Usmle Step 1 Smart Notes

Guys these are general notes from previous discussions are done here by very smart people smile emoticon

General notes

rubber dam gives a black background appearance, affecting the Shade selection
Everything will llook whiter than it actually is

The attachment of the JE to the tooth surface can occur on enamel, cementum, or dentin. The position of the EA on the tooth surface is initially on the cervical half of the anatomical crown when the tooth first becomes functional after tooth eruption.

ferrule means
“a metal ring or band around a slender shaft that prevents splitting”. In dentistry it basically means a ring of solid tooth structure going around your crown prep. I believe most prosthodontists recommend 1 mm minimum of good tooth structure in order to put a crown on a tooth in order to have a decent prognosis (this doesn’t include the build-up). I may be wrong about the 1 mm minimum- you definitely want as much tooth structure as possible going around the tooth. This creates what is referred to as a “ferrule effect” which improves retention and resistance, exactly and the longer the ferrule the more the resistance to fracture!

welcome…check mosby p 27 as well to get it..

In Davis Crowns a Post + Core is Casted where core covers 1-1.5 mm on to prepared coronal tooth stump to prevent vertical splitting of root due to wedging effect of cast post= Ferrule effect

*Forceps #
89# Maxillary right molar
90# Maxillary left molar
17# Mandibular molar
23# Mandibular molar roots
210# Maxillary 3rd molar
222# Mandibular 3rd molar
150A# Maxillary premolar and molars
151A# Mandibular premolars
150S#Maxillary primary teeth
151S#Mandibular primary teeth
65#Max premolars
286#Max premolars,incisors and root tips

Whats penumbra???
Smaller the focal spot area sharper the image appears
Fuzzy unclear area that surrounds a radiographic image is called as penumbra
So ↑ in source to object distance
↓ in film to object distance.

Smoking is not a contraindication for the placement of dental implants, however, failure rates are higher in smokers. The failure rate is related to the amount of smoking on a daily basis and the pack/years history for the patient.

Based onon angle formed by cutting edge with edge of the blade.
Away from the handle distal GMT
Towards the handle mesial GMT.


330- pear shaped, 34 inverted cone, 6-round, 558 straight fissure cross cut.

round- 1/4, 1/2, 1, 2,3,4,5,6,7,8,10

Inv cone- 33 1/2, 34,35,36,37,38,39, 36L, 37 L

Straight plain- 56,57,58,59,60, 57L,58L

Straight cross cut- 556,557,558,559,560,557L, 558L

Tapered fissure plain- 169, 170,171,169L,170L, 171L

taperd cross cut – 699(l)700 (l),701,702,703,

End cutting-957,958


Pear- 329,330,331 331L, 332

It’s dried blood. Someone mentioned on the earlier posts only dripping wet blood comes under regulated waste; went by that explanation

y-shaped in antral. I remember someone had got this in their exam.

ITS BBBB…CHECKED WIKI…ITS ASKING MOSTLY SO B MAKES SENSE..At low doses, nitroglycerin will dilate veins more than arteries (reduces preload, primary mechanism of action), but at higher doses it also dilates arteries (afterload reduction) and is a potent antihypertensive agent. In cardiac treatment, the lowering of pressure in the arteries reduces the pressure against which the heart must pump, thereby decreasing afterload.[18] Dilating the veins decreases cardiac preload and leads to the following therapeutic effects during episodes of angina pectoris: subsiding of chest pain, decrease of blood pressure, increase of heart rate, and orthostatic hypotension.

Ectopic eruption sequences: Its max first molar>max canine>mand canine>mand second premolar>max lateral…. Most common to least

Hep C. Also associated with chronic liver disease, hepatocellular carcinoma and the no 1 cause of liver transplantation in US

