AFK weekly newsletter 9

Mar 22 / AFK study plan
- Now's the moment to unleash your curiosity! Let's blend and mash up questions from various topics and truly put your collective dental knowledge to the test!

- 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!

#X-ray
1- A calcified mass which is longitudinal in shape is seen on a radiograph near the 3rd and 4th cervical vertebrae. Which of the following is the most likely diagnosis?
◯ A. Sialolith.
◯ B. Calcified lymph node.
◯ C. Carotid calcification.
◯ D. Tonsillolith.

  C. Carotid calcification
Carotid artery calcifications are found at the C3–C4 vertebral level. 
More irregular and patchy than other calcifications.
Carotid artery calcifications are medically significant as they may indicate vascular disease and a risk for stroke.

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Sialoliths (Red)

Located near the submandibular gland area.
Appear elongated or oval in shape.
Found in the floor of the mouth, near the mandible, and along Wharton's duct.

Tonsilloliths (Orange-Red)

Systemic sclerosis can involve internal organs such as the lungs (pulmonary fibrosis), heart (myocardial fibrosis), kidneys (scleroderma renal crisis), and gastrointestinal tract (esophageal dysmotility), leading to multi-organ failure over time.

Lymph Node Calcifications (Pink)

Appear as irregular, lobulated masses.
Found along the cervical lymph nodes.

Phleboliths (Purple)

Located within vascular structures.
Have a target-like appearance with a radiolucent center.

Mucous Retention Pseudocyst (Dark Blue)

Found in the sinuses, appearing as dome-shaped opacities.

Stylohyoid Ligament Calcifications (Teal)

Appear elongated along the stylohyoid ligament pathway.
Can be associated with Eagle syndrome if symptomatic.

Thyroid/Triticeous Cartilages (Light Blue)

Seen along the tracheal region, often confused with carotid calcifications.
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#Anatomy
2- Which of the following statements is true:
◯ A. Special sensation to the anterior two thirds of the tongue is provided by the lingual nerve.
◯ B. Special sensation to the posterior two thirds of the tongue is provided by the facial nerve.
◯ C. Motor innervation to the tongue is mainly provided by the glossopharyngeal nerve.
◯ D. None of the above.

  D. None of the above.
To determine the correct answer, let's break down the sensory and motor innervation of the tongue and evaluate each option.
The lingual nerve (V3) provides general sensation (touch, pain, temperature) to the anterior 2/3 of the tongue, but special sensation (taste) is provided by the chorda tympani (CN VII - Facial nerve).
The posterior one-third of the tongue is innervated by the glossopharyngeal nerve (CN IX) for both general and special sensation (taste), NOT the facial nerve.
 The hypoglossal nerve (CN XII) provides motor innervation to all tongue muscles (except the palatoglossus, which is innervated by CN X - Vagus nerve). The glossopharyngeal nerve has no role in motor innervation of the tongue.

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#Epidemiology 
3- Failing to inform the patient of a separated instrument during endodontic treatment violates which ethical principle?
◯A. Beneficence.
◯ B. Nonmaleficence.
◯ C. Veracity.
◯ D. Justice.

 C. Veracity
Veracity is the ethical principle that refers to truthfulness and honesty in patient communication. It requires that healthcare professionals provide accurate, complete, and truthful information to their patients.
If a dentist fails to inform a patient about a separated instrument during an endodontic procedure, they are withholding important information that could affect the patient’s treatment decisions and prognosis.
This violates the principle of veracity, as the patient has the right to know about any complications that occur during their treatment.

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❌ A. Beneficence

Beneficence refers to actions that promote the well-being of patients. While informing the patient would align with beneficence, the specific ethical violation in this case is dishonesty, which falls under veracity.

❌ B. Nonmaleficence

Nonmaleficence means "do no harm." While failing to inform the patient could lead to harm, the primary issue here is lack of truthfulness rather than direct harm.

❌ D. Justice

Justice refers to fairness and equal treatment of patients. This situation does not primarily involve fairness or discrimination but rather truthfulness (veracity).

#Pedo
4- During try in of a stainless-steel crown, the crown could not be fully seated. Which of the following is the most likely cause?
◯ A.Remaining bulge of the deciduous tooth.
◯B. Presence of a definitive finish line.
◯ C. Drifting of adjacent teeth.

  A.Remaining bulge of the deciduous tooth.
Stainless steel crowns (SSCs) are commonly used in pediatric dentistry to restore primary teeth with extensive decay or structural loss. When a stainless-steel crown does not fully seat during the try-in phase, the most likely cause is interference from the natural cervical bulge (height of contour) of the primary tooth.
Primary teeth have a pronounced cervical bulge, especially in molars, which can interfere with proper crown placement.
If this bulge is not sufficiently reduced during tooth preparation, the crown will not fully seat.

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❌ B. Presence of a definitive finish line.

Stainless steel crowns do not require a definitive finish line like permanent crowns. Instead, they rely on a feather-edge margin to allow for crimping and adaptation.

