ORPTH ADONS DSE OF PULP N PERIAP TISS

Question 1

1. The most common cause of odontalgia is
   (a) Dental caries
   (b) Pulpitis
   (c) Root fracture
   (d) Periodontitis

Answer 1

1. (b) Pulp is a soft connective tissue like any other connective
   tissue throughout the body and reacts to bacterial or
   other stimuli by an inflammatory response which causes
   toothache or odontalgia.

Question 2

2. The phenomenon by which bacteria circulating in blood
   accumulate at the site of pulpal inflammation is called as
   (a) Chemotaxis
   (b) Retrograde pulpitis
   (c) Anachoretic pulpitis
   (d) Aerodontalgia

Answer 2

2. (c) Anachoresis is a phenomenon by which blood-borne
   bacteria, dyes, pigments, etc. are attracted to the site of
   inflammation.

Question 3

3. Most accepted explanation for anachoretic pulpitis is
   (a) Increased capillary permeability
   (b) Increased vascular pressure
   (c) Presence of large number of dilated capillaries
   (d) Lack of collateral blood supply

Answer 3

3. (a) Current evidence indicates increased capillary permeability
   to be the most probable cause for the phenomenon
   of anachoresis. The capillary size increases due to the liberation of cytokines by the inflammatory cells mediating
   the response.

Question 4

4. Pulpitis aperta and pulpitis clausa refer to types of pulpitis
   classified on the basis of
   (a) Severity of inflammation
   (b) Extent of inflammation
   (c) Location of inflammation
   (d) Presence/absence of direct communication with oral cavity

Answer 4

4. (d) Pulpitis aperta and clausa refer to open and closed pulpitis
   respectively. Open pulpitis refers to pulpitis in which direct
   communication exists between the inflamed pulp and oral
   cavity while it is absent in case of closed pulpitis

Question 5

5. The more accepted terminology for pulp hyperemia is
   (a) Focal irreversible pulpitis
   (b) Focal reversible pulpitis
   (c) Subtotal pulpitis
   (d) Pulpitis clausa

Answer 5

5. (b) Vascular dilatation can occur pathologically due to dentinal
   as well as pulpal irritation and also artefactually during
   tooth extraction. Hence the term pulp hyperemia needs to
   be avoided.

Question 6

6. Focal reversible pulpitis is most commonly seen in all of the
   following cases except
   (a) Large metallic restorations
   (b) Shallow carious lesions
   (c) Deep carious lesions
   (d) Restorations with defective margins

Answer 6

6. (b) Focal reversible pulpitis is a mild form of pulpitis localized
   primarily to the pulpal ends of irritated dentinal tubules
   and is mostly seen in deep carious lesions, beneath large
   uninsulated restorations and restorations with defective
   margins.

Question 7

7. Pain which increases in intensity as the patient lies down is
   characteristic of
   (a) Focal reversible pulpitis
   (b) Acute pulpitis
   (c) Chronic hyperplastic pulpitis
   (d) Chronic pulpitis

Answer 7

7. (b) As intrapulpal abscess formation involves more of the
   pulp tissue, the pain becomes more acute and is liable to
   increase when the patient lies down. This may be due to
   the pressure on pulpal nerves by the intrapulpal abscesses.
   Heat application can exacerbate the pain.

Question 8

8. Microabscess formation within inflamed pulp is characteristic
   of
   (a) Acute pulpitis
   (b) Focal reversible pulpitis
   (c) Chronic pulpitis
   (d) Pulp hyperemia

Answer 8

8. (a) Rise in intrapulpal pressure associated with inflammatory
   exudate leads to collapse of venous part of circulation in that
   area which leads to anoxia, which in turn, leads to localized
   destruction and formation of small abscess called micro or
   pulp abscess.

Question 9

9. Sensitivity to electric pulp vitality tester in acute pulpitis is lost
   in later stages because of
   (a) Necrosis of pulp
   (b) Reduction in inflammatory exudate
   (c) Increase in the size of capillaries locally
   (d) Decreased secretion of prostaglandins

Answer 9

9. (a) Early stages of acute pulpitis is characterized by stabbing or
   lancinating pain and high sensitivity to electric pulp vitality
   tester. But when more of pulp is involved and necrosis sets
   in this sensitivity is lost.

Question 10

10. Pulp reacts to electric pulp vitality tester at higher levels in chronic
    pulpitis due to
    (a) Slow advance of pulp inflammation
    (b) Lack of edema fluid collection within inflamed pulp
    (c) Degeneration of nerves in affected pulp
    (d) Deposition of collagen around inflamed area

Answer 10

10. (c) Due to degeneration of the small nonmyelinated nerve
    fibers, the pulp in chronic pulpitis exhibits little or no pain
    and reacts to electric pulp vitality tests at higher voltages
    even in advanced cases.

