 14TH EDITION, page no 14-25
NEET MDS 2021 RECALL + MERITERS STRIKES

All of the following are the uses of EDTA, except:

1) Dissolution of pulp
2) Softening of dentin
3) Removal of smear layer
4) Chelation of calcium ions

Ans Key : 1 (Dissolution of pulp)

NEET MDS 2021 RECALL + MERITERS STRIKES
• EDTA functions by forming a calcium–chelate solution with the calcium ion of
dentin; the dentin thereby becomes more friable and easier to instrument. Many
clinicians use some form of EDTA routinely during shaping and cleaning of the root
canal and find it effective for achieving canal patency, enlargement, and smear layer
removal.
• EDTA, a chelating agent, has been used as an irrigating solution. This solution
removes the inorganic component of the endodontic smear layer.
• The effects of EDTA have been studied both in vitro and in vivo, and the following
conclusions have been reported:

o EDTA is effective in softening dentin.

o Irrigation with EDTA removes the inorganic part of the smear layer.
o The extent of demineralization by EDTA is proportional to the exposure time.
o EDTA has no deleterious effect when used clinically as an irrigating solution.
NEET MDS 2021 RECALL + MERITERS STRIKES

• EDTA as an irrigant is employed by depositing a few drops into the pulp chamber
with a syringe and then carefully pumping the solution into the root canal with a
fine root canal instrument.

KEY CONCEPT:

• EDTA is effective in softening dentin.

• Irrigation with EDTA removes the inorganic part of the smear layer.
• The extent of demineralization by EDTA is proportional to the exposure time.

Source Ref : GROSSMAN’S ENDODONTIC PRACTICE 14TH EDITION, page no 302

NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following can be used as a base under CaOH2, when the remaining dentin
thickness is less than 1 mm?
1) ZnOE
2) Resin modified GIC
3) Polycarboxylate
4) ZnPO4

Ans Key : 2 (Resin modified GIC)

NEET MDS 2021 RECALL + MERITERS STRIKES
Pulp Protection

• Ideal or shallow depth of preparation: If the tooth preparation is of ideal or

shallow depth, no liner or base is indicated.
• Remaining dentin thickness (RDT) of 1.0–1.5 mm: In deeper caries removal
(where the RDT is judged to be 1–1.5 mm), a layer (i.e. 0.5–0.75 mm) of a resin-
modified glass ionomer (RMGI) material should be placed.
o The RMGI insulates the pulp from thermal changes, bonds to dentin, releases
fluoride, is strong enough to resist the forces of condensation and reduces
micro-leakage.
o If extensive dentin is lost because of caries, and the tooth excavation extends
close to the pulp, a light cured RMGI base should be applied over the
already placed calcium hydroxide liner.
NEET MDS 2021 RECALL + MERITERS STRIKES

• RDT of < 0.5 mm: For pulpal protection in very deep caries removal (where
the RDT is judged to be < 0.5 mm and suspicion of potential microscopic
pulpal exposure is increased), a thin layer (i.e. 0.5–0.75 mm) of a calcium
hydroxide liner may be placed.
o The calcium hydroxide liner may elicit tertiary dentin formation if the original
odontoblasts are no longer vital. If the calcium hydroxide liner is used, it is
placed by using the same instrument and the same technique as described for
the RMGI liner.
o The calcium hydroxide liner should be placed only over the deepest portion of
the caries removal (nearest the pulp). A layer of RMGI liner should be used to
cover the calcium hydroxide. The entire dentin surface should not be covered.
o The RMGI liner is recommended to cover the calcium hydroxide to resist the
forces of condensation and to prevent dissolution over time by sealing the
deeply excavated area.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
• Remaining dentin thickness (RDT) of 1.0–1.5 mm: In deeper caries removal
(where the RDT is judged to be 1–1.5 mm), a layer (i.e. 0.5–0.75 mm) of a resin-
modified glass ionomer (RMGI) material should be placed.
• The RMGI insulates the pulp from thermal changes, bonds to dentin, releases
fluoride, is strong enough to resist the forces of condensation and reduces
micro-leakage.
• If extensive dentin is lost because of caries, and the tooth excavation extends
close to the pulp, a light cured RMGI base should be applied over the already
placed calcium hydroxide liner.

Source Ref : Sturdevant’s Art and Science of Operative Dentistry: Second South
Asia Edition, V. Gopikrishna, page no 310
NEET MDS 2021 RECALL + MERITERS STRIKES

Dentin bonding agent is:

1) Hydrophilic
2) Hydrophobic
3) Hydrophilic and hydrophobic
4) Lipophilic and lipophobic

Ans Key : 3 (Hydrophilic and hydrophobic)

NEET MDS 2021 RECALL + MERITERS STRIKES

DENTIN BONDING AGENTS

Mechanism of Bonding
Dentin adhesive molecule has a bifunctional structure:
M-R-X
Where,

• M is the double bond of methacrylate which copolymerizes with

composite resin.
• R is the spacer which makes the molecule large.
• X is a functional group for bonding which bonds to inorganic or organic
portion of dentin.
• Ideally dentin bonding agent should have both hydrophilic and hydrophobic
ends. The hydrophilic end displaces the dentinal fluid to wet the surface. The
hydrophobic end bonds to the composite resin.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Bonding to the inorganic part of dentin involves ionic interaction among the
negatively charged group on X (for example, phosphates, amino acids and amino
alcohols, or dicarboxylates) and the positively charged calcium ions.
• Bonding to the organic part of dentin involves interaction with Amino (-NH),
Hydroxyl (-OH), Carboxylate (-COOH),Amide (-CONH) groups present in dentinal
collagen.
• Dentin bonding agents have isocyanates, aldehydes, carboxylic acid anhydrides and
carboxylic acid chlorides which extract hydrogen from the above mentioned groups
and bond chemically.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

DENTIN BONDING AGENTS

Ideally a dentin bonding agent should have both hydrophilic and
hydrophobic ends. The hydrophilic end displaces the dentinal fluid to wet the
surface. The hydrophobic end bonds to the composite resin.

In a bonding agent, hydrophilic end

displaces the dentinal fluid to wet the
surface and hydrophobic end bonds to the
composite resin.

Source Ref : Textbook of OPERATIVE DENTISTRY, 3rd ed , Nisha Garg, page no 239
NEET MDS 2021 RECALL + MERITERS STRIKES
Which of the following solution is used to check for root canal calcification?

1) H2O2
2) EDTA
3) Sodium hypochlorite
4) Chlorhexidine

Ans Key : 3 (Sodium hypochlorite)

NEET MDS 2021 RECALL + MERITERS STRIKES

Missed canals can be located by:

• Taking radiographs
• Use of magnifying loupes or endo-microscope
• Accurate access cavity preparation
• Use of ultrasonics
• Use of dyes such as methylene blue
• Use of sodium hypochlorite: After thorough cleaning and shaping, pulp
chamber is filled with sodium hypochlorite. If bubbles appear in, it indicates
either there is residual tissue present in a missed canal or residual chelator
in the prepared canal. This is called Champagne bubble test.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Allowing sodium hypochlorite (NaOCl) to remain in the pulp

chamber may help locate a calcified root canal orifice. Tiny
bubbles may appear in the solution, indicating the position of
the orifice. This is best observed through magnification.

Source Ref : Textbook of Endodontics,4th ed , Nisha Garg, page no 351

NEET MDS 2021 RECALL + MERITERS STRIKES
Converging walls during cavity preparation provides:

1) Outline form
2) Retention form
3) Resistance form
4) Convenience form

Ans Key : 2 (Retention form)

NEET MDS 2021 RECALL + MERITERS STRIKES

• Primary retention form is the shape or form of the preparation that prevents
displacement or removal of the restoration by tipping or lifting forces.
• The design of preparation primary retention form is directly related to the
retention needs of the anticipated restorative material.
• Amalgam restoration of a Class I or II preparation is retained by developing
external tooth walls that converge occlusally. In this way, when the amalgam
is placed in the preparation and hardens, it cannot be dislodged.
• However, excessive occlusal convergence of the external walls will result in
unsupported enamel rods at the cavosurface margin and must be avoided.
• The external walls of Class III and V preparations diverge so as to provide strong
enamel margins. Retention of amalgam in these areas requires the creation of
secondary features (coves or grooves) in the dentinal walls that serve to retain
the restoration.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Primary Retention Form for Amalgam Restorations

• Amalgam restoration of a Class I or II preparation is retained by

developing external tooth walls that converge occlusally.
• In this way, when the amalgam is placed in the preparation and hardens, it
cannot be dislodged. The occlusal convergence should not be excessive which
would result in unsupported enamel rods at the cavosurface margin.

Source Ref : Sturdevant's Art and Science of Operative Dentistry - 7th Edition, Page 128
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the instrument:

1) Rubber dam forceps

2) Tissue forceps
3) Extraction forceps
4) Artery forceps

Ans Key : 1 (Rubber dam forceps )

NEET MDS 2021 RECALL + MERITERS STRIKES

Rubber dam forceps

• The rubber dam retainer forceps is used both for placement and removal of the
retainer from the tooth.
• They are designed to spread the two working ends of the forceps apart when the
handles are squeezed. Working ends have small projections that fit into two
corresponding holes on the rubber dam clamps.
• Area between the working end and the handle has a sliding lock device which
locks the handles in positions while the clinician moves the clamp around the
tooth.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Retainer Forceps
The rubber dam retainer forceps is used for placement and removal of the retainer
from the tooth.

Rubber dam forceps (A) engaging retainer (B)

Source Ref : Sturdevant’s Art and Science of Operative Dentistry: Second South Asia Edition, V. Gopikrishna,
page no 215
McDonald and Avery's Dentistry for the Child and Adolescent-- Second South Asia Edition, Page 104
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the instrument given below:

1) Smart bur
2) Plastic bur
3) Composite bur
4) Both 1 and 2

Ans Key : 4 Both 1 and 2

NEET MDS 2021 RECALL + MERITERS STRIKES
Smart Prep Burs

• Smart prep instrument is also known as polymer bur or smart bur.

• This type of instrument is made from polymer that safely and effectively
removes decayed dentin without affecting the healthy dentin.
• Smart prep bur has property of self-limiting, this means it will not cut the
healthy dentin. It cuts dentin only when large amount of force is applied.

Availability

• Sizes 2, 4, 6.
• Used with slow speed handpiece (500–800 rpm).
• Single patient use.
NEET MDS 2021 RECALL + MERITERS STRIKES
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Controlled selective rotary excavation Polymer burs:
• A "plastic" bur was made of a polyamide/ imide (PAI) polymer, possessing
slightly lower mechanical properties than sound dentin.
• Hard enough to remove decayed dentin,
• Stops at- hard healthy dentin

Source Ref : Textbook of Operative Dentistry Nisha Garg 2nd Ed P:130

NEET MDS 2021 RECALL + MERITERS STRIKES

Law of symmetry is not followed by:

1) Maxillary molars
2) Mandibular molars
3) Maxillary premolars
4) Mandibular premolars

Ans Key : 1 (Maxillary molars)

NEET MDS 2021 RECALL + MERITERS STRIKES

Krasner and Rankow’s Laws of Access Opening

• Law of centrality: The floor of the pulp chamber is always located in the center of
the tooth at the level of the CEJ.
• Law of concentricity: The walls of the pulp chamber are always concentric to
the external surface of the tooth at the level of the CEJ.
• Law of the CEJ: The distance from the external surface of the clinical crown to
the wall of the pulp chamber is the same throughout the circumference of the
tooth at the level of the CEJ. The CEJ is the most consistent, repeatable
landmark for locating the position of the pulp chamber.
• Law of symmetry 1: Except for maxillary molars, the orifices of the canals
are equidistant from a line drawn in a mesiodistal direction through the
pulp chamber floor.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Law of symmetry 2: Except for maxillary molars, the orifices of the canals
lie on a line perpendicular to a line drawn in a mesiodistal direction across
the center of the floor of the pulp chamber.
• Law of color change: The color of the pulp chamber floor is always darker than the
walls.
• Law of orifices location 1: The orifices of the root canals are always located at
the junction of the walls and the floor.
• Law of orifices location 2: The orifices of the root canals are located at angles in
the floor-wall junction.
• Law of orifices location 3: The orifices of the root canals are located at the
terminus of the root developmental fusion lines.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Law of symmetry 1: Except for maxillary molars, the orifices of the canals
are equidistant from a line drawn in a mesiodistal direction through the pulp
chamber floor.
• Law of symmetry 2: Except for maxillary molars, the orifices of the canals lie
on a line perpendicular to a line drawn in a mesiodistal direction across the
center of the floor of the pulp chamber.

Source Ref : GROSSMAN’S ENDODONTIC PRACTICE 14TH EDITION, page no 230

NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following is used to enlarge canal opening?

1) K-file
2) Reamer
3) Gates Glidden drill
4) Path finder

Ans Key : 3 (Gates Glidden drill)

NEET MDS 2021 RECALL + MERITERS STRIKES

• A Gates-Glidden drill of appropriate size (usually No. 3) or any other

suitable orifice enlarger is used to remove the palatal shoulder by working
from inside to outside with light strokes.
• The palatal shoulder is not an anatomic entity itself, but rather is a
prominence of dentin created when the palatal roof is removed.
• One gains direct access to the apical area of the root canal by removing the
palatal roof and the palatal shoulder of the pulp chamber in an anterior tooth.
• Direct access can be verified by placing the straight end of the endodontic
explorer into the canal orifice. The explorer should follow the path of the canal
without impedance from the walls of the surrounding access preparation.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Gates Glidden drills are typically used to

enlarge coronal canal areas. When
misused, GG drills can dramatically
reduce radicular wall thickness.

Source Ref : GROSSMAN’S ENDODONTIC PRACTICE 14TH EDITION, page no 234

Cohen's Pathways of the Pulp, Page 225
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

During bleaching, light emitted from LED lamp is:

1) Cold blue visible light 465 nm
2) Hot blue visible light 465 nm
3) Cold orange visible light 465 nm
4) Cold green visible light 465 nm

Ans Key : 1 (Cold blue visible light 465 nm)

NEET MDS 2021 RECALL + MERITERS STRIKES

• LED lamps emit cold blue light with a wavelength of around 465 nm, which
allows activation of hydrogen peroxide gels and accelerates the bleaching
process.
• LED lights are placed close to the patient’s teeth for 15- to 20-minute
treatments, which may have to be repeated up to three times.
• Cosmetic specialists with no dental background have adopted this method of
bleaching because it offers low risk, as no heat activation is involved.
• Green LED lights demonstrated the lowest intrapulpal temperature increase
compared to conventional halogen, hybrid lights with or without a laser
component, or high-intensity LED lights.
• However, a systematic review investigating the influence of the light source on
pulpal responses during bleaching procedures concluded that there was not
sufficient evidence to extrapolate the true human situation.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
• LED lamps emit cold blue light with a wavelength of around 465 nm, which
allows activation of hydrogen peroxide gels and accelerates the bleaching
process.

