PERSATUAN PELAJAR ISLAM PERGIGIAN UNIVERSITI MALAYA

1. Inferior alveolar nerve

a) Describe 3 anatomical landmarks of the inferior alveolar nerve block.(3m)

a. Pterygomandibular raphe
b. External oblique ridge
c. Level occlusal plane of mandibular posterior teeth
b) Describe the anatomical boundaries of the pterygomandibular space (4m)
a. Superior : lateral pterygoid mucsle
b. Posterior : parotid gland
c. Lateral : accending ramus of mandible
d. Medial : medial pterygoid muscle.

c) List THREE complications of inferior alveolar nerve block (other than unsuccesful block) (3m)

a. Facial nerve palsy

b. Paraesthesia to lip, chin and tongue
c. Trismus

2. A patient requests for extraction of a painful lone standing grossly carious upper right second
molar.
a. List TWO anticipated complications during the extraction of tooth.(2m)
1. Difficulty to extract tooth
2. Displacement of tooth into maxillary antrum
b. List SIX local causesof difficult extraction. (6m)
1. Easily detached crown
2. Brittle tooth
3. Impacted or buried tooth
4. Sclerotic bone
5. Tooth with strong supporting tissues
6. Tooth with narrow thin roots
7. Hypercementosis root
c. In case of fractured tooth during extraction, in what is it appropriate leave the
fractured part in situ?(2m)

In the mandible, if the root tip leave behind there not likely to be any problem.
Because to prevent damaging the nerve supplying to the lip, chin and tongue.so it
would not likely be any problem if leave behind.

d. Give 3 situations where the fractured part should be removed.(3m)

1. Gross contamination of fractured root
2. Pre existing sinus pathologies
3. The fractured part is gone out from the socket into the local anatomy.

PREPARED BY SUNSHINES 2013/2014

PERSATUAN PELAJAR ISLAM PERGIGIAN UNIVERSITI MALAYA

3. Name the nerve to anaesthetize and technique of achieving local anaesthesia in ecah of the
following clinical procedure.(10m)
Nerve technique
a) Extraction of 16 Posterior superior alveolar Infiltration technique
nerve
b) Extraction of 36 Inferior alveolar nerve, Block technique
lingual nerve, long buccal
nerve
c) Extraction of Incisive nerve Infiltration technique
31,32,41,42
d) Extraction of Incisive nerve Topical
exfoliating 71
e) Suturing of laceration Infraorbital nerve Block & infiltration
wound of the upper Anterior superior alveolar technique
lip nerve

4. a) Based on the clinical history and the clinical appearance as seen in Figure A, What is your
diagnosis?(2m)
Fordyce granules.

b)How would you explain the diagnosis to the patient ? (2m)

Multiple yellowish granules on the upper lip.

c)Describe the histo pathological features of your diagnosis as seen in Figure B. (4m)
-Keratinized stratified squamous epithelial layer.
- connective tissue surrounding the acinar of the sebaceous gland.
- in sebaceous cell, polygonoid in shape with centrally located nuclei and foamy cytoplasm.

d) what is the treatment needed for this patient?(2m)

No need treatment.

PREPARED BY SUNSHINES 2013/2014

PERSATUAN PELAJAR ISLAM PERGIGIAN UNIVERSITI MALAYA

5. A 60 year old man came to the clinic for a routine dental investigation.(4m)
a) Describe the clinical appearance of this patient tongue as seen in Figure A.
- The tongue has multiple fissure that located in the midline and
the dorsalateral of the tongue.
- Scrotal tongue
- multiple grooves/furrows
- 2-6mm deep
- mostly dorsalateral
- large central fissure

b) Name this condition seen in Figure A. ( 2m)

Fissured tongue

c) Name ONE syndrome that has this condition as one of its component. (2m)
Melkersson-Rosenthal Syndrome

d) What advice will you offer patients with this kind of condition?(2m)
Maintain good oral hygiene by brushing the tongue frequently since the food may
trapped in the fissure of the tongue.

PREPARED BY SUNSHINES 2013/2014