Canadian Acfd Eligibility Exam Thread 2

[tinman831]

The last thread has been closed due to the discussion of remembered questions on the exam. Remember that you are not permitted to discuss exam questions per the non disclosure clause you sign when taking it. Any future posts discussing remembered questions will be deleted and the user infracted. This will be your only warning.

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[chanty]

okay i read the dental decks regarding the function of lat.pterygoid muscle.It says when the lat. pterygoid muscles contract together they cause the disc and condyle to move forward and downward.like in protrusion and in jaw opening.
while in lateral excursions of mandible the non working side condyle moves forward down and medial while working side goes forward and lateral.so what do we say abt this??
now this question has appeared alot of times with different wordings sometimes they ask abt jaw opening and lat pterygoid,sometimes they ask abt just the lat pterygoids contraction.
it is also written in decks that in disc displacement the disc usually is displaced anteriomedially,but in normal occlusion it is prevented from doing so by the tmj ligaments.
so here is the summary now how would u answer this question?

I would say forward and medially. I looked in the questions that were in the acfd page, and they only had the first four options, they didn't put the option "None of above", so if we have to choose one of those, I say this is the correct one.

 

[chanty]

in a xerostomic patient which salivary glands are likely responsible for the lack of lubrication
a accessory
s. labial
c. parotid
d. sublingual and sub mandibular

Submandibular glands produce approx 70% of the saliva (mostly serous), but, although minor salivary glands secrete approx 10% of the total volume of saliva, they account for approx 70% of the mucus secreted..... so I am not sure, what do you think?

 

[leda]

Submandibular glands produce approx 70% of the saliva (mostly serous), but, although minor salivary glands secrete approx 10% of the total volume of saliva, they account for approx 70% of the mucus secreted..... so I am not sure, what do you think?

where do you find this information chanty ?? one more thing it says labial glands in the alternatives , right ? it does not say all minor salivary glands...as far as I know the minor salivary glands with a significant contribution are the palatal not the labial...

 

[leda]

I would say forward and medially. I looked in the questions that were in the acfd page, and they only had the first four options, they didn't put the option "None of above", so if we have to choose one of those, I say this is the correct one.

I agree, forward and medially...It also says which direction does the lat pterigoid muscle pulls the disk it doesnt ask which direction does the disk move.. Knowing the direction of lateral muscle fibers I would say they definitely excert the force forward and medially...

Do we all agree about the ortho questions discussed so far?

 

[chanty]

where do you find this information chanty ?? one more thing it says labial glands in the alternatives , right ? it does not say all minor salivary glands...as far as I know the minor salivary glands with a significant contribution are the palatal not the labial...

Basic histology, text and atlas, Junquira, Carneiro page 325, and review notes kaplan vol. 2 Part I.

 

[chanty]

And I think the question says accesory glands..

 

[dent rdh]

i think for this particular question i woul dalso stick to anterior medial,though there is one more question in which it asks in jaw opening the lateral pterygoid moves the disc in which direction ,would u answer it diffrently or still the same?
as for th eortho questions i am still unsure abt if it si class 2 molar or shud it be the anterior rotation.

 

[chanty]

a. severity of crowding

I would say that the right answer in this one is the bolton discrepancy, because you are only extracting the mandibular incisor, and you could end with a large overjet unless you have a discrepancy in bolton analysis.

 

[chanty]

i think for this particular question i woul dalso stick to anterior medial,though there is one more question in which it asks in jaw opening the lateral pterygoid moves the disc in which direction ,would u answer it diffrently or still the same?
as for th eortho questions i am still unsure abt if it si class 2 molar or shud it be the anterior rotation.

why wouldn't you correct the anterior rotation? It wouldn't correct itself. The molar relationship may correct itself when the primary molars exfoliate.

 

[leda]

Basic histology, text and atlas, Junquira, Carneiro page 325, and review notes kaplan vol. 2 Part I.

I also am reading a Kaplan review and it only says that
submandibular gland produces 70 % saliva seromucous
sublingual gland 5 % and mucous
accesory glamds only 5 % but it doesn't say anything about its composititon.

I thought that seromucous and sublingual producing more saliva than accessory would produce more mucins too..

If accessory glands produce more mucins than we should choose them as correct answer.

 

[leda]

why wouldn't you correct the anterior rotation? It wouldn't correct itself. The molar relationship may correct itself when the primary molars exfoliate.

by the exfoliation of primary molars both the upper and lower molar would move anteriorly..how is the relationship between them going to change ?