Other names for alarm clock headache: Cluster headache, Horton’s headache, red neuralgia, histamine headache, and Sphenopalatine neuralgia

best post= parallel and best pin= self threading

Biostatistics in Pt management
* Validity….> should be compared to gold standard and should be high sensitive,specific and unbiased
*Realibility….> should be reproducible and repeatable with same value means produce similar results
* Sensitivity….> % of persons having the disease TP/TP+FN X 100%
* Specificity ….> % of persons not having the disease TN/TN+FP X 100%
* predictive value positive….> TP/TP+FP X 100%
* predictive value negative….> TN/TN+FN X 100%
Highest prevalence of caries = Hispanics
Highest DMFT = White (caucasian) (highest amount of restored teeth)
Highest untreated primary teeth = Hispanic
Highest untreated perm teeth = Black (African American)
Moderate periodontitis = Black males ( African American)
Class II caries = Whites (caucasian)
Class III caries = Blacks (African American)
Cleft lip/palate w/ Class III occlusion = Native American
Cleft lip alone = Asian
Cleft lip in USA = 1:700 to 1:800
class 2 malocclusion : whites of northern European descent
class 3 malocclusion : Asian
Caucasians have more lip cancer while African american have more oropharyngeal carcinoma.
Anterior open bite: African American(blacks)
Deep bite: cuacasian( whites)
Cemento osseous dysplasia – black middle aged wome

so caries is generally low in down sy and periodontal disease are high in these patients. At the same time in case of cystic fibrosis due to medication (antibacterial specially tetracycline) and composition of saliva caries is very lowe(lower than Down sy). If you had both, then choose CF smile emoticon ,I red this today in oral patho smile emoticon

il-8 attracting inflammatory cells, TNF similar to il-1 but less potent, mmp 8 is collagenase so they involve in periodontal tissue destruction.

Minimum thickness of a connector is 3 mm
Mesiodistal area is shared by pontics and connectors

..In Class 2 –>Amalgam (internal line angles are rounded)
but in case of Class 2 –>Inlay (internal line angles are sharp)

umm..In working side interferences:BULL rule (inner inclines)

In Balancing side interferences:Mandibular Buccal Cusp (inner inclines)——->although they are Secondary Centric Holding Cusp
we never grind Maxillary lingual Cusp (Primary Centric holding Cusp)

Can be both D and B.. Supracrestal fibrotomy B is particularly for rotations..while D keep the contacts wide is for lower anteriors so as to make sure to prevent slippage of contacts…as given by Raleigh Williams and I think also in Garber…I ll go with D…

For Cusp Protection via GOLD
a.Capping is done in Functional cusp
b.Shoeing (Veneer) is done in Non functional cusp except Buccal cusp of MAXILLARY PREMOLARs and MOLARs

for minikin ..its 3 mm
minim …5 mm

cross bite:—-Dentoalveolar: Inclined plane, Reverse SS Crown, Tongue Blade, Maxillary Hawley with Z-Springs, and Posterior Bite Block Combination to discclude the anterior dentition
Functional… check for the premature contacts…. Most likely they are primary canines which are the culprits as they haven’t attritioned with rest of the primary dentition

osseous resective surgery includes ostectomy and osteoplasty…….in which aim is to reduce and removve supporting and non supporting bone ……in this first of osteoplasty includes technique of fesooning which is vertical grooving or bone festooning to reduce buccal and lingual thickness of bone interdentally……..

Aldosterone release and presence of insulin causes uptake of potassium from blood stream causing hypokalemia

Both true,etching time for primary teeth is 30-60 seconds.

patient is aware of problem but there are some barriers like time, expenses.. so it comes under contemplating

Overextended max denture ______ result in sore throat

Condylomata acuminata (6-11) HPV while 16 18 , 31 33 HPV for verrucous carcinoma

1 nd 2
High copper(no gamma 2 phase no loss of marginal integrity)
Spherical(less hg content 40-45%)

Acromegaly :Enlarged Tongue
Pieer robins:Posterior tongue displacement(glosoptosis)

Does anyone have a reference for 3?
A crown’s color is selected by looking at the adjacent teeth. And if it has gotten ‘lighter’ means the adjacent teeth have stained. And since a crown is selected by looking at surrounding teeth only, will we not change the crown rather then messing with all these other teeth?

