Ticket 1

1) Possible complications during tooth extraction?

Bleeding
Swelling and inflammation
Alveolar osteitis (dry socket)
Pain

2) TMJ disorders and classifications ?

By etiology > innate malformation / acquired (arthritis) /Dystrophy (arthrosis)
By course > Acute / chronic
Ankylosis (fibrous ,osseous)

1- Infectious Arthritis : a result of TMJ infection

Complains: edema , pain in parotidmassetrica region with irradiation into ear / limited lower
jaw movement / lower jaw shifted to affected side

2- Traumatic arthritis : due to acute injury

Complains: pain and tenderness
Treatment: NSAIDs/ application of heat / restriction of movement

3- Osteoarthritis : appears in people above 50 years

Complains: stiffness / grating / mild pain

4- Rheumatoid arthritis :
Complains: pain / swelling /ankyloses
Treatment: NSAIDs / jaw movement restriction / use of splint / surgery

5- Chronic arthritis :
Complains: crunch during mouth opening / headache / dizziness / dryness of mouth / pain
during pressing of mental region
Treatment : antibiotic / proper hydration / motion restriction

3) Jaw odontogenic osteomyelitis, pathogenesis , treatment plan ?

Inflammation of bone marrow with tendency of progression
Pathogenesis : as a result of odontogenic infections(inoculation of bacteria into jawbones from
tooth extraction, RCT , fracture of maxilla or mandible ) or result of trauma
Treatment : antibiotic , drainage , then surgery called sequestrectony and saucerizdation and
extraction of etiological tooth

4) Case : patient 12 years ,has visible swelling in submandibular region ?

Acute sialodenitis : enlarged painful salivary gland (saliva with pus)
Treatment : antibiotic (macrolides) / antihistamine/sialagogues (flavored sweets to encourage
saliva )
Or sialolithiasis
Ticket 2

1. General anesthesia in dentistry of children and adolescents?

General anesthesia is used in cases where methods of pain control or sedation are inadequate

Purpose used when a child needs extensive dental treatment, or has difficulty cooperating during
dental procedures

Administrationwe have 3 types of administration premedication, inhalation and non-inhalation

Procedure While under general anesthesia, the child is completely unconscious and unaware.

Risks and Considerations may include allergic reactions, respiratory problems, cardiac problems,
nervous system problems. Risks are carefully managed by dental and anesthesia team.

2. Neoarthrosis, pathogenesis, clinical representation and treatment plan

Define same as pseudarthrosis occurs when the broken ends of a bone do not fuse together
naturally, resulting in a non-healing or incomplete healing of the fracture.
Pathogenesis involves a disruption in the normal bone healing process, resulting in the
formation of a false joint or fibrous connection instead of a solid bony union.
Symptoms Persistent pain at the site of the fracture, Limited range of motion or functional
impairment, Instability or abnormal movement at the affected area, Visible deformity or
abnormal appearance.
Treatment 1- Surgical intervention: involve bone grafting to stimulate bone healing
2-Electrical bone stimulation: non-invasive technique uses low-intensity electrical currents to
promote bone healing.
3-Physical therapy: recommended to improve joint stability, range of motion, and strength after
surgical intervention.
4-Medications: Pain medications or anti-inflammatory drugs may be prescribed

3. Chronic osteomyelitis of the jaws. Types, diagnosis, clinic representation

Define purulent, necrotic infection and inflammation of bone marrow which occurs in the
bones of the jaws
Types primary chronic and chronic as a result of acute osteomyelitis (destructive, productive,
destructive – productive forms)
Diagnosis Medical History and Clinical Examination, Imaging Studies (panoramic X-rays, CT
scan or MRI), Biopsy and Cultures and Laboratory Tests (Blood tests- CBC, CRP or ESR)
Clinic representation pain, swelling, erythema over infected tooth, pus in palpation,
causative tooth has periodontitis, mobility of adjacent teeth, fever, Trismus, abscesses, fistula