 

[leda]

I would say that the right answer in this one is the bolton discrepancy, because you are only extracting the mandibular incisor, and you could end with a large overjet unless you have a discrepancy in bolton analysis.

what is exactly a bolton discrepancy ?? thanks in advance for explaining..

 

[leda]

i think for this particular question i woul dalso stick to anterior medial,though there is one more question in which it asks in jaw opening the lateral pterygoid moves the disc in which direction ,would u answer it diffrently or still the same?
as for th eortho questions i am still unsure abt if it si class 2 molar or shud it be the anterior rotation.

I would answer the same dent rdh

 

[chanty]

I also am reading a Kaplan review and it only says that
submandibular gland produces 70 % saliva seromucous
sublingual gland 5 % and mucous
accesory glamds only 5 % but it doesn't say anything about its composititon.

I thought that seromucous and sublingual producing more saliva than accessory would produce more mucins too..

If accessory glands produce more mucins than we should choose them as correct answer.

Yes, and this book (basic histology) also says this about the submandibular gland " the serous cells are the main component of this gland and are easily distinguished from mucous cells by their rounded nuclei and basophilic cytoplasm. In humans, 90% of the endpieces of the submandibular gland are serous acinar, whereas 10% consist of mucuous tubules with serous demilunes"

 

[chanty]

by the exfoliation of primary molars both the upper and lower molar would move anteriorly..how is the relationship between them going to change ?

Two factors:
1) in the mandible the leeway space is 3-4mm while in the maxilla it is about 2- 2.5mm, and
2) because of the eruption sequence; in the mandible generally the canine erupts first, then the first premolar and then the second premolar allowing the molar to move mesially.

 

[chanty]

what is exactly a bolton discrepancy ?? thanks in advance for explaining..

The Bolton analysis is the ratio of mesiodistal widths of the maxillary versus the mandibular teeth. The anterior ratio evaluates the six anterior teeth of each arch. An ideal relationship between the two archs allows a correct overjet and overbite. So, if you want to extract a mandibular incisor, but your Bolton analysis is normal, one of two things could happen, that you have a Class I canine, but an increased overjet, or that you have a good overjet but a Class III canine. (I am not sure that is the correct term though.......Class I canine? or is it Canine class I?)

 

[dent rdh]

which of the following conditions should not commonly be treated during the mixed dentistion stage
a. Anterior crossbite
b. posterior crossbite
c. maxillary incisor rotation
d. classs 2 molar realtionship
i wud choose d. class 2 molar relationship.
the most important factor to consider before extracting a mandibular incisoris
a. severity of the crowding
b. mandibular curve of spee
c. a bolton discrepancy
d. the vertical incisor relationship
e. th ehorizontal incisor relaitonship.
why would bolton discrepancy affect our decision?

 

[dent rdh]

i wud say submandibular and sublingual as they have the largest amount of production.

 

[leda]

The Bolton analysis is the ratio of mesiodistal widths of the maxillary versus the mandibular teeth. The anterior ratio evaluates the six anterior teeth of each arch. An ideal relationship between the two archs allows a correct overjet and overbite. So, if you want to extract a mandibular incisor, but your Bolton analysis is normal, one of two things could happen, that you have a Class I canine, but an increased overjet, or that you have a good overjet but a Class III canine. (I am not sure that is the correct term though.......Class I canine? or is it Canine class I?)

thank you chanty..

one more question, is it possible that teeth be in anterior bolton normal relation and still be in severe crowding in the mandible ? in my oppinion if that is the case an extraction of one lower incisor and a lingual arch for example would not detriment the over jet ..please correct me if I am wrong..

 

[leda]

Yes, and this book (basic histology) also says this about the submandibular gland " the serous cells are the main component of this gland and are easily distinguished from mucous cells by their rounded nuclei and basophilic cytoplasm. In humans, 90% of the endpieces of the submandibular gland are serous acinar, whereas 10% consist of mucuous tubules with serous demilunes"

yes, i will choose the accessory glands as the main responsible for the lubrication..thank you chanty for bringing up this information.

 

[leda]

Two factors:
1) in the mandible the leeway space is 3-4mm while in the maxilla it is about 2- 2.5mm, and
2) because of the eruption sequence; in the mandible generally the canine erupts first, then the first premolar and then the second premolar allowing the molar to move mesially.

this is true only if we a have a moderate Class II molar relationship...what about the severe case, do we still hope for selfcorrection ??

 

[chanty]

thank you chanty..

one more question, is it possible that teeth be in anterior bolton normal relation and still be in severe crowding in the mandible ? in my oppinion if that is the case an extraction of one lower incisor and a lingual arch for example would not detriment the over jet ..please correct me if I am wrong..