Source Ref : Cohen's Pathways of the Pulp 12th Edition

NEET MDS 2021 RECALL + MERITERS STRIKES

Strength of gypsum bonded investment material is provided by:

1) Carbon
2) Copper
3) Silica
4) Gypsum

Ans Key : 4 (Gypsum)

NEET MDS 2021 RECALL + MERITERS STRIKES

GYPSUM-BONDED INVESTMENTS

• The α-hemihydrate form of gypsum is generally the binder for investments used in
casting gold-containing alloys with melting ranges below 1000°C. When this
material is heated at temperatures sufficiently high to completely dehydrate the
investment and to ensure complete castings, it shrinks considerably and
occasionally fractures.
• The strength of an investment is usually measured under compressive stress.
• The compressive strength is increased according to the amount and the type of
the gypsum binder present.
• For example, the use of α-hemihydrate instead of plaster definitely
increases the compressive strength of the investment. The use of chemical
modifiers increases strength because more of the binder can be used
without a marked reduction in thermal expansion.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
GYPSUM-BONDED INVESTMENTS
• The strength of an investment is usually measured under compressive stress.
• The compressive strength is increased according to the amount and the type of
the gypsum binder present.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 201, 206
NEET MDS 2021 RECALL + MERITERS STRIKES

The dentist tries to prepare wax try-in using base plate wax in tropical area, the type of
wax preferred is:
1) Type I base plate wax
2) Type II base plate wax
3) Type III base plate wax
4) Type IV base plate wax

Ans Key : 3 (Type III base plate wax )

NEET MDS 2021 RECALL + MERITERS STRIKES
• Baseplate wax is used to establish the initial arch form in the construction of
complete dentures. Supplied in 1- to 2-mm-thick red or pink sheets, the wax is
approximately 75% paraffin or ceresin with additions of beeswax and other resins
or waxes.
• The harder the wax, the less the flow at a given temperature.
• The difference in flow of the three types may be advantageous for a
particular application.

1. Type I, a soft wax, is used for building veneers.

2. Type II, a medium wax, is designed for patterns to be placed in the mouth in normal
climatic conditions.
3. Type III, a hard wax, is used for trial fitting in the mouth in tropical climates.
Because residual stress is present within the wax from contouring and
manipulating the wax, the finished denture pattern should be flasked as soon
as possible after completion of all adjustments and manipulations.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Baseplate wax:

• Type I, a soft wax, is used for building veneers.

• Type II, a medium wax, is designed for patterns to be placed in the mouth in
normal climatic conditions.
• Type III, a hard wax, is used for trial fitting in the mouth in tropical
climates.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 200

NEET MDS 2021 RECALL + MERITERS STRIKES

All of the following statements regarding self cure as compared to heat cure are true,
except:
1) Self cure has lower molecular weight
2) Self cure has higher residual monomer content
3) Self cure is more porous
4) Self cure has more transverse strength

Ans Key : 4 (Self cure has more transverse strength)

NEET MDS 2021 RECALL + MERITERS STRIKES
• As a general rule, the degree of polymerization achieved using chemically
activated resins is not as complete as that achieved using heat-activated systems.
This indicates there is a greater amount of unreacted monomer in denture bases
fabricated via chemical activation. This unreacted monomer creates two major
difficulties.
• First, it acts as a plasticizer, resulting in decreased transverse strength of the denture
resin.
• Second, the residual monomer serves as a potential tissue irritant, thereby
compromising the biocompatibility of the denture base.
• The color stability of chemically activated resins generally is inferior to the color
stability of heat-activated resins.
• This property is related to the presence of tertiary amines within the chemically
activated resins. Such amines are susceptible to oxidation and accompanying color
changes that affect the appearance of the resin.
• Discoloration of these resins can be minimized via the addition of stabilizing agents that
prevent such oxidation.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 483

NEET MDS 2021 RECALL + MERITERS STRIKES

The process of making the impression material to conduct electricity is:

1) Metallizing
2) Electroplating
3) Iontophoresis
4) Galvanizing

Ans Key : 1 (Metallizing)

NEET MDS 2021 RECALL + MERITERS STRIKES
ELECTROFORMED DIES

• Metal dies produced from electroplated impression material have moderately high
strength, adequate hardness, and excellent abrasion resistance. Detail
reproduction of a line 4 µm or less in width is readily attainable on the resulting
metal-covered die when a nonaqueous elastomeric impression material is used.

• Copper-plated compound dies first became popular in the early 1930s, and
silver-plated dies became more popular in later years. Several modifications of
the fabrication technique are used, but the following description is typical.

• The first step in the procedure is to treat the surface of the impression material
so that it conducts electricity. This process is referred to as metallizing.
NEET MDS 2021 RECALL + MERITERS STRIKES
• In this process, a thin layer of metal, such as silver powder, is deposited on the
surface of the impression material. This metal layer determines to a large extent
the surface character of the finished die. Various metallizing agents are available,
including bronzing powder and aqueous suspensions of silver powder and
powdered graphite. These agents can be deposited on the surface of the
impression with a camel- hair brush.

• The electroplating bath itself is primarily a solution of silver cyanide.

NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• The first step in the procedure is to treat the surface of the impression material
so that it conducts electricity. This process is referred to as metallizing.
• Various metallizing agents are available, including bronzing powder and aqueous
suspensions of silver powder and powdered graphite.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 212, 213
NEET MDS 2021 RECALL + MERITERS STRIKES

The dentist decided to proceed with non-invasive tooth preparation using air-abrasion
under high suction. The material decided to be used is alumina. Which alumina particle
size is preferred?
1) 50 µm
2) 100 µm
3) 150 µm
4) 200 µm

Ans Key : 1 (50 µm )

NEET MDS 2021 RECALL + MERITERS STRIKES
Tooth Preparations Using Air Abrasion

• In this technique, kinetic energy is used to remove carious lesion. Here

powerful fine stream of moving aluminum oxide particles is directed against the
surface to be removed.

• The abrasive particles hit the tooth with high velocity and a small amount of tooth
structure is removed. Commonly used particle sizes are either 27 or 50
micrometers in diameter.

• The speed of the abrasive particles when they hit the target depends upon air
pressure, size of particles, powder flow, nozzle diameter, the angle of the tip
and the distance of tip from the tooth.
NEET MDS 2021 RECALL + MERITERS STRIKES
• Usually the distance from the tooth ranges from 0.5 to 2 millimeters. As the
distance increases, the cutting efficiency decreases.

• An added advantage is that tooth preparations achieved using air abrasion show
rounded internal contours when compared with those prepared with a
handpiece and straight burs.

• Air abrasion is not indicated in patients with dust allergy, asthma, chronic
obstructive lung disease, open wounds, advanced periodontal disease, fresh
extractions and recent placement of orthodontic appliances.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Tooth Preparations Using Air Abrasion

• In this technique, kinetic energy is used to remove carious lesion. Here

powerful fine stream of moving aluminum oxide particles is directed against
the surface to be removed.
• The abrasive particles hit the tooth with high velocity and a small amount of
tooth structure is removed. Commonly used particle sizes are either 27 or 50
micrometers in diameter.

Source Ref : Textbook of OPERATIVE DENTISTRY, 3rd ed , Nisha Garg, page no 471, 472
NEET MDS 2021 RECALL + MERITERS STRIKES

As the intensity increases, hue perception changes. The effect is called:

1) Metamerism
2) Bezold- Brucke effect
3) Chameleon effect
4) Tyndall effect

Ans Key : 2 (Bezold- Brucke effect )

NEET MDS 2021 RECALL + MERITERS STRIKES
THE EFFECT OF THE OBSERVER
• Signals of color are sent to the human brain from three sets of receptors in the
retina called cones, which are especially sensitive to red, blue, and green.
• Factors that interfere with the true perception of color generally include low or
high light levels, fatigue of the color receptors, sex, age, memory, and cultural
background.
• However, according to a 1995 study (Anusavice and Barrett, 1995), there appears
to be no effect related to observer age, gender, or clinical experience relative to
the accuracy of dental shade matching.
• At low light levels, the rods in the retina of the human eye are more
dominant than the cones, and color perception is lost.
• As the brightness becomes more intense, color appears to change (Bezold-
Brucke effect). Also, if an observer looks at a red object for a reasonably long
time, receptor fatigue causes a green hue to be seen when he or she then
looks at a white background.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• As the brightness becomes more intense, color appears to change (Bezold-

Brucke effect).
• Also, if an observer looks at a red object for a reasonably long time, receptor
fatigue causes a green hue to be seen when he or she then looks at a white
background.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 37, 38

NEET MDS 2021 RECALL + MERITERS STRIKES
The linear contraction of polysulfide is best represented by:

1) A
2) B
3) C
4) D

Ans Key : 2 (B)

NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Representative linear contraction of four elastomeric impression materials.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 165
NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following keratin is present in parakeratinized and absent in

orthokeratinized areas?
1) K6
2) K14
3) K19
4) K16

Ans Key : 3 (K19)

NEET MDS 2021 RECALL + MERITERS STRIKES

• In keeping with the complete or almost-complete maturation, histoenzyme

reactions for acid phosphatase and pentose-shunt enzymes are very strong.
• 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.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Parakeratinized areas express K19, which is usually absent from orthokeratinized

normal epithelia.

Source Ref : NEWMAN AND CARRANZA’S CLINICAL PERIODONTOLOGY

THIRTEENTH EDITION, page no 24.e1
NEET MDS 2021 RECALL + MERITERS STRIKES

Knives used in gingivectomy are:

1) Merrifield and Orban
2) Merrifield and Kirkland
3) Kirkland and Orban #1 and #2
4) Kirkland and Orban #3 and #4

Ans Key : 3 (Kirkland and Orban #1 and #2)

NEET MDS 2021 RECALL + MERITERS STRIKES
Periodontal Knives (Gingivectomy Knives)
• The Kirkland knife is representative of the knives that are typically used for
gingivectomy. These knives can be obtained as either double-ended or single-
ended instruments. The entire periphery of these kidney-shaped knives is the
cutting edge.

Interdental Knives
• The Orban knife (#1 and #2) and the Merrifield knife (#1 through #4) are
examples of knives that can be used for interdental areas.
• These spear-shaped knives have cutting edges on both sides of the blade, and
they are designed with either double-ended or single-ended blades.

Gingivectomy knives. (A) Kirkland knife. (B) Orban

interdental knife.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Gingivectomy Knives
o Periodontal knives (e.g., Kirkland) are used for incisions on the facial and
lingual surfaces.
o Orban periodontal knives (#1 and #2) are used for interdental incisions.
• Bard–Parker blades (#12 and #15), and scissors are used as auxiliary
instruments.

Source Ref : NEWMAN AND CARRANZA’S CLINICAL PERIODONTOLOGY

THIRTEENTH EDITION, page no 605, 606
NEET MDS 2021 RECALL + MERITERS STRIKES

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The plaque found in heavy calculus former differs from that in non-calculus former in that
it has:
1) Low calcium
2) Low potassium
3) Low phosphorus
4) Mineral content is same

Ans Key : 2 (Low potassium)

NEET MDS 2021 RECALL + MERITERS STRIKES

• Saliva is the primary source of mineralization for supragingival calculus,

whereas the serum transudate called gingival crevicular fluid furnishes the
minerals for subgingival calculus.
• The calcium concentration or content in plaque is 2 to 20 times higher than in
saliva.
• Early plaque of heavy calculus formers contains more calcium, three times
more phosphorus, and less potassium than that of non-calculus formers,
suggesting that phosphorus may be more critical than calcium for plaque
mineralization.
• Calcification entails the binding of calcium ions to the carbohydrate– protein
complexes of the organic matrix and the precipitation of crystalline calcium
phosphate salts.
• Crystals form initially in the intercellular matrix and on the bacterial surfaces
and finally within the bacteria.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Early plaque of heavy calculus formers contains more calcium, three times more
phosphorus, and less potassium than that of non-calculus formers, suggesting that
phosphorus may be more critical than calcium for plaque mineralization.

Source Ref : NEWMAN AND CARRANZA’S CLINICAL PERIODONTOLOGY

THIRTEENTH EDITION, page no 193
NEET MDS 2021 RECALL + MERITERS STRIKES

Drug of choice in acute necrotizing ulcerative gingivitis is:

1) Metronidazole
2) Clindamycin
3) Tetracycline
4) Ceftriaxone

Ans Key : 1 (Metronidazole)

NEET MDS 2021 RECALL + MERITERS STRIKES
• Metronidazole has been used clinically to treat acute necrotizing ulcerative
gingivitis, chronic periodontitis, and aggressive periodontitis.
• It has been used as monotherapy and also in combination with root planing
and surgery or with other antibiotics.
• Metronidazole has been used successfully to treat necrotizing ulcerative
gingivitis. Studies in humans have demonstrated the efficacy of metronidazole for
the treatment of periodontitis.
• A single dose of metronidazole (250 mg orally) appears in both serum and
GCF in sufficient quantities to inhibit a wide range of suspected periodontal
pathogens. When it is administered systemically (i.e., 750 mg/day to 1000
mg/day for 2 weeks), metronidazole reduces the growth of anaerobic flora,
including spirochetes, and it decreases the clinical and histopathologic signs of
periodontitis.
• The most common regimen is 250 mg 3 times daily for 7 days.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Metronidazole has been used clinically to treat acute necrotizing ulcerative
gingivitis, chronic periodontitis, and aggressive periodontitis. It has been used as
monotherapy and also in combination with root planing and surgery or with other
antibiotics.

Source Ref : NEWMAN AND CARRANZA’S CLINICAL PERIODONTOLOGY THIRTEENTH

EDITION, page no 559
NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following statements is incorrect for furcation defect?

1) Grade 3 defect is clinically visible.
2) Grade 1 can be visible radiographically as radiopaque.
3) In Grade 4 inter-radicular bone is completely lost.
4) In Grade 2 bone is attached to the dome of the furcation.

Ans Key : 1 (Grade 3 defect is clinically visible.)

