~DA A mc rica u S t ud en t Dental Associution

National Board Dental Examinations

TEST PACKET II-J
1991 Pilot Comprehensive Exam ination

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TEST PACKET II-J

National Board Denta l Exam inat ion Part II

1991 Pilot Examination

Contents Page

1991 Pilot Examinat ion (released 1991)

Com po nent A :
Random ly ordered test item s 1

Com pone nt B:
Case-ba sed test item s 12
Bookl et of cases 27

Revi ew documen t:
A nswer Key and ration ale 66

Examination released 1991. D istributed by the American Student Dental Association

w ith permi ssion from the American Dental Association. No part of this book may be
reprod uced in any form or by any means, electronic or mechanical, includi ng photo -
copying, recordi ng, or by any information storage and retrieval system, w ithout per-
mission in writing from the American Student Dental Association .

© 1991 American Dental Association

 COMPONENT A
1. Which of th e follow ing best explains wh y
the renal excret ion of salicylic acid is
increased in an alkaline urine1
A. The urine volum e is decreased.
B. The percentage of salicyli c acid that
is ionized in urine is increased.
C. The percentage of salicyli c acid that
is ioni zed in urine is decrease d.
D. Decreasing urine pH usually increases
th e renal exc ret ion of weak acids.
2. x -ravs are produced when
A . protons st rike the anode.
B. elect rons strik e the anode.
C. th e anode is heated above
3,000 degrees C.
D. the filam ent becom es positiv ely
charged.
3. Primary crow n mineralization (calcification)
generally begins
A. in the third to sixt h w eek in utero.
B. in th e second trimester.
C. in th e third trimest er.
D. at birth.
4. Which of t he f ollowing best describes the
usual behavioral characteristics of a child
w ho has Dow n syndrome7
A . Crying and st ubborn
B. Hyperactive and disoriented
C. Smiling, affectionate, and easily
distract ed
D. Fearful and unresponsive to verbal
communication
5. A membe r of the dental staff routinely fails
to clean up his wo rk area. Which of the
fo llow ing best exemplifies an assertive
message t hat could be made by a
co-worker?
A. "If you refuse to do your part, I'm
just going to have to report th e
sit uat ion to the boss."
B. "When you don't help w ith th e
clean-up, it makes me angry
because I have t o do both your
wo rk and my ow n."
C. " I'm ti red of cleaning up your mess!"
D. "I hope you'll remember to help me
clean up today."
E. "Is something bothering you7 You
sometimes forget to clean up."
6. The crown of an endodontically-t reated
maxillary lateral incisor is fractured near
th e gingival margin. The coronal end of
the silver cone used in filling that canal is
visibl e at th at level. The findin gs reveal
that th e exist ing root canal fillin g meets
all criteria t o be judged successfu l. Which
of the follow ing is the best w ay to obtain
the needed post space7
A . To prepare it alongside the silver cone
using burs and Peeso reamers.
B. To carefully grind away the coronal
part of the silver cone using round
burs or end-cutting burs.
C. T o remove the silver cone and re-treat
the canal using a gutt a-percha
t echnique, and th en to create t he
needed post space.
D. T o remove the silver cone, notc h it
4 mm from the apical end, coat it
with fr eshly mixed sealer, replace it
in th e canal, and "twist-off" the
coronal segment.
7. After receiving one cartri dge of a local
anesthet ic, a healthy adult pat ient became
unconscious in the dental chair. The
occurrence of a brief convulsion is
A . pathognomonic of grand mal epilepsy .
B. consistent w ith a diagnosis of
syncope.
C. usually caused by the epinephrine in
th e local anest het ic.
D. path ognomonic of int ravascular
injection of a local anesthetic.
 8. The axial w all of an occlusolingual
amalgam preparation on a maxillary molar
should be in dentin and
A . parallel to the dentin oenamel juncti on.
B. parallel to th e long axis of th e toot h.
C. at an acute angle with the pulpal
floor.
9. During the mixed dentiti on stage, wh ich
of the follow ing appliances should be used
as a space maintainer for missing primary
molars in the mandibular arch?
13. The Health Belief Model attempts to
explain patient recommendations by
A . examining patients' perceptions of
disease-seriousness and of the
tr eatm ent effectiveness.
B. f ocusing on the doctor-patient
relationship.
C. emphasizing the barriers th at are
ext ernal to behavior change, for
example, payment mechanisms.
D. focusing on patients ' skills at
carrying out recomm endations.

A. Distal shoe
B. Nance holding arch 14. Which of the following represents t he
C. Passive lingual arch MOST effec ti ve w ay of encouraging a
D. Removable acryl ic fun ct ional child to floss regularly?

A. Presenting a message that concerns

th e potential loss of teeth, should
10. Accepted methods for closing a diast ema th e pati ent not floss
betw een maxillary central incisors include B. Arranging for the child to earn
using either a removable appliance with privileges for flossing
finger springs or C. Repeating periodically th e message on
the value of floss ing
A. a rubber elastic around th e two teeth . D. Providing wr itten material that
B. a steel ligature around the t w o teeth. explains the mechanism of flossing
C. bonded brackets w ith int ert oot h
traction.

15. In an ideal Class V cavity preparation for

11 . Each of th e follow ing developmental cysts amalgam in a mandibular premolar,
appears on radiographs EXCEPT one. retention form is gained
Which one is this EXCEPT/Om
A . int o the mesial and distal w alls.
A. Nasolabial B. in the mesial and occlusal line angles.
B. Median palatal C. in the axio-occlusal and axiogingival
C. Globulomaxillar y line angles at the expense of the
D. Nasopalatin e axial wall.
D. in the axle-occlusal and axiogingival
line angles at the expense of the
occlusal and gingival w alls.
12 . When try ing-in a porcelain fused-to-metal
crow n, the dentist observes t hat the
gingival-margin finish-line integrity is
exce llent, but that the occlusal surface is 16 . Which of the fo llowing systems is thought
, mm too high. Which of th e following is to malfunc tion in the hereditary form of
t he most probable cause? angioneurotic edema7

A. Incorrectly related casts A. C-' esterase

B. Proximal cont acts being too t ight B. C-' q inhibitor
C. A distortion of th e metal during firing C. CHso consumption
D. An expansion of the porcelain during D. Serine phosphatase
fir ing E. Complement synthetase

2
17 . Following a bilateral mandibular f racture in 22. When a removable partial denture is
the canine region, the anterior fragment of terminally seated, the retentive clasp tips
t he mandible is displaced posteriorly by should
th e action of the geniohyoid and by which
oth er muscles7 A . be invisible.
B. exert no force.
A. Thyrohyoid and mylohyoid only C. apply retentive force into the body of
B. Genioglossus and mylohyoid the teeth.
C. Thyrohyoid. mylohyoid. and anterior D. resist to rque thr ough the long axis of
bellies of the digast ric the teeth.
D. Genioglossus and anterior bellies of
the digastri c

23. The decrease in ventilat ion caused by

18. The number of persons who die each year morphine and by some of the related
from oral cancer in the Unit ed States opioids depends chiefly upon a decrease in
approximates
A . blood pC0 2 concentr ation.
A. 2,000. B. medullary endorphin activity .
B. 4,000. C. sensitivity of the medullary
C. B,OOO. respiratory center to carbon
D. 16,000. dioxide.
D. sensitivity of aortic and carotid
chernoreceptors to blood
19. Each of the following parameters has an oxygen concentration.
effect on the distributi on of a drug
EXCEPT one. Which one is this
EXCEPTlONl
24. The depth of the clinical gingival sulcus is
A. The intrin sic act ivity of the drug th e dist ance from th e gingival margin to
B. The binding of a drug to plasma th e
proteins
C. The blood flow to vari ous organs and A. cementaenamel junction.
tissues B. most apical penetration of the
D. The relat ive SOlubility of th e drug in periodontal probe.
the tissues C. most apical exte nsion of t he junct ional
epit helium.
D. bottom of the sulcus in w ell·preserved
20. Which of the foll ow ing is MOST hist ologic block sections.
appropriat e for testing differences between
th e means of two groups7

A. Chi-square test 25. A bevel is CONTRA INDICA TED on the

B. Multipl e regression analysis cavosurface angles of a Class I dental
C. Correlation coefficient analysis amalgam cavity preparation. Which of t he
D. Student's t -test follow ing best explains why7

A. This typ e of margin is prone to

21. A pati ent wa s administered a flow rate of microleakage.
4 lit ers of oxygen and 2 liters of nitrous B. The cavosurface bevel makes
oxide. What percentage of nitrous oxide burnishing more difficult.
did t he patient inhale7 C. A thin f lange of th e amalgam
restorative material might
A. 25 % fra ctur e.
B. 33 % D. As th e tooth undergoes natural
C. 50% attrition, th e amalgam margin
D. 66 % can abrade.

