This action might not be possible to undo. Are you sure you want to continue?
Richard E. Walton, William T. Johnson, Lisa R. Wilcox
1. a. b. c. d.
Anesthetic testing is most effective in localizing pain to which of the following? Specific tooth Mandible or maxilla Across the midline of the face Posterior tooth
2. Areas of rarefaction are evident on radiographic examination in which of the following? a. b. c. d. 3. a. b. c. d. When the tooth is responsive to cold When the tooth is responsive to percussion When a tooth fracture has been identified When the cortical layer of bone has been eroded Irreversible pulpitis is often defined by which of the following? Moderate response to percussion Painful, lingering response to cold Short, painful response to cold Short, painful response to heat
4. The majority of patients with symptoms of severe odontogenic pain have a diagnosis of which of the following? a. b. Periodontal abscess Irreversible pulpitis
Acute apical periodontitis Acute apical abscess
5. Medical history of coronary heart disease is significant for which of the following reasons? a. b. c. d. 6. a. b. c. d. 7. a. b. c. d. It contraindicates endodontic treatment. Many heart medications impact dental treatment. It indicates the need for premedication with antibiotics. It contraindicates local anesthetic with epinephrine. The best approach for diagnosis of odontogenic pain is which of the following? Radiographic examination Percussion Visual examination A step-by-step, sequenced examination and testing approach Of the following, which is the most likely to have referred pain? Irreversible pulpitis Reversible pulpitis Acute apical periodontitis Phoenix abscess
8. A sinus tract that drains out on the face (through skin) is mostly likely from which of the following? a. b. c. d. Nonodontogenic pathosis A periodontal abscess Periradicular (i.e., endodontic) pathosis Pericoronitis of a mandibular, third molar
9. a. b. c. d. 10. a. b. c. d. 11. a. b. c. d. e.
Which of the following statements regarding a test cavity is accurate? It is the first test in diagnostic sequence. It often results in a dull-pain response. It is used when all other test findings are equivocal. It should be performed with local anesthetic. Percussion of a tooth is a test for which of the following? Pulpal inflammation Pulpal necrosis Acute periradicular inflammation Chronic periradicular inflammation Pulp stones are consistent indicators of which of the following? Periodontal inflammation impacting the pulp Pulpal inflammation Older patient Pulp that has been injured in the past but has recovered None of the above
12. Radiographically, which of the following statements regarding acute apical abscess is most accurate? a. b. c. d. 13. It is generally of larger size than other lesions. It has more diffuse margins than other lesions. It often contains radiopacities (i.e., calcification). It may not be evident. In which of the following may a false-negative response to the pulp tester occur?
a. b. c. d.
Primarily in anterior teeth In a patient with a history of trauma Most often in teenagers In the presence of periodontal disease
14. The lateral periodontal abscess is best differentiated from the acute apical abscess by which of the following? a. b. c. d. Pulp testing Radiographic appearance Location of swelling Probing patterns
15. The acute apical abscess is best differentiated from the acute apical periodontitis by which of the following? a. b. c. d. Pulp testing Radiographic appearance Presence of swelling Degree of mobility
16. Chronic apical periodontitis is best differentiated from acute apical periodontitis by which of the following? a. b. c. d. Pulp testing and radiographic appearance Pulp testing and nature of symptoms Radiographic appearance and nature of symptoms Pulp testing, radiographic appearance, and nature of symptoms
17. The abrupt change (arrow) in radiographic appearance in the following illustration probably indicates which of the following?
a. b. c. d.
Calcific metamorphosis A dense accumulation of diffuse calcification An increased density of overlying bone A bifurcation into two canals
18. The patient in the following illustration reports severe, throbbing pain in the mandibular right molar region. The pain is exaggerated by cold. Which tooth and which tissue is likely the source of pain?
a. b. c. d.
First molar and pulp First molar and periapex Second molar and pulp Second molar and periapex
19. Of the following cold-testing agents, which is the least effective in producing a response? a. b. c. d. 20. a. Bathing a tooth in ice water Dicholorodifluoromethane (DDM) CO2 snow (i.e., dry ice) Ethyl chloride Which of the following statements regarding internal resorption is accurate? The condition is usually accompanied by symptoms.
b. c. d. e.
It is continuous. It is self-limiting. It is usually visible in its early stages. It is treated only if time shows it to be progressive.
CHAPTER 2: OROFACIAL DENTAL PAIN EMERGENCIES: ENDODONTIC DIAGNOSES AND MANAGEMENT
1. Which of the following statements regarding the degree of pulp pathosis is accurate? a. b. c. d. It can be determined by the level of pain a patient experiences. It can be related to the level of response of the electrical pulp tester. It can be correlated best when a diagnosis of irreversible pulpitis is established. It does not correlate well with the level of pain a patient perceives.
2. A key measure as to the degree (i.e., intensity) of pain is to determine which of the following? a. b. c. d. e. Painful stimulus with cold Painful stimulus with heat Painful stimulus on biting Increasing pain Pain affecting patient's lifestyle
3. In describing the sensory innervation of the dental pulp, which of the following statements is accurate? a. A-delta fibers are high-threshold, myelinated fibers that transmit sharp, momentary pain. b. C fibers are low-threshold, unmyelinated fibers that produce pain in response to inflammatory mediators.
The domination of C-fiber stimulation produces pain that is not well localized.
d. The sharp, well-localized pain to cold testing is conducted by both A-delta and Cfiber stimulation. 4. a. b. c. d. Which of the following induces hyperalgesia in local-nerve fibers? Prostaglandin and serotonin Lysosomal enzymes Calcitonin gene-related peptide Substance P
5. Each of the following statements is correct regarding trigeminal neuralgia, except for one. Which is the exception? a. The onset occurs in midlife and is unilateral in location.
b. The pain occurs unilaterally but often involves more than one division of the trigeminal nerve. c. The pain is characteristically sharp, lasts for several hours, and is induced by a trigger point. d. The pain mimics pain of pulpal origin in that thermal sensitivity and tingling is often encountered just before an attack. 6. A patient complains of dull and constant pain that lasts 3 days on the left side of the face. The patient notes the pain increases on positional changes, such as bending over and when jogging. The most likely diagnosis is which of the following? a. b. c. d. 7. a. Myocardial infarction Maxillary sinusitis Atypical facial pain Irreversible pulpitis Which of the following most likely indicates pain that is not of pulpal origin? Unilateral pain that radiates over the face to the ear
b. c. d.
Pain that has paresthesia as a component Pain that is described as throbbing and intermittent Pain that is increased during mastication
8. A complete medical history is essential when treating an emergency dental patient for which of the following reasons? a. To identify patients with conditions that would contraindicate root canal treatment
b. To determine conditions that might require modifications in the approach to treatment c. To protect the health care team from potential blood-borne pathogens and other infectious diseases the patient may have d. For medical and legal protection and to determine if the medical status will affect the prognosis for root canal treatment 9. When a patient complains of severe pain that cannot be localized: a. The pain is most likely periradicular in origin and likely to persist even when the necrotic pulp is removed. b. Treatment procedures should be delayed and the condition managed with analgesic medications. c. d. The cause is most likely nonodontogenic in origin. Selective administration of local anesthesia can lead to a definitive diagnosis.
e. The pulp of more than one tooth will be involved and the pathosis produce a synergistic-hyperalgesia response within the central nervous system (CNS). 10. A patient's chief complaint is severe pain from the mandibular, right first molar (tooth no. 30) when eating ice cream and drinking iced tea. Clinical examination reveals MOD amalgam restorations in all posterior teeth. The margins appear intact and no cracks or caries is detected. Pulp testing indicates all teeth in the quadrant are responsive to electrical-pulp testing. Application of cold fails to reproduce the symptoms. Which of the following actions should be taken? a. The patient should be dismissed and asked to return when the symptoms increase and the pain to cold becomes prolonged.
b. Initiate root canal treatment by performing a pulpotomy or pulpectomy on tooth no. 30. c. Place a rubber dam on individual teeth and apply ice water.
d. Remove the restoration in tooth no. 30, place a sedative restoration, and prescribe a nonsteroidal, anti-inflammatory agent. 11. A patient complains of pain to biting pressure and sensitivity to cold in the maxillary, left, posterior quadrant that subsides within seconds of removal of the stimulus. Clinical examination reveals teeth nos. 2 and 3 exhibit occlusal amalgams. Which of the following test or actions is most appropriate based on the chief complaint? a. b. c. d. Periapical radiographs of the posterior teeth Examination with transillumination Electrical pulp testing Percussion and palpation testing
12. A practitioner refers a patient for root canal treatment. The clinician should obtain a new preoperative radiograph during which of the following situations? a. b. When the film from the referring dentist is more than 1 month old In cases when an emergency treatment procedure was performed
c. When the film from the referring dentist reveals a radiolucent area that has a "hanging drop" appearance d. Immediately before examining the patient
13. Which of the following is true regarding the periodontal ligament injection when treating a tooth with a pulpal diagnosis of reversible pulpitis? a. There will be a decrease in pulpal blood flow when anesthetic agents with a vasoconstrictor are used. b. Damage to the supporting structures can cause continued symptoms.
c. The periodontal-ligament injection is contraindicated when block or infiltration injections are not effective.
d. The periodontal ligament injection can be used as primary anesthesia in teeth that exhibit single roots, regardless of the number of canals. 14. A patient describes pain on chewing and sensitivity to cold that goes away immediately with removal of the stimulus. The mandibular, left, second molar (tooth no. 18) exhibits a mesial, occlusal crack. The tooth is caries free, and no restorations are present. Periodontal probing depths are 3 mm or less. Which of the following statements is correct? a. The pulpal diagnosis is normal pulp, and the tooth should be prepared and restored with a MO-bonded amalgam. b. The pulpal diagnosis is reversible pulpitis, and the tooth should be restored with a crown. c. The pulpal diagnosis is irreversible pulpitis, and root canal treatment should be performed, a bonded amalgam placed, and a crown fabricated. d. e. A radiograph will likely reveal a radiolucent area associated with the mesial root. The prognosis for the tooth is unfavorable.
15. Treatment of severe, throbbing pain associated with the maxillary, left, first molar (tooth no. 14) is best managed by which of the following? a. b. c. d. e. Pulpotomy Partial pulpectomy Pulpectomy Analgesic agents Analgesic and antibiotic agents
16. Which of the following statements regarding leaving a tooth open for drainage in cases of an acute, apical abscess is accurate? a. b. c. It is the recommended method of managing the emergency patient. It may adversely affect the outcome of treatment. It is appropriate, providing the patient is also placed on an antibiotic.
It should be considered in addition to soft tissue incision and drainage.
17. With acute, apical abscess, antibiotic administration is indicated in which of the following? a. b. c. d. Primarily only when there is diffuse swelling When there is swelling to any degree (i.e., localized or diffuse) 2 to 3 days before beginning treatment of the tooth Only if there is purulence draining from an incision
18. A 21-year-old model requires emergency treatment of a soft, fluctuant swelling over the facial alveolar process of the maxillary, left, lateral incisor (tooth no. 10). The swelling is visible because of a high-lip line. Which of the following statements is correct regarding performing incision and drainage? a. The incision should be placed vertically and go directly to bone.
b. The incision should be horizontal in the attached gingiva at the base of the swelling. c. d. If drainage occurs with the initial incision, blunt dissection is not necessary. The placement of a drain is necessary for 24 to 48 hours.
19. Which of the following statements regarding incision and drainage of an indurated swelling is accurate? a. b. c. They should be delayed until it becomes fluctuant. They can reduce pain caused by tissue distention. They provide a purulent exudate for culture and sensitivity testing.
d. They are not indicated, because antibiotic treatment will result in resolution of the lesion. 20. Flare-ups during root canal treatment are more commonly associated with which of the following? a. Teeth with vital-pulp tissue when compared to teeth with pulp necrosis
b. Teeth with apical radiolucent areas when compared to teeth with normal periapical tissues c. d. e. With single-visit endodontic procedures Symptomatic teeth exhibiting pulp necrosis Multirooted teeth
21. Of the following reasons, when is apical trephination through the faciobuccal, cortical plate advocated? a. To release exudate
b. As a routine procedure for relief of pain when the offending tooth has been obturated c. For treatment of severe, recalcitrant pain
d. Between multiple-visit endodontic procedures to prevent the occurrence of a flare-up 22. A 22-year-old, white man requires root canal treatment for pain and swelling in the mandibular, anterior area (see illustration). He notes that his dentist has been treating teeth nos. 25 and 26 for several months and that swelling has occurred after each visit for cleaning and shaping. Clinical examination reveals swelling located on the alveolar process in the area of the incisor teeth. Teeth nos. 25 and 26 are tender to palpation and percussion. The clinician should perform which of the following?
Diagnostic tests on the other incisor
b. Open teeth nos. 25 and 26, débride these teeth, and place calcium hydroxide as an antimicrobial intracanal medicament c. Open teeth nos. 25 and 26, débride these teeth, and perform incision and drainage
d. Open teeth nos. 25 and 26, débride these teeth, and leave the teeth open for drainage e. Perform incision and drainage and prescribe an antibiotic for supportive care
23. A cusp fractures in a noncarious, nonrestored premolar so that dentin is exposed. When this exposed dentin is contacted by cold fluids, the patient experiences brief, sharp pain. Which of the following pulp status is likely? a. b. c. d. 24. a. b. c. d. e. Normal and uninflamed Reversibly inflamed Irreversibly inflamed Innervated only by A-delta fibers Corticosteroids have their major pharmacologic effect as which of the following? Antimicrobial agent Analgesic Antiinflammatory agent Agent to reduce swelling Agent to prevent spread of infection
CHAPTER 3: NONODONTOGENIC OROFACIAL PAIN AND ENDODONTICS: PAIN DISORDERS INVOLVING THE JAWS THAT SIMULATE ODONTALGIA
1. Peripheral pain impulses in the dental pulp are transmitted centrally via which of the following pathways? a. b. Peripheral nerve, trigeminal nucleus, trigeminal ganglion, thalamus, cortex Peripheral nerve, trigeminal ganglion, mesencephalic nucleus, thalamus, cortex
c. Peripheral nerve, trigeminal ganglion, trigeminal nucleus, mesencephalic nucleus, cortex d. Peripheral nerve, trigeminal ganglion, trigeminal nucleus, thalamus, cortex
2. Each of the following statements regarding trigeminal neuralgia is correct, except for one. Which is the exception?
a. The empiric evidence suggests vascular compression of the trigeminal ganglion as a cause of trigeminal neuralgia. b. c. d. e. 3. The pain involves all three divisions of the trigeminal nerve equally. There is an electrical quality of the pain. The pain is severe, often shooting into the bone and teeth. The standard medical therapy is carbamazepine (i.e., Tegretol). Which of the following statements regarding cluster headaches is correct? a. Vessels that encircle nociceptive fibers compress the fibers during vasoconstriction, causing pain. b. The pain is usually unilateral and involves the maxilla, sinus, and retro-orbital area. c. d. Cluster headaches frequently involve females between 40 and 60 years of age. The pain, which is severe and lasts for 30 to 45 minutes, can occur at anytime.
4. Each of the following has been shown to benefit patients with cluster headaches, except for one. Which is the exception? a. b. c. d. e. Nifedipine Prednisone in combination with lithium Hyperbaric oxygen Alcohol Sumatriptin
5. A 57-year-old man complains of pain in the mandibular, left, posterior quadrant. The patient relates sporadic, spontaneous pain during his waking hours for the past 1 to 2 weeks. Upon examination no dental cause can be identified. Which of the following would be the most likely cause of the pain? a. b. Cluster headache Myalgia
c. d. e.
