AFK weekly newsletter 4

Feb 12 / Mohamed Moussa
- Studying orthodontics & anatomy may seem challenging, but it’s a trendy topic for the AFK (Assessment of fundamental knowledge) exam!

- Today, let’s tackle just 5 questions from our question bank together, diving into each answer and the concepts behind them.

-If you’re pressed for time, feel free to scroll to the end of the page to find the ✅ Takeaway & 📌 Study Tip. Together, let’s empower ourselves with knowledge!

#Orthodontics
1-The SNB angle in adolescents will generally:
◯ A. Increase
◯ B. decrease
◯ C. Stay constant

 A. Increase

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The SNB angle 

(Sella-Nasion-B Point angle) is used in cephalometric analysis to evaluate the anteroposterior position of the mandible relative to the cranial base.

During adolescence:

Mandibular growth typically continues in a forward and downward direction due to natural skeletal development. This growth causes the B-point (a landmark on the mandible) to move forward, leading to an increase in the SNB angle.
However, the rate of increase may vary depending on:
Genetic factors
Growth pattern (horizontal vs. vertical growth)
Orthodontic interventions
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#Anatomy
2-The most acceptable etiology of a bifid uvula is:
◯ A failure of fusion of the posterior palatine folds
◯ B. failure of fusion of the longitudinal fissures
◯ C. failure of fusion of the maxillary and nasal process
◯ D. none of the above

 A failure of fusion of the posterior palatine folds
A bifid uvula is a congenital condition where the uvula is split into two parts. It results from incomplete fusion of the posterior palatine folds (palatal shelves) during embryonic development. The palatal shelves normally fuse to form the soft palate, and failure of this process can lead to cleft palate or a bifid uvula, which is considered a mild form of clefting.

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❌ B. Failure of fusion of the longitudinal fissures

The term "longitudinal fissures" is not relevant to the development of the uvula or palate. This term is more commonly associated with brain anatomy, particularly the longitudinal fissure that separates the cerebral hemispheres.

❌ C. Failure of fusion of the maxillary and nasal process

The maxillary and nasal processes contribute to the formation of the upper lip and primary palate. Failure of their fusion leads to conditions like cleft lip or cleft primary palate, not a bifid uvula.

❌ D. None of the above

This option is incorrect because A is the correct answer—a bifid uvula is indeed due to failure of fusion of the posterior palatine folds.

#Management
3- A patient is currently taking tricyclic antidepressants. When using local anaesthetics, a possible outcome may include:
◯A. Increased blood pressure due to epinephrine
◯ B. Decreased blood pressure due to epinephrine
◯C. Decreased sympathomimetic effect
◯ D. No effect on the cardiovascular system

 A. Increased blood pressure due to epinephrine
Tricyclic antidepressants (TCAs), such as amitriptyline, nortriptyline, and imipramine, inhibit the reuptake of norepinephrine (NE) and serotonin in the central and peripheral nervous system.
This leads to increased levels of norepinephrine, which can amplify the effects of exogenous sympathomimetics like epinephrine in local anesthetics.

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 Local anesthetic containing epinephrine

(such as lidocaine with epinephrine) is administered, there is an increased risk of hypertensive episodes and tachycardia because
TCAs enhance the pressor effect of epinephrine by preventing norepinephrine reuptake.
Epinephrine stimulates α1 receptors, causing vasoconstriction, and β1 receptors, increasing heart rate and cardiac output.
The exaggerated sympathomimetic response may lead to a sudden and significant rise in blood pressure.

Clinical Considerations:

When using local anesthetics in patients taking TCAs, it's advisable to limit epinephrine dosage and monitor blood pressure carefully to avoid excessive cardiovascular stimulation.

❌ B. Decreased blood pressure due to epinephrine

Epinephrine primarily causes vasoconstriction (α1 effect) and increases cardiac output (β1 effect).
Since TCAs amplify the pressor effect of epinephrine, blood pressure is more likely to increase, not decrease.