3
26 . Which of the following represents a dental 30 . The soft tissue-tooth interface that forms
program in which eligible patients receive most frequently after flap surgery in an
services at specified facilities from a area previously denuded by inflammatory
limited number of dentists7 disease is a

A. An open-panel A . collagen adhesion.

B. A closed-panel B. reattachment by scar.
C. A capitation group C. long junctional epithelium.
D. A prepaid group D. connective tissue attachment .

31. Which of the following is inherited as an

autosomal dominant trait?

27 . Additional space for successive eruption of A. Lichen planus

permanent maxillary molars is provided by B. Bullous pemphigoid
C. Pemphigus vulgaris
A. interstitiai bone growth. D. White sponge nevus
B. appositional growth at the maxillary E. Epidermolysis bullosa acquisita
tuberosity .
C. continuous expansion of the dental
arch due to sutural growth.
D. an increase in palata l vault height due 32. Which of the following is the primary
to alveolar growth. substance or material removed during root
planing7

A. Stain
B. Dentin
C. Plaque
28 . Which of the following responses made by D. Calculus
the dentist is the MOST likely to increase a E. Cementum
patient's adherence to oral hygiene
prescriptions 7
33. Three days after full mouth extraction, an
A. " You don't want lots of cavities, do eiderly patient complains of black-and-blue
your' marks on her neck. The most probable
B. "If you take my advice, you can save diagnosis is
yourself pain and money."
C. "You really should spend the time it A. thrombocytopenia .
takes to brush and floss ." B. capillary fragility.
D. "What do you see as some of the C. hematoma formation .
problems with this approach7" D. postoperative ecchymosis.
E. "I can assure you that this approach is
quick and easy."
34 . Most epidemiologic studies indicate that
gingivitis in children is relatively common.
A strong positive association between
specific nutritional deficiencies and the
presence of periodontal disease in children
29. Amalgam scrap should be stored in a and adults has been demonstrated .
tightly-sealed container and covered with
which of the following 7 A. Both statements are TRUE.
B. Both statements are FALSE.
A. Water C. The first statement is TRUE, the
B. Glycerin second is FALSE.
C. Sulfide solut ion D. The first statement is FALSE, the
D. Sodium hypochlorite solution second is TRUE.

4
 35. Chroma is that aspect of color that 40. Which of th e following characterizeIs) the
signif ies th e histo pathologic changes in chronic
gingivitis7
A. degree of grayness.
B. degree of translu cency. A . The loss of rete pegs and the
C. degree of saturat ion of th e hue. dissolution of th e basement
D. combined effect of th e hue and value. membrane
B. An infl ammatory infil trate in w hich
macrophages predominat e
C. An inflammatory infiltrate in which
neutrophili c leukocytes and mast
36 . In a state of gingival health, the narrow est cells predominate
w idth of keratinized gingival tiss ue is D. The destru ction of the principal fib ers
usually found on t he f acial aspect of whi ch of th e periodontal ligament
of the foll owi ng teeth? E. The disruption of the gingival fibers
and an infl ammatory inf iltrate of
A. Mandibular centr al incisors plasma cells, lymp hocytes, and
B. Mandibular first premolars neutr ophilic leukocytes
C. Maxill ary second premolars

41. When provid ing endodontic tr eatm ent for a

37 . A patient is experiencing a thr obbing pain patient who has a history of rheumati c
in a specific tooth. This pain is heart disease, th e dentist should
aggravated by heat and relieved by cold. especially avoid wh ich of the foll ow ing?
The tooth is sensitive to percussion. The
most likely diagnosis is A . Underinstrumentati on of a vital tooth
B. Overinstrumentati on of a vital too th
A. occlusal tr auma. C. Underinstrumentation of a necrotic
B. periodontal abscess. too th
C. irreversible pulplt is. D. Overinstrumentation of a necrotic
D. hyperemia of th e pulp. tooth

38. Which of th e foll owing is th e most 42 . Whi ch of th e following tis sues is MOST
consistent finding in systemic infections? sensitive to radiation -induced
carcinogenesis7
A. Fever
B. Tachypnea A. Liver
C. Lymphadenopathy B. Thyroid
D. Abs cess formation C. Salivary gland
E. Cellulit is forma tion D. Prostate

39 . Which of the follow ing represent s the

variability about the mean-value of a group 43 , Which of t he followin g most strongly
of observations7 suggest cause-and-ef fect relationships?

A . Sensit ivity A. Correlational studi es

B. Standard deviation B. Controlled clinical trials
C. t-Statistic C. Case reports
D. Specificit y D. Epidemiologic surveys

5
44 . Spont aneous osteogenic sarcoma is 49. In late ral movements, th e non-w orking
associated with whi ch of the follow ing condyle moves in what direction7
disease processes of bone7
A. Laterally. posteriorly, and superiorly
A. Paget's disease B. Superiorly, posteriorly I and infe riorly
B. Hlstio cvtosls-X C. Inf eriorly. anteriorly. and medially
C. Hyperparathyroidism D. Inferi orly, anteriorly, and laterally
D. Letterer-Siwe disease
E. Osteogenesis imp erfecta

45. The drug·of·choice for t he tr eatment of

adrenergically-induced arrhythm ias is 50. A dent ist w ho is planning to rest ore a
t ooth w ith gold alloy desires a certain
A. quinidine. amou nt of expans ion in the casting
B. lidocaine. investme nt mold. Which of the following
C. phenytoin. best explains w hy this expansion is
D. propranolol. desirable7

A . It allows for th e shrinkage of the

molt en met al and th e w ax pattern.
46. Which of the following drugs. wh en B. It compensates for the shrinkage of
administered intravenously. is LEAST likely th e molt en metal as it cools in the
to produce respiratory depression1 mold.
C. It makes th e metal casting larger than
A. Fentanyl the w ax pattern so that th e casting
B. Diazepam w ill fit t he tooth t ightly.
C. Thiopental
D. Meperidine
E. Pentobarbital

51. The dentist is using poly ethe r material t o

47. Which of the following safet y techniques ma ke impressions. T he physical propert y
provi des the GREA TEST DECREASE in of t his material that should concern this
ov erall radiation-risk to pati ents7 dentist is the

A . Changing from Group D to Group E A. coeff icient of th ermal conducti vity.

film B. hydr ophilic nature.
B. Swit ching from round to rect angular C. extend ed setting t ime.
collimati on D. high modulus of elast icity .
C. Using an auto mati c rath er th an ma nual
processing switch
D. Adding a cervical collar to a leaded
apron

52. Streptococcus mutans is considered to be

a principal etiologic agent of caries
48. Premature exfoliation of a primary because it produces organic acids and it
mandibular canine is most often the
sequela of w hich of th e fo llowi ng7 A. forms a gelatino us matrix.
B. metab olizes substrate from saliva.
A. Caries C. derives energy from enamel
B. Trauma constituents.
C. Serial tooth extra cti on D. liv es symbiot ically w ith Lactob acillus
D. Arch lengt h inadequacy acidophilus.

6
53. Which of the following best explain s how 57. A pract itioner who is restoring a tooth w ith
high-copper amalgam restorat ions differ composites w ishes to be sure that the
from conventional amalgam restorations1 matrix has adhered to the filler. Which of
Th e high-copper restorations the following agents adheres th e resin
matri x t o the filler?
A . have little or no tin -mercury phase.
B. require less mercury . so there is more A. Wetting
matrix f ormed. B. Coupling
C. corrode at an accelerated rate due t o C. Cataly zing
increased copper content. D. Activating
D. are unaffe ct ed by moisture
contamination in th e presence of
zinc.