Cardiogenic jaw pain Temporal arteritis Otitis media
6. Each of the following statements regarding maxillary sinusitis is correct, except for one. Which is the exception? a. Pain is often referred to all teeth in the maxillary, posterior quadrant with percussion sensitivity being a common finding. b. The maxillary sinusitis may be initiated by a tooth with a necrotic pulp located in the maxillary, posterior area. c. Treatment of the sinusitis requires referral to an otolaryngologist and antibiotic therapy. d. The Waters view radiograph may be of diagnostic value in demonstrating fluid.
e. An allergen-induced inflammation of the sinus is an immediate-type hypersensitivity reaction mediated by IgE. 7. Which of the following statements regarding sialolithiasis is correct? a. The sialolith develops in patients that often exhibit increased levels of serum calcium. b. Pain may mimic pulpal pain in the maxillary, posterior teeth because sialolithiasis is most frequently noted in parotid duct. c. An occlusal radiograph provides more diagnostic information than a panoramic film. d. Sialolithiasis has been associated with kidney stones and gallbladder stones, so patient's exhibiting this disorder should be referred to a physician for evaluation. 8. Which of the following statements regarding myofascial pain is correct? a. Trigger points found in the superficial aspect of the masseter may refer pain the maxillary teeth and mandibular teeth. b. Trigger points have been noted only in the masseter muscles and temporalis muscles.
c. Initial treatment consists of finding occlusal discrepancies and performing an equilibration. d. Meniscus displacement and intraarticular adhesions are the cause, and corrective surgery provides long-term success. 9. Each of the following statements regarding malignant lesions of the head and neck is correct, except for one. Which is the exception? a. b. c. d. 10. a. b. Although paresthesia is an ominous symptom, motor deficits are rare. Metastatic lesions may develop from the lung, breast, and colon. Radiolucent areas detected on radiographs are frequently poorly marginated. Multiple myeloma may produce pain in the affected bone. Which of the following statements regarding atypical orofacial pain is false? The pain is often chronic, difficult to localize, and there is no identifiable cause. The pain has no specific symptoms that lead to a diagnosis.
c. Patient's with atypical orofacial pain may give a history of having endodontic treatment that did not alleviate the pain. d. Patient's with atypical orofacial pain complain of pain in other areas of the body.
e. Neuralgia-inducing cavitational osteonecrosis (NICO) is distinct from atypical orofacial-pain disorders. 11. a. b. c. Which of the following statements accurately describe phantom tooth pain? It occurs in 10% of the patients having endodontic treatment. It may be a form of deafferentation pain. It has been shown to have a psychopathologic component.
d. It has been associated with tooth extraction but does not occur with extirpation of the pulp.
CHAPTER 4: PLANNING
CASE SELECTION AND TREATMENT
1. Which of the following statements regarding the use of electronic-apex locators is accurate? a. b. c. d. The patient is physically impaired. Anatomic structures overlay the root apex. A pregnant patient wishes to avoid exposure to x-rays. All of the above statements are accurate.
2. Antibiotic prophylaxis is suggested for patients with a history of which of the following? a. b. c. d. e. 3. a. b. c. d. 4. a. b. c. Coronary bypass surgery Atrial fibrillation Artificial heart valve replacement Myocardial infarction Rheumatic fever Elective endodontic treatment is contraindicated in which of the following? Patient is a borderline diabetic. Patient has had a heart attack within the last 6 months. Patient has had numerous opportunistic infections secondary to HIV infection. Patient has an implanted pacemaker. Which of the following accurately describes external resorptions? They are untreatable. They can only be distinguished surgically from internal resorptions. They appear to be superimposed over the root canal.
d. 5. a. b. c. d.
They always require root canal treatment. Referral of difficult cases is indicated in which of the following? The general dentist does not have the indicated equipment. The general dentist does not have the indicated training and experience. The general dentist is not sure what procedures are indicated. All of the above
6. Which of the following statements regarding one-appointment root canal treatment is accurate? a. b. c. d. It is best performed in association with trephination or root end surgery. It may predispose the patient to postoperative flare-ups. It is equally successful as multiple-appointment root canal treatment. All of the above statements are accurate.
7. Single visit is equivalent in outcome to multiple visits (to complete RCT) with what situation? a. b. c. d. 8. a. b. c. d. Vital pulp with acute pain Necrotic pulp with acute pain Necrotic pulp without pain Necrotic pulp with a draining sinus tract Root end surgery is indicated for endodontic failure in which of the following? The dentist suspects a missed canal. There has been coronal leakage. A cast post and core and a well-fitting crown are present. All of the above
9. Prognosis for root canal treatment is worse when the patient is experiencing which of the following? a. b. c. d. 10. a. b. c. d. 11. a. b. c. d. e. Pain as a symptom Interappointment flare-up Class III mobility and loss of bone support (i.e., probing defects) Small, periradicular, radiolucent lesion When is endodontic treatment is contraindicated? The patient has no motivation to maintain the tooth. The canal appears to be calcified. A large periapical lesion is present. The tooth needs periodontal crown lengthening before restoration. With pregnancy, the safest period to provide dental care is during which month? First Second and third Fourth to the sixth Seventh and eighth There is no period that is most safe.
12. A preoperative finding that predisposes to a decreased prognosis (i.e., lowersuccess rate) is which of the following? a. b. c. d. e. The tooth is in hyperocclusion. The pulp is vital. The pulp is necrotic with no periradicular lesion. The pulp is necrotic with a periradicular lesion present. Treatment is in an elderly patient.
PREPARATION FOR TREATMENT
1. Which of the following statements describes human immunodeficiency virus (HIV)? a. b. c. HIV is more easily transmissible than Hepatitis B. HIV is more fragile than the Hepatitis B virus. HIV is a good model for infection control practices.
2. Which of the following statements regarding Occupational Safety and Health Administration (OSHA) standards is accurate? a. b. c. d. The standards are established to protect the dentist. They mandate that employees be offered the HIV vaccine. They include engineering and work practice controls. They do not impose financial penalties.
3. Which of the following statements regarding informed consent information for endodontic therapy is accurate? a. b. c. d. It must be freely given. It includes prognosis for the recommended treatment and also the alternatives. It includes the opportunity to ask questions. All the above statements are accurate.
4. Which of the following statements regarding radiation exposure from a single, full-mouth survey is accurate? a. b. c. 5. It is half that of a single chest film. It is comparable to a barium study of the intestines. It would be sufficient to cause skin cancer if all exposures were at one site. While exposing films, dental personnel should do which of the following?
a. b. c.
Stand back at least 6 feet in an area that is 90 to 135 degrees from the beam Stand behind a plaster, cinderblock, or 1-inch drywall barrier Wear a lead apron
6. The recommended antibiotics for a patient with a total joint replacement who is allergic to penicillin or cephalosporin is which of the following? a. b. c. d. Amoxicillin Erythromycin Clindamycin Tetracycline
7. The most effective method for controlling pain that often occurs after cleaning and shaping is to administer which of the following? a. b. c. d. Analgesic shortly before the procedure Equal amounts of the analgesic before and during the procedure Analgesic at the conclusion of the procedure Analgesic with instructions to the patient to take if necessary
8. Which of the following statements regarding the long-cone paralleling technique is accurate? a. b. c. 9. a. b. c. It minimizes distortion of tooth dimension. It minimizes superimposition of the infraorbital rim for maxillary molars. It requires the film be placed directly touching the tooth without bending the film. Radiographic contrast can be directly affected by altering which of the following? Milliamperage Exposure time Kilovoltage
10. An advantage of digitized radiography in endodontic treatment is which of the following? a. b. c. 11. a. b. c. d. Image quality is better for working length radiographs. X-ray generating source is not required. Radiation exposure is reduced. In which of the following situations is a rubber dam not placed? When the clamp impinges on the gingiva, causing discomfort When the chamber or canal may be difficult to locate on access When the tooth is rotated, preventing placement of a clamp on the indicated tooth None; there are no situations in which a rubber dam is not placed.
12. To enhance crown preparation and retention when an infrabony defect exists, crown lengthening is completed by which of the following? a. b. c. d. 13. a. b. Electrosurgery Gingivectomy Laser surgery Apically positioned flap, reverse bevel Of the following, which statement accurately describes radiograph units? It should be optimally capable of using 70 kVp. It should be pointed (i.e., cone) in shape.
c. It should be collimated to reduce exposure level, not to exceed 7 cm at the skin surface. d. It should have a filtration equivalent of 10 mm of aluminum.
14. With the cone moved to the distal and directed toward the mesial, which of the following accurately describes the mesiobuccal root of the first molar?
a. b. c. d. 15.
It is projected mesially on the film. It is projected distally on the film. It does not move. It is projected lingually on the film. The cone angulation in the following illustration is which of the following?
a. b. c. d.
Mesial Distal Parallel Bisecting
16. The radiopaque structure overlying the buccal roots in the following illustration is which of the following?
a. b. c. d.
Zygoma Floor of the maxillary sinus Coronoid process Eyeglass frame
17. Which of the following is the best way to "move" the structure in the previous illustration away from the buccal apexes of both molars? Reposition the cone a. b. c. d. 18. Inferiorly (i.e., decrease the vertical angle) Superiorly (i.e., increase the vertical angle) Mesially (i.e., the beam is directed more distally) Distally (i.e., the beam is directed more mesially) Why does the tooth in the following illustration appear elongated?
a. b. c. d.
There was excessive, positive-and-vertical angle to the cone. There was insufficient, positive-and-vertical angle to the cone. The film was not parallel to the tooth. The film was bent.
19. The radiopaque structure (arrow) in the following illustration is which of the following?
a. b. c. d.
Condensing osteitis Trabeculation Lamina dura Root surface
20. The view in the following radiograph is a mesially angled (beam is directed distally) film. The unobturated root is which of the following?
Buccal root Lingual root
21. Of the following, the best way to identify the source of the radiolucency (arrow) in the following illustration is which of the following?
a. b. c. d.
Pulp test Incisional biopsy Excisional biopsy Observation over time to evaluate for changes
ARMAMENTARIUM AND STERILIZATION
1. The patient is exposed to the least amount of radiation when which of the following is used? a. b. c. Digital imaging Ektaspeed film Ultraspeed film
2. a. b. c. 3. a. b. c. d.
Patients with a latex allergy can be treated how? Safely without a rubber dam With a rubber dam if there is no direct skin contact With a nonlatex, rubber dam The temporary restorative material, Cavit, is which of the following? Type of zinc oxide-eugenol (ZOE) material Superior to other materials in in vitro resistance to bacterial leakage Prepared by mixing a powder and liquid More durable than intermediate restorative material (IRM) or composite
4. The best way to clean dental instruments before sterilization is by which of the following? a. b. c. 5. a. b. c. d. Ultrasonic cleaning for 5 minutes in a perforated basket Hand scrubbing, using a brush and heavy rubber gloves Rinsing under a forceful water spray Steam sterilization is achieved when the load has reached which of the following? 250° C for 15 minutes 250° F for 15 minutes 250° C for 30 minutes 250° F for 30 minutes
6. An advantage of rapid-steam autoclave over traditional autoclave is which of the following? a. b. c. Rapid-steam autoclave will not corrode steel instruments. Rapid-steam autoclave is safe for all types of materials. Instruments do not have to be air dried at the end of the cycle.
Rapid-steam autoclave has a shorter sterilization cycle than traditional autoclave.
7. Of the following, which statement accurately describes a chemical vapor sterilizer? a. b. c. d. It uses a reusable chemical. It requires adequate ventilation in the area where it is used. It achieves sterilization when heated to 270° F at 20 psi for 10 minutes. It does not destroy heat-sensitive materials.
8. An approved method for reducing microorganisms in water output from dental units is which of the following? a. b. c. Filters at the water source Flushing the water line before attaching it to the hand piece or syringe Retrograde (i.e., reverse) flushing of all water lines
d. Careful sterilization of water lines within hand pieces and syringes between patients e. 9. a. b. c. d. 10. a. b. c. Installation of sterile water delivery systems Gutta-percha is best sterilized by which of the following? Immersion in full-strength sodium hypochlorite Immersion in rubbing alcohol Dry heat Bead sterilizer The effect of sterilization on endodontic files is which of the following? Negative and proportional to the number of times sterilized Neutral; no effect is seen on physical properties Positive; it restores to the files flexibility lost over time
11. a. b. c. d. e.
The most reliable agent for destroying microorganisms is which of the following? Chemical sterilizing agents Hot water Ultrasonics X-ray irradiation Heat
12. A good, two-stage technique (i.e., two burs in sequence) for access through a porcelain fixed-to-metal crown is which of the following? a. b. c. d. e. Stainless steel (SS), round-diamond, coated fissure Diamond-coated, round-carbide, end-cutting fissure SS fissure, carbide, end-cutting fissure carbide, round-diamond, coated, round fissure SS, round-carbide, end-cutting fissure
13. An advantage that nickel titanium (NiTi) has over SS for intracanal instruments is which of the following? a. b. c. d. e. Lower cost More resistance to breakage Sharper More uniform in shape More flexibility
CHAPTER 7: TOOTH MORPHOLOGY AND CAVITY PREPARATION
1. a. Which of the following statements describes dens-endente? It occurs primarily in maxillary, lateral, incisor teeth.
b. It requires the use of a long-shank bur for access because the pulp chamber is located in the middle portion of the root. c. d. It results in an untreatable, periodontal pocket. It produces an evagination of dentin and enamel in mandibular premolars.
2. The incidence of three roots and three canals in maxillary first premolars is which of the following? a. b. c. d. 3. Less than 1% 3% 6% 10% Vertucci noted in maxillary second premolars which of the following? a. When two canals were present and join at the apex, the lingual canal is the straightest. b. c. The incidence of two canals at the apex was high, approaching 75%. The incidence of accessory canals found in the furcation was 59%.
d. Histologically, calcification correlated with the radiographic narrowing of the canal space. 4. In their study of maxillary molars, Kulild and Peters noted which of the following? a. Although two canals were often present in the mesiobuccal roots, the canals merged apically. b. The use of magnification did not increase the number of canals found clinically in this tooth group. c. The orifice to a second canal in the mesiobuccal root was distal to the main orifice in a line connecting the mesiobuccal canal to the palatal canal. d. A high incidence of two canals with separate foramina in the mesiobuccal root (71%).
5. When treating a mandibular incisor with two canals evident on the preoperative radiograph, which of the following statements are true? a. b. c. d. 6. a. b. c. d. The internal morphology of the canals will be ribbon shaped. A facial-access opening might be considered. The canals often remain separate and distinct throughout the root. The access opening should be triangular with the apex at the cingulum. Which of the following teeth is most likely to exhibit C-shaped morphology? Maxillary first premolar Maxillary first molar Mandibular first premolar Mandibular first molar
7. In their study of mandibular molars, Skidmore and Bjorndal noted which of the following? a. The access opening should be rectangular.
b. When there were two canals in the distal root, they remained distinct with separate apical foramina. c. The incidence of four canals was over 50%.
d. The mesiobuccal canal was located under the mesiobuccal cusp tip and exhibited the straightest morphology. 8. The mandibular, second molar should be restored with a crown after endodontic treatment for which of the following reasons? a. The pulp chamber is relatively large in comparison to the crown, making the tooth susceptible to fracture. b. The tooth is in close to the insertion of the muscles of mastication, and the percentage of preexisting fractures is high. c. There is a tendency for the buccal cusps to shear off under occlusal loading.
Providing a post can be placed in the distal root to strengthen the root.