Flouride fatal doses
Fatal dose 16 mg/kg in children
2g in adults
while toxic dose 5-10mg/kg in children

Agranulocytosis, you see ragged ulcer in gingiva and palat

@Yeah Swiss cheese pattern in cribriform is seen in adeno ….and honey comb in acinic

1.5 mm between tooth and implant and 3 mm between two implants

This was discussed here a few days ago , someone wrote that serial extraction may cause deep bite , coz of lack of support , so in case there is already deep bite present then its better not to do it
it’s written in decks that OSHA responsible for all the employees to get hep b vaccination and it tells cdc to take care of those vaccination..I don’t remember

Bonding agent contains a hydrophilic n hydrophobic strata . Hydrophilic part bonds to dental tissues n composite should bond to the hydrophobic part… since dentin contains more organics n H2o than enamel, the agent bonds better to dentin than enamel

GINGIVAL CYST of newborn or adult Not seen radiologically. Not to be mistaken with Epstein’s Pearl (on median palatal raphe) and Bhon’s nodule – seen on alveolar ridge of the newborn.

Operant conditioning (sometimes referred to as instrumental conditioning) is a method of learning that occurs through rewards and punishments for behavior.

b, you dont remove caries when they are half way in enamel.. they are treated by flouride tx… but when it touched DEJ you have to remove it

16 Weeks between the 1st n 3rd dose n 8 weeks between dose 2 n 3. If only dose 3 is left it should be given immediately

For ADHD patient ask patient to have the medicine 1/2 hr before appointment, rest is all same , keep short appointment and morning one,

Yes most is chlorphenarmine maleate then phenargan then least is diphenhydramine

Aluminum is the weakest crown material for implant abutment

pneumbra, causes indiscrete margins of x-ray’s film

245- cavity prep

Prospective–>foward in time (starts with the risk factor and ends with the disease)
Retro(back)pective—>Backward in time(starts with the Disease and asking about the risk factor in the past)

iagnostic Clues Craze lines are frequently confused with cracks, but can be differentiated by transillumination. If the tooth is cracked, the light will be blocked, allowing only a segment of the tooth structure to light up; if the tooth only has a craze line, the entire tooth structure will light up,shouldn’t the answer be Periapical abscess then as the tooth is intact?What is the answer?
Ok,Periapical abscess seems appropriate as the whole tooth is intact n can be illuminated.

low grade mucoepidermoid carcinoma has best prognosis

Iopa of max canine in periapical region lateral wall of nasal fossa and anterior border of maxillary sinus form an inverted Y known as inverted Y OF ENNIS

B, this is what I found

Most Sensitive: Blood-forming organs
Reproductive organs
Bone and teeth
Least sensitive: Nervous system

Physical restraints for moderate retarded child at emergency … Cos voice control and HOME are for pts with normal mental activity.. GA not possible as it is an emergency visit…

Thanks sir smile emoticon what’s the sequence of hue value chroma when we have to match a shade?
First Hue then Chroma then Value
Wavelength dependence ——> hue
Concentration dependent——->chroma
Reflection of amount of light dependent—–> value

For years, people with asthma and allergies have been told to avoid antihistamines because they dry sinuses and cause constriction of the airways and sedation. Newer antihistamines, including fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) may be beneficial for mild allergic asthma, but antihistamines are still problematic and are usually not beneficial for moderate to severe asthma. People should not use antihistamines if a sinus or respiratory infection is present. Used routinely, antihistamines thicken mucous secretions and can worsen respiratory infections. It is particularly important to treat any co-existing sinus infection in people with asthma because they might not respond to asthma treatments unless the infection is first cleared up.


Contemplation . pt is thinking about quitting but not enough motivated yet..

pre-Contemplation .. pt is not even thinking of quitting
i think that denial and preContemplation are the same..

action. pt is actually working to quit.

correct me if i am wrong …

yep… I was reading some random article and according to tht., if fluconazole isn’t the given choice then ketoconazole is the answer…for systemic anti fungal

According to A.D.A., the acceptable dimensions of a tooth brush are
(a) 1-11/4 inch long, 5/16-3/8 inch wide, 2-4 rows, 5-12 tufts per row

caries is seen on which aspect of 1st primary molar??
distal surface, occlusal,
Ans is occlusal.