58. An operator has chosen to use a shielded

open-ended con e. Which of th e following
will contribute th e most to patient gonadal
dose?
54. What do Gardner syndrom e and
cleidocranial dysplasia have in common? A. Leakage fr om the x-ray machine head
B. Scatter from th e operatory walls
A. Intestinal polyps C. Scatter from the cone
B. Intraoral pigmentation D. Scatter fro m the patient's face
C. Impacted supernumerary teeth
D. Osteomas of the skull and jaws

59. Which of the foll owing provides th e best

guarantee for sterilizat ion in a heat
55. A healthy 3-year-old child has just had a sterilizer7
routine ex traction of a prim ary mandibular
molar. Which of the foll ow ing A. Using a chemical indicator str ip or
postoperative problems is the most likely pouch
to occur? B. Recording the t emperature and/or
pressure readings from th e
A. Prolonged bleeding sterilizer gauges
B. Pain C. Using bact erial spore tests
C. A dry socket D. Determinin g th e abilit y of the
D. Lip bite sterilizer to kill th e hepati tis B virus
E. Demonstrati ng inactiv ation of th e
tuberculosis bacterium

56. Two hours elapsed before a pat ient w ith

an avulsed t ooth w as ab le t o see a dent ist.
The denti st replanted and splinted th e 60 . The integrity of the floor of t he antrum is
tooth , and performed nonsurgical at greatest risk with surgery involving the
endodont ic th erapy. Which of the removal of (a)
foll owing probably result ed afte r th e
treatm ent] A. torus palatinus .
B. nasopalatin e cyst.
A. Radicular cyst formati on C. maxillary third molar.
B. Condensing ost eitis D. single remaining max illary molar.
C. Ext ernal root resorption E. supernumerary t eeth from th e
D. Chronic periapical periodontitis maxillary canine region .

7
61 . Which of t he following is the principal 66 . The day afte r receiving an inf erior alveolar
nonve rbal cue that two or more people can nerv e block, a pat ient ex periences limit ed
use t o regu late verbal communicat ion? ability to open his mouth. Which of t he
follow ing structures w as most probably
A. Posture injured?
B. Movement
C. Eye contact A. The medial pterygoid muscle
D. Body posit ion B. The st ylomandibular ligament
C. The deep fibers of t he masseter
muscle
D. The posterio r belly of the digastr ic
62. When the mandible is in it s physiologic rest muscle
posit ion. the distance between the E. The inferior head of the lateral
occluding surfac es of th e maxillary and pterygoid muscle
m andibular teeth or occl usion rim s is

A. vertical dimension.
B. interocclusal d istance. 67 . Lesions of recurrent herpetic stomatitis are
C. vertical dim ension of rest. usually f ound mainly on
D. centric occ lusion (maximum
inte rcuspat ion). A . loosely attached areas of the oral
mucosa, such as the buccal mucosa
and th e floor of the mouth.
63. Th e pract itioner w ould like to learn B. tightly attac hed areas of the oral
whether or not a patient underst ands th e mucosa, such as th e hard palate
t reatment plan. Which of th e followi ng and the atta ched gingiva.
quest ions is th e MOST likely to elicit this C. loosely att ached areas of th e oral
information? mucosa, such as th e soft palate and
the alveolar mucosa.
A. "0 0 you understa nd w hat 1 mea n 1" D. tis sue anyw here in th e oral mu cosa,
B. "00 you hav e any questions about including both looselv- and
th is approach?" tightly-attached areas.
C. "What benefit s or draw backs do you
see in thi s app roach ?"
D. "Is th is approach OK w ith you?"

68. Which of the follow ing inst rument s should

be used to plane t he facio -proxi mal
64. Th e distolingual extens ion of a mandibular cavosurface margin of a stan dard Class II
impression for a complete denture is preparation on a mandibular molar?
limited by t he act ion of w hich of the
fo llowi ng mu scles? A. Straight chisel
B. Binangle chisel
A . Sty lohyoid C. Enamel hatchet
B. l ateral pterygoid D. Bibeveled hatchet
C. Medial pterygoid
D. Superior co nstrictor

69 . Which of the follow ing most accurately

65. A defect in neuromuscular transmission describes the eff ect of individual plaque
causes w hich of th e followi ng? control instructions th at are conduct ed in
th e classroom?
A. Bell' s palsy
B. Mya sth enia gravis A. A short -t erm decrea se in gingivitis
C. Muscular dyst rophy B. A long-term decrease in gingivitis
D. Multiple sclerosis C. A short- term decrease in caries
E. Trig eminal neuralgia D. A lena-term decrease in caries

8
70. The greatest risk of oral cancer is in 73, Which of t he foll ow ing do polyc arbox yl ate
persons who and glass ionomer have in common7

A. have poor oral hygi ene and nutr itional A. Zinc oxide
deficien cies; and, frequ ently use B. Polysilox ane
alcohol. C. Phosphoric acid
B. have poor oral hygien e and nutritional D. Polyacrylic acid
defici encies; and, regularly use E. Ion-leachable glass
tobacco.
C. are older, frequently use alcohol, and
regularly use toba cco. 74. If an incipient carious lesion w ere
D. are older, have nutritional inadvertently covered w ith sealant, th e
deficiencies, and have poor oral lesion would most likely
hygiene.
A. progress at a slower rate.
B. progress at a more rapid rate.
C. not conti nue to progress.

71. An endodontic inst rument separated in the
apical third of a root canal. The fr agment
is 3 mm long and is tightly lodged. No
radiographic changes at the apex are
evident. The practitioner should
75, A pract ition er has burnished a margin. As
a result of this procedure, the dental
casting gold has become stronger , but less
ductile. Which of the following explains
why7

A . extra ct the to oth . A. The gold has w ork-hardened.

B. resect th e apical section of the root B. The grains have elongated.
containing the broken instrument. C. The stiffness has increased.
C. perform an apicoecto my and place a D. The surface flaws have been removed.
reverse fi lling .
D. comp lete t he root canal filling to the
level of the instrument and observe.
76. The light from vi sible-light polym erizat ion
units can cause wh ich of the foll owing7

A . Iritis
B. Cataracts
C. Retinal damage
D. Corneal ulcerations

72. A new pati ent had root canal therapy

performed seven months ago in another
country . No historical radiographs are
available. The root canal filling appears 77. Which of th e following responses made t o
to be satisfactory, the toot h is a child is MOST likely to reinforce
asymptomatic, and there is no associa ted positively th e child's appropriate behavior
sinus t ract . However, a small periapical in the dental selling7
radiolucency is evident . Which of the
following is indicated7 A. "You'r e doing a great job for me
today. "
A. Incision and drainage B. "I like it when you sit quietly in the
B. Nonsurgical retr eatm ent chair."
C. Re·evaluation in six months C. "This visit is going really w ell, don't
D. Ap icoectomy and apical amalgam you think7"
E. Prescription of an appropriate D. "Coming to the dentist isn't so bad
antib ioti c aiter all, is it7"

9
78. An endodontica lly-treated permanent 80. A pati ent has a skeletal deformity with a
mandibular f irst molar has incipient lesions Class III malocclusion. This deformity is
on its mesial and distal surfaces. During the result of a maxill ary deficiency . The
previous treatmen t, a minimal amount of treatment-of-choice is
tooth structure w as removed. T he
appropriate treatm ent for this tooth is A . orth odont ics.
a (an) B. surgical repositioning of the maxilla .
C. anter ior maxillary osteotomy .
A. MOD amalgam. D. post erior maxillary ost eotomy.
B. MOD cast gold inlay. E. surgical reposit ioning of t he mandible.
C. MOD cast gold onlay.
D. 3/4 crow n.
E. full crow n.

81. Approxlmataly how long did It take you to

completa Component A (test Items 1-8017

A. Less than 50 mi nutes

B. 50-59 minutes
C. 60-69 min utes
D. 70·79 minutes
79. Use of infection contro l procedures with all E. 80-89 minutes
patients, rather tha n with selected F. 90-99 minutes
patients, is properly referred to as G. 100-109 minutes
H. 110 minutes or more
A. OSHA requirements.
B. universal precautions.
C. ADA guidelines. Proceed with the Component B instruct ions
D. CDC recommendat ions. immediately.

10
 COMPONENT B - 100 CASE·BAS ED TE ST IT EMS

(IT IS I MPORTANT TO REA D THE SE I NST RU CTIONS)

1. The following t est ite ms are presented in 9 cases 1I . IX).

2. The t est ite ms for each case are in t his book let; th e case mat erials for each case are present ed in the
Boo klet o f Cases.