9. Which of the following statements regarding the mandibular, second molar exhibiting a C-shaped morphology is correct? a. The root morphology varies with two separate-and-distinct roots being a common finding. b. Research indicates that the presence of a C-shaped canal is most common in Caucasians. c. The C-shaped molar exhibits a ribbon-shaped orifice with a 180-degree arc beginning in the mesiobuccal area and forming an arch extending lingually to the distobuccal. d. The mesiolingual canal is often noted to be separate and distinct, exhibiting a separate foramen. 10. A 30-year-old male patient is being treated for a maxillary central incisor that he traumatized as a teenager. Radiographically, the canal appears calcified and there is evidence of apical pathosis. After attempting access the canal cannot be located despite drilling into the middle third of the root. Which of the following statements regarding further treatment is false? a. Radiographs may indicate the orientation of the access opening within the root.
b. The risk of perforation will be greatest on the lingual surface, should the clinician continue. c. The clinician should consider obturating the coronal segment and performing root end surgery. d. Because canals become less calcified as they proceed apically, a pathfinder might be used to negotiate the residual canal space.
CHAPTER 8: CLEANING AND SHAPING THE ROOT CANAL SYSTEM
1. Which of the following statements regarding shaping procedures is false? a. Shaping is performed after cleaning of the apical one third of the canal to ensure patency.
b. Shaping facilitates placement of instruments to the working length by increasing the coronal taper. c. Shaping permits the a more accurate assessment of the apical, cross-sectional canal diameter. d. Shaping is a necessary procedure because calcification occurs from the coronal portion of the canal to the apex. 2. Which of the following statements best describes the Profile Series 29 files? a. The Profile Series 29 files conform to the International Standards Organization (ISO) specifications for instrument design. b. The instruments exhibit a constant percentage change between successive instruments. c. The Profile Series 29 files were designed to facilitate preparation of the coronal portion of the radicular space. d. The instruments are most useful in the larger sizes because there is a smaller change in diameter between the files. 3. Each of the following are direct advantages of pre-enlarging the radicular space, except for one. Which is the exception? a. It provides better tactile control of instruments when negotiating a small, curved canal. b. c. d. It removes the bulk of tissue and contaminants before apical preparation. It facilitates obturation. It provides a reservoir for the irrigant.
4. The result of root canal treatment in establishing patency is which of the following? a. It revents procedural errors, such as canal blockage and transportation.
b. It causes irritation of the periodontal attachment apparatus and increased postoperative pain.
c. It enlarges the apical terminus and increases the potential for extrusion of obturating materials. d. 5. It requires insertion of a file 1.0 to 2.0 mm beyond the canal terminus. Which of the following statements regarding gauging and tuning is correct? a. Gauging is performed in the coronal portion of the canal to confirm the coronal enlargement is complete. b. Tuning identifies the most apical, cross-sectional diameter of the canal.
c. Gauging and tuning verify the completed shaping of the apical portion of the canal. d. Gauging and tuning produces a uniform, cylindric diameter to the canal in the apical 2 to 3 mm that enhances obturation and sealing. 6. a. b. c. d. Which of the following statements best describes the Quantec files? The instruments have a constant helical angle and three flutes. The recommended rotational speed is 1000 to 2000 RPM. The instruments exhibit a constant rate of taper along their length. The instruments exhibit varied tapers with a constant D0 diameter of 0.25 mm.
7. Which of the following statements regarding the use of chelating agents in canal preparation is correct? a. Aqueous solutions are preferred to viscous suspensions in canal preparation.
b. Viscous suspensions are more effective in preventing accumulation of tissue and dentinal debris. c. Viscous suspensions contain the highest concentration of ethylenediaminetetracitic acid (EDTA) and are most effective in removing the smear layer. d. Aqueous solutions are most efficient as lubricants and, therefore, preferred to viscous suspensions during canal preparation.
e. EDTA, in concert with sodium hypochlorite, causes a nascent release of oxygen, which kills anaerobic organisms. 8. Which of the following statements regarding an endogram is false? a. An endogram would provide information on the extent of internal resorptive lesion. b. The visualization of fractures and leaking restorations is attributed to the incorporation of Hypaque in the irrigating solution. c. Conventional radiography and digital radiography may both be used in producing an endogram. d. 9. The endogram is used to confirm the correct working length. During the early phase of root canal preparation, which of the following is true? a. The initial scouter file that moves easily through the canal should be advanced to the estimated working length. b. The initial scouter file may not advance to the estimated working length because of the rate of instrument paper. c. The initial scouter file should be advanced with a reciprocating action using apical pressure when resistance is encountered. d. The initial scouter file is used before the introduction of a viscous chelator in cases exhibiting vital tissue. 10. Which of the following statements is correct regarding coronal canal preparation in endodontic treatment? a. Nickel-and-titanium (NiTi) rotary instruments are preferred to Gates-Glidden (GG) drills because they remove dentin uniformly from the canal wall. b. NiTi rotary instruments are best used in a step-back fashion.
c. Both GG drills and NiTi rotary instruments should be used large to small, because this develops a preparation that is centered in the root. d. GG drills used in a step-back technique can relocate the canal away from the furcal wall.
11. When using the balanced-force technique for canal preparation, which of the following statements is accurate? a. The cutting stroke involves apical pressure and a counterclockwise rotation.
b. Clockwise rotation balances the tendency of the file to be drawn into the canal during the cutting stroke. c. Dentin is engaged with a counterclockwise rotation and cut with a 45- to 90degree, clockwise rotation. d. It requires the use of a crown down technique.
12. Extending a no. 10 file with a 0.02 taper 1.0 mm beyond the apical foramen will result in which of the following? a. b. c. It opens the apical foramen to a minimum diameter of 0.12 mm. It increases postoperative discomfort to occlusal forces. It reduces the percentage of change from a no. 10 file to a no. 15 file by 50%.
d. It eliminates the natural constriction of the foramen and increases the chance for an overfill.
CHAPTER 9: OBTURATION OF THE CLEANED AND SHAPED ROOT CANAL SYSTEM
1. Of the following, the least important determinant of root canal treatment success is which of the following? a. b. c. Proper placed restoration after root canal treatment Healthy periodontium Three-dimensional (3-D) obturation of the root canal system
2. Paraformaldehyde-containing obturating materials result in which of the following? a. b. Eliminate bacteria that remains in the canals Mummify tissue remnants in the canals
Reduce posttreatment pain Are below the standard of care for root canal treatment
3. It is preferable to not extrude sealer beyond the apex for which of the following reasons? a. b. c. d. 4. a. b. c. d. 5. a. b. c. d. e. The sealer usually does not resorb. The sealer often stains or tattoos the tissue. The sealer is a tissue irritant and may delay healing. The sealer promotes bacterial growth. Gutta-percha in contact with connective tissue is which of the following? Relatively inert Immunogenic unstable Carcinogenic The primary reason to use a sealer and cement is which of the following? Attainment of an impervious seal Canal disinfection Lubrication of the master cone Adhesion to dentin All of the above
6. Considering lateral versus vertical condensation, studies have shown which of the following? a. b. c. Lateral condensation results in a better seal. Vertical condensation results in a better seal. Both consistently fill lateral canals.
d. 7. a. b. c. d.
Sealability with either largely depends on the shape of the prepared canal. A problem with nickel-and-titanium (NiTi) spreaders is which of the following? Tendency to buckle under compaction pressure Tendency to break during condensation Creation of greater wedging forces, leading to root fracture They do not penetrate as deeply as stainless steel (SS) spreaders under equal force
8. Moderate extrusion of obturating materials beyond the apex is undesirable because of which of the following? a. There is more likelihood of postoperative discomfort.
b. Sealer and gutta-percha cause a severe, inflammatory reaction in periradicular tissue. c. d. 9. a. b. c. d. 10. a. b. c. d. 11. The prognosis is poorer. All of the above In which of the following is one-visit root canal treatment not recommended? The pulp is necrotic and not symptomatic. The pulp is necrotic and symptomatic. The pulp is necrotic and there is a draining sinus tract. The pulp is vital and symptomatic. When is an application of heater-injected gutta-percha potentially beneficial? When there is an open apex When there are aberrations or irregularities of the canal When the clinician cannot master lateral condensation When the canals are curved and small after preparation Which of the following statements accurately describe an adequate apical seal?
a. b. c.
It can only be achieved with lateral condensation. It depends on placing the compacting instrument close to the apical terminus. It can be achieved in small, nontapering canal preparations.
12. Which of the following statements accurately describe the continuous-wave technique? a. b. c. d. It uses a heat carrier that can both compact and heat gutta-percha. It is superior to other warm-compaction techniques. It has been shown to provide a better prognosis than cold-compaction techniques. It has been shown to have no adverse effects on the periodontium.
13. An advantage of the continuous-wave technique over warm, vertical compaction is which of the following? a. b. c. d. 14. a. b. c. d. The continuous-wave technique is faster. The continuous-wave technique adapts better to canal irregularities. The continuous-wave technique is not technique sensitive. No special devices are necessary. The most likely cause of a gross overfill is which of the following? Lack of an apical seat or stop Use of excessive amounts of sealer Use of excessive apical pressure on the spreader Use of a master cone that is too small
15. The obturation of the incisor shown in the following illustration is inadequate because of which of the following?
It appears short of the prepared length.
b. There is variable radiodensity (i.e., incomplete condensation) throughout its length. c. There is a space between the temporary restoration and the gutta-percha.
d. The diagnosis was pulp necrosis and chronic apical periodontitis; the canal should be filled to the apical foramen. 16. The dark tooth in the following illustration has a history of trauma and root canal treatment. It is likely that the discoloration is primarily caused by which of the following?
a. b. c. d.
Remnants of necrotic tissue A leaking restoration Blood pigments in the dentinal tubules Obturating materials not removed from the chamber
17. Of the following, what is the most likely cause of failure of root canal treatment on the lateral incisor in the illustration?
a. b. c. d.
The silver point corrodes. The canal is filled too close to the apex. There is coronal leakage. The silver point does not adapt to the prepared space.
RECORDS AND LEGAL RESPONSIBILITIES
1. Concerning making changes in a patient record, which of the following statements is accurate?
a. b. c. 2. a.
Any changes are forbidden. Deletions are permitted if erased completely as soon as they occur. Corrections are permitted, if dated. Standard of care, as defined by the courts, is which of the following? Requires absolute perfection
b. Describes what any careful-and-prudent clinician would do under similar circumstances c. d. 3. a. b. c. d. Does not allow for individual variations of treatment Is equivalent to customary practice The doctrine of informed consent does not require which of the following? Patients to be advised of reasonably foreseeable risks of treatment Patients to be advised of reasonable alternatives Patients forfeit their right to do as they see fit with their body. Patients be advised of the consequences of nontreatment.
4. Which of the following statements accurately describe a periodontal examination of a patient referred for endodontic treatment? a. b. c. d. 5. a. b. c. It should performed on the entire dentition. It must be performed at least on the tooth to be treated. It is necessary only if there is evidence of periodontal disease. It is necessary only if requested by the referring dentist. A dentist may legally do which of the following? Refuse to treat a new patient, despite severe pain and infection Be bound to see a former patient on recall after treatment is completed Discharge a patient from the practice at any time
Refuse to treat a patient who has an outstanding account balance
6. If a patient with human immunodeficiency virus (HIV) requests that the dentist not inform the staff of the condition, the dentist should do which of the following? a. b. c. Refuse to treat the patient Tell the staff in private, and then treat the patient with extra precautions Not tell the staff but treat the patient with great caution
d. Not tell the staff and require the patient to assume liability should anyone contract the virus 7. a. A specialist may be held liable if which of the following occurs? Informs the patient that the general practitioner performed substandard care
b. Fails to disclose to the patient or referring dentist evident pathosis on teeth other than those the specialist is treating c. Fails to locate a small canal that is not evident radiographically
d. Mistakenly initiates treatment on the wrong tooth in a difficult diagnostic situation 8. Of the following, which is the best way for clinicians to avoid legal actions by patients? a. b. c. d. 9. a. b. 10. Tell patients they have no malpractice insurance. Attend continuing education courses to remain informed of current techniques. Refer all major patient complaints to peer review. Demonstrate genuine interest in the welfare of the patient. Computerized treatment records may not be signed electronically. True False Suing to collect fees is a proven route to being counter sued for malpractice.
a. b. 11. a. b. c.
True False Standard of care for routine endodontics is set by which of the following? The state's dental licensing agency Endodontists The community of general dentists
12. A patient continues to have pain after a dentist uses the technique of Paraformaldehyde paste pulpotomy on a tooth with a necrotic pulp and apical pathosis and then places a crown. In this situation, which of the following statements is true? a. The dentist is liable for malpractice because unacceptable treatment procedures were followed. b. The dentist is not liable if the patient is now referred to the appropriate specialist who can treat the case. c. The dentist is not liable if the dentist performs additional treatment for no fee.
CHAPTER 11: STRUCTURE AND FUNCTIONS OF THE DENTIN AND PULP COMPLEX
1. In the process of tooth development, which of the following statements are true? a. The basement membrane separating the inner dental epithelium from the dental mesenchyme is composed of type I and III collagen. b. Blood vessels become established in the dental papilla during the cap stage.
c. Mature ameloblasts appear before odontoblasts mature. However, the formation of enamel takes place following the deposition of dentin. d. e. 2. The II collagen mRNA increase with odontoblastic differentiation. Ameloblasts form enamel spindles near the future dentinoenamel junction (DEJ). von Korff fibers are best described as which of the following?
a. b. c. d. 3. a.
The first-formed collagen fibers formed between preodontoblasts. Unmyelinated sensory fibers in the cell-free zone of Weil Odontoblastic processes interposed between ameloblasts Silver-stained ground substance located between odontoblasts Which of the following statements regarding root development is false? Root development begins after completion of enamel formation.
b. The inner epithelium, the stellate reticulum, and outer enamel epithelium form Hertwig's epithelial root sheath. c. The dental sac disintegrates upon induction of dentin formation and remnants persist as the Epithelial Rests of Malassez. d. Accessory canals in the root are formed when there is discontinuity in the root sheath. 4. Which of the following statements regarding dentin is correct? a. Mantle dentin is the first formed dentin and has collagen fibers that run perpendicular to the DEJ. b. Dentin deposited after eruption is termed secondary dentin.
c. Dentinal tubules make up 50% of the dentin volume and they exhibit extensive terminal ramifications. d. Calcification of dentin results in an organic component composed of noncollagenous matrix components. 5. Which of the following statements regarding the tubular structure of dentin is correct? a. Peritubular dentin and intertubular dentin are the same composition, except for the fact peritubular dentin lines the tubule. b. Peritubular dentin has a lower-collagen content when compared to intertubular dentin and is more susceptible to removal by acids.
c. Intertubular dentin is more highly mineralized when compared to peritubular dentin. d. 6. Peritubular dentin defines the tubule size and is common to all mammals. Which of the following statements regarding dentin permeability is true? a. Remains constant regardless of the depth of a cavity preparation because of a pulpal tissue pressure of 10.3 mm Hg b. Increases as the pulp and dentin border is approached (primarily because the tubular surface area increases) c. Is lower in radicular dentin because of tubular sclerosis
d. Increases near the pulp and dentin border as the hydrostatic pressure in the tubules decreases 7. Which of the following statements regarding tight junctions in the odontoblastic layer is true? a. They regulate permeability of extracellular substances between the odontoblastic layer and the predentin. b. They permit low-resistance pathways for electrical excitation when the odontoblastic process is distorted. c. d. They provide a mechanism for intracellular materials to be exchanged. They are infrequent but when found are located in the basal portion of the cells.