The Bolton analysis is not related with the length of the maxilla or mandible bones, it only depends on the mesiodistal measure of the teeth, whether they fit or not in the osseous basement . So, yes you could have a normal Bolton analysis and a severe crowding in the mandible or in the maxilla or both. But remember, that when you are making an orthodontic treatment, you are not just aligning teeth, you are looking for a Class I canine, a good overjet and overbite, and after all that the molar relationship.

 

[chanty]

yes, i will choose the accessory glands as the main responsible for the lubrication..thank you chanty for bringing up this information.

You are very welcome

 

[chanty]

this is true only if we a have a moderate Class II molar relationship...what about the severe case, do we still hope for selfcorrection ??

Well maybe in a severe Class II molar relationship,there are other factors to consider, maybe is a skeletal problem. But I really think that in this questions that is the best anwer.

 

[chanty]

The initial histological appearance of a successful apicectomy would show on a radiograph as

A. a radiolucent area
B. woven bone
C. cortical bone around surgical site
D. sclerotic dentin

When root canals are treated topically with antibiotics rather than with disinfectants

1. a greater success rate results
2. the same rules of mechanical preparation and filling must be observed
3. treatment may be completed in fewer appointments
4. there is greater assurance that all microorganisms are destroyed
5. there is a danger of sensitizing patients to antibiotics.

A. 1,3,4
B. 2,4,5
C. 1,2,3
D. 2,5
E. All of the above

 

[dent rdh]

i would like to know whats ur take on formocresol as a root canal medicament?

 

[dent rdh]

one more thing as the question says that it is a xerostomic patient,i have read that in xerostomia it is mainly th emajor glands parotid,sub mand,sub ling affected??

 

[dent rdh]

I also wanted to know are minor salivary glands same as accessory glands becoz i don't see it n any of the texts.

 

[dent rdh]

The initial histological appearance of a successful apicectomy would show on a radiograph as

A. a radiolucent area -wud choose this
B. woven bone
C. cortical bone around surgical site
D. sclerotic dentin

When root canals are treated topically with antibiotics rather than with disinfectants

1. a greater success rate results
2. the same rules of mechanical preparation and filling must be observed
3. treatment may be completed in fewer appointments
4. there is greater assurance that all microorganisms are destroyed
5. there is a danger of sensitizing patients to antibiotics.

A. 1,3,4
B. 2,4,5
C. 1,2,3
D. 2,5- i wud choose this
E. All of the above
i am not sure abt 4th option

 

[leda]

The initial histological appearance of a successful apicectomy would show on a radiograph as

A. a radiolucent area -wud choose this
B. woven bone
C. cortical bone around surgical site
D. sclerotic dentin

When root canals are treated topically with antibiotics rather than with disinfectants

1. a greater success rate results
2. the same rules of mechanical preparation and filling must be observed
3. treatment may be completed in fewer appointments
4. there is greater assurance that all microorganisms are destroyed
5. there is a danger of sensitizing patients to antibiotics.

A. 1,3,4
B. 2,4,5
C. 1,2,3
D. 2,5- i wud choose this
E. All of the above
i am not sure abt 4th option


I agree with the first.
The second I think is B. 2,4,5

 

[dent rdh]

i read in Harty ( the endo book) that due to a wide spectrum of bacteria in the canal it is not possible to achieve greater elimination of bacteria by any oen antibiotic,hence i am still not sure abt the 4 option if antibiotic would case a better elimination of bacteria

 

[chanty]

I haven't found any information about root canals treated topically with antibiotics, but I would say D. 2,5

In the other question, I don't understand it really well......are they saying what would be the radiographic appearance ( the first you would be able to appreciate) of a succesfully apicectomy??? in that case I would say B. woven bone

 

[chanty]

I also wanted to know are minor salivary glands same as accessory glands becoz i don't see it n any of the texts.

I think they are the same.

 

[chanty]

one more thing as the question says that it is a xerostomic patient,i have read that in xerostomia it is mainly th emajor glands parotid,sub mand,sub ling affected??

where did you read that??? I only found that "All these glands, whether major or minor, are controlled by the autonomic nervous system......" so I am assuming that all them would react in the same way.

 

[leda]

I haven't found any information about root canals treated topically with antibiotics, but I would say D. 2,5

In the other question, I don't understand it really well......are they saying what would be the radiographic appearance ( the first you would be able to appreciate) of a succesfully apicectomy??? in that case I would say B. woven bone

I think they are asking about the very first after the surgery.. Woven bone would be the first after radio appearance when the bone regeneration has begun.