3. In t he Booklet of Cases, each case is pre sented with:

A. a sy nopsis o f t he pati ent history.

B. a clin ical ex am inat ion ch art ,

C. rad iographs , whe n available,

D. cli nica l pho tog raphs, whe n necessar y.

Yo u sh ould review th ese mater ials befo re answe ring t he test items for each case .

4. The clinical examination charts represent each patient' s clinical findings. Restorations have not been
charted ; some (bu t not all) car ious lesion s t hat might be visible on rad iograph s have been charte d .

5. The sequenci ng o f ite ms wi th in cases parall els ac tua l practice. Th us, as th e t reatme nt pr oc eed s, new
informat ion might be given in subsequent ite ms t o guide you in mak ing fu ture trea tment dec isio ns.
When th is new infor mation is provided it should not inf luence you r answers to prio r items.

6. For Co mpon ent 8, enter th e fo llowin g o n you r seco nd answer sheet :

A. Yo u r nam e

B. Your reference numb er

C. Test nam e (Camp. B)

D. Test Numbe r (8 B)

7. You may begin Component B.

11
 COMPONENTB
I CASE I I
1. During the child's first visit, the denti st
requested that the paren ts wait in t he
recepti on room . The child cried
mod erat ely, but tearfully, throughout the
dental exa mination and prophylaxis. Th e
denti st " gav e her permi ssion" to cry
w hile he/sh e w orked and then took no
notice of her cryinq , Her crying diminished
in intensity ove r t im e and t hen sto pped.
W ith respect ONL Y to th e crying behavior,
th e denti st has
A. used positiv e reinforcement.
B. used negative reinforcement .
C. ex t inguished th e behav ior.
D. ignored th e probl em .
2. Which of the fo llow ing is th e LEAST
likely to cont ribute to thi s patient's
dental phobia?
5. Which of th e follow ing desc ribes the most
appropr iat e treatmen t for the
lingually -erupting perm anent ma ndibu lar
right central incisor?
A. Extra cti ng the prim ary right central
incisor im me diate ly. and th en
m oving the linquallv-erupted toot h
labially with an appliance.
B. Waiting for th e primary right central
incisor to exfoliate, and then
moving the lingually ·erupt ed too th
labially w ith an appliance.
C. Ext racting both primary mandibular
centra l incisors im m ediatel y . and
th en observing the erupt io n of the
perm anent central inciso rs.
D. Obs erv ing the primary mandibular
ce ntral incisors unt il they
exfoliate, and then allow ing the
perm anent incisors to mo ve
labially on th eir own.

A. Her age
B. Her gender
C. Her moth er's dental phobia 6. Whi ch of th e following best descr ibes the
D. Her prior dental experience radiolucency seen at the furcatio n of the
ma ndibul ar right second primary m olar?

A . It is of pulpal origin.
B. It is of periodont al origin.
3. At a subsequent vi sit, th e child's behavior C. It is of combined pulpal and
w orsen ed. Th e dent ist decided to use periodontal origin.
pharmacologic anx iety control. Whi ch of D. It is a normal feature of the m ixed
the following represent s the most dentit ion.
appropriate drug for this purpose?

A. Chlorprom azine IThorazine®i P.O. 7. Wh ich of th e following represents th e

B. Hydroxy zine (Vistaril ® ) P.O. most appropriate tr eatment for the
C. Meperidine (Dem erol ® ) P.O. primary mandibular right second m olar ?
D. Ket amine (Ket elar ® ) I.M .
E. Pent obarbital (Nembut al ® I P.O. A. An indirect pulp treatm ent
B. A pulpot omy follow ed by a Class II
am algam restora tion
C. A pulpotomy follow ed by a st eel
crown restorat ion
4. Afte r the permane nt mandibul ar left first D. An ext raction
mola r has furthe r erupted , placement of
which of th e following is indicated for
m anaging the spac e that is mesial to this 8. Whi ch of the following represents th e most
tooth? appropriate treatment for the primary
mandibul ar left first molar?
A. A band and loop space maint ainer
B. A distal shoe space maintainer A. MO and DO amalgam resto rations
C. A passive mandi bular lingual holding B. An MO D amalgam restora tion
arch C. A stainl ess stee l crown resto rat ion
D. A space·regaining appliance D. A n extr actio n

12
9. Which of th e following best describes the 13. How mu ch additional sy ste mic sodium
number of radiographs that accompany flu oride should t his child ingest per day7
this case7
A . None
A. Insuff icient B. 0 .25 mg
B. Appropriate C. 0 .5 mg
C. Excessive D. 1.1 mg
E. 2.2 mg

14, The presence of wh ich of th e following

can be confirmed from th e available
radiographs and photographs7
1 O. During t he fir st dental office visit , this A . A peg-shaped lateral incisor
child cooperated for th e exa mination, B. Multiple supernumerary teeth
prophylaxis, and radiographs. Which of C. A chronic periapical infect ion
the foll ow ing should be perform ed during D. Congenitally-missing permanent
the next appointment 7 prem olars
E. A normal complem ent of teeth for the
A. Restoration of the primary mandibular child 's age
left first and second molars
B. Extraction of t he erupted malform ed
tooth
C. Rest orati on of th e primary maxillary
right first and second molars
D. As much restorative treatment as the
child w ill allow
15. The peg-shaped tooth in the maxillary left
incisor area w ill most likely result in
w hich of the follow ing7

A. Loss of arch length (perimeter) in the

mixed and permanent dentit ions
11 . Which of the follow ing best describes this B. Ectopic eruption of the permanent
child' s primary molar relati onship7 maxill ary incisor(s)
C. The development of an odontog enic
A. Class II cyst or tumor and subsequent
B. Distal step infecti on
C. Mesial step
D. Flush terminal plane

16. Which of the following represents the most

12. Which of the follo w ing represents the most appropriate tr eatment for the tooth th at
appropriate tr eatm ent for this child's has erupted into the maxillary left incisor
prima ry man dibular molars7 space7

A . Sealants A. Restoring it with a comp osite resin

B. Am algam restorations crow n
C. Steel crown restorati ons B. Allowing itto resorb and exfoliate
D. Reinforced zinc oxid e-eugenol C. Observing it at six-month interva ls
restorations D. Extra cting it

13
17 . II one or more 01 this child's teeth w ere to
be extracted , which of th e l ollowing
should be prescr ibed?

A. Erythromy cin, 1 g PO 1 hour

preoperat ively, and 500 mg PO 20 . Wh ich 01 th e foll owi ng BEST represents
6 hours late r this patient 's dental age?
B. Penicill in V, 2 g PO 1 hour
preoperat ively, and 1 g PO 6 hours A. 6 years
later B. 8 years
C. Penicill in V. 1 g PO 1 hour C. 10 years
preoperatively, and 500 mg PO D. 12 y ears
6 hours lat er
D. Penicillin V, 1 gPO, 1 hour
preoperati vely, and 500 mg PO 2 1. The pat ient's m idlin e relat ionship is most
every 6 hours lor 8 doses likely to be th e result 01
E. Vancomy cin, 50 0 mg I.V . 1 hour
preoperat ively A. a mandibular lunct ional shil t.
B. asymmetric growth 01 th e mandible.
C. crowding in the mandibular arch.
D. blocked-out maxi llary lateral incisors.

1B, For this child, which 01 the l ollow ing 22. Whi ch of the lollow ing has most likely
represents the maximal dose (per caused th e pat ient's right poster ior
tr eatm ent session) 01 2 % lidocaine crossbite1
1:100, 0 0 0 epinephrine tha t can be
injected? A. A t ongue-thrust habit
B. A thumb -sucking habit
A. 40-80 mg C. A unilat eral constriction of the
B. 90-130 mg maxill ary right posterior te eth
C. 140-180 mg D. A bilateral sym met rical const ricti on 01
D. 190-230 mg th e maxillary posterior t eeth

23. From th e panoramic radiograph, th e dentist

can determine that th e maxillary
permanent ca nines are erupting
19. Wh en th e dentist removed th e caries in th e
primary maxillary right l irst mola r, t he A. ectopically.
pulp became exposed. W hich of the B. norm ally .
follow ing represent s the C. f acially .
tr eatm ent-ol-choice lor thi s t ooth? D. palatally .