8. Which of the following statements regarding production of collagen by the odontoblast is correct? a. Type I collagen is manufactured in the cellular cytoplasm, packaged by the Golgi complex, and released by reverse pinocytosis. b. Tropocollagen is synthesized in the rough endoplasmic reticulum (RER) and packaged in the Golgi complex. Vesicles consisting of collagen fibrils migrate into the odontoblastic process and are released. c. The Golgi complex packages collagen precursors (e.g., proline) into vesicles that are released into the predentin. These then precipitate to form tropocollagen and, eventually, collagen fibrils.
d. Synthesis begins in the RER with procollagen being packaged in the Golgi complex. Vesicles are formed and release tropocollagen in the predentin matrix. 9. Which of the following statements regarding dendritic cells is false? a. Dendritic cells are similar to Langerhans' cells and play a significant role in induction of T-cell immunity. b. Although not normally present in the healthy pulp, dendritic cells appear during inflammation and, like macrophages, are phagocytic. c. Considered accessory cells, the dendritic cell participates in antigen recognition and presentation. d. Dendritic cells are primarily found in lymphoid tissues.
10. Which of the following statements regarding the extracellular matrix of the pulp is false? a. The extracellular matrix changes with eruption of the tooth as the chrondroitin sulfate concentration decreases and the hyaluronic acid and dermatan sulfate fraction increase. b. c. The proteoglycans regulate the dispersion of interstitial solutes. The state of polymerization of the ground substance regulates osmotic pressures.
d. The water content of the extracellular matrix is relatively low, giving the tissue a colloidal consistency and limiting movement of components within the tissue. 11. Teeth with immature root development often are unresponsive to electrical pulp testing because which of the following? a. b. c. Myelinated fibers are the last structures to appear in the developing pulp. Predentin and intratubular fibers are not present until root formation is complete. There is a relative hypoxic condition of the pulp during developmental glycolysis.
d. Electrical stimulation of autonomic fibers decreases blood flow and depresses Adelta fiber activity. 12. Each of the following statements support the hydrodynamic theory for pain, except for one. Which is the exception?
a. Odontoblasts have a low-membrane potential and do not respond to electrical stimulation. b. Placement of local anesthetics on dentin does not alter the pain response.
c. There is a positive correlation between fluid movement in the tubules and the discharge of intradental nerves. d. Forty percent of the tubules in the area of pulp horns contain intratubular nerve endings. e. The presence of a smear layer decreases dentinal sensitivity.
13. Which of the following statements regarding a patient that has a sharp, short sensation to cold that resolves immediately with removal of the stimulus is correct? a. b. c. The patient's response indicates inflammation and tissue damage. A-delta and C fibers are responsible for the painful sensation. A-delta and A-beta fibers are being stimulated.
d. C-fibers are responding to the release of inflammatory mediators, such as bradykinin and substance P. 14. Which of the following statements regarding pulpal bloof flow is correct?
a. Blood flow within the pulp is homogenous with arteriovenous anastomoses maintaining an even flow. b. Unmyelinated, sympathetic fibers innervating the arterioles and venules produce vasoconstriction. c. The pulpal blood flow is the highest of oral tissues because of the relatively high metabolic activity of the pulp. d. Accessory and lateral canals provide adequate collateral circulation.
15. Which of the following statements outlines the most significant factor influencing the pulp's response to injury and compromised healing? a. Inflammatory cells, such as polymorphonuclear leukocytes and B-lymphocytes, are not found in the normal pulp.
b. c. d. e. 16.
There is a lack of a collateral circulation. Odontoblasts are end line cells incapable of replication. The fact that the pulp may not have a lymphatic system. The environment of the dental pulp is low compliant. Which of the following statements regarding age changes in the pulp are false?
a. There is a decrease in the cellularity and collagenous fibers, especially in the radicular pulp. b. Odontoblasts decrease in size and may disappear completely in some areas, particularly the pulpal floor of multirooted teeth. c. d. There is a reduction in the nerves and vasculature of the pulp. There is an increase in peritubular dentin.
e. The pulp demonstrates an increased resistance to the action of proteolytic enzymes.
1. a. b. c. d. 2. a. b. c.
PATHOBIOLOGY OF THE PERIAPEX
Inflammation of the periapical tissue is sustained by which of the following? Stagnant tissue fluid Necrotic tissue Microorganisms All of the above Acute, apical periodontitis is characterized by which of the following? A focus of neutrophils within the lesion A focus of granulomatous tissue in the lesion A focus of lymphocytes, plasma cells, and macrophages in the lesion
3. A periapical, true cyst communicates with the root canal; however, a periapicalpocket cyst does not. a. b. True False
4. The most important route of bacteria into the dental pulp is from which of the following? a. b. c. The general circulation via anachoresis Exposure to the oral cavity via caries The gingival sulcus
5. The least important factor influencing the pathogenicity of endodontic flora is which of the following? a. b. c. d. 6. a. b. c. d. 7. a. Microbial interaction Endotoxins released after bacterial death Exotoxins released by living bacteria Enzymes produced by bacteria Which of the following statements regarding neutrophils is accurate? They are nonspecific phagocytes. They have a single pathway for intracellular killing. They are mobilized primarily to neutralize bacterial endotoxins. All of the above are accurate. Which of the following statements regarding T-lymphocytes are accurate? They are thyroid-derived cells.
b. They concentrate in the cortical area of lymph nodes and also circulate in the blood. c. They are responsible for the cell-mediated arm of the immune system.
d. 8. a. b. c. d. 9. a. b. c. d. 10. a. b. c. d.
All of the above statements are accurate. Which of the following statements regarding B-lymphocytes are accurate? They were originally discovered in an avian gut-associated organ. They account for the majority of circulating lymphocytes. They produce antibodies. All of the above statements are accurate. The function(s) of macrophages include(s) which of the following? Phagocytosis of microorganisms Removal of small foreign particles Antigen processing and presentation All of the above Which of the following statements regarding osteocytes is accurate? They originate as monocytes in the blood. They respond only to mediators released by osteoblasts. They are mononuclear cells capable of bone demineralization. They form a ruffled border away from the bone surface.
11. Which of the following statements regarding acute apical periodontitis is accurate? a. b. c. d. It is limited to the periodontal ligament (histologically). It is detectable radiographically. It may heal if induced by a noninfectious agent. All of the above statements are accurate.
12. Which of the following statements regarding chronic, apical periodontitis is accurate?
a. It is a neutrophil-dominated lesion encapsulated in a collagenous connective tissue. b. c. d. 13. a. b. c. d. It may contain epithelial arcardes or rings. It represents a continuous, slow process that is asymptomatic. It is a predominance of B-cells over T-cells. Which of the following statements regarding cholesterol crystals is accurate? They may induce granulomatous lesions. They are potentially associated with nonresolving apical periodontitis. They are difficult for macrophages and multinucleated giant cells to remove. All of the above statements are accurate.
14. Which of the following statements regarding periapical actinomycosis is accurate? a. It is caused by gram-negative organisms exhibiting branching filaments that end in clubs or hyphae. b. It is a fungal disease characterized by filamentous colonies called sulphur granules. c. d. 15. a. b. c. d. It is most commonly an endodontic infection resulting from dental caries. All of the above statements are accurate. Extraradicular infections are not found in which of the following? Solid, apical granulomas Periapical-pocket cysts with cavities open to the root canal Periapical actinomycosis Acute, apical periodontitis
CHAPTER 13: ENDODONTIC MICROBIOLOGY AND TREATMENT OF INFECTIONS
1. a. b. c. d.
Pulpal and periradicular pathosis results primarily from which of the following? Traumatic injury caused by heat during cavity preparation Bacterial invasion Toxicity of dental materials Immunologic reactions
2. Which of the following statements regarding the organism producing pulpal pathosis is correct? a. b. c. The organisms are primarily facultative streptococci. Single isolates (i.e., monoinfection) produce the most severe reactions Isolates tend to be polymicrobial and anaerobic.
d. Organisms infecting the pulp tend to be aerobic, compared to organisms infecting the periapex. 3. Which of the following best describes anachoresis? a. The attraction of bloodborne microorganisms to inflamed tissue during a bacteremia b. The process of carious invasion, cavitation, and exposure of the pulp from bacteria c. Bacteria located in dentinal tubules, and the pulp that are seeded to the systemic circulation, inducing disease in other areas of the body 4. a. b. c. d. Which of the following statements regarding strict anaerobes is accurate? They are missing enzymes, catalase, and superoxide dismutase. They function best at high oxidation-reduction potentials. They can grow in the presence of oxygen. All of the above statements are accurate.
5. The most common black-pigmented bacteria cultivated from endodontic infections is which of the following?
a. b. c. d. 6. a. b. c. d. 7. a. b. c. d. 8. a. b. c. d. 9. a. b. c.
Bacteroides melaninogaster Fusobacterium nucleatum Prevotella nigrescens Porphyromonas intermedia Treatment of actinomycosis israelii may include which of the following? Root canal treatment Root end surgery Antibiotics All of the above Which is true regarding microbial virulence factors? Fimbriae assist in bacterial aggregation. Pili break off and form extracellular vesicles filled with enzymes. Lipopolysaccharides is found in the liposomes of gram-positive bacteria. All of the above. Which of the following statements regarding polyamines is accurate? They are produced by bacteria and host cells. They may be found in infected root canals. They are more concentrated in teeth with spontaneous pain. All of the above statements are accurate. Which of the following statements regarding fascial space infections is accurate? They are associated with radiographically visible periradicular lesions. They occur in potential spaces between fascia and underlying tissue. They occur when a tooth apex is located coronal to a muscle attachment.
d. 10. a. b. c. d. 11. a. b. c. d. 12. a. b. c. d. 13. a. b. c. d. e. 14.
All of the above statements are accurate. Which of the following statements regarding Ludwig's angina is accurate? It involves the submental, sublingual, and submental space of the right or left side. It can progress into the canine and infraorbital space. It can result in airway obstruction. All of the above statements are accurate. Antibiotics are recommended for which of the following? Sinus tracts Acute, apical periodontitis After root end surgery None of the above Incision and drainage is indicated which of the following? For sinus tracts When the swelling is diffuse and indurated For acute, apical periodontitis All of the above Incision and drainage of cellulitis is effective because of which of the following? It provides a pathway of drainage to prevent spread of infection. It relieves increased tissue pressure. It provides relief of pain. It increases circulation to the area and improves delivery of antibiotics. All of the above statements are accurate. Which of the following statements regarding potassium penicillin V is accurate?
a. b. c. d. 15. a. b. c. d. 16. a. b.
It has a broader spectrum than amoxicillin. It may be dosed at 4-hour intervals for severe infection. It will select for resistant organisms, especially in the GI tract. It has up to a 25% allergy rate. Which of the following statements regarding metronidazole is accurate? It is effective against facultative and anaerobic bacteria. It cannot be given with penicillin because of disulfuram reaction. It cannot be taken with lithium or alcohol. All of the above statements are accurate. Which of the following statements regarding clindamycin is accurate? It is an alternative to potassium penicillin V in allergic individuals. It is effective against facultative and anaerobic bacteria.
c. It is rarely associated with pseudomembranous colitis in doses recommended for endodontic infections. d. All of the above statements are accurate.
17. Which of the following statements regarding the American Heart Association (AHA) guidelines for prophylactic antibiotic coverage is accurate? a. b. c. 18. a. b. c. They are the standard of care for clinicians. They are based on controlled clinical studies. They are not a substitute for clinical judgment. The AHA recommends antibiotic prophylaxis for which of the following? Surgery Instrumentation beyond the apex Periodontal-ligament injection
All of the above
19. Which of the following statements regarding he theory of focal infection is accurate? a. b. c. d. e. It was propounded by Dr. William Hunter in 1910. It was referred to infections found around poorly made restorations. It was used to explain diseases for which there was no cure. It results in needles tooth extraction. All of the above statements are accurate.
20. Which of the following is correct in relation to the periradicular lesion formed in response to dental caries and subsequent pulp necrosis? a. b. Bacteria are commonly found in the granuloma. T-helper cells predominate over T-suppressor cells.
c. Formation of the granuloma is mediated through a specific immunologic response. d. The release of interleukins can mediate bone resorption.
INSTRUMENTS, MATERIALS, AND DEVICES
1. Which of the following statements regarding pulp stimulation with cold is accurate? a. b. c. d. 2. a. It is best accomplished with carbon dioxide snow (i.e., dry ice). It is an accurate assessment of pulp vitality. It directly stimulates the pain fibers in the pulp. It is best determined with a blast of air. With regard to electrical pulp testing, which of the following is true? Positive responses can be used for differential diagnosis of pulp pathosis.
b. c. d. 3. a. b. c. d.
The device uses a pulsating, alternating current with a duration of 1 to 15 ms. The device uses a low current with a high-potential difference in voltage. Gingival and periodontal tissues are more sensitive to testing than the pulp. Which of the following statements regarding digital radiographs is accurate? They are produced by a charged coupled device and do not require x-rays. They have the advantage of being manipulatable, which facilitates interpretation. They have greater resolution than traditional film. They are captured by a sensor that has a greater surface area than traditional film.
4. Which of the following statements regarding nickel and titanium (NiTi) instruments is accurate? a. They exhibit a high elastic modulus, which provides flexibility.
b. When stressed, they exhibit transformation from the austenitic crystalline phase to a martensitic structure. c. They cannot be strained to the same level as stainless steel (SS) without permanent deformation. d. 5. a. b. c. d. They are easier to prebend before placement in the canal than SS. A barbed broach is most useful for which of the following? Removal of cotton, paper points, and other objects from the canal Removal of vital tissue from fine canals Initial planing of the canal walls Coronal-orifice enlargement before establishing the correct working length
6. In comparing K-type files with reamers, which of the following statements regarding K-type files is accurate? a. b. They have more flutes per millimeter, which increase flexibility. They differ, because the file is manufactured by twisting a tapered, square blank.
They are more effective in removing debris. They are the least flexible when comparing instruments of the same size.
7. Based on instrument design and method of manufacturing, which of the following is most susceptible to fracture? a. b. c. d. 8. a. b. K-type file fabricated from tapered, square SS blank K-flex file fabricated from rhomboidal SS blank Hedström file fabricated from round SS blank Reamer fabricated from triangular SS blank Which of the following statements regarding Hedström files are accurate? They are manufactured by machining a round cross-sectional wire. They are effective when used in a reaming action.
c. They are safer than K-type files, because external signs of stress are more visible as changes in flute design. d. They are aggressive because of a negative-rake angle that is parallel to the shaft.
9. Which of the following statements regarding the Profile rotary instruments is accurate? a. b. c. d. 10. a. b. c. They are used at a range of 1500 to 2000 rpm. They are NiTi instruments manufactured in half sizes. They exhibit sizes that are ISO and ANSI standardized. They incorporate radial lands in the flute design. Which of the following statements regarding the best apex locators is accurate? They require training with the instrument to become proficient. They are sensitive to canal contents. They measure the impedance between the file and the mucosa.
On average, they are accurate to within 0.5 mm of the apex. All of the above statements are accurate.
11. Piezoelectric, ultrasonic devices differ from magneto-strictive devices in which of the following? a. b. c. d. The piezoelectric unit transfers more energy to the files. The piezoelectric unit produces heat that requires a coolant. The piezoelectric unit uses a RispiSonic, ShaperSonic, and TrioSonic file system. The piezoelectric unit vibrates at 2 to 3 kHz.
12. Which of the following statements regarding ultrasonic root canal instrumentation is accurate? a. b. c. d. It should be performed in a dry environment. It poses little risk of file breakage. It is not very useful for dentin removal. It is most useful in small canals where file contact with the wall is maximized.
13. Which of the following statements regarding sodium hypochlorite used as a root canal irrigating solution is accurate? a. b. It is buffered to a pH of 12 to 13, which increases toxicity. It exhibits a chelating action on dentin.
c. It should be used in higher concentrations because of the increased free chlorine available. d. It is a good wetting agent that permits the solution to flow into canal irregularities.