Question 11

11. Which amongst the following characteristics is not associated
    with chronic hyperplastic pulpitis?
    (a) Open carious lesion
    (b) Occurs in children and young adults
    (c) Occurs in people with high tissue resistance
    (d) Occurs around margins of a restoration

Answer 11

11. (d) Pulp polyp or chronic hyperplastic pulpitis is characterized
    by excessive and exuberant pulp proliferation. It is seen
    almost exclusively in children and young adults with large,
    open carious lesions.

Question 12

12. Which teeth are most commonly involved by chronic hyperplastic
    pulpitis?
    (a) Deciduous anteriors and permanent canines
    (b) Deciduous molars and permanent 1st molars
    (c) Deciduous canines and permanent incisors
    (d) Exclusively deciduous molars

Answer 12

12. (b) These teeth are primarily involved because of their excellent
    blood supply and large root opening.

Question 13

13. All of the following except _______ occur as a sequel to pulpitis.
    (a) Lateral periodontal cyst
    (b) Periapical granuloma
    (c) Apical periodontal cyst
    (d) Periapical abscess

Answer 13

13. (a) Lateral periodontal cyst is a developmental variety of
    odontogenic cyst and does not arise due to inflammatory
    changes within pulp

Question 14

14. All of the following except _______ are common radiological
    features associated with a periapical granuloma.
    (a) Thickening of PDL around root apex
    (b) Well-defined radiopacity
    (c) Root resorption of involved tooth
    (d) Well-defined radiolucency with sclerotic borders

Answer 14

14. (b) Periapical granuloma is characterized radiologically by a
    well-defined radiolucent lesion associated with the root of
    a pulpally involved tooth

Question 15

15. Giant cell hyaline angiopathy and Rushton bodies are associated
    with which of the following lesions?
    (a) Ludwig angina
    (b) Odontogenic keratocyst
    (c) Pulp polyp
    (d) Periapical granuloma

Answer 15

15. (a) Giant cell hyaline angiopathy consists of inflammatory cell
    infiltration, collections of foreign body type giant cells and
    ring-like eosinophilic material called Rushton bodies.

Question 16

16. Which cells, secreting osteoclast activating factor are believed
    to be responsible for much of root and bone destruction in
    periapical granulomas?
    (a) B lymphocytes
    (b) T lymphocytes
    (c) Macrophages
    (d) Mast cells

Answer 16

16. (b) The T-lymphocytes are thought to liberate osteoclast
    activating factor and also other cytotoxic lymphokines,
    collagenases and other enzymes which may be responsible
    for much of destructive potential of periapical granuloma

Question 17

17. Foam cells within periapical granulomas are ______ cells that
    have ingested lipids.
    (a) Polymorphonuclear leukocytes
    (b) Langerhans cells
    (c) Macrophages
    (d) Plasma cells

Answer 17

17. (c) In some periapical granulomas, large numbers of phagocytes
    (macrophages) ingest lipid material and become collected
    in groups of so called foam cells. Cells appear “clear”
    because the entire ingested lipid is washed off during tissue
    processing involving solvents like alcohol, xylene, etc.

Question 18

18. Cholesterol clefts observed in periapical granulomas are derived
    from
    (a) Breakdown of adipose cells
    (b) Breakdown of epithelial cells
    (c) Breakdown of RBCs
    (d) Breakdown of cholesterol

Answer 18

18. (c) Cholesterol clefts seen in chronic inflammations like
    periapical granuloma are usually derived from the
    breakdown of extravasated red blood cells. Here also, the
    same explanation as above holds true for the formation of
    clear, needle-like spaces.

Question 19

19. Apical periodontal cyst usually occurs as a sequela of
    (a) Acute pulpitis (b) Periodontal abscess
    (c) Osteomyelitis (d) Periapical granuloma

Answer 19

19. (d) The usual mode of development of apical periodontal cyst
    or radicular cyst is through stimulation and proliferation
    of
    cell rests of Malassez within the periapical granuloma.

Question 20

20. _________ is least likely to produce any noticeable signs or
    symptoms.
    (a) Radicular cyst
    (b) Acute pulpitis
    (c) Periapical abscess
    (d) Ludwig angina

Answer 20

20. (a) Majority of cases of radicular cysts are asymptomatic and the
    dentist discovers them accidentally during routine dental
    radiological examination. This is due to the fact that cysts
    are chronic lesions, developing slowly.