NEET MDS 2021 RECALL + MERITERS STRIKES
Glickman classified furcation involvement into four grades:
Grade I
• A grade I furcation involvement is the incipient or early stage of furcation
involvement. The pocket is suprabony and primarily affects the soft tissues. Early
bone loss may have occurred with an increase in probing depth, but radiographic
changes are not usually found.
Grade II
• A grade II furcation can affect one or more of the furcations of the same tooth.
The furcation lesion is essentially a cul-de-sac with a definite horizontal
component. If multiple defects are present, they do not communicate with each
other because a portion of the alveolar bone remains attached to the tooth.
The extent of the horizontal probing of the furcation determines whether the
defect is early or advanced.
Vertical bone loss may be present and represents a therapeutic complication.
Radiographs may or may not depict the furcation involvement.
NEET MDS 2021 RECALL + MERITERS STRIKES
Grade III

• In grade III furcations, the bone is not attached to the dome of the
furcation.
• In early grade III involvement, the opening may be filled with soft tissue and
may not be visible.
• The clinician may not even be able to pass a periodontal probe completely
through the furcation because of interference with the bifurcational ridges or
facial-lingual bony margins. However, if the clinician adds the buccal and lingual
probing dimensions and obtains a cumulative probing measurement that is equal
to or greater than the buccal-lingual dimension of the tooth at the furcation
orifice, the clinician must conclude that a grade III furcation exists.
• Properly exposed and angled radiographs of early class III furcations display the
defect as a radiolucent area in the crotch of the tooth.
NEET MDS 2021 RECALL + MERITERS STRIKES

Grade IV

• In grade IV furcations, the interdental bone is destroyed, and the soft tissues
have receded apically so that the furcation opening is clinically visible.
• A tunnel therefore exists between the roots of such an affected tooth. Thus
the periodontal probe passes readily from one aspect of the tooth to another.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
A. Grade I furcation involvement. Although a
space is visible at the entrance to the furcation,
no horizontal component of the furcation is
evident on probing.
B. Grade II furcation in a dried skull. note both the
horizontal and the vertical components of this
Glickman’s classification of cul-de-sac.
furcation involvement.
C. Grade III furcations on maxillary molars. Probing confirms that the buccal furcation
connects with the distal furcation of both these molars, yet the furcation is filled
with soft tissue, not visible clinically.
D. Grade IV furcation. The soft tissues have receded sufficiently to allow direct
vision into the furcation of this maxillary molar.
Source Ref : Newman and Carranza's Clinical Periodontology - 13th Edition, page no 655, 656
NEET MDS 2021 RECALL + MERITERS STRIKES

Cheese like material composed of food particles, desquamated epithelial cells,

leukocytes and microbes, which can be easily displaced with water spray is known as:
1) Materia alba
2) Pellicle
3) Calculus
4) Acquired plaque

Ans Key : 1 (Materia alba)

NEET MDS 2021 RECALL + MERITERS STRIKES
Materia Alba, Food Debris, and Dental Stains
• Materia alba is an accumulation of microorganisms, desquamated epithelial cells,
leukocytes, and a mixture of salivary proteins and lipids, with few or no food
particles; it lacks the regular internal pattern observed in plaque.
• It is a yellow or grayish-white, soft, sticky deposit, and it is somewhat less
adherent than dental plaque.
• The irritating effect of materia alba on the gingiva is caused by bacteria and their
products.
• Most food debris is rapidly liquefied by bacterial enzymes and cleared from the oral
cavity by salivary flow and the mechanical action of the tongue, cheeks, and lips.
• The rate of clearance from the oral cavity varies with the type of food and the
individual. Aqueous solutions are typically cleared within 15 minutes, whereas sticky
foods may adhere for more than 1 hour.
• Dental plaque is not a derivative of food debris, and food debris is not an important
cause of gingivitis.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Materia Alba, Food Debris, and Dental Stains

Materia alba refers to soft accumulations of bacteria, food matter, and tissue cells that
lack the organized structure of dental plaque and that are easily displaced with a water
spray.

Source Ref : NEWMAN AND CARRANZA’S CLINICAL PERIODONTOLOGY THIRTEENTH EDITION, page no 195, 119
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the cell shown in the histological section, found in the basal cell layer
of epithelium and in vicinity of unmyelinated nerve fibers.

1) Langerhans cell
2) Merkel cell
3) Macrophage
4) Keratinocyte

Ans Key : 2 (Merkel cell)

NEET MDS 2021 RECALL + MERITERS STRIKES

Merkel cells

• Merkel cells are found among the basal cells.

• It has nerve tissue immediately subjacent and is presumed to be a specialized
neural pressure-sensitive receptor cell. It responds to touch sensation.
• They are commonly seen in masticatory mucosa, but are usually absent in lining
mucosa. Merkel cells differ from other nonkeratinocyte in that they are not
dendritic.
• Ultrastructurally, the nucleus shows a deep invagination and characteristic rodlet.
They contain numerous characteristic electron- dense granules that are located
almost exclusively at the side of cytoplasm in contact with axon terminals.
Intermediate-type junctions are noted between axon terminals and Merkel cells.
• The function of these granules are not known. Merkel cells migrate from the
neural crest. They are stained by PAS stain.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Source Ref : Orban’s Oral Histology and Embryology, 13th ed, page no 254
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the structures in the image:

1) Gubernacular canals
2) Incisive foramen
3) Canals of Hirschfeld and Zuckerkandl
4) Volkmann’s canals

Ans Key : 1 (Gubernacular canals)

NEET MDS 2021 RECALL + MERITERS STRIKES

• Bone removal is necessary for permanent teeth to erupt. In the case of those
teeth with deciduous predecessors there is an additional anatomic feature, the
gubernacular canal and its contents, the gubernacular cord, which may have an
influence on eruptive tooth movement.
• When the successional tooth germ first develops within the same crypt as its
deciduous predecessor, bone surrounds both tooth germs but does not
completely close over them.
• As the deciduous tooth erupts, the permanent tooth germ becomes situated
apically and is entirely enclosed by bone except for a small canal that is filled with
connective tissue and often contains epithelial remnants of the dental lamina.
This connective tissue mass is termed the ‘gubernacular cord’, and it may have a
function in guiding the permanent tooth as it erupts.
• After removal of any overlying bone there is loss of the intervening soft
connective tissue between the reduced enamel epithelium covering the crown
of the tooth and the overlying oral epithelium.
NEET MDS 2021 RECALL + MERITERS STRIKES

Gubernacular canal and its contents in histologic section. The canal is filled with
connective tissue that connects the dental follicle to the oral epithelium. Strands of
epithelial cells (arrowheads), remnants of the dental lamina, are often present.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Bone removal is necessary for permanent teeth to erupt.

• In the case of those teeth with deciduous predecessors there is an
additional anatomic feature, the gubernacular canal (as shown in the
image in explanation) and its contents, the gubernacular cord, which
may have an influence on eruptive tooth movement.

Source Ref : ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY, 14th ed, page no 283, 285
NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following is not found in the root?

1) Enamel
2) Dentin
3) Cementum
4) Pulp

Ans Key : 1 (Enamel)

NEET MDS 2021 RECALL + MERITERS STRIKES

• The tooth consists of crown and root.

• That part of the tooth visible in the mouth is called clinical crown; the extent of
which increases with age and disease. The root portion of the tooth is not
visible in the mouth in health.
• The tooth is suspended in the sockets of the alveolar bone by the
periodontal ligament.
• The anatomical crown is covered by enamel and the root by the
cementum.
• The root has a root canal that houses the pulp and majority of its bulk is formed
by dentin.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Plz mention the reference as present in the original ppt

Note that enamel is not present in root, rest all three components dentin,
cementum and pulp are present in root.
NEET MDS 2021 RECALL + MERITERS STRIKES
H/E stained salivary gland cells are shown in the following image. Identify
the structure marked with arrow:

1) Intercalated duct
2) Mucous acini
3) Serous acini
4) Mixed acini

Ans Key : 2 (Mucous acini)

NEET MDS 2021 RECALL + MERITERS STRIKES
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
Mucous cells in tubular secretory end pieces,
stained with hematoxylin and eosin. Poorly stained
mucous secretory granules fill the cytoplasm, and
the nuclei (arrowheads) are flattened and
compressed against the basal
surfaces of the cells.

Source Ref : TEN CATE’S ORAL HISTOLOGY, NINTH EDITION, page no 243
NEET MDS 2021 RECALL + MERITERS STRIKES

Type of secretion shown by the gland section as depicted in the following figure:

1) Merocrine
2) Holocrine
3) Apocrine
4) Paracrine

Ans Key : 1 (Merocrine)

NEET MDS 2021 RECALL + MERITERS STRIKES
Based upon the mode of secretion, there are three types of glands: merocrine
(eccrine), apocrine and holocrine.
1. Merocrine: The secretions are excreted via exocytosis from secretory cells into an
epithelial-walled duct into the lumen or body surface.
• It is the most common manner of secretion.
• The gland releases its product and no part of the gland is lost. E.g., most of the
sweat glands are of merocrine variety.

2. Apocrine: The secretions of the cell take off a part of plasma membrane producing
membrane-bound vesicles in the lumen.
• The apical portion of the secretory cell of the gland pinches off and enters
the lumen.
• It loses part of its cytoplasm in their secretions.
• Few sweat glands belong to apocrine variety. e.g. ceruminous gland and
mammary glands are modified sweat glands of apocrine variety.
NEET MDS 2021 RECALL + MERITERS STRIKES

3. Holocrine: The secretions are produced in the cytoplasm of the cell and released by
the rupture of the plasma membrane, which destroys the cell and results in the
secretion of the product into the lumen.

Examples: Sebaceous gland (skin), meibomian glands (eyelid).

NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Three basic types of secretions are shown in cells
of the exocrine glands.

1. Merocrine secretion (most common) involves

exocytosis of the vesicle content at the apical
cell membrane.
2. Apocrine secretion (like in mammary gland
cells) the apical portion of membrane covers
the secretion and leaves the cell.
3. Holocrine secretion cause disintegration of
secretory cells is seen (as seen in sebaceous
glands of hair follicles).
NEET MDS 2021 RECALL + MERITERS STRIKES

Which vitamin deficiency is seen in chronic alcoholics?

1) Vit B12
2) Thiamine
3) Riboflavin
4) Vit A

Ans Key : 2 (Thiamine)

NEET MDS 2021 RECALL + MERITERS STRIKES
Wernicke–Korsakoff syndrome

• This is a rare but important indirect complication of chronic alcohol misuse.

It is an organic brain disorder resulting from damage to the mamillary bodies,
dorsomedial nuclei of the thalamus and adjacent areas of periventricular
grey matter caused by a deficiency of thiamin (vitamin B1).
• The syndrome most commonly results from long-standing heavy drinking and an
inadequate diet but can also arise from malabsorption or even protracted
vomiting.
• Wernicke’s encephalopathy (nystagmus or ophthalmoplegia with ataxia and
delirium) often presents acutely and, without prompt treatment (see below), can
progress and become irreversible. Korsakoff’s syndrome (severe short-term
memory deficits and confabulation) can develop chronically or acutely (with
Wernicke’s).
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
The deficiency of vitamin B1 (Thiamine) results in a condition called beri- beri.
Wernicke-Korsakoff syndrome

• This disorder also known as cerebral beri-beri, is mostly seen in chronic

alcoholics. The body demands of thiamine increase in alcoholism.
• Insufficient intake or impaired intestinal absorption of thiamine will lead to
this syndrome.
• It is characterized by loss of memory, apathy and a rhythmical to and fro motion
of the eye balls.

Source Ref : Davidson's Principles and Practice of Medicine, Page 1195

Biochemistry by Dr. U. Satyanarayana, U Chakrapani, 4th ed page no 135, 137
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

Serum lipase levels are increased in:

1) Acute pancreatitis
2) Diabetes mellitus
3) Myocardial infarction
4) Obstructive jaundice

Ans Key : 1 (Acute pancreatitis)

NEET MDS 2021 RECALL + MERITERS STRIKES

Investigations for Acute pancreatitis

• The diagnosis is based on raised serum amylase or lipase concentrations and

ultrasound or CT evidence of pancreatic swelling.

• Plain X-rays should be taken to exclude other diagnoses, such as perforation or

obstruction, and to identify pulmonary complications.

• Amylase is efficiently excreted by the kidneys and concentrations may have

returned to normal if measured 24–48 hours after the onset of pancreatitis. A
persistently elevated serum amylase concentration suggests pseudocyst
formation.

• Peritoneal amylase concentrations are massively elevated in pancreatic ascites.

NEET MDS 2021 RECALL + MERITERS STRIKES

• Serum amylase concentrations are also elevated (but less so) in intestinal
ischaemia, perforated peptic ulcer and ruptured ovarian cyst, while the salivary
isoenzyme of amylase is elevated in parotitis. If available, serum lipase
measurements are preferable to amylase, as they have greater diagnostic
accuracy for acute pancreatitis.

• Ultrasound scanning can confirm the diagnosis, although in the earlier stages
the gland may not be grossly swollen. The ultrasound scan is also useful
because it may show gallstones, biliary obstruction or pseudocyst formation.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Investigations for Acute pancreatitis

• The diagnosis is based on raised serum amylase or lipase concentrations and

ultrasound or CT evidence of pancreatic swelling.
• Serum amylase concentrations are also elevated (but less so) in intestinal
ischaemia, perforated peptic ulcer and ruptured ovarian cyst, while the salivary
isoenzyme of amylase is elevated in parotitis. If available, serum lipase
measurements are preferable to amylase, as they have greater diagnostic
accuracy for acute pancreatitis.

Source Ref : Davidson’s Principles and Practice of Medicine, 23rd ed, page no 839
NEET MDS 2021 RECALL + MERITERS STRIKES

The 18:8 stainless steel is composed of:

1) 18 – Chromium, 8 – Nickel
2) 18 – Cobalt, 8 – Chromium
3) 18 – Cobalt, 8 – Nickel
4) 18 – Nickel, 8 – Chromium

Ans Key : 1 (18 – Chromium, 8 – Nickel )

NEET MDS 2021 RECALL + MERITERS STRIKES
• The addition of nickel to the iron-chromium-carbon composition stabilizes
the austenite phase on cooling.
• Type 18-8 stainless steel, which contains 18% chromium and 8% nickel by
weight, is the most commonly used alloy for orthodontic stainless steel wires and
bands.
• Austenitic stainless steel is preferable to ferritic stainless steel for dental
applications because it has the following properties:
▪ Greater ductility and ability to undergo more cold work without fracturing
▪ Substantial strengthening during cold working (some transformation to
martensite)
▪ Greater ease of welding
▪ Ability to overcome sensitization
▪ Less critical grain growth
▪ Comparative ease of forming.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Type 18-8 stainless steel, which contains 18% chromium and 8% nickel by weight, is
the most commonly used alloy for orthodontic stainless steel wires and bands.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 407

NEET MDS 2021 RECALL + MERITERS STRIKES

Titanium welding is done using:

1) Argon
2) Laser assisted
3) Spot welding
4) Thermal welding

Ans Key : 1 (Argon)

NEET MDS 2021 RECALL + MERITERS STRIKES

Welding

• Titanium alloys are highly reactive with oxygen at high temperature. Because of
their high melting temperatures and this reactivity, soldering of these alloys with
torches is not advisable.
• To prevent the potential reaction of titanium alloys with the oxygen in ambient
air during the metal joining process, these procedures are often performed in a
vacuum or in an argon environment.
• The β-titanium wires are the only orthodontic wire alloy type that demonstrates
true weldability, and clinically satisfactory joints can be made by electrical
resistance welding.
• Such joints need not be reinforced with solder, which is necessary for welded
joints in stainless steel and Elgiloy wires.
• A weld made with insufficient heat will fail at the interface between the wires,
whereas overheating may cause a failure adjacent to the joint.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
To prevent the potential reaction of titanium alloys with the oxygen in ambient air
during the metal joining process, these procedures are often performed in a vacuum
or in an argon environment.

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 12th ed page no 411

NEET MDS 2021 RECALL + MERITERS STRIKES

A dentist prepared a maxillary molar to receive a full coverage cast crown. He placed
palatal cusp bevel in order to achieve:
1) Structural durability
2) Resistance form
3) Retention form
4) Functional integrity

Ans Key : 1 (Structural durability)

NEET MDS 2021 RECALL + MERITERS STRIKES

• A functional cusp bevel is placed using a round-end tapered diamond, on:

o The palatal inclines of maxillary palatal cusps
o The buccal inclines of mandibular buccal cusps
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Source Ref : Shillingburg HT. Fundamentals of Fixed Prosthodontics. Edition:3. Page:141

NEET MDS 2021 RECALL + MERITERS STRIKES

Functional cusp bevel angle with respect to long axis of tooth:

1) 40°
2) 45°
3) 60°
4) 90°

Ans Key : 2 (45°)

NEET MDS 2021 RECALL + MERITERS STRIKES

Functional (Centric) Cusp Bevel

• Reasonably uniform tooth reduction results in a preparation that

somewhat mimics the form of the original clinical crown.
• Proper placement of a functional cusp bevel achieves this.
• Because additional reduction is needed for the functional cusps (to provide a
minimum of 1.5 mm of occlusal clearance), the functional cusp bevel must be
angled flatter than the external surface of the original tooth.
• On most posterior teeth, the functional cusp bevel is placed at an angle of
approximately 45 degrees to the long axis of the prepared tooth.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

The functional cusp bevel

is placed at an angle of
approximately 45 degrees
to the long axis of the
prepared tooth.