14. When ethylenediaminetetraacetic acid (EDTA) is used as an endodontic irrigant, which of the following statements is accurate? a. It must be completely removed after use to prevent continued action and destruction of dentin. b. It is a rapid-and-efficient method of removing the smear layer.
It acts on organic-and-inorganic components of the smear layer. It penetrates deep into dentin and enhances root canal preparation.
15. Calcium hydroxide is advocated as an interappointment medication primarily because of which of the following a. b. c. d. Its ability to dissolve necrotic tissue Its antimicrobial activity Its ability to stimulate hard-tissue formation Its ability to temporarily seal the canal
16. Which of the following statements is accurate regarding gutta-percha points is accurate? a. b. c. d. 17. a. b. c. d. They contain 40% to 50% pure gutta-percha. They adhere to dentin when compacted. They can be heat sterilized. They are not compressible. An advantage to AH26 as an endodontic sealer is which of the following? The release of formaldehyde on setting Low toxicity Long working time, but quick setting (i.e., 1 to 2 hours) at body temperature It can be distinguished from gutta-percha radiographically
18. N2, Endomethasone, and Reibler's paste are sealers that do which of the following? a. b. c. Produce liquefaction necrosis in the periradicular tissues Induce healing in the apical pulp wound after vital pulp extirpation Can cause periapical inflammation
d. 19. a. b. c. d.
Do not produce a seal when used in combination with a core material Which of the following statements is accurate regarding TERM is accurate? It seals as well as Cavit. It is the material of choice when strength is a requirement. It is a zinc oxide-reinforced material that can be light cured. It has a eugenol component that is antibacterial.
20. The root end is ultrasonically prepared during endodontic surgery for which of the following reasons? a. b. c. d. It results in apical cracks at low settings. It results in larger, but cleaner, cavity walls. It can make a deeper cavity more safely than a bur. It does not require as acute an angle of root resection.
CHAPTER 15: PULPAL REACTION TO CARIES AND DENTAL PROCEDURES
1. a. b. c. d. The most common response in the dentin deep to caries is which of the following? Increased permeability Alteration of collagen Dissolution of peritubular dentin Dentinal sclerosis
2. Relatively few bacteria are found in a pulp abscess because of which of the following? a. b. c. Immune response of pulp tissue High tissue pH in the adjacent inflammation Mechanical blockage of sclerotic dentin
Antibacterial products of neutrophils
3. A periodontal ligament injection of 2% lidocaine with 1:100,000 epinephrine causes which of the following? a. b. c. d. 4. a. b. c. d. The pulp circulation ceases for about 30 minutes. The pulp circulation remains the same. The pulp circulation increases markedly. The pulp circulation decreases slightly. The highest incidence of pulp necrosis is associated with which of the following? Class V preparations on root surface Inlay preparations Partial veneer restorations Full-crown preparations
5. A disadvantage of acid etching dentin (regarding effects on the pulp) is which of the following? a. b. c. Dentinal tubules are opened, thereby increasing permeability. Acid penetrates to the pulp and kills large numbers of cells. Acid penetrates to the pulp and damages the vessels.
d. Acid softens the dentin and increases microleakage at the restoration dentin interface. 6. The response of the pulp to a recently placed amalgam without a cavity lining is usually which of the following? a. b. c. d. Slight-to-moderate inflammation Moderate-to-severe inflammation Slight but increasingly severe with time None
7. The smear layer on dentin walls acts to prevent pulpal injury for which of the following? a. b. c. d. It reduces diffusion of toxic substance through the tubules. It resists the effects of acid etching of the dentin. It eliminates the need for a cavity liner or base. Its bactericidal activity acts against oral microorganisms.
8. A reaction that tends to protect the pulp from injury from dentinal caries is which of the following? a. b. c. d. e. 9. a. b. c. d. A predictable stimulation of sensory nerves resulting in pain A decrease in permeability of dentin An increase in numbers of odontoblasts under the tubules affected by the caries A buffering (i.e., neutralization) by ground substance of bacterial toxins A decrease in pulpal metabolism Hypersensitivity is best relieved or controlled by which of the following? Opening the tubules to permit release of intrapulpal pressure Root planing to remove surface layers that are hypersensitive Applying antiinflammatory agents to exposed dentin Blocking exposed tubules on the dentin surface
10. Deeper cavity preparations have more potential for pulpal damage because of which of the following? 1. 2. 3. Tubule diameter and density increases; therefore there is increasing permeability. There is more vibration to pulp cells. Odontoblastic processes are more likely to be severed. a. 1 only
b. 3 only c. 1 and 3 d. 2 and 3 e. 1 and 2 11. a. b. c. d. Agents that clean, dry, or sterilize the cavity are which of the following? Best used in deep cavities Indicated when a patient reports symptoms Generally very damaging to the pulp Generally not useful
12. Of the following, which is the best way to prevent pulp damage during cavity preparation? a. b. c. d. Retain the smear layer Use sharp burs with a brush stroke Use adequate air coolant Use adequate water coolant
13. Which is the major reason why Class II restorations with composite are damaging to the pulp? a. b. c. d. Microleakage occurs at the occlusal surface. Microleakage occurs at the gingival margin. Toxic chemicals are released from the composite and diffuse into the pulp. Polymerization shrinkage distorts cusps and opens gaps.
14. A pulp has been damaged and is inflamed because of deep caries and cavity preparation. What material placed on the floor of the cavity aids the pulp in resolving the inflammation? a. Calcium hydroxide
b. c. d.
Zinc oxide-eugenol Steroid formulations None; there is no material that promotes healing.
15. A cusp fractures and exposes dentin but not the pulp. What is the probable response in the pulp? a. b. c. d. Severe damage with irreversible inflammation Mild-to-moderate inflammation Pain but no inflammation No pulp response
16. The following illustration shows a section of pulp and dentin underlying an area of cavity preparation, which was done 1 day previous. The best description of the pulp reaction is which of the following?
a. b. c. d.
There is no reaction; the pulp appears normal. The odontoblast layer is disrupted, and there is mild inflammation. Odontoblasts are aspirated into tubules, and there is mild inflammation. Odontoblasts are absent, and there is extravasation of erythrocytes.
17. This is an area of pulp close to a carious exposure (see the following illustration). The inflammatory response is primarily which of the following?
a. b. c. d.
Acute Chronic Giant cell Vascular
18. The early inflammatory cell infiltrate response of the pulp to caries involves primarily which of the following? a. b. c. Neutrophils Macrophages Neutrophils, plasma cells, and lymphocytes
Macrophages and lymphocytes Lymphocytes, plasma cells, and macrophages
19. Hypersensitivity of the pulp after restoration placement indicates which of the following? a. b. c. d. e. Acute inflammation in the pulp Chronic inflammation in the pulp Microleakage at the restoration and tooth interface Stimulation of sensory nerves by hydrodynamics Tubules are blocked by restorative material or smear layer or both
1. If several teeth are out of alignment after trauma, the most reasonable explanation is which of the following? a. b. c. d. Luxation Subluxation Alveolar fracture Root fracture
2. Initial vitality testing of traumatized teeth is most useful to which of the following? a. b. c. d. It establishes a baseline for comparison with future testing. It determines whether root canal treatment is indicated. It determines if the blood supply to the pulp is compromised. It predicts the prognosis.
3. A normal periapical radiograph of a traumatized tooth is useful for which of the following?
a. b. c. d. 4. a. b. c. d.
It visualizes most root fractures. It visualizes concussion injuries. It gathers baseline information. It locates foreign objects. Which of the following statements regarding crown infraction is accurate? It may indicate luxation injuries. It is rarely seen on transillumination. It seldom requires a follow-up examination. It describes the process of coronal pulp necrosis.
5. Which of the following statements regarding uncomplicated crown fracture is accurate? a. b. c. d. e. It is an indication for a dentin-bonded restoration. It requires baseline pulp testing. It involves root canal treatment if the exposed dentin is sensitive to cold stimulus. It has a questionable long-term prognosis. It is managed differently in young versus older patients.
6. Which of the following statements regarding complicated crown fractures is accurate? a. Exposure to the oral cavity permits rapid bacterial penetration through the pulp.
b. Inflammation is limited to the coronal 2 mm of the exposed pulp for the first 24 hours. c. 7. a. The tooth is normally managed by root canal treatment and restoration. Which of the following statements regarding replacement resorption is accurate? It results from direct contact between root, dentin, and bone.
b. c. d. 8. a. b. c. d. 9. a. b. c. d. 10. a. b.
It is managed by surgical exposure and repair with a biocompatible material. It results when at least 75% of the root surface is damaged. It can be avoided by timely endodontic intervention. Pulp necrosis is most likely to occur after which of the following? Midroot fracture Intrusive luxation Concussion Complicated crown fracture Which of the following statements regarding cervical root resorption is accurate? It is a common, self-limiting result of luxation injury. It causes significant pulpal symptoms. It can be arrested by root canal treatment. It may extend coronally to present as a pink spot on the crown. Which of the following statements regarding internal root resorption is accurate? It is more common in permanent than deciduous teeth. It is simple to differentiate from other types of resorption.
c. It is characterized histologically by inflammatory tissue with multinucleated giant cells. d. 11. a. b. c. It is ruled out when there is no response to pulp testing. A luxated tooth should be splinted in which of the following situations? If the tooth is mobile after splinting Until the root canal treatment is completed With the composite as close to the gingiva as possible
All of the above
12. Which medium of storage for an avulsed tooth is best for prolonged extraoral periods? a. b. c. d. 13. a. b. c. d. 14. a. b. c. d. e. 15. a. b. c. d. Hanks balanced salt solution Milk Distilled water Saliva The most important factor for managing avulsion is which of the following? Extraoral time Decontamination of the root surface Prompt initiation of root canal treatment Proper preparation of the socket Tooth mobility after trauma may be because of which of the following? Displacement Alveolar fracture Root fracture Crown fracture All of the above Which of the following is true about thermal and electrical tests after trauma? Sensitivity tests evaluate the nerve and circulatory condition of the tooth. False-positive tests are more likely than false-negative tests. It may take up to 9 months for normal blood flow to return. None of the above statements are accurate.
16. a. b. c. d. 17. a.
Which of the following statements regarding internal root resorption is accurate? It is rate in deciduous teeth. It is initiated by odontoblasts. It is seldom confused with external resorption. It is usually asymptomatic. Which of the following statements regarding avulsed teeth is accurate? They can be treated endodontically outside the mouth in limited circumstances.
b. They should be rigidly splinted for 3 to 4 weeks to allow periodontal support to mature. c. d. They generally do not require antibiotic treatment at the time of replantation. They should have apexification attempted when the apex is not closed.
CHAPTER 17: ENDODONTIC AND PERIODONTIC INTERRELATIONSHIPS
1. According to Gutmann, molar teeth are most likely to have accessory and lateral canals: a. b. c. d. 2. Branching from the main canal to form an apical delta In the apical one third of the root On the lateral surface of the root In the furcation Which of the following statements regarding palatogingival grooves is false? a. The incidence of palatogingival grooves ranges from 10% to 20% of the population. b. The maxillary lateral incisor is affected more that the central incisor.
c. The grooves extend apically in varying distances, with less than 1% reaching the apex.
d. Pulp necrosis frequently occurs in teeth with palatogingival grooves because of the lack of cementum covering the dentin. 3. The prognosis for a tooth with a perforation is affected by all of the following factors, except for one. Which is the exception? a. b. c. d. e. 4. Location of the perforation The time of repair The ability to seal the defect The ability to perform root canal treatment on the remaining canals The placement of a post to retain the core after perforation repair Which of the following statements best describes retrograde periodontitis? a. Inflammation from the periodontal sulcus migrates apically, causing pulp inflammation and eventually pulp necrosis b. Pulp necrosis occurs, and the toxic irritants cause inflammation that migrates to the gingival margin, creating a periodontal pocket. c. Irritants gain access to the periodontal tissues at the site of a vertical-root fracture, producing tissue destruction that mimics periodontitis. d. Pulp necrosis results in the formation of an apical, radiolucent lesion characterized by the loss of the apical lamina dura. 5. Which of the following statements best describes the effect periodontal disease has on the dental pulp? a. There is a direct correlation between the severity of the periodontal disease and the percentage of pulps that become necrotic. b. When periodontal disease or the treatment of the disease exposes a lateral or accessory canal, complete pulp necrosis will result. c. Although periodontitis can cause pulp inflammation and necrosis, treatment procedures have little effect on the pulp. d. Periodontal disease that does not expose the apical foramen is unlikely to produce significant damage to the pulp.
6. Which of the following statements regarding the primary endodontic lesion with secondary periodontic involvement is correct? a. Pulp necrosis occurs initially and an apical lesion forms. Apical migration of periodontal disease results in communication between the two lesions. b. Treatment consists of performing endodontic treatment, which is followed by a 6month recall examination. If the periodontal component is still present, periodontal therapy is initiated. c. The primary endodontic lesion with secondary periodontic involvement exhibits a poorer prognosis when compared with the primary periodontal lesion with secondary endodontic involvement. d. Pulp necrosis occurs and forms a sinus tract through the periodontal ligament that, over time, permits the accumulation of plaque and calculus on the root. 7. a. b. c. d. Which of the following statements regarding root resection is false? Success depends primarily on treatment planning and case selection. Failures occur primarily because of continued periodontal breakdown. The long-term prognosis for the pulp in teeth with vital-root resection is poor. Endodontic treatment should precede resection of a root.
8. Which of the following statements regarding guided tissue regeneration (GTR) is false? a. GTR is an effective adjunct to treatment of periodontal disease but has limited value in treating endodontic pathosis. b. The combined endodontic periodontic lesion has the least favorable prognosis for GTR because of the relationship of the lesion to the gingival margin. c. Bioresorbable membranes exhibit results similar to nonresorbable membranes.
d. Evidence suggest that GTR enhances bone formation by preventing contact of connective tissue with the bone. 9. A 24-year-old female patient has drainage from the gingival sulcus of her maxillary, right, central incisor (tooth no. 8). Three years ago she relates a porcelain fused-to-metal bridge (nos. 6 to 8) was placed because of a congenitally missing, lateral
incisor. Clinical examination reveals a 12 mm probing defect on the lingual aspect of tooth no. 8. Additional probing depths are 3 mm or less. Pulp testing reveals that no. 6, no. 8, no. 9, no. 10 are responsive to CO2 snow. Radiographic examination reveals a diffuse radiolucent area along the mesial lateral root surface extending from the crestal tissue to the apex. Which of the following is the most likely cause of this lesion? a. b. c. d. e. Vertical-root fracture Palatogingival groove Pulp necrosis Periodontitis Osteogenic sarcoma
10. A 51-year-old woman seeks evaluation of swelling of the buccal tissue opposite her mandibular, right, first molar (tooth no. 30). She relates a history of having a full-gold crown placed 2 months ago. She states that she has had pain for the past week and that the swelling began yesterday. Clinical examination reveals swelling in the buccal furcation area of tooth no. 30. Probing depths are 3 to 4 mm, except for a 6-mm defect in the furcal area of tooth no. 30. Pulp testing with CO2 snow reveals teeth nos. 28, 29, and 31 respond. Tooth no. 30 is not responsive. Radiographic examination reveals normal apical structures, however, there is a radiolucent area in the furcation of tooth no. 30. This area was not evident on the film taken before placement of the crown. Based on this information what diagnostic classification is most appropriate? a. b. c. d. e. Primary endodontic lesion Primary periodontic lesion Primary endodontic lesion with secondary periodontic involvement Primary periodontic lesion with secondary endodontic involvement Concomitant endodontic and periodontic lesion
Odontogenic pain is usually caused by which of the following? Noxious physical stimuli
b. c. d. 2. a. b. c. d. 3. a. b. c. d.