4. Patient, 9 years of age suffers from severe pain in submandibular region, body temperature
elevated 39.2 degrees C, swelling in submandibular region, skin redness is observed. Palpation
gives fluctuation under the skin. The oral cavity we observed decayed 36 tooth, lossened and
painful percussion. Swelling and redness on mouth floor. Give primary diagnosis, additional
examination and treatment approach
Ticket 3

1. Jaws odontogenic osteomyelitis, pathogenesis , treatment plan – same as ticket 7

2. TMJ fibrosis ankyloses, clinical representation, pathogenesis, surgical approach – same ticket 5
Siaolithiasis, salivary gland stone- diagnosis, treatmen

Ticket 4

1) Local anesthesia in dentistry of children and adults?

Local anesthesia in dentistry is a technique used to numb a specific area of the mouth,
allowing dental procedures to be performed without pain or discomfort.
Anesthetic Agents: Local anesthetic solutions commonly used in dentistry include lidocaine,
articaine, mepivacaine, and prilocaine. These agents temporarily block nerve conduction,
numbing the area where the dental work will be performed.

Local anesthesia techniques

- Infiltration Anesthesia: Infiltration anesthesia involves injecting the local anesthetic

solution directly into the tissues surrounding the tooth being treated. This technique is
typically used for procedures that involve a single tooth or a small area.

- Nerve Block Anesthesia: Nerve block anesthesia involves injecting the local anesthetic
near a major nerve that supplies sensation to a larger area of the mouth. By blocking the
nerve, the entire region supplied by that nerve becomes numb. Examples of nerve block
techniques include the inferior alveolar nerve block (numbing the lower jaw and teeth)
and the maxillary nerve block (numbing the upper jaw and teeth).

- Topical Anesthesia: Topical anesthesia involves applying a numbing gel or spray to the
surface of the oral tissues, such as the gums or mucous membranes. It is commonly
used as a preliminary step to reduce the discomfort associated with needle insertions
during local anesthesia injections.

2) Salivary glands inflammation , types , clinic , diagnosis and treatment ?

1- Sialodenitis : inflammation of salivary glands most commonly parotid gland
Example Mumps : (epidemic parotitis )
Is a viral disease caused by paramyxovirus
Symptoms : parotitis / fever / headache /pain behind ear during palpation / hyperemic
orifices of the duct /orchitis / dry mouth
Diagnosis : physical examination of swollen glands / saliva test / blood test
Treatment : ice or heat to affected area /warm water gargles /soft food

2- Acute/chronic sialodenitis : bacterial or viral

 Symptoms: Pain and Swelling: The affected salivary gland becomes painful, tender, and
swollen. The swelling may be localized to one side of the face, typically around the
jawline, cheeks, or neck. Difficulty Eating and Drinking / Foul-tasting Drainage/ Fever
and Malaise
Diagnosis : according complains and clinical signs
Treatment : antibiotics / salivary gland massage /hydration /NSAIDs

3- Sialothiasis : salivary gland stones disease caused by presence of stones either within
the gland itself or in the duct that is draining the gland

Symptoms : painful enlargement of gland during eating /asymmetry of submandibular

area / free mouth opening/hyperemic mucosa saliva is transparent with pus
Diagnosis : palpation and xray
Treatment : stones in anterior part can be removed via the mouth by opening and
marsupialising the duct but if its far or in submandibular gland itself , we should remove
the gland externally by neck incision to avoid damage of lingual nerve /parotidectomy

3) Answered before
4) Case :
Acute serous odontogenic lymphadenitis
treatment ; remove risk factors /antibiotic / surgery

Ticket 7:

1) Jaws odontogenic osteomyelitis, pathogenesis and treatment plan

Pathogenesis osteomyelitis occurs as a result of spread of odontogenic infections, or as a

result of trauma.Classification of osteomyelitis:
It is classified into five groups:
By the spreading of infection:
odontogenic and nonodontogenic
By the type of infection: Specific and nonspecific
By the course of a disease:
 acute primary
 chronic
 chronic as the result of acute osteomyelitis
By the anatomy:
 osteomyelitis of the upper or lower jaw
By the spreading:
 localized
 generalized
Treatment:
Surgery, with aggressive debridement of the jaws to viable, bleeding bone and
extraction of etiologic teeth, supported with parenteral and oral antibiotics are the
mainstays of treatment.
2) Sialolithiasis diagnosis and treatment
 Sialolithiasis is a benign condition involving the formation of stones within the
ducts of the major salivary glands: parotid, submandibular, and sublingual
glands.
Diagnosis:
A healthcare provider can diagnose sialolithiasis during a physical examination.
They'll feel around your face and neck and look inside of your mouth for lumps or
other abnormalities. They'll also review your medical history and ask about your
symptoms.
Treatment:
The classic treatment of sialolithiasis is antibiotics and anti-inflammatory agents,
hoping for a spontaneous stone expression through the papilla.
1) Temporomandibular joint disorders classification
answered

ticket 8:

1) general anesthesia in dentistry of children and adolescents:

answered
2) Chronic osteomyletis of the jaw. Types diagnosis and clinical presentation:
The three major types are:
 Acute Osteomyelitis (AO)
 Secondary Chronic Osteomyelitis (SCO)
 Primary Chronic Osteomyelitis (PCO)
Diagnosis of osteomyelitis is primarily performed through panoramic radiography,
oral cavity photography, and clinical diagnostic examination.
Signs and Symptoms
 Jaw pain.
 Facial swelling.
 Sinus drainage.
 Tooth loss.
 Pus (thick, usually yellow-white fluid)
 Fatigue.
 Fever.
 Tenderness, redness, and warmth in the area of the infection.
 Swelling around the affected bone

Ticket 9

Q1-Neoarthrosis. Pathogenesis, Clinical representation, treatment plan

Condition when bone fracture fail to heal properly and result in absence of bony union
when fractured
bone ends do not re join and there is mobility at fracture site
Pathogensis—>
Poor blood supply to fractured area, inadequate immabliziation on infection+smoking
Clinical manifestation—>
 Persistence pain/ immobility / delay in bone healing/ sweaing or tenderness functional
impairments
Treatment —>
1- consecutive management ( limit movement of attached site )
2- surgical intervention/ bone grafting / internal fixation
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Q2 mokarar ticket 5
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Q3 mokarar ticket 1

Ticket Number 10

Q1- Acute odontogenic osteomyelitis. Pathogenesis, diagnostic method, treatment plan

Definition->
One of types of osteomyelitis inflammation of bone marrow that progress rapidly.
Symptoms—>
Pain, swelling , fever, parasthesia of inferior alveolar nerve, trismus, fatigue
Elevation of CPR/ESR in blood—>
Indicate inflammation
Examination —>
Ortho pantomogram/ ortho panoramic/ CT/ mouth eaten syndrome
Treatment of acute osteomyelitis—>
Combination of medical&surgery
* ANTIBIOTIC —> penicillin - Cephalosporins-clinclamycin from 4-6 weeks
* Surgery—> abscess drainage + bone grafting + remove all of necrotic bone +Pain
management
Examination—>
X-ray/ CT / needle aspiration
Treatment ( 4-6 weeks duration)—>
* antimicrobial therapy
* Surgical drainage
* Antibiotic -> clindamycin - cephalosporin- natcilin
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Question 2 mokarar ticket 5
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Q3- local anesthesia in dentistry of children and adolescents:
Injection—>
In titration: peripheral nerve in tissue near the tooth we want to work on indicate for
extraction tooth in
child, not effective in adult extraction NERVE BLOCK because of dense bone can use
ultracaine or
obislesin
NON-injection—>
Topical irrigation: as gel / ointment / to remove temporary tooth or relief pain on injection
Complication —>
* local: hematoma nevritis
* General: syncope anaphylactic
Before local anesthesia is important to take allergic test
Nerve block —>
PSA/ Intraorbital / greater palatine/ nasopalatine /mental nerve block
Anesthesia main nerve brand 2,3 trigemnal nerve
* Preferred extra oral method for children
* In children age 6-15y
* For extraction of permanent tooth
* Don’t give vasoconstrictor under age 3