❌ C. Drifting of adjacent teeth.

While tooth drifting can create space issues, it does not typically prevent a crown from seating. It would more likely make placement difficult due to tight mesial/distal contacts, rather than preventing full seating.

#Operative
5- A patient is to undergo root canal treatment of tooth 2.1. Tooth 2.1 has extensive mesial, lingual, and distal caries. Which of the following is considered to be the most appropriate foundation restoration prior to placement of a crown on tooth 2.1?
◯A. Composite build-up with no post.
◯ B. Fiber post and composite core.
◯ C. Metal post and composite core.
◯ D. Fiber post and amalgam core.
◯ E. Metal post and amalgam core.

   B. Fiber post and composite core.
Tooth 2.1 (maxillary left central incisor) has extensive caries on the mesial, lingual, and distal surfaces, meaning it has lost significant coronal structure. In such cases, a post and core are needed to provide adequate retention and support for the final crown after root canal treatment.

✅ Fiber Post Advantages:

 Elasticity similar to dentin, reducing the risk of root fracture compared to metal posts.
Better stress distribution, lowering the risk of root fractures.
Excellent bonding with resin cements and composite cores, leading to good retention.
Aesthetic advantage, as fiber posts are translucent, making them ideal for anterior teeth like 2.1.

✅  Composite Core Advantages:

Strong bond to fiber post and tooth structure.
Easy to shape and contour for crown preparation.
Aesthetic and light-cured, allowing better control in anterior restorations.

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✅ Takeaway & 📌 Study Tip

1️⃣  X-ray Interpretation: Identifying a Calcified Mass

✅ Takeaway:
Carotid artery calcifications appear as longitudinal radiopaque masses near the C3-C4 vertebrae on X-rays.
These can indicate atherosclerosis, which may increase stroke risk.
📌 Study Tip:
✅ Memorize common radiographic calcifications (tonsilloliths, sialoliths, lymph node calcifications, etc.).
✅ Use diagrams (like the one provided earlier) to visualize common calcifications.
✅ Practice radiograph interpretation by reviewing real cases in textbooks or online sources like Radiopaedia.

2️⃣ Anatomy of Tongue Innervation

✅ Takeaway:
Special sensation (taste):
Anterior 2/3 → Chorda tympani (branch of facial nerve - CN VII)
Posterior 1/3 → Glossopharyngeal nerve (CN IX)
Motor innervation: Hypoglossal nerve (CN XII) supplies all muscles except palatoglossus (vagus nerve - CN X).
📌 Study Tip:
✅ Use mnemonics:
"The tongue TASTES with VII (7) in the front and IX (9) in the back" for taste.
"Hypoglossal (XII) moves the tongue" for motor innervation.
✅ Draw a diagram of the tongue and label nerve supply.
✅ Test yourself with quick recall questions on nerve functions.

3️⃣ Randomized Controlled Trials (Epidemiology)

✅ Takeaway:
Veracity (truthfulness and honesty) is the ethical principle violated if a dentist does not disclose a separated instrument.
Patients have the right to know about any complications in their treatment.
📌 Study Tip:
✅ Memorize the four main ethical principles:
Autonomy (patient’s right to decide)
Beneficence (acting for patient’s well-being)
Nonmaleficence (do no harm)
Veracity (truthfulness)
✅ Practice ethical scenarios by asking: "Which principle applies?"
✅ Review ADA Code of Ethics for real-world case examples.

4️⃣  Pediatric Dentistry: Why a Stainless-Steel Crown Won’t Seat

✅ Takeaway:
Most common cause: Remaining cervical bulge of the primary tooth prevents full seating of the crown.
Solution: Further tooth reduction at the height of contour (especially buccal/lingual surfaces).
📌 Study Tip:
✅ Memorize steps for stainless-steel crown prep:
Occlusal reduction
Proximal slicing
Cervical contouring (bulge reduction)
Crown crimping & adaptation
✅ Watch videos demonstrating SSC placement to visualize errors and solutions.
✅ Practice on models if possible!

5️⃣  Endodontic Foundations: Choosing the Best Post and Core

✅ Takeaway:
Fiber post + composite core is the best choice for anterior teeth because it provides:
Good bonding strength
Similar flexibility to dentin (reduces fracture risk)
Better aesthetics (translucent post vs. metal post)
Metal posts are outdated due to increased risk of root fracture.
📌 Study Tip:
✅ Memorize post-and-core selection guidelines:
Posterior teeth → Metal post can be considered due to high occlusal forces.
Anterior teeth → Fiber post is preferred for aesthetics and flexibility.
✅ Compare materials: Know advantages and disadvantages of fiber vs. metal posts, composite vs. amalgam cores.
✅ Use clinical case studies to apply knowledge in decision-making.

🔹 Read questions twice

Don't jump to options before reading questions.

🔹 Look for the keyword

It will guide you to the correct answer, which will guide you to the Ferrari later.  

🔹 Draw diagrams

Drawing nerve pathways, expansion appliances can help you retain key concepts. 🚀

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