The release of inflammatory mediators Stimulation of sympathetic fibers in the pulp Edema produced in a ridged, noncompliant root canal system Which of the following best describes the neural innervation of the dental pulp? A-delta fibers transmit pain to the trigeminal nucleus. C fibers transmit pain to the superior cervical ganglion. Sympathetic fibers are not blocked with application of local anesthetic agents. A-delta fibers play the predominant role in encoding inflammatory pain. Nociceptive signals are transmitted primarily to which of the following? Nucleus caudalis Limbic system Reticular system Superior cervical ganglion
4. Pain that refers from an inflamed maxillary sinus to maxillary molars is likely to the phenomenon of which of the following? a. b. c. d. e. 5. a. b. Convergence Sublimation Nociception Information transfer Projection Which of the following statements is true regarding descending fibers? They inhibit transmission of nociceptive information. They are not affected by endogenous opioid peptides.
They transmit information from the cerebral cortex to the thalamus.
d. They are sympathetic fibers that modulate blood flow in the pulp after sensory stimulation. 6. Hyperalgesia is characterized by the following, except for one. Which is the exception? a. b. c. d. 7. a. b. Hyperalgesia is primarily a central mechanism. Spontaneous pain is present. The pain threshold is reduced. Hyperalgesia produces an increased pain perception to a noxious stimuli. Regarding etodolac (i.e., Lodine), which of the following statements is correct? The drug exhibits minimal gastrointestinal irritation when compared to ibuprofen. When compared with ibuprofen, etodolac has a more profound analgesic action.
c. Studies indicate etodolac is unique, because the drug does not have a peripheral analgesic mechanism of action. d. This drug can be prescribed for adult patients with aspirin hypersensitivity.
8. Which of the following statements regarding activation of the opiate receptor is accurate? a. b. c. d. It blocks nociceptive signals from the trigeminal nucleus to higher brain centers. It blocks transmission of signals from the thalamus to the cerebral cortex. It induces the release of endorphins. It blocks the release of dynorphins.
9. Opioids are frequently used in combination with other drugs because which of the following? a. The nonsteroidal, antiinflammatory drugs in combination with the opioid act synergistically on the opiate receptor.
b. The combination permits a lower dose of the opioid, which can reduce side effects. c. d. 10. a. Opioids do not act peripherally. Opioids are not antipyretic. Which of the following is true for the use of codeine as an analgesic agent? Codeine prescribed in 60-mg doses is more effective than 650 mg of aspirin.
b. Codeine prescribed in 30-mg doses is more effective than 600 mg of acetaminophen. c. d. Codeine prescribed in 30-mg doses is more effective than a placebo. Codeine prescribed in 60-mg doses is more effective than a placebo.
11. Management of pain of endodontic origin should focus on which of the following? a. b. c. d. Removing the peripheral mechanism of hyperalgesia Providing an adequate level of nonsteroidal, anti-inflammatory analgesic agent Prescribing an appropriate antibiotic in cases where pain is the result of infection Using long-acting, local anesthetic agents to break the pain cycle
12. Which of the following best describes a "flexible plan" for prescribing analgesic agents? a. A maximal dose of an opioid is administered. If pain persists, the opioid is supplemented with a non-steroidal, antiinflammatory agent or acetaminophen. Doses are then alternated. b. A maximal dose of a nonsteroidal, antiinflammatory agent or acetaminophen is administered. If pain persists, the drug is supplemented with an opioid. Doses are then alternated. c. Patients are advised to take the maximal dose of a nonsteroidal, antiinflammatory agent a day before the appointment and then as necessary for postoperative pain.
d. Patients are advised to take an opioid agent a day before the appointment and then as necessary for postoperative pain. 13. Nonsteroidal, antiinflammatory agents administered in combination with cyclosporine may result in which of the following? a. b. c. They increase the risk of nephrotoxicity. They induce bone marrow suppression. They decrease the activity of the cyclosporine.
d. They result in increased concentrations of the nonsteroidal agent in the blood plasma. 14. Nonsteroidal, antiinflammatory agents administered in combination with anticoagulants may result in which of the following? a. b. c. d. Increase the prothrombin time Result in a decreased bleeding time Increase the bioavailability of the anticoagulant Produce no adverse effect
15. Indomethacin administered in combination with sympathomimetic agents results in which of the following? a. b. c. d. Decreased blood pressure. Increased blood pressure. Decreased water retention Decreased absorption of indomethacin, requiring a higher dose
16. Peripheral afferent nerve fibers in an inflamed pulp may respond to mediators by which of the following? a. b. c. Reducing the concentration of those mediators Decreasing responsiveness to nociceptive stimuli Decreasing the number of anesthetic molecule receptors
Decreasing numbers of ion channels Sprouting of terminal fibers
17. Two nonsteroidal antiinflammatory drugs (NSAIDs) that have minimal adverse gastrointestinal side effects are which of the following? a. b. c. d. e. Etodolac and ibuprofen Etodolac and rofecoxib Ibuprofen and ketoprofen Ketoprofen and etodolac Ibuprofen and rofecoxib
18. To minimize posttreatment pain, when are analgesics most effective when administered? a. b. c. d. e. As a pretreatment Immediately after treatment When the anesthetic begins to wear off When the patient first perceives pain When the pain is the most intense
19. Prophylactic administration of antibiotics to control adverse posttreatment symptoms in prospective, controlled, clinical trials on asymptomatic patients has been shown to be which of the following? a. b. c. d. Ineffective Effective if given in high doses Effective only if given pretreatment Effective if given in conjunction with intracanal antibiotics
1. A 45-year-old man has a radiolucent area associated with his maxillary, right, central incisor (tooth no. 8) and facial swelling. He relates traumatic injury as a child with root canal treatment during his teenage years. Subsequent to this treatment he fractured tooth no. 8 playing basketball in his early thirties. Root canal retreatment was necessary and the tooth was restored with a cast post, core and crown. Which of the following is the most appropriate treatment sequence? a. Incision and drainage followed by nonsurgical retreatment and fabrication of a new restoration b. Root end surgery and a postsurgical antibiotic
c. Management of the infection and performance of root end surgery when the swelling subsides d. Incise and drain the swelling, prescribe an antibiotic, and follow the patient on recall examinations e. Tooth extraction and implant placement
2. Each of the following statements on the reasons two radiographs are recommended for evaluation of a tooth to be treated surgically is correct, except for one. Which is the exception? a. b. c. d. e. 3. a. b. c. d. Two films permit the evaluation and location of normal anatomic structures. The root length can be assessed. The size of the lesion can be determined. Root curvatures can be viewed. The depth of the overlying bone can be determined. When a vessel is severed, initial hemostasis results from which of the following? Contraction of the vessel wall Formation of a platelet plug The conversion of prothrombin to thrombin The conversion of fibrinogen to fibrin
4. The anesthetic of choice when performing endodontic root end surgery on a patient with mild cardiovascular disease is which of the following? a. b. c. d. e. 1.5% etidocaine 1:200,000 epinephrine 0.5% marcaine 1:200,000 epinephrine 2% lidocaine 1:100,000 epinephrine 2% lidocaine 1:50,000 epinephrine 4% prilocaine plain
5. The primary beneficial action of epinephrine when performing root end surgery is which of the following? a. b. c. d. 6. It effects the drug on alpha-1 receptors in the alveolar mucosa. It effects the drug on beta-1 receptors of skeletal muscle. It decreased systemic uptake of the anesthetic solution. It prolonged the duration of anesthesia. Which of the following statements regarding flap reflection is correct? a. The horizontal incision for the mucogingival flap is made perpendicular to the cortical bone. b. The rectangular flap design is most appropriate in the posterior areas.
c. The mucogingival flap with an anterior-releasing incision is preferred in posterior areas. d. The type of vertical-releasing incisions distinguish the mucogingival flap from the Luebke-Oschsenbein flap. e. The semilunar flap has the advantage of providing an esthetic result without scar formation. 7. Which of the following hemostatic agents activates the intrinsic coagulation pathway? a. Ferric sulfate
b. c. d. e.
Calcium sulfate paste Microfibrillar collagen Bone wax Epinephrine pellets
8. Which of the following is the recommended hemostatic technique to control bleeding during root end surgery? a. Local anesthesia with 2% lidocaine 1:50,000 epinephrine, epinephrine saturated pellets, ferric sulfate, calcium sulfate paste b. Local anesthesia with 2% lidocaine 1:50,000 epinephrine, ferric sulfate, microfibrillar collagen, bone wax c. Local anesthesia with 2% lidocaine 1:100,000 epinephrine, ferric sulfate, microfibrillar collagen, Telfa pad d. Local anesthesia with 0.5% marcaine 1:200,000 epinephrine, ferric sulfate, calcium sulfate paste 9. Each of the following statements is correct regarding the use of the H 161 Lindemann bone cutter for root end surgery is correct, except for one. Which is the exception? a. b. c. d. 10. It reduces frictional heat when resecting bone. It has more flutes that conventional burs, so cutting is faster and more efficient. When used with the Impact Air 45 hand piece splatter is decreased. It has fewer flutes and is less likely to clog. Which of the following statements regarding root end resection is correct?
a. The root should be resected at a 45-degree angle to ensure adequate access and visibility. b. The apical 2 mm should be removed to ensure that apical ramifications are not present. c. Root end resection should precede apical curettage.
d. Resection of the root should be as perpendicular to the long access of the root as possible. 11. Which of the following statements regarding the isthmus between canals is correct? a. Although often noted between canals, failure to include this area in the preparation does not affect the prognosis of a tooth. b. The incomplete isthmus should be prepared with a tracking groove before ultrasonic preparation. c. Isthmus incidence is not affected by the amount of the root resection but increases as the bevel approaches 45 degrees. d. When using a surgical operating microscope, the absence of an isthmus at 16 × to 25 × is evidence that no connection between canals exist. 12. Which of the following statements regarding ferric sulfate is correct?
a. Ferric sulfate acts by producing a tamponade effect and is absorbed by the body over 2 to 3 weeks. b. Ferric sulfate exhibits an alkaline pH.
c. Applied to the osseous surface, ferric sulfate causes agglutination of blood proteins. d. 13. Ferric sulfate induces osseous tissue formation. Which of the following statements regarding root end preparation is false?
a. The ideal preparation should extend 3 mm into the root and follow the long axis of the tooth. b. c. The lingual wall of the preparation is the most difficult area to evaluate. Ultrasonic preparation has the potential to induce micofractures in the dentin.
d. KiS tips have enhanced cutting efficiency for root end preparations because of a zirconium nitride coating. e. Ultrasonic root end preparation may thermoplasticize the remaining gutta-percha.
Which of the following statements regarding root end filling materials is false?
a. Super EBA is preferred as a root end filling material over IRM because it lacks eugenol. b. IRM is preferred over amalgam.
c. Mineral trioxide aggregate (MTA) is not adversely affected by contamination with blood. d. Periapical healing with MTA results in cementum formation over the material.
e. Composite resins appear to be acceptable, providing a dry-opening field can be maintained. 15. Which of the following statements is correct regarding treatment for a 73-year-old woman who develops ecchymosis after root end surgery? a. Instruct the patient to place warm compresses over the area three to four times daily. b. c. d. Place the patient on an antibiotic to prevent infection of the area. Prescribe an antiinflammatory analgesic to enhance the healing process. Explain the cause of the problem to the patient and provide reassurance.
MANAGEMENT OF PAIN AND ANXIETY
1. The majority of life-threatening systemic complications arise in which of the following? a. b. c. d. 2. a. During or immediately after injection of local anesthetics In conjunction with surgical procedures, such as tooth extraction During the pulp extirpation phase of root canal treatment As a result of bleeding from patients with known bleeding disorders Which of the following tooth groups is the most difficult to anesthetize? Mandibular premolars
b. c. d. 3. a. b. c. d. 4. a. b. c. d.
Maxillary premolars Maxillary molars Mandibular molars Which of the following is not a factor affecting the onset of local anesthesia? Diffusion of the local anesthetic through the lipid-rich nerve sheath The pKa for the anesthetic agent The pH of the tissue The protein-binding ability of the local anesthetic A decrease in the tissue pH causes which of the following? It increases the free base of the local anesthetic agents. It results in fewer anesthetic molecules entering the nerve sheath. It changes the pKa value for a given local anesthetic. It cecreases the protein-binding of the local anesthetic.
5. Failure to obtain adequate anesthesia after an appropriately administered nerve block is most likely the result in which of the following? a. b. c. d. pH changes in the pulp tissue caused by inflammations Morphologic neurodegenerative changes and inflammatory mediators Insufficient volume of local anesthetic injected Tolerance to the anesthetic agent
6. When comparing amide and ester local anesthetic agents, which of the following is true? a. b. c. Esters are more likely to produce systemic toxicity when compared to amides. Amides are more allergenic when compared to esters. Amides are more effective than esters.
Esters and amides are equally effective.
7. A patient is anesthetized using a posterior superior alveolar (PSA) nerve block to perform endodontic treatment on the maxillary, first molar. Adequate anesthesia is not obtained. In this situation the clinician should consider which of the following? a. b. c. d. Anesthetizing the anterior, superior nerve Anesthetizing the middle, superior nerve Performing a palatal infiltration Repeating the PSA
8. An infiltration injection is given for a maxillary, second premolar. Adequate anesthesia is not obtained. Which injection should be considered? a. b. c. d. e. Anterior superior alveolar (ASA) block PSA block Palatal infiltration Maxillary (division II) block Greater palatine nerve block
9. Infiltration in the mandible may be an effective technique in treating the which of the following? a. b. c. d. 10. Central incisor Canine First premolar Second molar In performing the Akinosi technique, which of the following are accurate?
a. The needle is inserted at the height of the mucogingival junction of the most posterior, maxillary tooth. b. The needle is passed lingual to the mandibular ramous until is bone is contacted.
Injection at the neck of the mandibular condyle is the objective. All of the above statements are accurate.
11. The Stabident local anesthesia system is used for which one of the following reasons? a. b. As a true intraosseous injection As a modified periodontal ligament injection
c. To limit the adverse reactions to vasopressor components of local anesthetic cartridges d. 12. a. b. As a method to administer intrapulpal injections painlessly Prescriptions for analgesic agents should provide which of the following? Instructions for administration at regular intervals Instructions for taking the medication when patients experience pain
c. Administration instructions for patients in pain the day before initiating root canal treatment to ensure adequate blood levels d. Immediate preoperative administration of opiates when pulpal pain is present
13. For emergency treatment of patients with pulp pathosis, oral sedation should be considered during which of the following? a. b. c. d. When deep sedation of the fearful patient is desired When barbiturates with oral sedation should be considered When oral sedation with midazolam may provide an amnesia effect When a short-acting agent permits the patient to leave without an escort
14. Which of the following statements regarding the use of nitrous oxide inhalation sedation is accurate? a. It produces significant analgesic effect when used in conjunction with local anesthetics.
b. It is difficult in managing endodontic patients because of the application of the rubber dam. c. It should be considered if oral sedation cannot be used.
d. It should be used only when an auxiliary of the same sex as the patient is present to assist. 15. Which of the following statements regarding supra-periosteal injection (infiltration) is accurate? a. b. c. d. 16. a. It is effective for most maxillary teeth. It is more effective in the presence of infection It is ineffective for both adults and children in anesthetizing mandibular teeth. It is targeted mesial and distal to the apex of the involved tooth. Which of the following statements regarding regional nerve block is accurate? It achieves anesthesia by blocking efferent nerve impulses.
b. It may be more effective because it is deposited in normal, rather than inflamed, tissue. c. d. It is exemplified by the long buccal nerve block. It requires use of an agent without vasoconstrictors.