Source Ref : Contemporary Fixed Prosthodontics - Stephen Rosenstiel, Martin Land, Junhei Fujimoto - 5th
Edition, page no 211
Shillingburg HT. Fundamentals of Fixed Prosthodontics. Edition:3. Page:141
NEET MDS 2021 RECALL + MERITERS STRIKES

Following tooth preparation, which chemicals are suitable for gingival retraction before
making the impression?
1) Acidic
2) Basic
3) Neutral
4) Highly basic

Ans Key : 1 (Acidic)

NEET MDS 2021 RECALL + MERITERS STRIKES

Chemicomechanical Methods of Gingival Retraction (Retraction Cord)

• It is a method of combining a chemical with pressure packing, which leads

to enlargement of the gingival sulcus as well as control of fluids seeping from
the sulcus.
• Gingival retraction cord soaked in a chemical (which promotes gingival
contraction) will provide better gingival retraction compared to a plain
retraction cord. This is the principle behind the chemicomechanical method of
gingival retraction.
NEET MDS 2021 RECALL + MERITERS STRIKES

Generally acidic chemicals are used.

Acidity of Commonly Used Hemostatic Agents

Agent Active ingredient Mean pH
Astringedent 15.5% Fe2(SO4)3 0.7
Gingi-Aid Buffered 25% AICI3 1.9
Styptin 20% AICI3 1.3
Hemodent 21.3% AICI3 – 6 hydrate 1.2
Hemogin-L AICI3 0.9
Orostat 8% 8% Racemic epinephrine HCI 2.0
ViscoStat 20% Fe2(SO4)3 1.6
Aluminum chloride 25% 25% AICI3 1.1
Stasis Gingi-Pak 2.0
For comparison: Ketac conditioner 25% polyacrylic acid 1.7
NEET MDS 2021 RECALL + MERITERS STRIKES
Key concept:
Gingival retraction cord soaked in a chemical (which promotes gingival contraction)
will provide better gingival retraction compared to a plain retraction cord.

Chemicals used:
Generally acidic chemicals are used. The following chemicals are generally local
vasoconstrictors which produce transient gingival shrinkage:
• Aluminium chloride
• Alum (Aluminium potassium sulphate)
• Aluminium sulphate
• Ferric sulphate
• 8 percent Racemic epinephrine
Source Ref : Textbook of Prosthodontics, Deepak Nallaswamy, Ed 2, page no 811, 812 Stephen Rosenstiel,
Martin Land, and Junhei Fujimoto. Contemporary
Fixed Prosthodontics. Edition: 5. Page:371
NEET MDS 2021 RECALL + MERITERS STRIKES
Identify the use of instrument in given image:

1) Depth measurement
2) Torque wrench
3) Ridge mapping
4) Parallelism assessment

Ans Key : 2 (Torque wrench)

NEET MDS 2021 RECALL + MERITERS STRIKES

Wrenches

• Surgical kits include a ratchet wrench or torque wrench to place the

implant.
• A torque wrench or torque driver is a manual instrument used to apply a
specific amount of torque when placing an implant or prosthetic screw.
• A torque controller refers to an electronic machine designed for the same
purpose.
• A torque wrench is recommended to ensure the application of a force that
conforms to the manufacturer's recommendation.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
A torque wrench or torque driver is a manual instrument used to apply a
specific amount of torque when placing an implant or prosthetic screw

Source Ref : Misch's Contemporary Implant Dentistry E-Book - Page 31 Randolph Resnik · 2020
NEET MDS 2021 RECALL + MERITERS STRIKES

Which density of bone is best suited to achieve a minimum difference in elastic

modulus of titanium implant and the residual alveolar bone?
1) D1
2) D2
3) D3
4) D4

Ans Key : 2 (D2)

NEET MDS 2021 RECALL + MERITERS STRIKES

The type of bone in which the implant will be placed is of critical

importance.

Bone for implantation has been classified into four types:

• Type I consists of mostly homogeneous compact bone.
• Type II consists of a thick layer of compact bone surrounding a core of
dense trabecular bone
• Type III is a thin layer of cortical bone surrounding a core of dense
trabecular bone; and
• Type IV is composed of a thin layer of cortical bone with a core of low-
density trabecular bone.

Type IV bone is by far the most compromised bone environment for implant stability
because of its inadequate quality and quantity.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Source Ref : PHILLIPS’ SCIENCE OF DENTAL MATERIALS, 11th ed page no 513

Textbook of Oral and Maxillofacial Surgery, 4th ed, Neelima Anil Malik, page no 1006
NEET MDS 2021 RECALL + MERITERS STRIKES

A 4-year-old child living in an area with water fluoride content of 0.5ppm, should be
given supplemental fluoride tablet of:
1) 0.15 mg/day
2) 0 mg/day
3) 5 mg/day
4) 0.25 mg/day

Ans Key : 4 (0.25 mg/day)

NEET MDS 2021 RECALL + MERITERS STRIKES

If fluoride level is unknown, drinking water should be tested for fluoride

content before supplements are prescribed. For testing of fluoride content,
contact the local or state health department.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

If fluoride level is unknown, drinking water should be tested for fluoride

content before supplements are prescribed.
According to the given question 4 yr old child getting 0.5ppm of fluoride from
drinking water, so he can get fluoride supplement of 0.25 mg/day.

Source Ref : Textbook of Public Health Dentistry by CM Marya, edition 1, page no 346
NEET MDS 2021 RECALL + MERITERS STRIKES

A country is taking precautions for a disease which has not yet occurred. Which
of the following level of prevention is most relevant?
1) Primordial Prevention
2) Primary Prevention
3) Secondary Prevention
4) Tertiary Prevention

Ans Key : 1 (Primordial Prevention)

NEET MDS 2021 RECALL + MERITERS STRIKES
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Primordial prevention:
It is the prevention of the emergence or development of risk factors in countries or
population groups in which they have not yet appeared.

The main intervention is by individual and mass education.

Eg: Efforts directed towards discouraging children from adopting harmful lifestyles.

Source Ref : Park's Textbook of Preventive and Social Medicine K. Park · 25th
edition, page no 49
Essentials of Preventive and Community Dentistry, Soben Peter 4th ed page no 18
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

DI-S score is 0.6, CI-S score is 0.7. What is the interpretation for OHI-S from this data?
1) Good
2) Excellent
3) Fair
4) Poor

Ans Key : 3 (Fair)

NEET MDS 2021 RECALL + MERITERS STRIKES

SIMPLIFIED ORAL HYGIENE INDEX (OHI-S)

• The Simplified Oral Hygiene Index (OHI-S) was developed in 1964 by John C.
Greene and Jack R. Vermillion.
• The OHI-S has two components, the Simplified Debris Index (Dl-S) and the
Simplified Calculus Index (Cl-S).
• The oral hygiene examination and scoring for the Dl always should
precede the oral examination and scoring for the CI.

Calculation of the Index

• For each individual/the debris and calculus scores are totaled and divided by the
number of tooth surfaces scored.
NEET MDS 2021 RECALL + MERITERS STRIKES

Index teeth Scoring criteria

NEET MDS 2021 RECALL + MERITERS STRIKES

Interpretation:

For the Dl-S and Cl-S score,

Good - 0.0 to 0.6
Fair - 0.7 to 1.8
Poor - 1.9 to 3.0

For the OHI-S score,

Good - 0.0 to 1.2
Fair - 1.3 to 3.0
Poor - 3.1 to 6.0
OHI-S = Dl-S + Cl-S
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Here, in the question:

DI-S score is 0.6, CI-S score is 0.7

OHI-S = 0.6+0.7
= 1.3 i.e, Fair.

Source Ref : Essentials of Preventive and Community Dentistry, Soben Peter 4th ed
page no 320, 321
NEET MDS 2021 RECALL + MERITERS STRIKES

Patient with temporary restorations on four fractured anterior teeth, 6 teeth with
chalky and rough spots and two 3rd molars extracted due to pericoronitis. What is the
DMFT score according to WHO Modified DMFT Index 1987?
1) 6
2) 0
3) 10
4) 12

Ans Key : 2 (0)

NEET MDS 2021 RECALL + MERITERS STRIKES

WHO modification of DMF Index (1987)

1. All third molars are included.

2. Temporary restorations are considered as ‘D’
3. Only carious cavities are considered as ‘D’, the initial lesion (Chalky spots, stained
fissures, etc) are not considered as ‘D’.

Patient with temporary restorations on four fractured anterior teeth, 6 teeth with
chalky and rough spots and two 3rd molars extracted due to
pericoronitis.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Temporary restorations on fractured teeth = not considered so F=0

• Chalky and rough spots or incipient lesion = not considered so D=0
• Third molars extracted due to pericoronitis = not included, M=0

So D+ M+ F = 0

Source Ref : Essentials of Preventive and Community Dentistry, Soben Peter 4th ed page
no 345
NEET MDS 2021 RECALL + MERITERS STRIKES

Which phase of clinical trial is used to include large population to check the
effectiveness, dosage and safety of drugs?
1) Phase 2
2) Phase 4
3) Phase 5
4) Phase 3

Ans Key : 4 (Phase 3)

NEET MDS 2021 RECALL + MERITERS STRIKES

Phase III: Therapeutic confirmation/comparison

• Generally these are randomized double blind comparative trials conducted

on a larger patient population (500–3000) by several physicians (usually
specialists in treating the target disease) at many centres.
• The aim is to establish the value of the drug in relation to existing therapy.
• Safety and tolerability are assessed on a wider scale, while pharmacokinetic
studies may be conducted on some of the participants to enlarge the population
base of pharmacokinetic data.
• Indications are finalized and guidelines for therapeutic use are
formulated.
• A ‘new drug application’ (NDA) is submitted to the licensing authority, who if
convinced give marketing permission.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Source Ref : Essentials of Medical Pharmacology Seventh Edition KD TRIPATHI, page no 80

NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following fluoride preparation combines with hydroxyapatite crystals

to form calcium fluoride, which further diffuse to form fluorapatite crystals?
1) Stannous fluoride
2) Sodium fluoride
3) Amine fluoride
4) APF

Ans Key : 2 (Sodium fluoride)

NEET MDS 2021 RECALL + MERITERS STRIKES

Mechanism of action of sodium fluoride

• When sodium fluoride solution is applied on the tooth surface as a topical agent,
it reacts with the hydroxy apatite crystals in enamel to form calcium fluoride
which is the main end product of the reaction.
• As a thick layer of calcium fluoride gets formed, it interferes with the further
diffusion of fluoride from the topical fluoride solution to react with
hydroxyapatite and blocks further entry of fluoride ions. This sudden stop of the
entry of fluoride is termed as "Chocking off effect".
• Fluoride then slowly leaches from the calcium fluoride. Thus calcium fluoride acts
as a reservoir for fluoride release (It is for this reason that after each application
of sodium fluoride on to the tooth surface, it is left to dry for 4 minutes).
• The calcium fluoride formed reacts with the hydroxyapatite crystals to form
fluoridated hydroxyapatite. The hydroxyapatite thus formed increases the
concentration of fluoride on enamel surface, which in turn makes the tooth
surface resistant against caries attack through the action of fluoride.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

• When sodium fluoride solution is applied on the tooth surface as a topical

agent, it reacts with the hydroxy apatite crystals in enamel to form calcium
fluoride which is the main end product of the reaction.
• The calcium fluoride formed reacts with the hydroxyapatite crystals to form
fluoridated hydroxyapatite. The hydroxyapatite thus formed increases the
concentration of fluoride on enamel surface, which in turn makes the tooth
surface resistant against caries attack through the action of fluoride.

Source Ref : Essentials of Preventive and Community Dentistry, Soben Peter 4th ed
page no 257
NEET MDS 2021 RECALL + MERITERS STRIKES

A dentist from Australia wants to get IDA membership to practice in India. Under
which category would he be placed?
1) NRI
2) Affiliate member
3) Honorary member
4) Not eligible

Ans Key : 2 (Affiliate member)

NEET MDS 2021 RECALL + MERITERS STRIKES

MEMBERSHIP OF IDA

Dental practitioners registered under the Indian Dentist Act 1948 are eligible to become
members of the association.
The members of the association itself are of different categories.

1. Honorary members
Persons of high scientific or literary attainment or person who have rendered
conspicuous services to the association or persons whose connections with the
association may be deemed desirable and if willing to be made Honorary members
are so elected according to the rules of
the association.
2. Life members
Dental practitioners and other members of the dental profession eligible to become
a member of the association on payment of life subscription.
NEET MDS 2021 RECALL + MERITERS STRIKES

3. Annual members
Persons with required qualifications mentioned in rule 10 who pay by annual
subscription.
4. Direct members
Persons eligible for membership but who are not residing or practicing in the area of
a local branch. These members shall be attached to a state
branch or to the central head-quarters.
5. Student members
Only undergraduate students of recognized dental institution may be admitted as
student members.
6. Affiliate members
Non residential foreign dental practitioners having dental qualification according
to section 10 are eligible to become affiliated members, subject to the approval of
the central council of the Indian dental Association. All affiliated members will be
attached only to the head office.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Affiliate members

• Non residential foreign dental practitioners having dental qualification

according to section 10 are eligible to become affiliated members, subject to
the approval of the central council of the Indian dental association.
• All affiliated members will be attached only to the head office.

Source Ref : Essentials of Preventive and Community Dentistry, Soben Peter 4th ed page
no 541
NEET MDS 2021 RECALL + MERITERS STRIKES

In a school, children from a class were examined and those with some visible lesion
were shortlisted. Among them, a few were selected who needed restorative
treatment. This type of sampling is:
1) Multiphase sampling
2) Purposive sampling
3) Systematic sampling
4) Multistage sampling

Ans Key : 1 (Multiphase sampling)

NEET MDS 2021 RECALL + MERITERS STRIKES

Multiphase sampling

• In this method, part of the information is collected from the whole sample
and a part from the sub-sample.
• For example, in a school health survey, all the children in the school are
examined. From these, only the ones with oral health problems are selected in
the second phase.
• A section needing treatment are selected in the third phase. The number of
children in the sub-samples in the 3rd and 4th phase becomes smaller and
smaller. This method may be adopted when the interest is in any specific disease.
Survey by such procedure is less costly, less laborious and more purposeful.
NEET MDS 2021 RECALL + MERITERS STRIKES

Multistage sampling
The first stage is to select the groups or clusters. Then subsamples are taken in as
many subsequent stages as necessary to obtain the desired sample size.
Eg: 1st stage: Choice of states within countries, 2nd stage: Choice of towns within each
state, 3rd stage: Choice of neighborhoods within each town
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Multiphase sampling

• In this method, part of the information is collected from the whole sample
and a part from the sub-sample.
• For example, in a school health survey, all the children in the school are
examined. From these, only the ones with oral health problems are selected in
the second phase.

Source Ref : Essentials of Preventive and Community Dentistry, Soben Peter 4th ed page
no 369, 370
NEET MDS 2021 RECALL + MERITERS STRIKES

Hypertensive drugs were given to pregnant and non-pregnant group of patients.