A. A pulpot omy and an amalgam

restoration 24. Which 01 the follo w ing describes an
B. A pulpot omy and a stai nless-steel
appropriate procedure l or initiating thi s
crown restoration
patient 's orthodontic treatment?
C. An ext ractio n and th e subsequent
placement of a space maintainer
A. Expanding th e maxillary arch
D. An indirect pulp tr eatme nt and a
B. Corre cting the cros sbit e of th e
reinforced zinc oxide-eugenol
maxillary lateral incisors
restorat ion
C. Extracting the primary mandibular
E. A direct pulp cap w ith
canines
calcium·hydroxide and an amalgam
D. Removing the primary maxill ary lirst
restoration
molars

14
25. The mixed·dentition arch-length analysis 29. The practitioner has determined that
reveals a 1.5 mm deficiency in the Tooth #31 is the source of the patient's
mandibular arch. These results support pain. This tooth is sensitive to percussion.
which of the foil owing alternatives? Vitality tests elicit no response . These
signs and symptoms are consistent with a
A. Expanding the mandibular arch diagnosis of which of the foilowing7
B. Leaving the mandibular arch as it is
C. Extracting the mandibular primary A. Pulpal hyperemia
canines B. Reversible pulpitis
D. Initiating a serial-extraction C. Suppurative pulpitis
procedure D. Acute apical periodontitis
E. Chronic apicai periodontitis

26. This patient's mother requests a 30. In order to alleviate this patient's pain
prescription for systemic sodium from Tooth #31, the dentist should do
fluoride supplements. Which of the which of the following?
foil owing represents the appropriate daily
supplemental dosage? A. Adjust the occlusion
B. Prescribe an antibiotic
A. None C. Perform an indirect pulp cap
B. 0 .5 mg D. Initiate root canal treatment
C. 1.1 mg E. Perform a pulpotomy
D. 2.2 mg

31. The practitioner has relieved the patient's

27. Which of the following represents the most pain, conducted a thorough examination,
appropriate periodontal diagnosis for this and designed a complete treatment plan.
child? Which of the following represents the most
appropriate next step?
A . Periodontal health
B. Generalized marginal gingivitis A . Controlling the caries in Teeth U's 3,
C. Localized prepubertal periodontitis 1B, 19 . and 30
8. Placing a temporary crown on
Tooth #3 and restoring all remaining
carious lesions with amalgam
C. Placing a full crown on Tooth #3

I
CASE IV I D. Extracting Teeth #'s 3 and 31

32 . Tooth #3 has a vertical root fracture. The

dentist determines that this tooth is
nonrestorable. Which of the following
replacements represents the most
28. The evidence gathered from this patient's
appropriate choice?
oral and radiographic examinations, as well
as from his medical and dental histories,
A. A resin-bonded fixed partial denture
suggests that his plaque flora contain
that uses Teeth #'s 2 and 4 as
elevated percentages of which of the
abutments
foilowing?
B. A conventional fixed partial denture
that incorporates three-quarter-crown
A. Bacteroides gingivalis
retainers on Teeth #'s 2 and 4
B. Streptococcus mutans C. A single-tooth osteointegrated implant
C. Eikenella corrodens
D. A cast-metal removable partial denture
D. Actinobacillus actinomycetemcomitans
that has appropriate clasps and rests

15
33. Whi ch of the following materials is the 37. Dur ing a subsequent afternoon visit that is
most appropriate for restoring schedul ed for addition al dental tr eatment,
Teeth #'s 18, 19, and 20 ? th e pati ent becom es pale, sw eat y, and
tremulous . Administrat ion of which of th e
A. Am algam f ollowing represents th e most appropriate
B. Cast gold course of actio n for thi s patient's
C. Resin bonded composite condition?
D. Intermediate restorative material
A. Regu lar insulin
B. A sugar-co ntaining drink
C. Intravenous glucose
D. Oxyg en

34. The restorative treatm ent of Tooth #19

required indirect pulp capping. After
compl etin g thi s porti on of the treatm ent,
the dent ist should proceed by 38. Th e deci sion has been made to extract th e
impacted third mola rs. When should th ey
A. grinding t he too t h out of occlusion. be remov ed?
B. relieving the occlusion in the opposing
to oth . A. Imm ediat ely
C. taki ng an additiona l periapical B. After th e teeth cause problem s
radiograph of th e tooth . C. After th e roots are 50%-developed
D. instru cting the pati ent in home -care D. After th e roots are fully develop ed
maint enance for th is tooth .

39. While the dentist is performi ng root ca nal

therapy on Tooth #3 1, the patien t
develops an infec tio n. Which of th e
following is the most appropriat e antibiotic
35. An orat leslon can be seen in the for tr eating this infec tion?
phot ograph. What is th e most likely
clini cal diagnosis? A. Erythromycin
B. Tetracycline hydro chloride
A. Lichen planus C. An ex te nded-spectrum penicillin
B. Verruca vulgar is D. A n increase in the patient's
C. Act inic cheilitis m inocycl ine
D. Fibrom a

40. After performing root canal treatm ent, th e

dentist plans to rest ore Tooth #31 . Which
of the following represent s the most
36 . Whi ch of th e following represents th e
appropriat e restorat ive treatm ent for thi s
tr eatm ent-of- choice for th e lesion seen in
tooth?
th e phot ograph?
A. Am algam core and cast full crown
A . Observation onl y
B. Pref abricated post-retained amalgam
B. Incisional biopsy
and cast onlay
C. Excisional biopsy
C. Pin-ret ained amalgam
D . lntra-leslonal steroid injec tion
D_ Resin -bonded composite
E. Topical applic atio n of
anti-i nflam mato ry agents

16
 45 . The dentist has decided that a thr ee-w eek
course of tetracycline th erapy (250 mg.
q6hl. in conjunction w it h periodontal
surgery, will benefit this pati ent . In
addition to it s antimicrobial activity .
tetracycline will
41 . This is th e patient's fir st visit to th e
dentist as an adult. It is imp ortant for A . sti mulat e the act ivity of ost eoblasts.
the dentist to do which of the following? B. block th e activity of collagenase.
C. inhibit th e synth esis of prostaglandin.
A. Explain to th e patient in detail how D. promote neutrophil chemota xis.
each procedure is perform ed
B. Explore the patient's views about
dental care
C. Discuss the need for anti -anxiety
medicat ion to be used prior t o
treatm ent
D. Adm onish t he pati ent for avoiding
dental care

46 . Befor e prescribing the t etracycline therapy.

42 . The clinical and radiog raphic findings
suggest that t his patient has w hich of the
follow ing periodontal conditions ?
th e denti st should warn th e patient th at
she might be at increased risk of
pregnancy . Which of the following best
explains why the use of tet racyc lines
elevat es th is risk?

A. Generalized severe gingivitis A. It alt ers the gut flora and decreases
B. Localized juven ile periodontitis th e plasma levels of est rogen.
C. Generalized marginal periodont iti s B. It changes th e genital flora and allows
D. Rapidly progressive periodontitis for increase d sperm motility.
C. It chelates the estrogen in oral
contraceptives and permit s
ovulation.

43. Th e vertical radiolucent lines seen in th e

mandibular alveolar process betwee n
Teet h #'s 20 and 28 most likely represent
which of th e fo llowing?

A . An artifact
8 . Nut rient canals
C. Healed fracture lines
D. Alveo lar process synchondrosis
44. Asymptomat ic white lesions are apparent
on th e buccal mucosa (see photograph).
Whi ch of the following represents the most
appropriat e clinical diagnosis?
47 . Three we eks afte r beginning the
tetracycline therapy, th e patient comp lains
of a burning mouth . Upon exam ining her
oral tissue s, th e denti st sees wh ite
plaques on her buccal mucosa. These
plaques rub off easily. After being rubbed
aw ay, th ey leave a surface that is red and
raw . Prescribing which of the following
will be mo st appropriate?