17. Which of the following statements regarding the anterior middle superior alveolar (AMSA) nerve block is accurate? a. It anesthetizes all branches of the maxillary nerve.
b. It can be delivered by a computer-controlled system or by traditional needle and syringe. c. d. It anesthetizes buccal and palatal bone, but not soft tissue. It occasionally anesthetizes the orbicularis oris.
18. If the dentist thinks there may be considerable posttreatment pain, the clinician may do which of the following?
a. b. c. d. 19. a. b. c. d.
Prescribe antibiotics Reanesthetize with a long-acting anesthetic Prescribe antianxiety medications All of the above Which of the following statements regarding oral sedation is accurate? It has a quick onset of action. It has a significant number of adverse reactions. It has a reasonably short duration. It is difficult to titrate to ideal levels.
CHAPTER 21: TOOTH-WHITENING MODALITIES FOR PULPLESS AND DISCOLORED TEETH
1. The whitening mechanism for bleaching teeth is thought to be which of the following? a. A result of the degradation organic molecules of high molecular weight that reflect a specific wavelength of light b. c. d. Related to changes in the inorganic hydroxyapitite crystals Related to the dissolution of the stain A result of removal of free-metal ions, such as iron and copper
2. Which of the following statements is correct regarding the incidence of cervical resorption after internal bleaching? a. b. Cervical resorption can be as high 25% when Superoxyl and heat are used. Lesions develop rapidly and can be detected 1 to 2 months after bleaching.
c. The incidence of cervical resorption increases in patients who are 25 years old and older.
d. Although cervical resorption is often attributed to bleaching, it is more likely caused by a previous traumatic injury to the involved tooth. 3. Each of the following is an intrinsic form of tooth discoloration, except for one. Which is the exception? a. b. c. d. 4. Endemic fluorosis Hereditary opalescent dentin Tetracycline staining Peridex staining Which of the following statements regarding microabrasion is correct? a. The agent used in the technique is 30% hydrogen peroxide, which can be obtained in proprietary products, such as Prema. b. c. The technique is useful in treating white-and-brown-spot surface lesions. Microabrasion should not be used before placement of bonded restorations.
d. Requires a local anesthetic and frequently produces postoperative thermal sensitivity. 5. When performing a walking bleach procedure, which of the following statements is accurate? a. The dentin should be etched before placement of the bleaching agent to increase permeability of the tubules and enhance the bleaching action. b. The sodium perborate paste should be covered by a minimum of 2 mm of Cavit or IRM. c. A barrier over the obturating material is not required.
d. The definitive bonded restoration should be placed at the visit in which the sodium perborate paste is removed. 6. Which of the following statements regarding power bleaching is false? a. Power bleaching often uses a liquid rubber dam composed of a light cured resin gel.
b. Vitamin E can be used to neutralize the oxidizing effects of hydrogen peroxide that comes in contact with soft tissues. c. Power bleaching can often be performed by trained dental auxiliary personnel.
d. After fabrication of custom trays with appropriate reservoirs, patients apply a bleaching gel every 2 hours during their waking hours.
CHAPTER 22: RESTORATION OF THE ENDODONTICALLY TREATED TOOTH
1. Which of the following statements regarding the density of dentinal tubules (per square millimeter) is accurate? a. It remains constant as they progress from the periphery to the pulpal dentin junction with a decreasing diameter. b. It remains constant as they progress from the periphery to the pulpal dentin junction with an increasing diameter. c. It decreases as they progress from the periphery to the pulpal dentin junction, maintaining a constant diameter. d. It increases as they progress from the periphery to the pulpal dentin junction with an increase in diameter. e. It increases as they progress from the periphery to the pulpal dentin junction, maintaining a constant diameter. 2. Which of the following statements regarding teeth restored with crowns is correct? a. When teeth exhibiting no caries, fracture, or other causative factors are restored with crowns, those serving as abutments exhibit a higher rate of necrosis. b. The periodontal status of teeth restored with crowns is not a significant factor in the pulpal prognosis. c. Should pulp necrosis occur in teeth restored with crowns, the process occurs rapidly, usually within the first 3 years after cementation.
d. The amount of occlusal reduction is a more significant factor in inducing pulpal pathosis when compared to axial reduction. e. Pulpal pathosis becomes significant when the remaining thickness of dentin is less than 1.5 mm. 3. Which of the following would best fit the definition of the "stressed pulp syndrome"? a. A tooth recently prepared for a porcelain fused-to-metal crown that (with placement of a provisional crown) exhibits severe pain to thermal stimulation b. A tooth that is asymptomatic but has had numerous restorations placed over a period of years because of recurrent caries c. d. A nonrestored tooth that exhibits probing depths of 4 to 5 mm A tooth that is not responsive to pulp testing with CO2 and EPT
4. Each of the following is a concern when restoring an endodontically treated molar with minimal remaining tooth structure, except for one. Which is the exception? a. b. c. d. e. Increased chance for root fracture Greater potential for recurrent caries Infringement on the biologic width The altered light refraction Changes in collagen cross linking
5. A tooth requires a post, core, and crown for adequate restorative treatment. Which of the following is the most important factor in the restorative equation? a. b. c. d. e. Dowel length Dowel width The surface configuration of the dowel The core material An adequate ferrule
6. A patient requires a post and core for restoration of a narrow, mandibular, central incisor tooth with 1 mm of structure above the gingival level. Which of the following would be the most appropriate dowel for this situation? a. b. c. d. 7. a. b. c. d. 8. a. b. c. d. Cast post and core Carbon fiber post with a composite core Parallel stainless steel (SS) post with an amalgam core Threaded dowel with a composite core Which of the following statements regarding the carbon fiber dowels is false? They are radiolucent. They have a modulus of elasticity similar to dentin. They provide esthetic qualities similar to metal dowels. The carbon fiber dowels are more resistant to fracture. Which of the following statements regarding the zirconia dowel is accurate? It is easily removed from the canal by ultrasonics and special burs. It is readily seen on radiographs. It requires a composite core. It is similar to dentin in elasticity.
9. The most appropriate time to determine the precise method for restoring the endodontically treated tooth is which of the following? a. b. c. d. 10. When the initial diagnosis and treatment plan is established During the endodontic treatment procedures After completion of the root canal treatment After the initial-crown preparation Which of the following statements regarding post space is correct?
a. The post space for passive dowels must provide intimate contact between the dowel and the dentin wall. b. Post space should extend into the root to a depth 3 to 5 mm from the apex.
c. The post space required for fabrication of a dowel and core using a direct technique requires removal of more tooth structure than the proprietary dowel systems because of the need to remove undercuts. d. Direct composite-reinforced systems require the least amount of preparation.
CHAPTER 23: PEDIATRIC ENDODONTICS: ENDODONTIC TREATMENT FOR THE PRIMARY AND YOUNG, PERMANENT DENTITION
1. The basic morphologic difference between primary and permanent teeth is which of the following? a. b. c. d. Thickness of dentin between pulp and enamel is greater in primary teeth Enamel is thicker in primary teeth The pulp chamber is comparatively smaller in primary teeth The pulp horns are higher in primary molars
2. Radiographically, which of the following statements regarding primary teeth is accurate? a. Pathologic changes in the periradicular tissues are most often apparent at the apexes than the furcation of molars. b. The presence of calcified masses within the pulp is indicative of acute pulpal disease. c. d. By the time internal resorption is visible the only treatment is extraction. Pathologic bone-and-root resorption is always indicative of nonvital pulp.
3. Which of the following diagnostic tests is usually reliable for determining pulpal status of primary teeth? a. Thermal pulp tests
b. c. d. 4.
Electrical pulp tests Percussion None are reliable in children. Which of the following statements regarding indirect pulp therapy is accurate?
a. It is indicated only in the treatment of teeth with deep carious lesions in which there is no clinical evidence of pulpal degeneration or periapical pathosis. b. It removes much of the bacteria present in dentin.
c. It includes placing calcium hydroxide or zinc oxide-eugenol (ZOE) over the remaining caries and permanently restoring the tooth with amalgam. d. It involves all of the above.
5. Direct pulp capping is recommended for primary teeth with which of the following? a. b. c. d. 6. a. b. c. d. Carious exposures Mechanical exposures Calcification in the pulp chamber All of the above Symptoms of pulp abnormalities in primary teeth include which of the following? Pain to percussion History of spontaneous pain Variations in mobility All of the above
7. A calcium hydroxide pulpotomy performed on a young, permanent tooth is judged to be successful during which of the following? a. b. When the patient is asymptomatic When the tooth responds to pulp testing
When normal root development continues All of the above statements are accurate.
8. Formocresol pulpotomy on a primary tooth is indicated during which of the following? a. b. c. d. When there is a history of spontaneous toothache When the inflammation or infection is confined to the coronal pulp When the pulp does not bleed When there is only apical pathosis
9. The effect of formocresol on the pulp tissue is controlled by which of the following? a. b. c. d. Concentration used Method of application Length of time applied All of the above
10. An increasingly popular technique for pulpotomy in primary teeth is which of the following? a. b. c. d. Formocresol Calcium hydroxide Electrosurgery Laser surgery
11. Glutaraldehyde may be preferred to formocresol for primary pulpotomy because of which of the following reasons? a. b. c. It has less systemic distribution beyond the pulp. It has a better prognosis. It is not antigenic.
d. 12. a. b. c. d.
It is less readily metabolized. Which of the following is an indication for root canal treatment of primary teeth? Radiographic evidence of internal root resorption Periapical lesion Dentigerous cyst Mechanical or carious perforation of the chamber floor
13. Which of the following statements regarding access opening on primary incisors is accurate? a. b. c. d. 14. a. b. c. d. They are from the facial surface. They are from the lingual surface. They are from the incisal edge. They are different for maxillary teeth and mandibular teeth. Which of the following is true in placing zinc oxide-eugenol in a primary tooth? Techique is not important The overfill has a poorer prognosis than a flush fill. The paste should be mixed to a thick consistency. All are true.
1. As related to dental visits by the older patient, which of the following statements are accurate? a. b. c. Older patients have fewer visits per year than younger patients. The number of visits by older patients should decrease in the future. Most visits are for comprehensive procedures.
d. Dental visits of older patients are for less-complicated procedures when compared to younger patients. 2. Which of the following statements regarding secondary dentin formation in the radicular pulp in an older patient is accurate? a. b. c. d. It is less likely to occur in response to abrasion than in younger patients. It may result in complete pulp obliteration. It may compromise the blood supply and cause pulp necrosis. It does not require an irritant.
3. In the older patient (as compared with a younger patient), regarding pulpal inflammation from caries, which of the following statements is accurate? a. b. c. d. It is less likely to be as painful as in a younger patient. It usually progresses more slowly. It is less likely to occur. It is more likely to be acute than chronic.
4. Pulps in older patients tend to be less responsive to thermal stimuli because of which of the following reasons? a. Sensory nerves in dentin degenerate with time.
b. Sensory nerves in pulp lose their myelin sheath as a result of long-term, repeated injuries. c. With age, patients become less alert and, therefore, less responsive to external stimuli. d. e. Pulpal calcifications block external stimuli from reaching receptors. Pulps tend to have less sensory innervation in older teeth.
5. An abrupt midroot radiographic disappearance of a canal usually indicates which of the following? a. Bifurcation in the canal
b. c. d.
Secondary dentin formation apically Concentrations of dystrophic calcifications apically Diminished (often unnegotiable) sized canal
6. In the older patient (as compared with the younger patient) the exit of the canal (i.e., apical foramen) is which of the following? a. b. c. d. Closer to the radiographic apex Closer to the true apex Easier to detect tactilely More variable because of cementum formation
7. Which of the following statements regarding single-visit root canal treatment in an older patient is accurate? a. It should be avoided because there is more likely to be an increase in postappointment pain. b. c. d. It should be avoided because it decreases successful prognosis. It is acceptable if it is more convenient for the patient. It should be avoided to place an intracanal medicament.
8. Success of root canal treatment in older patients (as compared with younger patients) is which of the following? a. b. c. d. Better Poorer Equivalent Unknown (has not been investigated)
9. In the older patient root canal treatment (as compared to extraction) is which of the following? a. Usually more emotionally traumatic
b. c. d.
Usually more tissue traumatic Often less expensive in the long run More likely to result in postappointment complication
10. A postsurgical condition that tends to occur more frequently in older patients is which of the following? a. b. c. d. e. 11. a. b. c. d. 12. a. b. c. d. 13. Ecchymosis (i.e., discoloration) of soft tissues Infection of the surgical site Loss of sutures because of more friable tissues Continued hemorrhage of the incision site Loss of consciousness When should periapical radiographs be prescribed? Before discussion of the chief complaint After discussing the chief complaint with the patient Just before the clinical examination After completing the clinical examination With aging, which of the following statements are accurate? Lateral canals enlarge and become more clinically significant. Gingival recession exposes cementum and dentin, which is less resistant to caries. The cementodentinal junction locates progressively more coronally. All of the above occur. In geriatric patients, which of the following statements are accurate?
a. There is a direct correlation between the nature of response to electrical-pulp testing and the degree of inflammation. b. There is a reduced volume and increased neural component of the pulp.
Tooth discoloration usually is not indicative of pulpal death. Diffuse pain of vague origin is unlikely to be odontogenic.
14. In evaluating success and failure of endodontic treatment in aged patients, a consideration is which of the following? a. b. c. d. The bone of the aged patient is more mineralized than that of a younger patient. Overlooked canals are seldom a problem because they are usually calcified. There may be failure even though the patient has no symptoms. Cold sensitivity is the usual symptom that indicates a missed canal.
15. Which of the following statements regarding endodontic surgery in older patients is accurate? a. b. It requires more anesthetic and vasoconstrictor than in younger patients. It may be somewhat easier because the vestibule is deeper.
c. It is risky because inadequate blood supply may result in postsurgical osteomyelitis. d. It has been demonstrated to be much less successful than in younger patients.
16. The radiolucent structure at the periapex of the premolar in the following illustration is likely which of the following?
a. b. c. d.
A maxillary sinus An endodontic apical pathosis A fibroosseous lesion A bony trabecular pattern
17. The elevated structure facial to the crowned first molar in the following illustration is likely which of the following?
a. b. c. d.
Acute apical abscess Periodontal abscess Fibroma Exostoses
CHAPTER 25: NONSURGICAL ENDODONTIC RETREATMENT
1. a. b. c. d. Canals may be missed during treatment because of which of the following? Calcification Anomalous location Inadequate access All of the above
2. Radiographically, which of the following statements regarding canals that appear calcified are accurate? a. b. They are seldom able to be instrumented. They have a different appearance than the surrounding dentin.
c. 3. a. b. c. d.
They should be opened up with rotary rather than ultrasonic instruments. The major reason for failure, requiring retreatment, is which of the following? Persistent pain Draining sinus tract Restorative indications Microleakage
4. Presence of excess gutta-percha beyond the apex is usually caused by which of the following? a. b. c. 5. a. b. c. d. e. 6. a. b. c. d. 7. Use of too small a master cone Excessive heating and compaction during warm, vertical condensation Destruction of the natural apical constriction Lateral or furcal canals are which of the following? Commonplace Not able to be mechanically cleaned Not routinely obturated Seldom the sole cause of endodontic failure All of the above Retreatment has the most favorable prognosis during which of the following? When the cause of failure is identified and is correctable When the patient is asymptomatic When gutta-percha was used instead of paste When a surgical microscrope is used For silver point removal, ultrasonics are used for which of the following reasons?
a. b. c.