Which test of significance will be used in this study?
1) Student t-test
2) Paired t-test
3) ANOVA
4) Chi square test

Ans Key : 1 (Student t-test )

NEET MDS 2021 RECALL + MERITERS STRIKES

Student's t-test:

Paired Student's t-test: Comparing means (+ SD) in paired data (in same group of
individuals before and after an intervention)

Example: Mean serum albumin level of dengue patients before treatment was 3.6 g/dL
and after treatment was 3.2 g/dL; Comparison of mean levels can be done by Paired
Student's t-test

Unpaired Student's t-test: Comparing means (+ SD) in two different group of

individuals
Example: Mean Hb level of anemia patients was 9.6 g/dL and those of hookworm
patients was 7.2 g/dL; Comparison of mean levels can be done by Unpaired Student's
t-test
NEET MDS 2021 RECALL + MERITERS STRIKES

Key concept:

In the given question, the study to assess the effect of a hypertensive drug in pregnant
and pregnant women (2 limbs of the study).

Thus the effect of hypertensive drug would be obtained in the two samples, thereby
making 'two-sampled student’s t-test' as the test of choice.

[Ref. Simple Biostatistics by Indrayan & Indrayan, 1/e p162-63]

NEET MDS 2021 RECALL + MERITERS STRIKES

A study was conducted on two groups of people. One was given a new drug for a
disease, while the other was not. The people remain in either of the two groups during
investigation. What type of study is being carried out?
1) Randomized control trial
2) Cross over study
3) Parallel concurrent study
4) COHORT Study

Ans Key : 2 (Cross over study)

NEET MDS 2021 RECALL + MERITERS STRIKES

Cross-over type of study designs

• With this type of study design, each patient serves as his own control. The
patients are randomly assigned to a study group and control group.
• The study group receives the treatment under consideration. The control group
receives some alternate form of active treatment or placebo. The two groups are
observed over time.
• Then the patients in each group are taken off their medication or placebo to allow
for the elimination of the medication from the body and for the possibility of any
"carry over” effects.
• After this period of medication (the length of this interval is determined by the
pharmacologic properties of the drug being tested), the two groups are
switched.
• Those who received the treatment under study are changed to the control
group therapy or placebo, and vice versa.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Schematic diagram of the design of cross-over controlled therapeutic trials

Source Ref : Textbook of Preventive and Social Medicine K. Park · 25th edition, page no 91, 92
NEET MDS 2021 RECALL + MERITERS STRIKES

Permanent tooth erupts after:

1) 1/4th of the root is formed
2) 3/4th of the root is formed
3) ½ of the root is formed
4) Root completed

Ans Key : 2 (3/4th of the root is formed)

NEET MDS 2021 RECALL + MERITERS STRIKES
1st Tooth Development and Eruption

1. Formation of alveolar cavities – 3-4 m of IU life

2. Development of tooth:
(i) begins with the formation of cellular tooth germ within the alveolar bone
(ii) Ultimately takes the shape of the crown

3. Formation of enamel and dentin:

(i) Takes place within the tooth germ
(ii) crown is formed
(iii) At birth rudiments of all temporary teeth and of first permanent molars are
present in the jaws

4. Neonatal line – Well formed at the time of birth

NEET MDS 2021 RECALL + MERITERS STRIKES
5. Eruption of deciduous tooth:
(i) Root formation begins after completion of crown
(ii) As root becomes longer, the crown erupts through the bone, and comes out of
jaws [eruption of deciduous tooth]
(iii) Tooth eruption [both temporary and permanent] begins when 3/4 of its final
root length is established
6. Completion of the formation of root
(i) Forms completely some time after the tooth has erupted and is in full functional
occlusion.
7. Calcification of teeth – Occurs from crown to neck to roots.
8. Eruption of permanent tooth:
(i) When permanent tooth, it presses upon the overlying root of its deciduous
predecessor
(ii) The root of overlying deciduous tooth resorbs, until only the crown remains
(iii) The unsupported crown then falls off.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Tooth eruption [both temporary and permanent] begins when 3/4 of its final root
length is established.

Source Ref : APC Essentials of Forensic Medicine and Toxicology By Anil Aggrawal, Page 152
NEET MDS 2021 RECALL + MERITERS STRIKES
Patient with history of extraction of impacted mandibular 3rd molar lying close to inferior
alveolar nerve develops the following lesion as shown in radiograph. What is the most
probable diagnosis?

1) Neuroma
2) Axonotmesis
3) Neuropraxia
4) Wallerian degeneration

Ans Key : 1 (Neuroma)

NEET MDS 2021 RECALL + MERITERS STRIKES

Neuroma

• After peripheral nerve transection, the proximal portion of the nerve

generally forms sprouts in an effort to regain communication with the
severed distal component.
• When sprouting occurs without distal segment communication, a stump of
neuronal tissue, Schwann cells, and other neural elements can form.
• This stump, or neuroma, can become exquisitely sensitive to mechanical and
chemical stimuli.
• The pain is commonly burning or shocklike. Frequently a positive Tinel sign is
present. In this test, tapping over the suspected neuroma produces sharp,
shooting, electric shocklike pain.
• Damage to the mandibular or lingual nerve after third molar surgery is a source
for neuroma formation that a dentist might see.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Damage to the mandibular or lingual nerve after third molar surgery is a

source for neuroma formation that a dentist might see.

Source Ref : CONTEMPORARY ORAL AND MAXILLOFACIAL SURGERY, SEVENTH

EDITION, Tucker, page no 647
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

Child patient has a history of trauma and complains of deviation of mandible to the
right side. Clinical examination shows a growing button shaped swelling in front of his
right ear which was present since the past 2 years. What is the most likely diagnosis?
1) Right unilateral ankylosis
2) Left unilateral ankylosis
3) Bilateral ankylosis
4) Hyperplasia of Condyle

Ans Key : 1 (Right unilateral ankylosis)

NEET MDS 2021 RECALL + MERITERS STRIKES

Unilateral Ankylosis
• Seen in a child or in a person where the onset was usually in the childhood.
• Obvious facial asymmetry.
• Deviation of the mandible and chin on the affected side.
• The chin is receded with hypoplastic mandible on the affected side.
• Roundness and fullness of the face on the affected side.
• The appearance of the flatness and elongation on the unaffected side. The lower
border of the mandible on the affected side has a concavity that ends in a well-
defined antegonial notch.
• In unilateral ankylosis, some amount of oral opening may be possible.
• Interincisal opening will vary depending on whether it is fibrous or bony ankylosis.
• Crossbite may be seen.
• Class II angles malocclusion on the affected side plus unilateral posterior crossbite
on the ipsilateral side seen.
• Condylar movements are absent on the affected side.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

The features of the child given in the question are suggestive of the diagnosis
of unilateral right side ankylosis.

Unilateral Ankylosis

• Seen in a child or in a person where the onset was usually in the

childhood.
• Deviation of the mandible and chin on the affected side, here in this case
the right side.
• The chin is receded with hypoplastic mandible on the affected side.
• Roundness and fullness of the face on the affected side.

Source Ref : Textbook of Oral and Maxillofacial Surgery, 4th ed , Neelima Anil Malik, page no 360, 361
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the technique shown in the image given below:

1) IANB
2) Extraoral IANB
3) Akinosi Vazirani technique
4) Gow-Gates technique

Ans Key : 4 (Gow-Gates technique)

NEET MDS 2021 RECALL + MERITERS STRIKES

• The Gow-Gates technique is a true mandibular nerve block because it provides

sensory anesthesia of virtually the entire distribution of V3. The inferior alveolar,
lingual, mylohyoid, mental, incisive, auriculotemporal, and buccal nerves all are
blocked with the Gow-Gates injection.
• Significant advantages of the Gow-Gates technique over IANB include its higher
success rate, its lower incidence of positive aspiration (approximately 2% vs. 10%
to 15% with the IANB), and the absence of problems with accessory sensory
innervation to the mandibular teeth.

Technique

1. A 25- or 27-gauge long needle recommended.

2. Area of insertion: mucous membrane on the mesial aspect of the
mandibular ramus, on a line from the intertragic notch to the corner of the
mouth, just distal to the maxillary second molar.
NEET MDS 2021 RECALL + MERITERS STRIKES

3. Target area: lateral side of the condylar neck, just below the insertion of the lateral
pterygoid muscle.

4. Landmarks:
a. Extraoral:
1. The intertragic notch (lower border of the tragus).
The correct landmark is the center of the external auditory meatus, which is
concealed by the tragus; therefore its lower border is adopted as a visual aid.
2. Corner of the mouth on the contralateral side.
a. Intraoral:
1. Height of injection established by placement of the needle tip just below the
mesiolingual (mesiopalatal) cusp of the maxillary second molar.
NEET MDS 2021 RECALL + MERITERS STRIKES

Intraoral landmarks for a Gow-Gates mandibular

block.
The tip of the needle is placed just below the
mesiolingual cusp of the maxillary second molar (A) and
is moved to a point just distal to the molar (B),
maintaining the height established in the preceding
step. This is the insertion point for the Gow-Gates
mandibular nerve block.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Target area for a Gow-Gates mandibular nerve block—neck of the condyle.

Source Ref : Handbook of Local Anesthesia SEVENTH EDITION Stanley F. Malamed, page no 549-555
NEET MDS 2021 RECALL + MERITERS STRIKES

A carpenter reported with bleeding and amputated fingertip. The patient wants to re-
attach/re-plant the tip. The LA used is without adrenaline. The reason behind this is :
1) Leads to systemic complication
2) Gangrene of toes and digit
3) Delayed healing
4) Delayed onset of action

Ans Key : 2 (Gangrene of toes and digit)

NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

In this case LA without adrenaline is chosen, as adrenaline is a potent

vasoconstrictor. Using Adrenaline can compromise the blood supply to the amputated
part and can lead to ischemia that can progress to necrosis which further progresses to
the gangrene.
NEET MDS 2021 RECALL + MERITERS STRIKES
A dentist while treating an HIV positive patient suffered an accidental needle prick injury.
What would be the next step?
1) Wash the area
2) Anti-retro viral therapy
3) Wait for investigation result
4) No action needed

Ans Key : 1 (Wash the area)

NEET MDS 2021 RECALL + MERITERS STRIKES
MANAGEMENT OF OCCUPATIONAL EXPOSURE AND POSTEXPOSURE
PROPHYLAXIS
In anticipation of accidental exposure of Health Care Workers (HCW), it is necessary to
have a comprehensive program in place, for Postexposure Prophylaxis (PEP). The risk
of infection varies with types of exposure and other factors such as:
• The amount of blood involved in the exposure
• The amount of virus in the patient’s blood at the time of exposure
• Whether postexposure prophylaxis was taken within the recommended time.

Steps to be taken on exposure to HIV infected blood/body fluids and

contaminated sharps, etc. immediately following exposure:
• Needle stick injuries and cuts should be washed with soap and water
• Splashes to the nose, mouth or skin should be flushed with water
• Eyes should be irrigated with clean water, saline or sterile irrigants
• Pricked finger should not be put into the mouth by reflex.
NEET MDS 2021 RECALL + MERITERS STRIKES

Reporting of the Exposure

• Report the exposure to the appropriate authority and treat as an

emergency. PEP should be started within 2 hours.
• Initiating treatment after 72 hours of exposure is not recommended.

Determination of HIV Status Code

The main purpose of determining HIV status code (HIV SC) is to know the HIV status of
source of exposure.

• No PEP is required in case, the source was HIV negative.

• If the source was HIV positive, but it was a low titer exposure, the status is HIV
SC1. If it was a high titer exposure then status is HIV SC2.
• If the status of the source is unknown or if the source is unknown, then the status
is HIV SC unknown.
NEET MDS 2021 RECALL + MERITERS STRIKES

Basic Regimen

Zidovudine (AZT)—600 mg in divided dose (300 mg/twice a day or 200 mg/thrice a

day for 4 weeks + lamivudine (3TC)—150 mg twice a day for 4 week).

Four weeks of drug therapy is usually sufficient to provide protection against HIV.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Step to be taken on exposure to HIV infected blood/body fluids and

contaminated sharps, etc. immediately following exposure: Needle stick
injuries and cuts should be washed with soap and water
• In anticipation of accidental exposure of Health Care Workers (HCW), it is
necessary to have a comprehensive program in place, for Postexposure
Prophylaxis (PEP).
Basic Regimen

Zidovudine (AZT)—600 mg in divided dose (300 mg/twice a day or 200 mg/thrice a

day for 4 weeks + lamivudine (3TC)—150 mg twice a day for 4 week).

Source Ref : Textbook of Oral and Maxillofacial Surgery, 4th ed , Neelima Anil Malik, page no 54, 55
NEET MDS 2021 RECALL + MERITERS STRIKES

A patient with an infected lower molar, presents with fever and tachycardia. Patient also
complains of difficulty in breathing and swallowing, and has pain on opening the
mouth. On examination, a swelling is seen around the soft palate with uvula deflected
to the opposite side. Swelling on pharyngeal slits is visible with dysphagia. The most
probable space involved is:
1) Temporal space
2) Submandibular space
3) Buccal space
4) Pterygomandibular space

Ans Key : 4 (Pterygomandibular space )

NEET MDS 2021 RECALL + MERITERS STRIKES

Pterygomandibular Space Infection

• Even the established cases of pterygomandibular space infections, do not cause

much swelling of face over the submandibular region.
• However, there is severe degree of limitation of mouth opening. Tenderness
can be elicited over the area of swollen soft tissues medial to anterior border of
ramus of the mandible. Dysphagia is present.
• Medial displacement of the lateral wall of the pharynx, redness and
• edema of the area around the 3rd molar.
• Midline of the palate is displaced to the unaffected side and the uvula is
swollen. Difficulty in breathing.
NEET MDS 2021 RECALL + MERITERS STRIKES

Spread
• Occasionally, infection may spread superiorly along the medial surface of ramus
to involve the infratemporal fossa and beneath the temporal fascia.
• The infection can spread posteriorly to lateral pharyngeal space and then to
retropharyngeal space.
• It can also spread around the front of the ramus of the mandible to involve
the buccal space.
• It can also spread around the front of the ramus of the mandible extending
anteroinferiorly below the lower border and under the superior constrictor
to involve the submandibular space.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
Features of Pterygomandibular Space Infection
• Severe degree of limitation of mouth opening.
• Tenderness can be elicited over the area of swollen soft tissues medial to
anterior border of ramus of the mandible. Dysphagia is present.
• Midline of the palate is displaced to the unaffected side and the uvula is
swollen.
• Difficulty in breathing.

Source Ref : Textbook of Oral and Maxillofacial Surgery, 4th ed , Neelima Anil Malik, page no 869
NEET MDS 2021 RECALL + MERITERS STRIKES
Patient with history of controlled hypertension undergoes maxillary posterior tooth
extraction. Immediately post-extraction the patient collapses. What is the probable
cause of the patient's condition?
1) Orthostatic hypotension
2) Stroke
3) Increased peripheral resistance
4) Hypoglycemia

Ans Key : 1 (Orthostatic hypotension)

NEET MDS 2021 RECALL + MERITERS STRIKES

Orthostatic Hypotension

• A common cause of a transient altered state of consciousness in the dental

setting is orthostatic (or postural) hypotension.
• This problem occurs because of pooling of blood in the periphery that is not
remobilized quickly enough via peripheral vasoconstriction and increased heart
rate to prevent cerebral ischemia when a patient rapidly assumes an upright
posture. Therefore the patient will feel light-headed or become syncopal.
• Patients with orthostatic hypotension who remain conscious will usually
complain of palpitations and generalized weakness. Most individuals who
are not hypovolemic or have orthostatic hypotension resulting from the
pharmacologic effects of drugs such as antihypertensive agents will quickly
recover by reassuming the reclined position. Once symptoms disappear, the
patient can generally sit up (although this should be done slowly on the edge
of the chair for a few moments before standing).
NEET MDS 2021 RECALL + MERITERS STRIKES

• Blood pressure can be taken in each position and allowed to return to normal
before a more upright posture is allowed.