 

[leda]

i read in Harty ( the endo book) that due to a wide spectrum of bacteria in the canal it is not possible to achieve greater elimination of bacteria by any oen antibiotic,hence i am still not sure abt the 4 option if antibiotic would case a better elimination of bacteria

I am not sure either..my endo book does not compare the spectrums of desinfectants and antibiotics. it only explains why the former are more hazardous to the periapical tissues and the trend not to use them ..instead antibiotics can be used safely...

 

[chanty]

I think they are asking about the very first after the surgery.. Woven bone would be the first after radio appearance when the bone regeneration has begun.

Exactly, but then, why did they write "histological"? that make me think that they are talking about the regeneration phase

 

[leda]

where did you read that??? I only found that "All these glands, whether major or minor, are controlled by the autonomic nervous system......" so I am assuming that all them would react in the same way.

I agree chanty...

dent rdh do not confuse with Sjogren which is a syndrome that affects bilaterally only the major salivary glands...xerostomia can be caused by systemic routes such as medications mainly, and affects all salivary glans under autonomic innervation.

 

[chanty]

Leda, have you find anything about the antibiotic therapy inside the root canals?

 

[chanty]

The instrument most easily broken in the root canal is a
A. barbed broach
B. reamer
C. file
D. rat tail file
E. Hedstrom file

A carious maxillary central incisor with acute suppurative pulpitis requires
A. immediate endodontics and apicectomy
B. incision and drainage
C. opening of the canal and drainage for one week
D. pulpotomy

 

[leda]

The instrument most easily broken in the root canal is a
A. barbed broach right answer, not 100 % sure
B. reamer
C. file
D. rat tail file
E. Hedstrom file

A carious maxillary central incisor with acute suppurative pulpitis requires
A. immediate endodontics and apicectomy
B. incision and drainage
C. opening of the canal and drainage for one week
D. pulpotomy

niether of the option sin the second question seems correct to me

 

[chanty]

I think the correct answer in the first one could be the hedstrom file, but I an not sure.
With respect to the second one, is this term still used? Acute suppurative pulpitis? I think this is a late irreversible pulpitis, am I right?

 

[chanty]

Quote "....Combined with the compressibility of the dentin it is easy for the inexperienced user to enter into a situation where the file (they are referring to Hedstrom files) is so far into the dentin that it cannot be pulled or unscrewed but will fracture. This rarely happens with a K-type file or reamer" Pathways of the pulp, page 484

 

[chanty]

"The rasp or rat tail files are used to instrument..............not widely used today since the barbs readily fall off during instrumentation and end up in the root canal" Clinical Endodontics: A Textbook By Leif Tronstad, page 158

So, I think I am going with this one. Do you agree?

 

[leda]

"The rasp or rat tail files are used to instrument..............not widely used today since the barbs readily fall off during instrumentation and end up in the root canal" Clinical Endodontics: A Textbook By Leif Tronstad, page 158

So, I think I am going with this one. Do you agree?

I have some reference that mentions frequent fracture of broaches due to:
1. insertion in narrow canals
2. design of broach which can easily encroach in dentin.

Endodontic therapy, fourth edition..

as for files I think there is less chance to break them if used with care and proper manipulation..

I do not know which to choose honestly...This will be a call of luck I guess.

what about the second question do you have any idea?

 

[fiona2008]

On their website they said:[FONT=Arial, Helvetica, sans-serif] As of March 17, 2010 - Over 120 applications for the PLA program have been received.
.
My application arrived on March 17, not sure it fell within the 100 or not...So far haven't heard anything.

[FONT=Arial, Helvetica, sans-serif].

 

[dent rdh]

leda no this statement abt the major salivary glands was a generalised statement not for sjogrens syndrome.I will give u the ref too ....kinda tired right now
as for the antibiotic and root canals i think we should stick to option 2,5.none of the books mention anything other then that.

 

[dent rdh]

ac suppurativ epulpitis is irreversible pulpitis.

 

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[chanty]

I have some reference that mentions frequent fracture of broaches due to:
1. insertion in narrow canals
2. design of broach which can easily encroach in dentin.

Endodontic therapy, fourth edition..

as for files I think there is less chance to break them if used with care and proper manipulation..

I do not know which to choose honestly...This will be a call of luck I guess.

what about the second question do you have any idea?

I don't know, I think the ideal treatment is not in the options. But, if it were an emergency, I would say D. pulpotomy (at least this is a possible temporal treatment)