Full ext—how long do you wait for max denture o 1 day
o Same day o 1 week
o T- 8 week o 16 week
6 weeks for preliminary impression and 8 weeks for final impression

The pain from the loss of
pulpal vitality is the most common presenting complaint ofpatients with combined lesions. The symptoms reported are those most often found with pulpal disease. Thermal pulp testing provides information relative to the status ofthe pulp, and dental radiographs can confirm the presence of apical changes and the extent ofbone loss. Careful probing confirms the presence and morphology ofany periodontal pocket and permits location of the conmunication with the apical lesion.

In combined endodontic-periodontic lesions, it is generally wise to treat the endodontic component first, because in many cases this will lead to complete resolution of the problem.

After successful endodontic treatment, the residual periodontal pocket that remains can be more predictably heated. The periodontal therapeutic objeclives vary with the extent

Permissive way….wid special child decisive is when its a normal child and u know he has ro capabilities to understand the reason

ans is pemphigoid where there is seperation of membrane and epethilium from connective tissue whie in pemphigus there is blistering of skin due to antibodies being direted against desmosomal adhesion molecules ..meaning only the epidermis is affacted
Pemphigoid -sub basilar cleft
Pemphigus- intra epidermal cleft

intenal: RCT, for external: if not self limitting than in most cases extraction

chi-square is the sum of the squared difference between observed (o) and the expected (e) data (or the deviation, d), divided by the expected data in all possible categories.

From best to worst for implantation …
D1 Ant Mand,
D2 Post Mand,
D3 Ant Max,
D4 Post Max:)

ECC locations start with the most affected
1. Ant max
2. Post max
3. Post mand
4. Ant mand –> least because tongue cover them

unbundling is done by dentists and downcoding is done by insurance
bundling : all pricedures into one -by insurance
upcoding : dentist playing with codes to get more $$

If there was any other problem the margins wouldnt have fit….whenever we are fitting a crown the first thing u check is proximal contacts…then margins and then occlusion…so if the margins are ok it is understood tht the proximal contacts are ok too

Its iv bisphosphonates its effect will not reduce on stopping the medication just 3 months before that too when patient is taking from 2 years, I guess second option will be best , we will definitely choose non invasive procedure coz its IV bisphosphonates

Normal salivation rate is : It’s 1.5 L/day = 1 ml/min

a pier abutment is a natural tooth located between 2 terminal abutments for example..if u have a missing 1st premolar and missing 1st molar,the 2nd premolar would be the pier abutment that is located between the canine and 2nd molar.

condyle for both…only difference is second most common…symphysis is 2nd most common in children and angle is nd most ommn in adults To make the crown narrower , Move line angles more facially and increase interproximal embrasure mental the most difficult one,platal the easiest but painful,The buccal block is a successful injection because the buccal nerve is readily located on the surface of the tissue and not within bone

In self cure: initiator- benzoyl peroxide, activator: toluidine. In heat cure: initiator -benzoyl perxide , activator -heat.

Working cusp for amalgam is 2.5 to 3
Non working for amalgam is 2.o
W cusp for cast gold is 1.5
Non w cusp for cast gold is 1.0
W cusp for metal ceramic is 1.5 – 2.0
Non w cusp for metal ceramic is 1.5 -2.0

I read that people with CP have a 30-50% or 35-50% of seizure development and mental retardation/learning disability.

Working side interference: reduce de lingual incline of the buccal cusps of maxilary molars and inner incline of lingual cusps of mandibular molars. Non working side interference: grind only the inner incline of the buccal cusps of madibular molars. In reality u should never reduce the primary centric holding cusps (lingual of max.) But in nbde u can reduce it if is high in centric, protusive and lateral excursion movement.

Stieglitz pliers — use for removing silver points

Implanted opened apex tooth regain blood, Ans is 20 days…it will be regained within 20 days after replantation but nerve supply lags behind.

Cavicide disinfectant for dental chair

Is phenargan contraindicated in pregnancy
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
CATEGORY C-pregnancy

b . cheek bite with edge to edge relationship

A dentrifices have 20-40% abrasive particles. And a abrasive paste have about 80% of abrasive particles. Also most dentrifices (tooth pastes) have fluoride incorporated… most tooth pastes have 1450 ppm of fluoride.

300-200/1000 = 0.1, incidence define no. Of new cases- pasted from another group.


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