• Some patients have a predisposition to orthostatic hypotension.

• In the ambulatory population, this is usually encountered in patients receiving the

following medications: drugs that produce intravascular depletion such as
diuretics; drugs that produce peripheral vasodilation such as most nondiuretic
antihypertensives, narcotics, and many psychiatric drugs; and drugs that prevent
the heart rate from increasing reflexively such as β-sympathetic antagonist
medications (e.g., propranolol).
NEET MDS 2021 RECALL + MERITERS STRIKES

• Patients with a predisposition to postural hypotension can usually be managed by

allowing a much longer period to attain the standing position (i.e., by stopping at
several increments while becoming upright to allow reflex cardiovascular
compensation to occur).

• If the patient was sedated by using long-acting narcotics, an antagonist such as

naloxone may be necessary.

• Patients with severe problems with postural hypotension as a result of drug therapy
should be referred to their physician for possible modification of their drug
regimen.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Orthostatic Hypotension

• A common cause of a transient altered state of consciousness in the dental

setting is orthostatic (or postural) hypotension.
• This problem occurs because of pooling of blood in the periphery that is not
remobilized quickly enough via peripheral vasoconstriction and increased heart
rate to prevent cerebral ischemia when a patient rapidly assumes an upright
posture.
• Therefore the patient will feel light-headed or become syncopal.

Source Ref : CONTEMPORARY ORAL AND MAXILLOFACIAL SURGERY, SEVENTH EDITION ,

Tucker , page no 31, 32
NEET MDS 2021 RECALL + MERITERS STRIKES

Organ of corti is a part of:

1) Scala media
2) Scala tympani
3) Saccule
4) Ampulla

Ans Key : 1 (Scala media)

NEET MDS 2021 RECALL + MERITERS STRIKES
Duct of the Cochlea or the Scala Media
• The spiral duct occupies the middle part of the cochlear canal between the
scala vestibuli and the scala tympani.
• It is triangular in cross-section. The floor is formed by the basilar membrane;
the roof by the vestibular or Reissner’s membrane; and the outer wall by the
bony wall of the cochlea.
• The basilar membrane supports the spiral organ of Corti which is the end organ
for hearing. It comprises rods of Corti and hair cells.
• Hair is embedded in a gelatinous membrane called the membrana
tectoria.
• The organ of Corti is innervated by peripheral processes of bipolar cells
located in the spiral ganglion.
• This ganglion is located in the spiral canal present within the modiolus at the
base of the spiral lamina. The central processes of the ganglion cells form the
cochlear nerve.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Cochlear Duct (Scala Media)

The cochlear duct is a spiral anterior part of the membranous labyrinth

having two- and three-fourth turns. It lies in the middle part of the cochlear canal
between scala vestibuli and scala tympani. The cochlear duct contains spiral organ of
Corti, which is sensory receptor for hearing.

Source Ref : Human Anatomy B. D. Chaurasia, 8th ed page no 322

NEET MDS 2021 RECALL + MERITERS STRIKES
Identify the type of muscle:
1) Cardiac
2) Smooth
3) Skeletal
4) Striated

Ans Key : 2 (Smooth)

NEET MDS 2021 RECALL + MERITERS STRIKES

Ans Key : 2 (Smooth)

• Smooth muscle cells (fibres) are smaller than those of striated muscle.
• Their length can range from 15 µm in small blood vessels to 200 µm, and
even to 500 µm or more in the uterus during pregnancy.
• The cells are spindle-shaped, tapering towards the ends from a central
diameter of 3–8 µm. The nucleus is single, located at the midpoint, and often
twisted into a corkscrew shape by the contraction of the cell.
• Smooth muscle cells align with their long axes parallel and staggered
longitudinally, so that the wide central portion of one cell lies next to the
tapered end of another.
• Such an arrangement achieves both close packing and a more efficient
transfer of force from cell to cell.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
• In a longitudinal section through smooth muscle elongated spindle shaped cells
without striations are seen.
• A single elongated (oval) centrally placed nucleus can be identified.
• Smooth muscle is present in the walls of parts of the alimentary canal, in the
urogenital tract etc.

Longitudinal section through

smooth muscle

Source Ref : Grays Anatomy

The Anatomical Basis of Clinical
Practice,Ed.41,Page 123
NEET MDS 2021 RECALL + MERITERS STRIKES

Identify the marked structure:

1) Primary right bronchus
2) Primary left bronchus
3) Pulmonary artery
4) Tertiary bronchiole

Ans Key : 2 (Primary left bronchus)

NEET MDS 2021 RECALL + MERITERS STRIKES

The left lung, A. Lateral Surface, B. Medial Surface

NEET MDS 2021 RECALL + MERITERS STRIKES
NEET MDS 2021 RECALL + MERITERS STRIKES
Key concept: The left lung, A. Lateral Surface, B. Medial Surface

Grays Anatomy The Anatomical Basis of Clinical Practice by Susan Standring, 41st ed, page no 955
NEET MDS 2021 RECALL + MERITERS STRIKES
Identify the plane denoted by A:

1) Sagittal plane
2) Coronal plane
3) Transverse plane
4) Frontal plane

Ans Key : 1 (Sagittal plane )

NEET MDS 2021 RECALL + MERITERS STRIKES

There are three planes commonly used; sagittal, coronal and transverse.

• Sagittal plane - a vertical line which divides the body into a left section and a
right section.
• Coronal plane - a vertical line which divides the body into a front
(anterior) section and back (posterior) section.
• Transverse plane - a horizontal line which divides the body into an upper
(superior) section and a lower (inferior) section.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• In anatomy, the sagittal plane, or longitudinal plane, is an anatomical plane

which divides the body into right and left parts.
• The plane may be in the center of the body and split it into two halves or away
from the midline and split it into unequal parts.
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

Pre-maxilla develops from:

1) Lateral nasal process and maxillary process
2) Frontonasal process
3) Median nasal process
4) Nasopalatine process

Ans Key : 2 (Frontonasal process)

NEET MDS 2021 RECALL + MERITERS STRIKES
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Primary palate:

• Fusion of the two medial nasal processes of frontonasal process at a deeper level
forms a wedge-shaped mass of mesenchyme opposite upper jaw carrying four
incisor teeth.
• The part of the palate derived from the frontonasal process forms the form
premaxilla or primary palate which carries the incisor teeth.
• This ossifies and represents only small part lying anterior to incisive fossa.

Source Ref : Textbook of Clinical Embryology, 1e Vishram Singh, page no 136 Inderbir
Singhs Human embryology, Ed.11th ,Page 160
NEET MDS 2021 RECALL + MERITERS STRIKES

Most common site for securing i.v. cannula in long saphenous vein for resuscitation is:
1) Anterior to medial malleolus
2) Posterior to medial malleolus
3) Lateral to medial malleolus
4) Posterior to lateral malleolus

Ans Key : 1 (Anterior to medial malleolus)

NEET MDS 2021 RECALL + MERITERS STRIKES

• In general, initial access in trauma patients is best secured in the groin so that
placement of the catheter will not interfere with the performance of other
diagnostic and therapeutic thoracic procedures.

• A rule of thumb to consider for secondary access is placement of femoral access

for thoracic trauma and jugular or subclavian access for abdominal trauma.

• Internal jugular or subclavian catheters provide a more reliable measurement of

central venous pressure (CVP), which may be helpful in determining the volume
status of the patient and in excluding cardiac tamponade.

• Saphenous vein cutdowns at the ankle can also provide excellent access. The
saphenous vein is reliably found 1 cm anterior and 1 cm superior to the medial
malleolus.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Standard 14-gauge catheters can be quickly placed, even in an

exsanguinating patient with collapsed veins.

• In severely injured children younger than 6 years of age, the preferred

venous access is peripheral intravenous catheters followed by an IO
needle.

• Central venous catheter placement or saphenous vein cutdown may be

considered as the third choice of access based upon provider experience.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

A. The vein is consistently found 1 cm

anterior and 1 cm superior to the medial
malleolus.
B. Proximal and distal traction sutures are
placed with the distal suture ligated.
C. A 14-gauge IV catheter is introduced and
secured with sutures and tape to prevent
dislodgment.

Saphenous vein cutdowns

are excellent sites for fluid Source Ref : Schwartz’s Principles of Surgery
resuscitation access. Eleventh Edition, page no 187, 188
NEET MDS 2021 RECALL + MERITERS STRIKES

Which of the following is not a feature of superficial burns?

1) They form blisters
2) They heal by scarring
3) Extremely painful
4) Pink and moist

Ans Key : 2 (They heal by scarring)

NEET MDS 2021 RECALL + MERITERS STRIKES
• Superficial burns involve damage to the epidermis only and present with erythema,
no blistering, and full sensation with blanching of skin.
• These will heal without scarring.
• Superficial partial-thickness burns involve damage to the papillary dermis; all skin
appendages are preserved, and therefore, these readily re-epithelialize with minimal
to no scarring.
• Superficial partial-thickness burns are sensate and present with pain, erythema,
blistering, and blanching of skin.
• Topical dressings are the mainstay of treatment.
• Deep partial-thickness burns involve damage to the reticular dermis with damage to
skin appendages, as well as the dermal plexus blood vessels and nerves. These have
decreased sensation and no cap refill and appear pale or white. Blistering may be
present. Damage to the skin appendages and blood supply in the dermal plexus
precludes spontaneous healing without scar. Excision with skin grafting is needed.
• Third-degree burns involve full-thickness damage through the dermis and are
insensate with no blistering. They appear dry, leathery, and even charred.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Superficial burns involve damage to the epidermis only and present with
erythema, no blistering, and full sensation with blanching of skin.
• These will heal without scarring.
• Superficial partial-thickness burns are sensate and present with pain,
erythema, blistering, and blanching of skin.

Source Ref : Schwartz’s Principles of Surgery Eleventh Edition, page no 1958

NEET MDS 2021 RECALL + MERITERS STRIKES
A child presents with a swelling in the middle of the neck, which moves on
swallowing. What would be the probable diagnosis?
1) Brachial cyst
2) Thyroglossal duct cyst
3) Thyroid carcinoma
4) Cystic hygroma
Source Ref :

Ans Key : 2 (Thyroglossal duct cyst)

NEET MDS 2021 RECALL + MERITERS STRIKES
Thyroglossal Duct Cyst

• A thyroglossal duct cyst is a midline neck lesion that originates at the base of
the tongue at the foramen cecum and descends through the central portion
of the hyoid bone.
• Although thyroglossal duct cysts may occur anywhere from the base of the
tongue to the thyroid gland, most are found at or just below the hyoid bone.
• The thyroglossal duct normally regresses by the time the thyroid gland reaches
its final position.
• When the elements of the duct persist despite complete thyroid descent, a
thyroglossal duct cyst may develop.
• The diagnosis usually is established by observing a 1- to 2-cm, smooth, well-
defined midline neck mass that moves upward with protrusion of the tongue.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Routine thyroid imaging is not necessary, although thyroid scintigraphy and

ultrasound have been performed to document the presence of normal thyroid
tissue in the neck.

• Treatment involves the “Sistrunk operation,” which consists of en bloc cystectomy

and excision of the central hyoid bone to minimize recurrence.

A, Thyroglossal duct cyst presents as a

midline neck mass.
B, Sistrunk procedure consists of excision of
the thyroglossal duct cyst up to its origin at
the foramen cecum, including the central
portion of hyoid bone.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:
Thyroglossal Duct Cyst

• The diagnosis usually is established by observing a 1- to 2-cm, smooth,

well-defined midline neck mass that moves upward with protrusion of
the tongue.
• Treatment involves the “Sistrunk operation,” which consists of en bloc
cystectomy and excision of the central hyoid bone to minimize
recurrence.

Source Ref : Schwartz’s Principles of Surgery Eleventh Edition, page no 1626 Sabiston
Textbook of Surgery, 20th ed, page no 1861
NEET MDS 2021 RECALL + MERITERS STRIKES
Patient complains of anxiety, irritability, fine tremor of the hands and fingers,
heat sensitivity and an increase in perspiration along with warm, moist skin and
weight loss. Thyroid scan reveals the following. What would be the probable
diagnosis?

1) Toxic multinodular goitre

2) Grave's disease
3) Thyroid carcinoma
4) Hyperthyroidism

Ans Key : 2 (Grave's disease)

NEET MDS 2021 RECALL + MERITERS STRIKES
• Graves disease is five to ten times more common in women than in men and is
seen with some frequency. It affects almost 2% of the adult female population.

• Graves disease is most commonly diagnosed in patients during the third and
fourth decades of life.

• Most patients with Graves disease exhibit diffuse thyroid enlargement. Many of the
signs and symptoms of hyperthyroidism can be attributed to an increased
metabolic rate caused by the excess thyroid hormone.

• Patients usually complain about nervousness, heart palpitations, heat

intolerance, emotional lability, and muscle weakness.
NEET MDS 2021 RECALL + MERITERS STRIKES

• The following are often noted during the clinical evaluation:

o Weight loss despite increased appetite
o Tachycardia
o Excessive perspiration
o Widened pulse pressure (increased systolic and decreased
diastolic pressures)
o Warm, smooth skin
o Tremor

• Ocular involvement, which develops in 20% to 40% of affected

patients, is perhaps the most striking feature of this disease.
NEET MDS 2021 RECALL + MERITERS STRIKES

Diagnosis
• Since the vast majority of cases of hyperthyroidism are caused by primary thyroid
gland dysfunction with overproduction of T4 and/or T3, and resultant suppression
of pituitary TSH, a suppressed TSH is the most sensitive diagnostic test for
hyperthyroidism.
• Therefore, a low TSH is the single best test for the diagnosis of
hyperthyroidism.
• After primary hyperthyroidism is diagnosed, the clinician must identify the
exact cause, which could be stimulating antibodies, autonomous nodule(s), or
gland destruction with hormone release.

This is done by assessing the uptake and pattern of diagnostic radioactive iodine
by the thyroid gland; it is diffuse in Graves’ disease, patchy in autonomous
nodules, and little or none in gland destruction.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• After primary hyperthyroidism is diagnosed, the clinician must identify the

exact cause, which could be stimulating antibodies, autonomous nodule(s), or
gland destruction with hormone release.
• This is done by assessing the uptake and pattern of diagnostic radioactive
iodine by the thyroid gland; it is diffuse in Graves’ disease (as shown in the
image in question), patchy in autonomous nodules, and little or none in gland
destruction.