A. Leukoplakia A. Nystatin
B. Leukoedema B. Clindamycin
C. Candidiasis C. Acyclovir
D. Lichen planus D. Amphotericin B
E. Squamous cell carcinom a E. Acidophilus tablets

17
48. For periodontal reasons, the dentist has
recomm ended that Teeth #' s 2 and 32 be
ext ract ed. Which of th e following, then,
will represent the most appropriat e
treatm ent for Tooth # 11
51. The dentist w ishes to persuade this patient
A. Extraction to brush and floss regularly. This dent ist
B. Periodontal t herapy fo llowe d by a should place the greatest emphasis on
fi xed partial dent ure t hat extends whi ch of the following7
from Teeth #'s 1 to 3
C. Periodontal th erapy foll ow ed by A. Avoidance of future extensive dental
orthodontic movement of procedures
Tooth #1 into th e former space of B. Cost-benefit rati o of brushing and
Tooth #2 flo ssing
C. Necessity of remov ing plaque
organisms
D. Maint enance of dental esthetics

52. Prior to perform ing scaling procedur es for

49 . The lesions associated with Tooth # 14 this patient, the dentist should administer
should be classified as whi ch of th e following ant ibiotic
regimens?
A. periodont al.
B. pulpal. A. Penicilli n V, 2 grams 1 hour before
C. primarily periodontal, and secondarily scaling, then 1 gram 6 hours
pulpal. follow ing the first dose
D. primarily pulpal, and secondarily B. Amoxicillin, 3 grams 1 hour befo re
periodontal. scaling, then 1 1/2 grams 6 hours
E. a true combined lesion. fo llowing the fir st dose
C. Erythromy cin, 1 gram 1 hour before
scaling, th en 500 mg 6 hours
following the first dose
D. Erythromycin, 1 gram 2 hours befor e
scaling, th en 500 mg every 6 hours
for 8 doses

50. The dent ist has selected a fi xed part ial

denture for the replacement of Tooth #19
and is considering three-quarter-crown
retain ers for the abutme nt teeth . Which of
th e following might prevent thi s dentist 53. Of the medications taken by th is pati ent,
from selecting these ret ainers7 wh ich one is th e most likely to promot e
proliferation of subgingival,
A. The circumference of the crow ns black-pigmented bact eroides.
B. The length of t he crowns
C. The caries rate
D. The posit ion of the t eeth A . Oral cont racept ives
E. The length of t he span B. Propranolol Underal®)
C. Chloroth iazide (Diuril ®1

1B
54. Orthodontic treatment is being considered
for repositioning Tooth # 1O. Which of the
following treatment sequences would be
the most appropriate?
A. Orthodontically moving Tooth #10,
and then scaling and polishing all
teeth
B. Scaling and polishing all teeth, and
then orthodontically moving
Tooth #10
C. Surgically reducing all pocket depths
around the maxillary anterior teeth,
and then orthodontic ally moving
Tooth #10
57. To meet orthodontic and esthetic
requirements, this patient's
porcelain-fused-to-metal crowns should
exhibit each of the following
characteristics EXCEPT one. Which one is
the EXCEPTION?
A . These crowns should have their
margins placed subgingivally.
B. These crowns should be splinted
together.
C. These crowns should have a 3 mm
vertical overlap (overbite).
D. These crowns should exhibit minimal
horizontal overlap (overietl,

55. The patient has insisted upon crowns for

Teeth #'s 7, 8, 9, and 10. Prior to
ICASE VIII
const ruct ing these crowns, the practitioner
has decided to correct the crossbite on # 1O.
For corre cting the crossbite, this practitioner
58. The palatal mucosa reveals a diffuse white
has chosen to use a modified Hawley
lesion that is of unknown duration and of
appliance. Each of the following represents
asymptomatic character. Which of the
an appropriate rationale for selecting this type
following represents the most appropriate
of appliance EXCEPT one. Which one is this
clinical diagnosis?
EXCEPTION?
A. Candidiasis
A. It will be cost effective.
B. lichen planus
B. It will help to correct the patient's
C. Stomatitis nicotine
midline discrepancy .
D. Necrotizing sialometaplasia
C. It can effectively tip the tooth out of
E. Lupus erythematosus
crossbite.
D. It can effectively control the
undesirable movement of the other
teeth.
59. Within the white lesion over the hard
palate are several red punctate areas .
These areas represent which of the
following?

A. Traumatic ulcers
56. The dentist has selected a modified Hawley
B. Suppurative drainage sites
removable appliance for correcting the
C. Ruptured vesicles of viral origin
malposition of Tooth # 1O. In initiating
D. Min or salivary gland duct openings
this patient's combined orthodontic-restorative
treatment for Teeth #'s 7 through 10, this
dentist should do which of the following?
60. Whi ch of the following is the LEAST likely
A. Complete crown preparati ons on the to have played an etiologic role in this
four incisors and place temporary patient's periodontal disease?
crowns
B. Reduce the mesiodistal width of the A. Wolinella recta
maxillary left lat eral incisor B. Eikenella corrodens
C. Place separators between Teeth #'s 7 C. Bacteroides gingivalis
through 10 D. Actinomyces viscosus
D. Place separators on the maxillary molars E. Actinobacillus actinomycetemcomitans

19
6 1. Which of the foll owi ng represent s t he
M OST appropriate t reat ment for
Tooth # 171
A. Ext ractin g t he tooth
B. Splinti ng t he toot h to Toot h # 19 and
th en perf orm ing periodont al surgery
C. Root ·planing th e t ooth and th en
splinti ng it to Tooth # 19
D. Hoot -planinq t he t oot h and then
ort hodonticall y m ovi ng it in a
mesial direction
E. A mput at ing th e me sial root of t he
too t h and then cons tructi ng a fixed
part ial dentu re
64. One month after scaling and root planing,
th e pati ent 's plaque control has rem ained
ex cellent. For t he maxillary teeth,
howeve r, th ere is st ill generalized bleeding
upon probing, and ontv a minimal decrease
(1 mm or less) in pocket depth s. Whi ch
of th e following describes th e most
acceptabl e next phase in periodontal
treatment for th ese teeth7
A. Placing th e pat ient on a th ree-month
recall schedule
B. Perf orming poc ket reduction surge ry in
both quadrants
C. Splinting Teeth #'s 7 through 10 and
repeating th e root planing
D. Splinting Teeth #'s 11 th rough 14 and
repeatin g th e root planing

65. If periodontal surgery were to be

perform ed f or th is patient , which of th e
62. . In tr eati ng t his pati ent' s periodont al following w ould represent th e mo st lik ely
disease, the dent ist shou ld use postoperativ e complication?
tetra cy clin es in conjunc t ion w ith scaling
and root planing. Tetr acy clines help to A. Inf ection
prev ent suprainfection of pocket s with B. Prolonged bleeding
Candida alb icans. C. Excessive swe lling
D. Dev elopment of petechiae
A . Bot h statements are TRUE.
B. Both sta te me nts are FALSE.
C. The first state me nt is TRUE, th e
second is FALSE. 66, Th e dent ist should leave Tooth # 16 in
D. The fir st sta t eme nt is FALSE, the place for each of th e following reasons
second is TRUE. EXCEPT one. Wh ich one is th e
EXCEPTION7

A. The tooth is likel y to remain health y .

B. The morbidity of extraction will be
excessive.
C. Wh en attempting th e extract ion, th e
dentist might displ ace th e to oth into
the sinus.
D_ The healing of the surgical defect
63. T his patient has an app ointment for scaling would probably be prolonge d and
and root planing. If the patient w ere to incom plete.
rinse twi ce per day with 0.12 %
chlorhexidine fo r one w eek prior to this
appoi ntment, it w ould be like ly to 67. Whi ch of th e following represents th e
MOST likely clin ical diagnosis for
A. increase th e risk of candid iasis. Toot h #97
B. hav e no substantia l effect on t he
subgingival flora. A. A pical cyst
C. select for resistant subgingival B. Chron ic abscess
periodon topathog ens. C. A cut e apical periodon titis
D. diminish the ti me required fo r D. Ch ronic apical periodontitis
co mplete sca ling and root planing. E. Supp urati ve apica l periodont itis

20
68. Which of the follow ing f actors have most 72. If a post and core w ere to be fabricated f or
likely contributed to the 15-year success Tooth 119, whi ch of the foll owi ng w ould
of the root canal therapy on Tooth #97 be th e most appropriate7

A . Instrumenting and filling TO the apex, A. A cast post and core

and debriding the root canal spaces B. A thr eaded post with an alloy core
B. Instrumenting and f illing TO t he apex, C. A thr eaded post w ith a composite core
and using intracanal medicaments D. A prefabricated post w ith a composit e
C. Instrum enting and filling SHORT of the core
apex, and debriding the root ca nal
spaces
D. Instru menting and filling SHORT of the
apex, and using intracanal
medicaments

