AFK weekly newsletter 6

Mar 1 / 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!

 #Pathology
1- A patient presented with bone pain. After radiographic examination, a cotton wool and overall mosaic pattern was observed. What clinical diagnosis is most likely?
• A. Gigantism
• B. ameloblastoma
• C. basal cell carcinoma
• D. Paget's disease

  D. Paget's disease
Paget’s disease of bone (also called osteitis deformans) is a chronic skeletal disorder that involves abnormal bone remodeling. It is characterized by excessive bone resorption followed by disorganized and excessive bone formation, leading to structurally weak and deformed bones.

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Key Radiographic Findings in Paget’s Disease:

Cotton Wool Appearance:
This refers to irregular, patchy areas of sclerosis (dense bone) and lucency (bone loss) seen in the skull and other affected bones.
Mosaic Pattern of Bone:
This histological feature results from haphazardly arranged bone with irregular cement lines due to disorganized bone remodeling.

Common Symptoms of Paget's Disease:

Bone pain (most common complaint)
Bone deformities (thickening of skull, bowed long bones)
Increased risk of fractures
Enlargement of affected bones
Skull involvement can lead to hearing loss (due to compression of cranial nerves)
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#Management
2- Shortly after entering the dental office, the patient started becoming irritable, breathing heavily and feeling dizzy. The assistant instructed the patient to breathe in a paper bag, breathing in a bag helps to:
• A. Increase CO2 in blood
• B. Increase 02 in blood
• C. Relaxes the patient
• D. Distract the patient

 A. Increase CO₂ in blood
The symptoms described (irritability, heavy breathing, dizziness) suggest that the patient is experiencing hyperventilation. Hyperventilation leads to excessive exhalation of carbon dioxide (CO₂), causing a condition called respiratory alkalosis. This results in:
  • Reduced CO₂ levels (hypocapnia)
  • Increased blood pH (alkalosis)
  • Symptoms like dizziness, tingling, muscle cramps, and even fainting

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Why Does Breathing into a Paper Bag Help?

When a patient breathes into a paper bag, they re-inhale exhaled CO₂, which helps to:
✅ Restore normal CO₂ levels in the blood
✅ Reverse respiratory alkalosis
✅ Alleviate symptoms of hyperventilation

Why Not the Other Options?

B. Increase O₂ in blood
Hyperventilation does NOT cause oxygen deficiency; it primarily reduces CO₂. Breathing in a bag does NOT increase O₂.
C. Relaxes the patient
While breathing into a bag may have a calming effect, its primary function is to correct CO₂ levels, not just relaxation.
D. Distract the patient
Although distraction can help in anxiety management, the physiological goal of paper bag breathing is CO₂ regulation.

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#Pharma
3- A 60-year-old patient presents to the clinic with pain due to a dental infection that requires antibiotics. The medical history indicates the patient is using antipsychotic drugs (haloperidol and donepezil). The antibiotic and pain killer of choice is which of the following?
◯A. Amoxicillin and tramadol
◯ B. Clindamycin and tramadol
◯ C. Amoxicillin + ibuprofen
◯ D. Clindamycin and ibuprofen

 C. Amoxicillin + Ibuprofen
When choosing an antibiotic and painkiller for a patient on antipsychotic medications (Haloperidol and Donepezil), we need to consider:

Drug Interactions

Haloperidol:
 Can prolong the QT interval, increasing the risk of fatal arrhythmias (torsades de pointes).
Donepezil:
Used for Alzheimer’s, it has cholinergic effects, which can increase the risk of bradycardia.

Choice of Antibiotic

Amoxicillin (Preferred): 
It is a broad-spectrum beta-lactam antibiotic, effective for most dental infections, and has minimal drug interactions with antipsychotic drugs.
Clindamycin (Alternative, but risky):
Although effective against dental infections, it increases the risk of QT prolongation, which could worsen the cardiac side effects of haloperidol.

Choice of Painkiller

Ibuprofen (Preferred): 
A non-steroidal anti-inflammatory drug (NSAID), effective for dental pain and inflammation. It has no significant interaction with haloperidol or donepezil.
Tramadol (Risky):
Increases serotonin levels, potentially leading to serotonin syndrome when combined with donepezil.
Lowers the seizure threshold, which is a concern in patients on antipsychotic medications.
Can prolong the QT interval, increasing the risk of serious cardiac arrhythmias.

#Perio
4- Which of the following is not likely to be seen in a tooth with a periodontal abscess?
◯ A.No response to the electric pulp tester.
◯B. Pain to palpation.
◯ C. Swelling in the associated soft tissues.
◯ D. Radiographic bone loss.

  A. No response to the electric pulp tester.
A periodontal abscess is a localized infection that occurs within the periodontal tissues, typically caused by bacterial invasion of a deep periodontal pocket. It presents with acute pain, swelling, and pus formation in the surrounding soft tissues.
Key Features of a Periodontal Abscess:
  • Pain to palpation (B) → Due to inflammation and pus accumulation
  • Swelling in the soft tissues (C) → The infection leads to localized swelling, redness, and sometimes pus drainage.
  • Radiographic bone loss (D) → Bone destruction due to periodontal disease and infection is visible on X-rays.