To break up cement surrounding the point To reduce the level of dentin on the floor of the chamber to expose the point To break up the silver point into small pieces, which can then be flushed out
d. To loosen the silver point by applying the vibrating instrument directly to the silver cone 8. a. b. c. d. e. How should rotary instruments be used for the removal of gutta-precha? To remove all the gutta-percha the length of the canal At the highest speeds In reverse of the canal preparation direction In portions of the canal where the instruments fit passively In portions of the canal where the instruments fit snugly
9. If a cervical root perforation occurs during the treatment and the canal preparation is incomplete, the generally preferred time for repairing the defect is which of the following? a. b. c. d. 10. a. b. c. d. 11. Immediately, that is, before proceeding with further preparation After cleaning and shaping is complete but before obturation Immediately after obturation After an appropriate recall period, to assess the status of the tissues Removal of objects can be facilitated by: Straight-line access A good light source Magnification All of the above Carrier-based gutta-percha removal and retreatment is:
a. b. c. d. 12. a. b. c. d.
Generally easy, because all components are soluble Very difficult, because the gutta-percha is insoluble Usually by using a combination of techniques Impossible Type III transportation is best managed by: Extraction Apexification with calcium hydroxide Forming an artificial barrier with a material, such as MTA Obturation, as best as possible, then surgery
CHAPTER 26: PRACTICE
DIGITAL TECHNOLOGIES IN ENDODONTIC
1. A disadvantage of digital cameras relative to film-based cameras is that the digital cameras: a. b. c. d. e. Are very expensive to purchase Are more expensive to operate Have inferior image resolution Have a greater delay in obtaining images Are very complicated to operate
2. An advantage of conventional radiographic film relative to digital radiographic imaging is that film: a. b. c. d. Generally produces an image of superior quality Is easier to duplicate (reproduce) Requires less radiation exposure Accurately depicts the extent of caries
e. 3. a. b. c. d. e. 4. a. b. c. d. 5. a. b.
Produces an image more quickly The Internet is usable in dentistry for all of the following except: Inter-doctor consultations Online scheduling of patients Patient access to his/her dental records Online ordering of supplies Transmission of insurance claims The Clinical Chairside Workstation is used for: Storing and displaying clinical information Electronically determining shades for porcelain crowns Selecting and mixing cements Communicating by voice with the front desk The pre-registration specialized system is designed to: Obtain early registration for professional meetings Remind patients of recall appointments
c. Automatically contact insurance companies to determine coverage limits of a patient d. e. Record pertinent data on a referred patient prior to any appointment Any of the above are possibilities
TEST YOUR KNOWLEDGE
Questions 1 to 3 relate to the following radiograph.
The patient does not have symptoms. All teeth shown in the radiograph respond to pulp testing, except the canine. 1. The radiolucent structure (arrow) at the apex of the canine is likely which of the following? a. b. c. d. 2. a. Maxillary fracture Apical pathosis Nasopalatine duct Nutrient canal The radiographic appearance internally indicates which of the following? Two likely superimposed canals
b. c. d.
Dentinogenesis imperfecta Dense accumulations of linear calcifications Calcific metamorphosis
3. The recommended treatment and reason for the treatment is which of the following? a. Root canal treatment; there is pulp pathosis.
b. Root end resection and root end filling; there is pathosis, but the pulp space is too small to attempt root canal treatment. c. d. No treatment; there is no pathosis. Extraction is prescribed.
Questions 4 to 8 relate to the following illustration.
Tooth no. 30 (first molar) causes the patient prolonged pain to cold and episodes of spontaneous pain. The tooth responds to probing with an explorer into the carious lesion.
There is no pain to percussion or palpation and no swelling. Periodontal probing is within normal limits. 4. a. b. c. d. 5. a. b. c. d. 6. a. b. c. d. 7. a. b. c. d. 8. What is the pulpal diagnosis? Reversible pulpitis Irreversible pulpitis Necrosis Unknown, pending further information What is the periapical diagnosis? Normal Acute apical periodontitis Chronic apical periodontitis Acute apical abscess What is the likely appearance of the pulp histologically? Coronal pulp is necrotic; radicular pulp is inflamed. Coronal pulp is inflamed; radicular pulp is normal. The entire pulp is inflamed. The entire pulp is necrotic. What is the likely appearance of the periapex histologically? Normal structures Acute inflammation; no bone resorption Acute inflammation; bone resorption Chronic inflammation; bone resorption What minimal immediate treatment is indicated?
a. b. c. d.
None. Schedule the patient for future evaluation. Complete canal preparation at this visit. Remove the caries and place a sedative temporarily. Perform pulpotomy or partial pulpectomy.
Questions 9 to 13 relate to the following photograph and radiograph.
A 50-year-old woman comes to the clinic complaining of sharp sensitivity with chewing on the lower left second molar. She reports a period of cold sensitivity 6 months prior but has not had any cold tenderness for several months. The third and first molars respond to pulp testing; the second molar does not respond. There is no pain to palpation, but the tooth is tender to percussion on the cusps and tender to biting on a bite stick. There is an isolated 6mm probing defect on distal. (Photograph: The shallow occlusal alloy has been removed.) 9. a. b. c. d. 10. a. What is the pulpal diagnosis for tooth no. 18? Normal Hypersensitive Irreversible pulpitis Necrosis What type of bacteria would likely be found in the pulp? Gram-positive aerobes
b. c. d. 11. a. b. c. d. 12. a. b. c. d. 13. a. b. c. d.
Gram-negative anaerobes Mixed flora None What is the likely cause of the patient's pain? Inflamed pulp Apical abscess Cracked tooth Periodontal abscess What additional tests are indicated? Cold test Heat test Test cavity Transillumination What type of permanent restoration is indicated? Occlusal amalgam Occlusal bonded complete Pin-retained amalgam Full-cast crown
Questions 14 to 20 relate to the following photograph and radiograph.
The patient reports "a bad toothache for 2 days. I can't bite on these lower, right, front teeth." There is pain on pressure and palpation in the region of the lateral incisor and canine. The premolar (small amalgam) is asymptomatic. The lateral and premolar respond to pulp testing; the canine does not respond. There is no swelling. There is an aphthous ulcer on the facial attached gingiva of the lateral. All probings are normal. The lateral and canine have moderate mobility. 14. a. b. c. d. 15. a. b. c. d. 16. a. b. c. d. 17. a. b. c. Which tooth and tissue are the probable source of pain? Lateral incisor and pulp Canine and pulp Canine and periapical tissue Lateral incisor, canine, and periapical tissue What is the likely pulpal and periapical diagnosis for the lateral incisor? Irreversible; phoenix abscess Normal; chronic apical periodontitis Necrosis; phoenix abscess Reversible; normal What is the likely pulpal and periapical diagnosis for the canine? Irreversible pulpitis; phoenix abscess Normal; chronic apical periodontitis Necrosis; phoenix abscess Necrosis; suppurative apical periodontitis Which teeth (tooth) require(s) endodontic treatment? Lateral incisor only Canine only Both the lateral incisor and canine
d. 18. a. b. c. d.
Neither at present Which bacteria have been related to this pathosis? Gram-negative rods; anaerobic Gram-positive rods, anaerobic Gram-negative cocci; aerobic Gram-positive cocci; aerobic
19. Of the following inflammatory cells, which would likely predominate periapically? a. b. c. d. Lymphocytes Polymorphonuclear neutrophilic leukocytes Plasma cells Macrophages
20. Looking at the radiograph and clinical photograph, what is the likely cause of the pulpal and periapical pathosis? a. b. c. d. Incisal attrition Cervical erosion Caries Impact trauma
Questions 21 to 25 relate to the following radiograph.
The patient reports severe, continuous pain in the mandibular, right quadrant. She states that the pain began when she was drinking iced tea last evening and the pain has not subsided. She slept poorly last night. Medical history is noncontributory. Amalgams were place a few months earlier after removal of deep caries on both molars. She has increased pain on lying down. The pain is not relieved with analgesics. She cannot localize the pain to an individual tooth. Pulp testing shows response on the premolar and second molar. The first molar does not respond. Cold-water application causes intense, diffuse pain in the region. Percussion and palpation are not painful. Probings are normal. 21. a. b. c. d. 22. Which tooth (teeth) is (are) the most likely cause of her pain? Premolar First molar Second molar First and second molars What is the pulpal and periapical diagnosis for the first molar?
a. b. c. d. 23. a. b. c. d. 24.
Necrosis; chronic apical periodontitis Necrosis; phoenix abscess Irreversible pulpitis; chronic apical periodontitis irreversible pulpitis; acute apical periodontitis What is the pulpal and periapical diagnosis for the second molar? Irreversible pulpitis; normal Irreversible pulpitis; acute apical periodontitis Irreversible pulpitis; acute apical abscess Normal; normal What would be the minimal emergency treatment on the offending tooth (teeth)?
a. Remove the amalgam and place a sedative dressing. Prescribe analgesics and antibiotics. b. c. d. Do a complete canal preparation. Place a cotton pellet of formocresol. Reduce the occlusion and prescribe antibiotics. Perform a pulpotomy and place a dry-cotton pellet.
25. Inferior alveolar injection is indicated. If the offending tooth (teeth) is (are) not anesthetized, what is the likely reason? a. b. There is a decreased pH in the region favoring formation of cations. The anesthetic solution is diluted by the inflammatory fluids.
c. There may be morphologic changes in the nerves that originate in the inflamed areas; these nerves becomes more excitable. d. Because of inflammation, there is increased circulation in the area; this carries away the anesthetic very rapidly. Questions 26 to 28 relate to the following radiograph.
The patient has no adverse signs or symptoms. Surgery was several years ago. There are no probing defects. The canine responds to pulp testing. 26. a. What diagnosis is likely? Chronic apical periodontitis
b. c. d. 27. a. b. c. d. 28. a. b. c. d.
Foreign-body reaction Apical radicular cyst Scar tissue What is the likely cause? Continued irritation from an undébrided, unsealed canal Adverse reaction to corrosion of the amalgam Coronal leakage Perforation of both cortical plates. What should the treatment plan be? Replace the crown; retreat the canal. Perform another surgery and place another root end material. Place the patient on antibiotics to resolve the lesion. No treatment is needed.
Questions 29 to 35 relate to the following clinical photograph and radiograph.
A 58-year-old woman has swelling in the maxillary anterior area that has steadily increased for 2 days. She denies thermal sensitivity and tenderness to biting pressure. The swelling is between teeth nos. 9 (central incisor) and 10 (lateral incisor). There is normal mobility, and probing depths are 4 to 5 mm with the distofacial surface of tooth no. 9 probing 8 mm. There is no tenderness to percussion, but there is tenderness to palpation. Pulp tests reveal that teeth nos. 8, 9, 10, and 11 are responsive to electrical-pulp testing and to thermal stimulation with carbon dioxide snow (i.e., dry ice). 29. Based on this information, the clinical photograph, and the radiograph, what is the pulpal diagnosis for tooth no. 9? a. b. Normal Reversible pulpitis
Irreversible pulpitis Necrotic
30. Based on this information, the clinical photograph, and the radiograph, what is the pulpal diagnosis for tooth no. 10? a. b. c. d. 31. a. b. c. d. e. Normal Reversible pulpitis Irreversible pulpitis Necrotic What is the periradicular diagnosis for tooth no. 9? Normal Chronic apical periodontitis Chronic suppurative, apical periodontitis Acute apical periodontitis Acute periodontal abscess
32. Which of the following is the most likely the cause of swelling associated with teeth nos. 9 and 10? a. b. c. d. e. Pulp necrosis Periodontal disease A developmental groove defect Vertical-root fracture Peripheral giant-cell granuloma
33. Which of the following is most important in determining if this lesion is of periodontal origin or of pulpal origin? a. Percussion
b. c. d. e. 34. a. b.
A periapical radiograph Periodontal mobility and mobility assessment Pulp testing Periodontal probing Treatment of this case requires which of the following? Periodontal scaling, root planing of the area, and drainage Root canal débridement of tooth no. 9, followed by incision and drainage
c. Analgesic treatment and antibiotic treatment until the involved tooth can be localized d. e. Flap reflection to inspect the root for a vertical root fracture or lateral canal Surgical excision and biopsy
35. Which of the following statements is true regarding the effects of periodontal treatment procedures on the dental pulp? a. Scaling and root-planing procedures remove cementum, expose dentinal tubules, which are invaded and result in pulp inflammation. b. Citric acid application appears to produce pulpal inflammation when used in conjunction with reattachment procedures. c. Hypersensitivity may result from scaling but is a sign of pulpal pathosis or inflammation or both. d. Scaling and root-planing procedures may produce deposition of tertiary dentin.
ANSWER KEY Chapter 1
1. 2. b; d;
3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
b; b; b; d; a; c; c; c; e; d; b; a; c; d; d; c; d; b.
1. 2. 3. 4. d; e; c; a;
5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
b; b; b; b; b; c; b; b; a; b; c; b; a; a; b; d; c; a; b; c.
1. 2. d; b;
3. 4. 5. 6. 7. 8. 9. 10. 11.
b; d; c; c; c; a; a; e; b.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. d; c; b; c; d; c; d; c; c; a; c; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. b; c; d; b; a; c; d; a; c; c; c; d; c; a; c; a; a; d; c; b; a.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. a; c; b; a; b; d; b; c; a; b; e; b; e.
1. 2. 3. 4. 5. 6. 7. a; c; a; d; b; c; a;
8. 9. 10.
b; d; b.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. a; b; c; a; c; d; b; d; b; d; a; a.
1. 2. 3. 4. 5. c; d; a; c; e;
6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.
d; a; d; c; b; b; a; a; a; a; d; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. c; b; c; b; a; a; b; d; b; a;
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. c; a; b; a; b; b; a; d; b; d; a; d; c; b; b; a.
1. 2. c; a;
3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
b; b; c; a; c; a; d; a; c; b; b; c; a.
1. 2. 3. 4. 5. 6. 7. 8. 9. d c a a c d b; d b;
10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
c d b; e b; c; c; c; d; e; b.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. a; c; a; b; a; a; c; a; c; e; a;
12. 13. 14. 15. 16. 17. 18. 19. 20.
c; a; b; b; d; b; c; a; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. d; d; a; d; a; a; a; b; d; c; d; d; b;
14. 15. 16. 17. 18. 19.
d; b; b; a; e; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. c; a; c; a; b; b; a; b; d; c; a; a; a; e; c; d;
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. b; a; e; b; d; d; b; a; b; a.
1. 2. 3. 4. 5. 6. 7. 8. 9. a; a; a; a; a; a; a; a; b;
10. 11. 12. 13. 14. 15. 16. 17. 18. 19.
d; a; b; a; a; b; e; b; a; a.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. c; e; a; d; a; d; c; a; b; d; b; c;
13. 14. 15.
b; a; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. a; d; d; b; c; c; b; a; d; a; a; a; c; d; a; b; c; b; d.
1. 2. 3. 4. 5. 6. a; a; d; b; b; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. d; a; b; d; e; a; d; b; d; d.
1. 2. 3. d; c; d;
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
d; b; d; c; b; a; c; a; b; b; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. c; d; a; e; a; d; c; c; c; a; d;
12. 13. 14. 15. 16. 17.
b; c; c; b; a; d.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. d; b; d; c; e; a; a; d; a; d; c; d.
1. 2. c; a;
3. 4. 5.
c; a; d
Test Your Knowledge
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. d; d; c; b; a; b; a; d; d; c; c; d; d; c; d; c; b; a; b;
20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.
a; c; a; a; d; c. d; d; d; a; a; e; b; d; a; d.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.