Source Ref : Burket’s ORAL MEDICINE Eleventh Edition page no 528

Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm, DDS, Carl M.
Allen, DDS, MSD · ed 4, page no 779
NEET MDS 2021 RECALL + MERITERS STRIKES

A patient presented with right side submandibular and sublingual swelling and left side
submandibular swelling following toothache. Patient has high fever, pasty saliva, anxiety
and restlessness. The tongue is elevated since last night with increased difficulty in
breathing. The most probable diagnosis is:
1) Cavernous sinus thrombosis
2) Ludwig’s angina
3) Chronic osteomyelitis
4) Osteoradionecrosis

Ans Key : 2 (Ludwig’s angina )

NEET MDS 2021 RECALL + MERITERS STRIKES
Ludwig Angina

• Ludwig angina is an aggressive and rapidly spreading cellulitis that involves the
sublingual, submandibular, and submental spaces bilaterally.
• Once the infection enters the submandibular space, it may extend to the lateral
pharyngeal space and then to the retropharyngeal space. This extension may
result in spread to the mediastinum with several serious consequences.
• Ludwig angina creates massive swelling of the neck that often extends close to
the clavicles. Involvement of the sublingual space results in elevation, posterior
enlargement, and protrusion of the tongue (woody tongue), which can
compromise the airway.
• Submandibular space spread causes enlargement and tenderness of the neck
above the level of the hyoid bone (bull neck). Although initially unilateral,
spread to the contralateral neck typically occurs.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Pain in the neck and floor of mouth may be seen in addition to restricted neck
movement, dysphagia, dysphonia, dysarthria, drooling, and sore throat.
• Involvement of the lateral pharyngeal space can cause respiratory
obstruction secondary to laryngeal edema. Tachypnea, dyspnea,
tachycardia, stridor, restlessness, and the patient’s need to maintain an
erect position suggest airway obstruction.
• Fever, chills, leukocytosis, and an elevated sedimentation rate may be seen.
Classically, obvious collections of pus are not present.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

Ludwig Angina

• Ludwig angina creates massive swelling of the neck.

• Involvement of the sublingual space results in elevation, posterior enlargement,
and protrusion of the tongue (woody tongue), which can compromise the
airway.
• Pain in the neck and floor of mouth may be seen in addition to restricted neck
movement, dysphagia, dysphonia, dysarthria, drooling, and sore throat.
• Tachypnea, dyspnea, tachycardia, stridor, restlessness, and the patient’s need to
maintain an erect position suggest airway obstruction. Fever, chills,
leukocytosis, and an elevated sedimentation rate may be seen.
Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm, DDS, Carl M. Allen,
DDS, MSD · ed 4, page no 126, 127
NEET MDS 2021 RECALL + MERITERS STRIKES

A patient presents with a history of hypercalcemia and mobility with respect to 31,
32, 41, 42. Which disease should be considered?
1) Giant cell tumor
2) Hyperparathyroidism
3) Osteoclastoma
4) Hypothyroidism

Ans Key : 2 (Hyperparathyroidism)

NEET MDS 2021 RECALL + MERITERS STRIKES

• Hyperparathyroidism is a relatively rare disease.

• Occasionally the first sign of the disease may be a giant cell tumor or a ‘cyst’ of the
jaw. The effects of the disease on bone are of special interest to dentists.
• Almost all patients with hyperparathyroidism have skeletal lesions, some of which
may occur in the skull or jaws.
• The loss of phosphorus and calcium in this disturbance results in a generalized
osteoporosis with abortive attempts at bone repair and new bone formation.
• The new bone may be resorbed, and the resorption may lead eventually to
pseudocyst formation, the extent of which depends on the duration and
intensity of the disease.
• According to Schour and Massler, malocclusion caused by a sudden drifting with
definite spacing of the teeth may be one of the first signs of the disease.
• In the jaws, the bone radiograph in hyperparathyroidism has been described as
having a ‘ground-glass’ appearance. The lamina dura around the teeth may be
partially lost.
NEET MDS 2021 RECALL + MERITERS STRIKES

Diagnosis.

• It is confirmed by blood investigation which shows hypercalcemia,

hypophosphatemia, and elevated serum parathormone level along with
hypercalciuria, and hyperphosphaturia.
• The serum alkaline phosphates level is increased in osteolytic lesions.
• If hyperparathyroidism is present, the serum calcium will be elevated above
the normal level of 9–12 mg/dl.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

• One of the first clinical signs of this disease is seen radiographically as

subperiosteal resorption of the phalanges of the index and middle fingers.
• Generalized loss of the lamina dura surrounding the roots of the teeth is also
seen as an early manifestation of the condition.

• A decrease in trabecular density and blurring of the normal trabecular pattern

occur; often a “ground glass” appearance results.
• If hyperparathyroidism is present, the serum calcium will be elevated above
the normal level of 9–12 mg/dl.

Source Ref : Shafer’s Textbook of Oral Pathology, 7/e Rajendran and

Sivapathasundharam, page no 652, 653
NEET MDS 2021 RECALL + MERITERS STRIKES

Most common feature of Hurler's syndrome is:

1) Congenital absence of teeth
2) Intermittent calcification of brain
3) Corneal clouding
4) Tooth mobility

Ans Key : 3 (Corneal clouding)

NEET MDS 2021 RECALL + MERITERS STRIKES

HURLER SYNDROME (Mucopolysaccharidosis I, MPS IH, gargoylism)

• Hurler syndrome is a disturbance of mucopolysaccharide metabolism
exhibiting a variety of classic clinical features. It is characterized by an elevated
mucopolysaccharide excretion level in the urine.
• The disease, in which there is an excessive intracellular accumulation of both
chondroitin sulfate B and heparan sulfate in those tissues and organs where
they are normally found, is inherited as an autosomal recessive trait.

Clinical Features.
• The disease usually becomes apparent within the first two years of life,
progresses during early childhood and adolescence and terminates in death
usually before puberty. The head appears large and the facial characteristics are
quite typical, consisting of a prominent forehead, broad saddle nose and wide
nostrils, hypertelorism, puffy eyelids with coarse bushy eyebrows, thick lips,
large tongue, open mouth, and nasal congestion with noisy breathing.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Progressive corneal clouding is a classic manifestation of the disease as is

hepatosplenomegaly, resulting in a protuberant abdomen.
• A short neck and spinal abnormalities are typical, while flexion contractures
result in the ‘claw hand’. These dwarfed individuals are mentally retarded.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

HURLER SYNDROME (Mucopolysaccharidosis I, MPS IH, gargoylism) Clinical

Features.

• Progressive corneal clouding is a classic manifestation of the disease as is

hepatosplenomegaly, resulting in a protuberant abdomen.
• A short neck and spinal abnormalities are typical, while flexion contractures
result in the ‘claw hand’. These dwarfed individuals are mentally retarded.

Source Ref : Shafer’s Textbook of Oral Pathology, 7/e Rajendran and

Sivapathasundharam, page no 630, 631
NEET MDS 2021 RECALL + MERITERS STRIKES

A patient with history of trauma few years ago, presents with progressively restricted
mouth opening. This could most likely be due to:
1) Traumatic myositis ossificans
2) Masseteric hypertrophy
3) Duchenne hypertrophy
4) Ankylosis

Ans Key : 1 (Traumatic myositis ossificans )

NEET MDS 2021 RECALL + MERITERS STRIKES

Traumatic Myositis Ossificans

• In this condition, a painful area develops in muscle or soft tissue following a
single blow to the area, a muscle tear, or repeated minor trauma.
• The painful area gradually develops masses of cartilaginous consistency, and
within four to seven weeks, a solid mass of bone can be felt.
• Common sites include the pectoralis major, biceps, and thigh muscles. A
nontraumatic type of myositis ossificans also may exist.

Oral Manifestations.
• Myositis ossificans involving the muscles of the face, particularly the masseter
and temporal muscles, has been reported on numerous occasions, usually
following a single acute traumatic injury.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Goodsell, as well as Plezia and his associates, have reviewed the literature dealing
with myositis ossificans of the masseter muscle and found that, in most reported
cases, growth of the calcified lesions has been rapid, maximum size obtained, and
then the lesion remained static or even diminished in size.

• Some difficulty in opening the mouth may be experienced by patients with

myositis ossificans of the masseter muscle.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Myositis ossificans involving the muscles of the face, particularly the

masseter and temporal muscles, has been reported on numerous occasions,
usually following a single acute traumatic injury.
• Some difficulty in opening the mouth may be experienced by patients with
myositis ossificans of the masseter muscle.

Source Ref : Shafer’s Textbook of Oral Pathology, 7/e Rajendran and

Sivapathasundharam, page no 869
NEET MDS 2021 RECALL + MERITERS STRIKES
A child presents with brachycephalic skull, high arch palate, narrow maxilla, and
hypertelorism. Identify the condition:
1) Crouzon syndrome
2) Treacher-Collin syndrome
3) Cleidocranial dysplasia
4) Gardner’s syndrome

Ans Key : 1 (Crouzon syndrome )

NEET MDS 2021 RECALL + MERITERS STRIKES

CROUZON SYNDROME (CRANIOFACIAL DYSOSTOSIS)

• Crouzon syndrome is one of a rare group of syndromes characterized by

craniosynostosis, or premature closing of the cranial sutures.
• It is believed to be caused by one of a variety of mutations of the fibroblast
growth factor receptor 2 (FGFR2) gene on chromosome 10q26.

Clinical and Radiographic Features

• Crouzon syndrome exhibits a wide variability in expression.
• The premature sutural closing leads to cranial malformations, such as
brachycephaly (short head), scaphocephaly (boat-shaped head), or
trigonocephaly (triangle-shaped head).
• The most severely affected patients can demonstrate a “cloverleaf” skull
(kleeblattschädel deformity). The orbits are shallow, resulting in characteristic
ocular proptosis.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Skull radiographs typically show increased digital markings (i.e., “beaten-

metal” pattern (as shown in the image in question)).
• The maxilla is underdeveloped, resulting in midface hypoplasia. Often the
maxillary teeth are crowded, and occlusal disharmony usually occurs.
• Some patients will exhibit one or more congenitally missing teeth. Cleft lip and
cleft palate are rare, but lateral palatal swellings may produce a midline maxillary
pseudocleft.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

CROUZON SYNDROME (CRANIOFACIAL DYSOSTOSIS)

• Crouzon syndrome is one of a rare group of syndromes characterized by

craniosynostosis, or premature closing of the cranial sutures.
• The premature sutural closing leads to cranial malformations, such as
brachycephaly (short head), scaphocephaly (boat-shaped head), or
trigonocephaly (triangle-shaped head).
• Skull radiographs typically show increased digital markings (i.e.,
“beaten-metal” pattern (as shown in the image in question).

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D.
Damm, DDS, Carl M. Allen, DDS, MSD · ed 4, page no 39
NEET MDS 2021 RECALL + MERITERS STRIKES

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A 54 year old female complains of swelling in the anterior maxilla between the canine
and lateral incisor. This lesion is seen in almost 2/3rd of females and generally seen in
anterior maxillary region. The most probable diagnosis is:
1) AOT
2) CEOT
3) CGCG
4) Compound odontoma

Ans Key : 1 (AOT)

NEET MDS 2021 RECALL + MERITERS STRIKES

ADENOMATOID ODONTOGENIC TUMOR

The adenomatoid odontogenic tumor represents 2% to 7% of all odontogenic
tumors.
Clinical and Radiographic Features

• Adenomatoid odontogenic tumors are largely limited to younger patients, and

two-thirds of all cases are diagnosed when patients are 10 to 19 years of age.
• This tumor is definitely uncommon in a patient older than age 30.
• It has a striking tendency to occur in the anterior portions of the jaws and is
found twice as often in the maxilla as in the mandible.
• Females are affected about twice as often as males.
• Adenomatoid odontogenic tumors are frequently asymptomatic and are
discovered during the course of a routine radiographic examination or when
films are made to determine why a tooth has not erupted.
• Larger lesions cause a painless expansion of the bone.
NEET MDS 2021 RECALL + MERITERS STRIKES

Adenomatoid Odontogenic Tumor.

Relative distribution of adenomatoid odontogenic tumor in the jaws.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

ADENOMATOID ODONTOGENIC TUMOR

• Adenomatoid odontogenic tumors are largely limited to younger patients, and

two-thirds of all cases are diagnosed when patients are 10 to 19 years of age.
• It has a striking tendency to occur in the anterior portions of the jaws and is
found twice as often in the maxilla as in the mandible.
• Females are affected about twice as often as males.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D.
Damm, DDS, Carl M. Allen, DDS, MSD · ed 4, page no 664
NEET MDS 2021 RECALL + MERITERS STRIKES
Patient complains of fever and dull throbbing pain in an upper right tooth. On
examination the tooth was found to be non-carious, however halitosis was
present. What is the diagnosis?
1) Chronic maxillary sinusitis
2) Acute alveolar abscess
3) Acute maxillary sinusitis
4) Nasal obstruction

Ans Key : 1 (Chronic maxillary sinusitis)

NEET MDS 2021 RECALL + MERITERS STRIKES
• Localized involvement of the maxillary sinus can occur as pain over the cheekbone,
toothache, periorbital pain, or temporal headache.
• Maxillary sinusitis is associated with increased pain when the head is held upright
and less discomfort when the patient is supine.
• Chronic sinusitis is less diagnostic, and radiographic imaging becomes more
important. Frequent complaints include facial pressure, pain, or a sensation of
obstruction.
• In some cases, nonspecific symptoms, such as headache, sore throat,
lightheadedness, or generalized fatigue, also may be present or even dominate.
Radiographically, the involved sinus has a cloudy, increased density.
• At times, sinusitis can be confused with an odontogenic infection. In such cases, close
examination of periapical radiographs, a thorough periodontal examination, and
assessment of tooth vitality often may point to an odontogenic infection. A sinus
infection should be strongly considered when patients complain of pain from several
teeth, demonstrate tenderness over one or both of the maxillary sinuses, exhibit nasal
congestion, or have a nasal discharge accompanied by a foul odor, fever, and headache.
NEET MDS 2021 RECALL + MERITERS STRIKES

• Historically, 10% to 12% of maxillary sinusitis cases were thought to arise from
an odontogenic source, but many current investigators believe the prevalence
is closer to 30%.
• Common causes include periapical or periodontal infection from the
maxillary teeth, dental trauma, or iatrogenic causes, such as dental
extractions, maxillary osteotomies, or placement of dental implants.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Localized involvement of the maxillary sinus can occur as pain over the
cheekbone, toothache, periorbital pain, or temporal headache.
• Maxillary sinusitis is associated with increased pain when the head is held
upright and less discomfort when the patient is supine.
• Chronic sinusitis is less diagnostic, and radiographic imaging becomes more
important. Frequent complaints include facial pressure, pain, or a sensation of
obstruction.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D.
Damm, DDS, Carl M. Allen, DDS, MSD · ed 4, page no 186, 187
NEET MDS 2021 RECALL + MERITERS STRIKES
A radiograph shows antero-posterior radiolucent swelling with less buccal and lingual
expansion. Which of the following would be the probable diagnosis?
1) Keratocystic odontogenic tumour
2) Dentigerous cyst
3) Ameloblastoma
4) CEOT

Ans Key : 1 (Keratocystic odontogenic tumour)

NEET MDS 2021 RECALL + MERITERS STRIKES

ODONTOGENIC KERATOCYST (KERATOCYSTIC ODONTOGENIC TUMOR)

The odontogenic keratocyst (OKC) is a distinctive form of developmental odontogenic
cyst that deserves special consideration because of its specific histopathologic features
and clinical behavior. There is general agreement
that the OKC arises from cell rests of the dental lamina.