Why Not A (No response to electric pulp tester)?

The pulp of the tooth remains vital in most cases of periodontal abscesses.
A negative response to an electric pulp tester (EPT) suggests pulpal necrosis, which is characteristic of a periapical abscess (endodontic abscess), not a periodontal abscess.
In a periodontal abscess, the main issue is infection in the periodontal ligament and surrounding structures, NOT the pulp itself.

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✅ A periodontal abscess typically does not affect the pulp, so the tooth should still respond to an electric pulp test. If there is no response, consider pulpal necrosis and a periapical abscess instead.

#Operative
Which of the following statements is true?
◯A. All elderly patients have reduced salivary flow.
◯ B. Pit and fissure sealants should never be used for adults.
◯ C. Elderly patients may be able to undergo a simple restorative procedure without anesthesia.
◯ D. All of the above.

  C. Elderly patients may be able to undergo a simple restorative procedure without anesthesia.
As patients age, several physiological changes occur that can affect their dental treatment. Let’s analyze each statement carefully:

A. "All elderly patients have reduced salivary flow." → ❌ False

 While xerostomia (dry mouth) is common in elderly patients, not all elderly individuals experience reduced salivary flow.
Primary aging does not significantly reduce salivary production; rather, it is often caused by medications (e.g., antihypertensives, antidepressants, anticholinergics) or systemic diseases (e.g., Sjögren's syndrome, diabetes).
Many elderly patients still maintain normal salivary function, especially if they are not on xerostomia-inducing medications.

B. "Pit and fissure sealants should never be used for adults." → ❌ False

While sealants are primarily used in children and adolescents, they can be beneficial for adults at high risk for caries, especially those with deep fissures and no existing restorations.
Sealants have been shown to reduce caries risk in high-risk adults just as they do in children.

C. "Elderly patients may be able to undergo a simple restorative procedure without anesthesia." → ✅ True

Aging is associated with dentinal sclerosis, leading to reduced dentin permeability and a decrease in pain sensitivity.
In some cases, elderly patients may not require anesthesia for simple procedures, such as shallow cavity preparations, due to nerve desensitization.
However, this varies among individuals, and some may still require anesthesia depending on their pain threshold.

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✅ Takeaway & 📌 Study Tip

1️⃣  A patient presented with bone pain

✅ Takeaway:
Paget’s disease of bone presents with bone pain, deformities, and radiographic "cotton wool" & mosaic bone patterns.
It is due to abnormal bone remodeling with excessive resorption and disorganized formation.
It can lead to cranial nerve compression, hearing loss, and increased fracture risk.
📌 Study Tip:
Remember: "Paget’s disease = Patchy sclerosis (cotton wool) + Mosaic pattern."
Differentiate it from fibrous dysplasia, which presents with a ground-glass radiographic appearance.

2️⃣  A patient started becoming irritable

✅ Takeaway:
The patient is hyperventilating, causing excess CO₂ loss and respiratory alkalosis.
Breathing into a paper bag increases CO₂ levels, restoring acid-base balance.
📌 Study Tip:
Key signs of hyperventilation: Dizziness, tingling, muscle cramps, rapid breathing.
Don't use a paper bag in true hypoxia (e.g., asthma, COPD)—it worsens oxygen deprivation!

3️⃣  A 60-year-old patient on haloperidol and donepezil

✅ Takeaway:
Amoxicillin + Ibuprofen is the safest choice.
Avoid tramadol (risk of serotonin syndrome & seizures).
Avoid clindamycin (risk of QT prolongation, especially with haloperidol).
📌 Study Tip:
Remember: Haloperidol prolongs QT → Avoid clindamycin.
Serotonin drugs (donepezil) + Tramadol = BAD! → Risk of serotonin syndrome.

4️⃣ A patient with periodontal abscess

✅ Takeaway:
A periodontal abscess involves pain, swelling, and radiographic bone loss but the pulp remains vital.
A non-vital pulp (no response to EPT) suggests a periapical abscess (endodontic issue), not a periodontal abscess.
📌 Study Tip:
Differentiate abscesses:
Periodontal abscess → Vital pulp, pocket-related, bone loss along the root.
Periapical abscess → Non-vital pulp, originates from necrotic pulp, periapical radiolucency.

5️⃣ Elderly patients

✅ Takeaway:
Elderly patients may not require anesthesia for shallow restorations due to dentin sclerosis & reduced pain perception.
Not all elderly patients have dry mouth (only those on medications/systemic conditions).
Sealants can be used in adults if caries risk is high.
📌 Study Tip:
Aging & pain sensitivity: Nerves become less responsive, but deep cavities still need anesthesia.
Xerostomia = Medication-induced, not aging itself!

🔹 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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