69. After 15 years, w hich of th e foll owing is

ICASE Villi
MOST likely to have initi ated the apparent
root canal failure on Tooth #9 7

A. Generalized periodontal disease

B. Occlusal traum atism
C. The loss of the coronal seal
D. The core filli ng mat erial
73. A lesion can be see n on th e lateral and
E. The root canal sealer dorsal aspects of th is patient's tongue (see
photo graph). The dentist should perform
w hich of t he follow ing7

A. W ide exc isional biopsy

B. Incisional biopsy
C. Cyt ological smear
70. Which of the follow ing represents t he
D. Periodic examination
MOST appropriate tr eatment fo r the
condition associated w ith Toot h #97

A. Extract ion
B. Surgical endodontics
C. Non-surgical endodontics
D. Combined surgical and non-surgical
endodontics
E. Administration of antib iot ics and
observation
74. The arrow on the radiograph points to an
intramandibular defect th at is anterior to
Tooth #18. The area is asymptoma tic:
there is no evidence of jaw expansio n,
71. Which of t he follow ing combi nations of
tenderness on firm palpat ion, or sinus-tr act
lengt hs and adaptations best describes the
formati on. Which of the follow ing
post in Tooth #97
represents th e most likely clinical
diagnosis7
LENGTH ADAPTATION
A. Chronic osteomyelitis
A. Unacceptable Acceptable
8. Early cemento ma fo rmation
B. Unacceptable Unacceptable
C. Static bone defect
C. Acceptable Acceptabl e
D. Focal zone of osteoporosis
D. Acceptable Unacceptable

21
THE DENTIST PRESENTED THE FINDINGS TO THE 78. Which of the following represents th e
PATIENT. THE DENTIST AND PATIENT AGREED appropriat e tr eatment for Tooth #21 ?
TO THE PLACEMENT OF A MAXILLARY COMPLETE
DENTURE. A. Extract ion
B. Periodont al t herapy
75. Whi ch of th e f ollowing provid es th e best C. Surgical endodonti cs
rati onale for having selected a complete D. Nonsurgical endodont ics
maxillary denture? E. Combined endodontic-periodontal
treatm ent
A. Retain ing and rest oring some of the
maxillary teeth w ould bear a higher
risk of failure than w ould
fa bricating a complete max illary
dentur e.
B. Each of the maxillary teeth has a
hopeless periodontal prognosis.
C. The periodontal and prosth odonti c care
that is necessary w ould be too IN ADDITION TO DESIRING A MAXILLARY
costl y for this patient. DENTURE, THE PATIENT HAS CHOSEN (1) TO
D. Th ere are no teeth to serve as RETAIN TEETH #'S 18,22, AND 27; AND (2) TO
acceptable abut ments for a WEAR A MANDIBULAR REMOVABLE PARTIAL
complete overdenture. DENTURE.

79. In view of the pati ent's past m edical

history, the practiti oner can anti cipate
certain medical com plications. Which of
the following measures w ill most
effectively prevent these com plications7

A. Providing sublingual nitroglycerin

B. Following a stress reduction protocol
76 . An asymptoma tic sinus tract is adjace nt to C. Performing surgery late in the
the mesiof acial root of Tooth # 14. The afternoon
probable diagnosis is

A. acute apical abscess.

B. periapical granuloma .
C. chron ic apical periodontitis.
D. suppurative apical periodontitis.

80. When administering local anesthesia for

this patient's surgical and restorative
procedures, th e dentist should

A . avoid all anesthetic solutions that

contain epinephrine.
B. limit the dosage of epinephrin e to
0 .04 mg per vis it.
77. The clinical and radiographic findin gs that C. limit th e dosage of epinephrine to th at
are associated with Tooth #21 suggest found in four cartridg es of
which of th e foll owing? anestheti c solution containing
epinephrine 1:100,000.
A . Acute apical abscess D. limit the dosage of epinephrine to th at
B. Vert ical root fr acture found in 10 cc of anesthetic
C. Traumatic occlusion solution containing epinephrin e
D. Lateral periodontal cyst 1:100,000.

22
81. When coordinati ng th e prosth etic
treatment fo r both arch es, the dentist
must establish t he occlusal plane. Which
of th e following best describes the proper
timing of this step7
A . When the maxillary occlusal rim is
available
B. Prior to removal of the maxillary teeth
C. After th e dentur e teeth have been
placed on th e mandibular removable
partial denture
THE NEXT TWO ITEMS REFER TO THE
PHOTOGRAPH OF THE MANDIBULAR ARCH
CA ST.
84. " the dentist elects to place a passiv e
tissue bar (not retent ive) between
Teeth #'s 22 and #27, he/she would
select wh ich of the following occlusal
designs7

Facial

•~
Facial

& Lingual
@
Lin gual
@)

Fig. 1 Fig. 2

82. A mandibular partial denture has been

planned. In preparation for this partial
denture, the denti st w ill place Facial Facial
full- coverage crowns on Teeth #' s 18, 22,
and 27 . The primary role of these crow ns
is to
0P 4B @z -6})
Li ngual Lingual
A . protect th e teeth fr om additional w ear. Fig. 3 Fig. 4
B. establish an ideal occlusal plane.
C. diminish the possibility of recurrent
caries.
D. reduce the patient's susceptibility to
periodontal disease.

A. Figure 1
B. Figure 2
C. Figure 3
D. Figure 4

83 . The dentist is preparing Teeth #'s 18, 22,

and 27 for full-coverage crown s. Where 85. The ful crum line fo r the planned removab le
should this dent ist place the margins of partial denture should span between wh ich
these crowns? of the numbered locat ions illu strated in th e
phot ograph7
A. Supragingivally
B. At the gingiv al margin A. locations 1 and 3
C. Subgingivally B. locations 1 and 4
D. At the cementoenamel juncti on C. locations 2 and 3
E. At t he gingival attachment D. locations 2 and 4

23
86. This item refers to th e phot ograph of the
completed dentures . The verti cal overlap
of the canine indicate d by the arrow
necessitated w hich of the following
occlusal schemes7
A. A more severe Curve of Spec
B. Bilateral balanced occlusion
C. Omitt ing th e second mandibular molar
ICASE IXI
87 . During a visit the patient, usually a
cheerful person, appears quiet and
depressed.
Dentist: "You seem a little ' dow n' today.
Is someth ing wrong 7"
Patient: " My mother passed away a
month ago today and even though she
was 88 years old, I am terribly depressed
by it. It was all I could do to get organized
and come in today ."
Which of the following verbal responses
made by th e dent ist offers the most
respect for th is pati ent7
A. "My mother passed aw ay a few years
ago and I thought I w ould never get
over it. but I did; you will too at
som e point ."
B. "It would help to get out and to do
things that take your mind off it.
It is probably a good thing that you
kept your dental appointm ent."
C. "Maybe a dental appointment right
now is too difficult . If you prefer,
we could skip th e tr eatm ent today
and you could come back wh en
you are feeling bett er."
D. "I know that you must have loved
your mother very much, but I loved
mine too and I found that
remaining busy was the best w ay
of dealing w ith it. "
24
88. If the practit ioner elected t o remove all of
the remaining te eth and to construct
immediate dentur es, whi ch of the
following extraction patterns w ould be
opt imal7
A . Removing all of the teeth during the
appointment at whi ch the
immed iate complete dentures w ere
being delivered
B. Removing Teeth #'s 18 • 21 and
28 - 30 during one appointment;
then removing Teeth #'s 22 - 27
and all maxillary teeth during a
subsequent appointment at which
the imm ed iate comp lete dentur es
were being delivered
C. Removing Teeth #'s 18 - 2 1 and
29 - 30 during one appointment;
and removi ng Teeth #'s 22 - 28
and all ma xillary teeth during a
subsequent appointm ent
at whi ch t he imm ediate complete
dentures wer e being delivered
D. Removing Teeth #'s 5, 18 - 21, and
28 -30 during one appoint ment th en
removing all rema ining ma xillary
and mandibular anter ior teeth during
a subsequent appointment at whi ch
the immediate complete dentures
w ere being deliver ed
89. If the dentist w ere to remove seven
mandibular posterior teeth, which of the
following w ould represent the most
appropriate analgesic for thi s patient7
A. Aspirin 650 mg
B. Acetam inophen 600 mg
C. Ibuprof en 400 mg
D. Meperidine 50 mg
E. Oxy codone 5 mg and acetaminophen
325 mg IPercocet ®)
90. Which of the follow ing optio ns represents
the MOST appropriate treatment for th is
patient's maxillary arch7
A. A complete denture
B. A fixed partial dentur e using
osteointegrated implants
C. A removable partial denture
D. An anterior f ixed partial denture and a
poster ior removable partial dentu re
91 . The patien t says, "The thought of needing 94. The patient's financial considerations
to w ear dentur es ma kes me depressed. I allowed for only two crowns. When taking
feel old and ugly ." Which of the following into acc ount the function, prognosis, and
responses is t he most likely to build existing restorations of the mandibular
rapport w it h the patient7 t eeth, the denti st should elect 10 construct
crow ns for whi ch of th e foll owing pairs of
A. " Would you like to tell me more about teeth 7
how you feel7"
B. " Well, if we get t he color right, not A . #'s l 8andl 9
many people w ill notice ." B. #'s 18 and 20
C. " If you think it w ould help, I can C. r« 20 and 29
prescribe an anti-depressant." D. #'s 29 and 30
D. "I w ould not w orry about th at. You E. r« 19 and 30
will still be an attra ct ive person."