Clinical and Radiographic Features

• OKCs may be found in patients who range in age from infancy to old age, but
about 60% of all cases are diagnosed in people between 10 and 40 years of age.
There is a slight male predilection. The mandible is involved in 60% to 80% of
cases, with a marked tendency to involve the posterior body and ramus.
• Small OKCs are usually asymptomatic and discovered only during the course of
a radiographic examination. Larger OKCs may be associated with pain,
swelling, or drainage. Some extremely large cysts, however, may cause no
symptoms.
NEET MDS 2021 RECALL + MERITERS STRIKES

• This feature may be useful in differential clinical and radiographic diagnosis

because dentigerous and radicular cysts of comparable size are usually associated
with bony expansion.

KEY CONCEPT:

ODONTOGENIC KERATOCYST (KERATOCYSTIC ODONTOGENIC TUMOR)

The odontogenic keratocyst (OKC) is a distinctive form of developmental odontogenic
cyst that deserves special consideration because of its specific histopathologic
features and clinical behavior. There is general agreement that the OKC arises from cell
rests of the dental lamina.
OKCs tend to grow in an anteroposterior direction within the medullary cavity of
the bone without causing obvious bone expansion.
Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm, DDS, Carl M. Allen,
DDS, MSD · ed 4, page no 636, 637
NEET MDS 2021 RECALL + MERITERS STRIKES

A 10 year old patient comes to the clinic with bilateral expansion of the mandible.
The lesion started at the age of 4 and has progressed until now. Identify the
condition:
1) Cherubism
2) Fibrous dysplasia
3) CGCG
4) Ewing's sarcoma

Ans Key : 1 (Cherubism)

NEET MDS 2021 RECALL + MERITERS STRIKES

CHERUBISM
Cherubism is a rare developmental jaw condition that can be inherited as an autosomal
dominant trait with variable expressivity.
Clinical and Radiographic Features
• The condition usually first becomes evident at around 2 to 5 years of age,
although in mild cases the diagnosis may not be made until 10 to 12 years.
• The clinical alterations typically progress until puberty, then stabilize and slowly
regress.
• The plump, cherub-like cheeks result from painless, bilaterally symmetric
expansion of the posterior mandible.
• In early disease, cervical lymphadenopathy also may contribute to the
apparent fullness. In severe cases, involvement of the inferior and/or lateral
orbital walls may tilt the eyeballs upward and retract the lower eyelid, thereby
exposing the sclera below the iris to produce an “eyes upturned to heaven”
appearance.
NEET MDS 2021 RECALL + MERITERS STRIKES

• In the mandible, lesions frequently develop in the angles, ascending rami, and
coronoid processes, but the condyles usually are spared. In severe cases, most of
the mandible is affected. Involvement of the maxillary tuberosities or entire maxilla
also is possible, and there may be a V- shaped palatal arch.
• Radiographic examination typically shows bilateral, multilocular, expansile
radiolucencies. This radiographic presentation is virtually diagnostic.

Cherubism.
Panoramic radiograph of a 7-year-old white boy. Bilateral multilocular radiolucencies
can be seen in the posterior mandible.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:
Cherubism.
This young girl shows the typical cherubic facies
resulting from bilateral expansile mandibular and
maxillary lesions.

Source Ref : Oral and Maxillofacial Pathology Brad W.

Neville, DDS, Douglas D. Damm, DDS, Carl M. Allen,
DDS, MSD. ed 4, page no 587, 588
NEET MDS 2021 RECALL + MERITERS STRIKES
Which of the following lesions show soap bubble appearance on radiographs?
1) Ewing’s sarcoma
2) Fibro-osseous dysplasia
3) Giant cell lesion
4) Osteosarcoma

Ans Key : 3 (Giant cell lesion)

NEET MDS 2021 RECALL + MERITERS STRIKES

Internal Septation
• Septations within a lesion represent bone that has been organized into long
strands or walls within the lesion. If these septa appear to divide the internal
structure into at least two compartments, the term multilocular is used to
describe the lesion.
• The origin of this internal bone may be trapped bone, such as in ameloblastomas,
or reactive bone, such as in giant cell granulomas, or the bone may be
manufactured by the lesion, such as in ossifying fibromas.
• The appearance of the septa also informs the observer about the nature and
pathology of the lesion.
• For instance, curved, coarse septa may be seen in ameloblastoma giving the
internal pattern a multilocular, “soap bubble” appearance. This pattern also may
be observed sometimes in odontogenic keratocysts.
NEET MDS 2021 RECALL + MERITERS STRIKES
• Another example of internal septation is seen in giant cell granulomas.
• Radiographically, the central giant cell granuloma appears as a unilocular or
multilocular radiolucency, with well-delineated but generally non- corticated
borders.
• The lesion may vary from a 5 mm incidental radiographic finding to a destructive
lesion greater than 10 cm.
• Ewing’s sarcoma may stimulate the periosteum to produce new bone; this is usually
the result of gross disturbances to the overlying periosteum and takes the form of
Codman’s triangle or “sunray” or “hair-on-end” spiculation. Laminar periosteal new
bone formation has been reported to occur but is not a common feature of active
Ewing’s sarcoma lesions of the jaws.
• Osteosarcoma has an ill-defined border in most instances. When viewed against
normal bone, the lesion can be either relatively radiolucent or radiopaque with no
peripheral sclerosis or encapsulation. If the lesion involves the periosteum directly or
by extension, one may see the typical “sunray” spicules or “hair-on-end” trabeculae.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• Ewing’s sarcoma - Codman’s triangle or “sunray” or “hair-on-end” spiculation.

• Osteosarcoma- The typical “sunray” spicules or “hair-on-end” trabeculae.
• Radiographically, the central giant cell granuloma appears as a unilocular or
multilocular radiolucency, with well-delineated but generally non- corticated
borders.

Source Ref : ORAL RADIOLOGY PRINCIPLES AND INTERPRETATION, SEVENTH EDITION , White & Pharaoh
page no 279
Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm, DDS, Carl M. Allen, DDS, MSD ·
ed 4, page no 585, 442, 439
NEET MDS 2021 RECALL + MERITERS STRIKES

The most common tumour of the salivary gland is:

1) Pleomorphic adenoma
2) Mucoepidermoid carcinoma
3) Adenoid cystic carcinoma
4) Adenocarcinoma

Ans Key : 1 (Pleomorphic adenoma)

NEET MDS 2021 RECALL + MERITERS STRIKES
PLEOMORPHIC ADENOMA (BENIGN MIXED TUMOR)

Clinical Features.
• Pleomorphic adenoma is the most common tumor of salivary glands.
• The parotid gland is the most common site of the pleomorphic adenoma; 90% of
a group of nearly 1,900 such tumors reported by Eneroth.
• It may occur in any of the major glands or in the widely distributed
intraoral accessory salivary glands; however its occurrence in the
sublingual gland is rare.
• In the parotid this tumor most often presents in the lower pole of the superficial
lobe of the gland, about 10% of the tumors arise in the deeper portions of the
gland.
• Approximately 8% of pleomorphic adenomas involve the minor salivary glands,
the palate is the most common site (60–65%) of minor salivary gland
involvement.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

PLEOMORPHIC ADENOMA

• The pleomorphic adenoma, or benign mixed tumor, is the most common

salivary neoplasm. It accounts for 50% to 77% of parotid tumors, 53% to
72% of submandibular tumors, and 33% to 41% of minor gland tumors.
• Pleomorphic adenomas are derived from a mixture of ductal and
myoepithelial elements.

Source Ref : Shafer’s Textbook of Oral Pathology, 7/e Rajendran and

Sivapathasundharam, page no 225 Oral and Maxillofacial Pathology Brad W. Neville,
DDS, Douglas D. Damm, DDS, Carl M. Allen, DDS, MSD · ed 4, page no 444
NEET MDS 2021 RECALL + MERITERS STRIKES

The OPG reveals a radiolucent lesion indicative of OKC. What should be

the most concerning factor during/post treatment?

1) Malignant transformation
2) Higher recurrence rate
3) Bleeding
4) Paresthesia

Ans Key : 2 (Higher recurrence rate)

NEET MDS 2021 RECALL + MERITERS STRIKES

ODONTOGENIC KERATOCYST (KERATOCYSTIC ODONTOGENIC TUMOR)

The odontogenic keratocyst (OKC) is a distinctive form of developmental
odontogenic cyst that deserves special consideration because of its specific
histopathologic features and clinical behavior.
The authors currently favor retaining “odontogenic keratocyst” as the primary
term for this lesion, although both terms will be found in the
literature and should be considered synonymous. Regardless of which term is preferred,
these lesions are significant for three reasons:
1. Greater growth potential than most other odontogenic cysts
2. Higher recurrence rate
3. Possible association with the nevoid basal cell carcinoma syndrome

Although there are wide variations in the reported frequency of OKCs compared
with that of other types of odontogenic cysts, most studies indicate that OKCs
make up 3% to 11% of all odontogenic cysts.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

In contrast to other odontogenic cysts, OKCs often tend to recur after

treatment. Whether this is due to fragments of the original cyst that were not
removed at the time of the operation or a “new” cyst that has
developed from dental lamina rests in the general area of the original cyst cannot be
determined with certainty.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm,
DDS, Carl M. Allen, DDS, MSD · ed 4, page no 636
NEET MDS 2021 RECALL + MERITERS STRIKES
A female patient complains of progressive protrusion of the upper anterior teeth with
incompetency of the lips and shows generalized hypercementosis. What would be the
probable diagnosis?
1) Paget’s disease
2) Compound odontoma
3) Hypophosphatasia
4) Hyperparathyroidism

Ans Key : 1 (Paget’s disease)

NEET MDS 2021 RECALL + MERITERS STRIKES

PAGET DISEASE OF BONE (OSTEITIS DEFORMANS)

Paget disease of bone is characterized by abnormal, anarchic resorption and deposition

of bone, resulting in skeletal distortion and weakening.
Clinical and Radiographic Features

• Paget disease of bone primarily affects older patients. Disease frequency

increases with age, and the mean age at diagnosis has been increasing in many
populations. The condition is rare in patients younger than 40 years.
• Jaw involvement is present in about 17% of patients, with a predilection for the
maxilla (approximate 2 : 1 maxilla-to-mandible ratio).
• Maxillary disease produces enlargement of the middle third of the face and
may result in nasal obstruction, enlarged turbinates, obliterated sinuses, and
deviated septum.
NEET MDS 2021 RECALL + MERITERS STRIKES
• In extreme cases, there is a lion-like facial deformity (leontiasis ossea). The
alveolar ridges tend to remain symmetrical but become grossly enlarged.
• Alveolar enlargement may cause spacing between teeth, and edentulous
patients may complain that their dentures feel too tight.
• Osteitis deformans or Paget’s disease of bone (q.v.) is a generalized skeletal disease
characterized by deposition of excessive amounts of secondary cementum on the
roots of the teeth and by the apparent disappearance of the lamina dura of the
teeth, as well as by other features related to the bone itself.
• Although the bone changes are the most prominent features of the disease,
generalized hypercementosis should always suggest the possibility of the
presence of osteitis deformans.
NEET MDS 2021 RECALL + MERITERS STRIKES
KEY CONCEPT:

PAGET DISEASE OF BONE (OSTEITIS DEFORMANS)

Paget disease of bone is characterized by abnormal, anarchic resorption and
deposition of bone, resulting in skeletal distortion and weakening.
• Alveolar enlargement may cause spacing between teeth, and edentulous patients
may complain that their dentures feel too tight.
• Osteitis deformans or Paget’s disease of bone (q.v.) is a generalized skeletal disease
characterized by deposition of excessive amounts of secondary cementum on the
roots of the teeth and by the apparent disappearance of the lamina dura of the
teeth, as well as by other features related to the bone itself.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm, DDS, Carl M. Allen, DDS,
MSD · ed 4, page no 583
Shafer’s Textbook of Oral Pathology, 7/e Rajendran and Sivapathasundharam, page no 587
NEET MDS 2021 RECALL + MERITERS STRIKES
A 10 year old child complains of bilateral expansion of the maxilla and mandible. Lab
diagnosis reveals increased alkaline phosphatase. What could be the probable
diagnosis?
1) Osteopetrosis
2) Osteosarcoma
3) Fibrous dysplasia
4) Ewing’s sarcoma

Ans Key : 3 (Fibrous dysplasia)

NEET MDS 2021 RECALL + MERITERS STRIKES

Cherubism (Familial fibrous dysplasia of jaws, disseminated juvenile fibrous

dysplasia, familial multilocular cystic disease of jaws, familial fibrous swelling of
jaws)

• Cherubism is a rare developmental jaw condition that can be inherited as an

autosomal dominant trait with variable expressivity. It is seen in children.
• It is believed that mutations in the gene may lead to pathologic activation of
osteoclasts and disruption of jaw development. Regression may occur after
adolescence.
• The plump, cherub-like cheeks result from painless, bilaterally symmetric
expansion of the posterior mandible.
• The jaw is broad and protruding. Involvement of the maxilla and the
mandible is symmetric.
• The only significant laboratory abnormality is an elevated alkaline
phosphatase level.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

Cherubism

• The plump, cherub-like cheeks result from painless, bilaterally symmetric

expansion of the posterior mandible.
• Elevated alkaline phosphatase level.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D.
Damm, DDS, Carl M. Allen, DDS, MSD · ed 4, page no 587, 588
Shafer’s Textbook of Oral Pathology, 7/e Rajendran and Sivapathasundharam, page
no 715
NEET MDS 2021 RECALL + MERITERS STRIKES

On direct immunofluorescence there is evidence of IgG against the hemidesmosomes.

What could be the diagnosis?
1) Lichen planus
2) Bullous pemphigoid
3) SLE
4) Pemphigus vulgaris

Ans Key : 4 (Pemphigus vulgaris)

NEET MDS 2021 RECALL + MERITERS STRIKES

• The diagnosis of pemphigus vulgaris should be confirmed by direct

immunofluorescence examination of fresh perilesional tissue or tissue submitted
in Michel’s solution.
• With this procedure, antibodies (usually IgG or IgM) and complement
components (usually C3) can be demonstrated in the intercellular spaces
between the epithelial cells in almost all patients with this disease.
• Indirect immunofluorescence is also typically positive in 80% to 90% of cases,
demonstrating the presence of circulating autoantibodies in the patient’s serum.
• Enzyme-linked immunosorbent assays (ELISAs) have been developed to detect
circulating autoantibodies as well.
• It is critical that perilesional tissue be obtained for both light microscopy and
direct immunofluorescence to maximize the probability of a diagnostic sample.
• If ulcerated mucosa is submitted for testing, then the results are often inconclusive
because of either a lack of an intact interface between the epithelium and
connective tissue or a great deal of non-specific inflammation.
NEET MDS 2021 RECALL + MERITERS STRIKES

KEY CONCEPT:

• The diagnosis of pemphigus vulgaris should be confirmed by direct

immunofluorescence examination of fresh perilesional tissue or tissue
submitted in Michel’s solution.
• With this procedure, antibodies (usually IgG or IgM) and complement
components (usually C3) can be demonstrated in the intercellular spaces
between the epithelial cells in almost all patients with this disease.

Source Ref : Oral and Maxillofacial Pathology Brad W. Neville, DDS, Douglas D. Damm,
DDS, Carl M. Allen, DDS, MSD · ed 4, page no 715
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS
INI-CET MDS, BDS
Trusted by over 90% of Dental Students

Download Now
NEET MDS 2021 RECALL + MERITERS STRIKES

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NEET MDS 2021 RECALL + MERITERS STRIKES

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