❌ C. Decreased sympathomimetic effect

The opposite is true—TCAs actually increase the sympathomimetic effect because they block norepinephrine reuptake, leading to enhanced epinephrine effects.

❌ D. No effect on the cardiovascular system

This is incorrect because TCAs potentiate the cardiovascular effects of epinephrine, leading to possible hypertension, tachycardia, or arrhythmias.

#Prothesis
4-Functional cusp bevelling is done to:
◯ A. Increase retention and strength of a restoration
◯B. Allow for occlusal harmonization
◯ C. Directing forces vertically down long axis
◯ D. Improve structural durability

  D. Improve structural durability

Functional cusp beveling is a critical step in tooth preparation for crowns, especially in posterior teeth, where it helps in distributing occlusal forces efficiently.

 The functional cusps are the cusps that bear the most occlusal load during mastication:
Maxillary palatal cusps
Mandibular buccal cusps

Beveling these cusps:

Insure enough thickness of the materials improving load distribution and reducing stress on the restoration.

This is important for preventing fracture and enhancing the longevity of the restoration by minimizing excessive lateral stress.

#X-ray
5-If the target to object distance is doubled, exposure time should be:
◯A. Doubled
◯ B. tripled
◯ C. quadruple
◯ D.increased 10 times

 C. Quadrupled
This question is based on the Inverse Square Law, which states that the intensity of radiation is inversely proportional to the square of the distance from the source. Mathematically, it is expressed as:
- This means that if the distance between the X-ray source and the object (target-to-object distance) is doubled, the intensity of the X-ray beam will be reduced to one-fourth of the original intensity.

- If the target-to-object distance is doubled, exposure time must be quadrupled to maintain the same radiation dose.

✅ Takeaway & 📌 Study Tip

1️⃣ SNB Angle in Adolescents

✅ Takeaway:
The SNB angle increases during adolescence as the mandible grows forward. This occurs because of natural skeletal development.
📌 Study Tip:
Understand cephalometric landmarks (Sella, Nasion, B point).
Compare SNA, SNB, and ANB angles to assess skeletal discrepancies.
Use diagrams to visualize mandibular growth trends.

2️⃣ Bifid Uvula Etiology

✅ Takeaway:
A bifid uvula results from failure of fusion of the posterior palatine folds during embryonic development. It is a mild form of clefting.
📌 Study Tip:
Memorize embryological structures and timing of fusion (hard vs. soft palate).
Differentiate between cleft lip (maxillary & nasal process failure) and cleft palate (palatal shelf failure).
Use mnemonics like "Palatal shelves for the palate" to remember their role.

3️⃣ Tricyclic Antidepressants & Local Anesthetics

✅ Takeaway:
TCAs increase the effects of epinephrine, leading to higher blood pressure and potential cardiovascular risks when using local anesthetics with vasoconstrictors.
📌 Study Tip:
Understand drug interactions between TCAs and sympathomimetics.
Learn which local anesthetics contain epinephrine (e.g., lidocaine with epinephrine).
Know when to limit epinephrine dosage in high-risk patients.

4️⃣ Functional Cusp Beveling

✅ Takeaway:
 Functional cusp beveling improve structure durability by reducing stress and preventing fracture.
📌 Study Tip:
Study tooth preparation principles and the role of beveling in crown design.
Use illustrations to visualize functional vs. non-functional cusps.
Remember: Maxillary palatal & mandibular buccal cusps bear occlusal loads.

5️⃣ X-ray Distance & Exposure Time

✅ Takeaway:
If the target-to-object distance is doubled, exposure time must be quadrupled due to the Inverse Square Law.
📌 Study Tip:
Memorize the Inverse Square Law formula
Practice distance vs. intensity calculations for radiology.
Use real-life examples (e.g., flashlight brightness at different distances) to reinforce the concept.

🔹 Use flashcards

for key concepts (e.g., cephalometric angles, embryology, pharmacology).

🔹 Practice clinical scenarios 

(e.g., when to adjust epinephrine dosage).

🔹 Draw diagrams

 to visualize processes like palatal development and X-ray intensity.

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