Question 21

21. Which amongst the following is not a predisposing factor of
    osteomyelitis?
    (a) Trauma to bone
    (b) Radiation damage to bone
    (c) Paget’s disease
    (d) Fibrous dysplasia

Answer 21

21. (d) The major predisposing factors of osteomyelitis are –
    trauma, gunshot wounds, Paget’s disease, osteopetrosis
    and systemic conditions like malnutrition, acute leukemia,
    uncontrolled diabetes, chronic alcoholism, sickle cell
    anemia, etc

Question 22

22. What is the most frequent cause of acute osteomyelitis of jaw?
    (a) Dental infection
    (b) Trauma
    (c) Paget disease
    (d) Malnutrition

Answer 22

22. (a) A periapical abscess if it is not walled off and is very virulent,
    may spread spontaneously throughout the surrounding
    bone.

Question 23

23. Condensing osteitis is another name for
    (a) Chronic suppurative osteomyelitis
    (b) Chronic focal sclerosing osteomyelitis
    (c) Chronic diffuse sclerosing osteomyelitis
    (d) Garre’s osteomyelitis

Answer 23

23. (b) Condensing osteitis is an unusual reaction of bone to mild
    bacterial infection entering the bone through carious tooth in persons having high degree of tissue resistance and
    reactivity.

Question 24

24. In which type of osteomyelitis will you find focal gross thickening
    of periosteum with peripheral reactive bone formation?
    (a) Chronic focal sclerosing osteomyelitis
    (b) Chronic diffuse sclerosing osteomyelitis
    (c) Florid osseous dysplasia
    (d) Garre’s osteomyelitis

Answer 24

24. (d) Garre’s osteomyelitis results from mild irritation or infection
    and is seen almost exclusively in premolar (–) molar
    regions of young individuals below 25 years of age. The
    subperiosteal reaction is manifested characteristically as
    “onion skin” appearance on a radiograph

Question 25

25. Root resorption is commonly seen in
    (a) Cellulitis
    (b) Radicular cyst
    (c) Garre’s osteomyelitis
    (d) Periapical abscess

Answer 25

25. (b) As the radicular cyst enlarges in size, it causes the resorption
    of root to which it is attached primarily due to pressure
    exerted by it

Question 26

26. What term is applied to a radiolucent lesion within the alveolar
    ridge at the site of a previous tooth extraction?
    (a) Lateral radicular cyst
    (b) Lateral periodontal cyst
    (c) Residual cyst
    (d) Periapical abscess

Answer 26

26. (c) A residual cyst is one that remains behind on the alveolar
    ridge after a tooth is extracted without initially ascertaining
    its periapical condition.

Question 27

27. If a periapical abscess drains intraorally through a sinus tract
    after perforating the buccal cortical plate and surface epithelium
    it forms a mass of granulation tissue known as
    (a) Phoenix abscess
    (b) Residual cyst
    (c) Parulis
    (d) Lateral radicular cyst

Answer 27

27. (c) With progression, a periapical abscess spreads along the
    path of least resistance. The pus may extend through the
    medullary spaces away from the apical area (osteomyelitis),
    or it may perforate the cortex and spread diffusely through
    the overlying soft tissue (cellulitis). It can also channelize
    through the overlying soft issue leading to parulis or
    gumboil.

Question 28

28. The lateral radicular cyst arises from
    (a) Cell rests of Malassez
    (b) Cell rests of Serres
    (c) Overlying oral epithelium
    (d) Dental lamina

Answer 28

28. (a) Like the periapical cyst this lesion also usually arises from
    rests of Malassez. The source of inflammation may be
    periodontal disease or pulpal necrosis with spread through
    a lateral foramen

Question 29

29. Which of the following lesions cannot be differentiated from each
    other on the basis of size and radiographic appearance?
    (a) Periapical granuloma from periapical cyst
    (b) Periapical abscess from periapical cyst
    (c) Periapical granuloma from periapical abscess
    (d) Periapical cyst from phoenix abscess

Answer 29

29. (a) Both lesions are a result of a chronic process. Due to this
    they enlarge slowly and produce similar radiographic
    appearances

Question 30

30. Chronic apical periodontitis is another name of
    (a) Phoenix abscess
    (b) Periapical abscess
    (c) Periapical granuloma
    (d) Periapical cyst

Answer 30

30. (c) The term periapical granuloma refers to a mass of
    chronically inflamed granulation tissue at the periapical
    region of a nonvital tooth.