Analgesia, paediatric trauma and restorative decisions

Correct answer: A. Aspirin

• A. Correct. Aspirin is the one to avoid outright: it irreversibly inhibits platelet function — a real concern in liver disease with impaired clotting factor synthesis — and it is directly ulcerogenic in a patient with reflux.
• B. Ibuprofen carries gastrointestinal risk too and should be used cautiously and briefly, but it is not absolutely contraindicated.
• C. Hydrocodone spares the stomach and platelets. It needs care in hepatic impairment because of the paracetamol usually combined with it, but it is not the contraindicated choice.
• D. Naproxen shares that caution; its longer half-life makes the gastrointestinal exposure greater.

Note: Acetaminophen at a reduced ceiling dose is usually the safest starting point in hepatic impairment — confirm current liver function with the physician.

Correct answer: C. Extraction

• A. Pulpectomy of a primary tooth is technically demanding and time-consuming — poorly matched to a short appointment with an apprehensive, inexperienced patient.
• B. Pulpotomy would be reasonable in a cooperative child with adequate time, but it still requires profound anaesthesia and careful isolation.
• C. Correct given these constraints. Extraction is the single-visit, definitive option for an anxious, anaesthetic-naive child when time does not permit lengthier pulp therapy on a primary tooth.
• D. Splinting is for luxation and avulsion injuries, not for a crown fracture with pulp exposure.

Note: ⚑ The behavioural constraints, not the tooth, drive this answer. With a cooperative child and adequate time, a pulpotomy preserving the tooth would be preferred. Plan space maintenance after extraction.

Correct answer: A. Die spacer relief for the cement film

• A. Correct. Die spacer is painted onto the die, short of the margin, to create deliberate internal relief. Without it, the cement cannot escape and the crown will not seat completely.
• B. An open margin is a gap at the finish line, visible at the periphery rather than internally.
• C. Casting porosity appears as voids within the metal itself, not as uniform internal relief.
• D. Overcontouring is an external form problem that causes plaque retention and gingival inflammation.

Note: Spacer is kept about 1 mm short of the margin so that marginal adaptation is unaffected.

Correct answer: C. Extraction

• A. Endodontics addresses the pulp but does nothing about a margin sitting 4 mm subcrestally, and the tooth is vital in any case.
• B. A crown placed over a margin this deep violates the biologic width and guarantees chronic inflammation and bone loss.
• C. Correct. At 4 mm below the crest, crown lengthening cannot re-establish the biologic width and an adequate ferrule without removing so much bone that the tooth — and its neighbours — are compromised. Extraction is the realistic answer.
• D. Crown lengthening works for margins at or just below the crest, roughly 1 to 2 mm. Four mm below the crest is beyond its reach on the lingual of a posterior tooth.

Note: ⚑ The recall does not mark a key for this item. The reasoning above follows the biologic width principle — roughly 3 mm of sound structure is needed coronal to the bone (2 mm biologic width plus 1 mm ferrule). Orthodontic extrusion is the alternative worth raising in the group if the tooth is strategically important.