FOR THE ITEMS FOLLOWING, THE PATIENT HAS

ELECTED TO HAVE A MAXILLARY COMPLETE
OVERDENTURE CONSTRUCTED AND TO RETAIN
ALL MANDIBULAR TEETH .
95.
92. Although the patient's plaque control w as
adequate, the scaling and root planing of
t he mandibular arch did not succeed in
reducing the pocket depths . Which of the
fo llowing w ould be the next step in
treatment7
In preparation for a ma xillary overdenture,
the dentist has performed root canal
therapy on Teeth #'s 6 and 11 (each of
which w ere vita ll, Before completing a
max illary overdenture, th is dentis t must
allow these t eeth to remain asymptomatic
for w hich of th e following periods of time7

A . Curettage A. No w aiting period

B. Topical and systemic anti microbial B. 2 w eeks
th erapy C. 4 w eeks
C. Surgical entry for access to th e root D. 6 w eeks
surfaces
D. A pically-positioned flaps for pocket
reduction

93. Bot h the radiographs and t he periodontal

examination provide information about the 96. Mandibular arch resto ration and periodontal
mandibular teeth. Which of these teet h stabilizatio n must be achieved prior to
has t he poorest periodontal prognosis7 which of t he follow ing7

A. # 18 A. Recording the jaw relat ions

B. #28 B. Try ing-in the w ax set-up
C. #2 9 C. Removing selected maxillary teeth
D. #30 D. Completing endodontic treatment

25
97. The dent ist w ishes to restore th e access
opening into the pulpal spaces of t he
endodontically-t reated max illary teet h.
Given t his pati ent' s histor y, the dentist
w ould ideally proceed by
A. placing composite restorations.
B. placing ama lgam restorations.
C. constructi ng cast chamfer crow ns.
D. const ruct ing endodontic posts and
chamfer crowns .
99. The dentist should begin management of
the tongue lesion by
A . scraping th e surfac e of th e lesion to
obtain cells f or cytology.
B. observing the lesion for two weeks.
C. performing excisi onal biopsy of th e
lesion.
D. injecting steroids ltriamcinolone} into
th e base of the lesion.

100. Approxim ately how long did it take you to

98 . Th e lesion near t he lef t latera l margin of the complete Component B (test it ems 1-9917
tongue {see photograph} concerned t he
patient and the dentis t. Which of the A. l ess than 50 minutes
followi ng is the MOST likely diagnosis B. 50 -59 minutes
o f this lesion ? C. 60-69 minut es
D. 70-79 minutes
A. Pyogenic granuloma E. 80-89 minut es
B. Papilloma F. 90 -99 minut es
C. Hemangioma G. 100 -109 minut es
D. Melanoma H. 110 minutes or more

When you have finish ed Component B, please complete the brief Candidate Ouestionnaire. When you have
com plete d t he Qu estionn aire, turn in the follow ing to t he test adm inistrator:

1. the original of both answ er sheets

2. the Candidate Ouestionnaire

You will th en be given a review document that contains th e answ er key. You may keep all of th e foll owing:

1. Both booklets
2. Candidate' s Copy of bot h answ er sheets
3. Review document

Thank you fo r participating in t he project .

Joint Commission on National Dental Examinations

Department of T esting Services
American Dental Association
2 11 East Chicago Av enue
Chicago, Illinois 606 11

26
 PILOT PART II EXAMINATION
NATIONAL BOARD DENTAL EXAMINATIONS

BOOKL ET OF CASES
COMPON ENT B

Th is booklet contains cases for nine pat ients. The test items for these nine cases are contained in the Exam ination Booklet,
pages 11 . 26.
rc
" Many of th e radiographs and clinical photograph s used in this Examination have been cropped, reduced or enlarged for the
purpose of enhancing the clarity of the structures or the lesions that they represent.

Cop yright 1990

Jo int Commissio n o n Nation al Dent al Examination s
Department of Testing Services
A merican Dental Assoc iat ion
21 1 East Chicago Ave., Chicago, Illinois 606 11
 SYNOPSIS Age S y rs 7 mas VITAL SIGNS 5. Smokes or uses tobacco product s • o Yes GNo
I CASE I I
OF PATIENT Sex F Blood pressu re 112/6 2 6. Is pregnant • • . . • . • • • • • o Yes ~o
HI STORY He; ght 4'3" Pulse Ra te 104 /min

CASE lVeight- lbs : ~ Respiration rat e 241m in

-kg: 25
- -
MEDICAL HISTO RY: Unremark abl e
1. Under ca re of a physi ci an .. 0 Yes G1 No
Condi tion _

2. Hosp i t a li zed with in t he last f ive years c=J Yes ~ No

Reason _ DENTA L HISTOR Y: The pat ient fi rst saw a dent ist
10 months ago for an initial exam inat ion. She had her
3. Has or had t he f ollowing condit i ons primary mandi bular left second molar ext racted
9 month s ago. Th e child is very frightened of denti sts,
Yes No resists t reat ment, and cries. She has poor oral hygiene.
0 g Heart murlJlJ r The pa rent s re port th at the ch ild doe s not bru sh regular ly.
She has received neither systemic fluoride nor top ical
0 ILl Hear t a t t ack fluoride tr eat ment s. Th e community dr inking wat er
rc
0 g Angi na pecto r i s contains 0.4 ppm fluo ride. The parents want to avoid
ce 0 g Hyper t ens i on t he extraction of th e other teeth .
0 g Diabetes mell i tus
0 g Hepat i ti s
0 g Bleeding disorder
0 g As thm a
0 G1 ALlergy (medicat ion, f ood)
SOC IAL HISTORY : T he pat ient is th e yo ungest of fo ur
Al lergic t o ch ildren. Altho ugh t he child is persona ble and pleasant,
she is very frighte ned in t he dental off ice. Both of t he
g -
0 Other parents also have a fear of dental tr eatm ent t hat is ext reme.

4. , Current medi cat i ons

Yes No
o ~ Ant icoagulant s
o o Insulin
o G1 Ant i bi ot ; es
CHIE F COMPLAINT: " Cavit ies"

o g Asp ; ri n
o og Nit r oglycer in
o Hi gh blood pres s ur e med i cat i on
o g Steroids
o --
G? Oral cont r aceptives
 Too t h I
2 )4~
CLIN ICAL EXAMINATION
678 '} 10 II 12 13 14 l~
'0
I CASE I I

SUPPLEMENTAL ORAL
EXAMIN ATI ON FINDINGS :

Probing dept hs do not exceed 3 mrn.

ro
to
!I'luvn!
~ l1If 111 tl ~ VI In IV ~
~It __
'11- · •

)} JI JO 29 18 27 26 2~ 24 2) 22 21 20 19 18 17
T u ut h •

ro Clinicall y visib le cario us lesion

' ''C'''~

R
'iJ: Clinically missing tooth

\ IOIQ....\

L;;. Fureat ion

.. "Throuqh -and-throuqh" lu reati on

\"..G.... ~
Probe 1: init ial prob ing depth
R \1\ IA
l AC, .. . Prob e 2: foll ow-up probing depth t aken o ne
mo nt h afte r scali ng and root planing

T s • 0 p O N " L K
.....

30
 w
~
o
u..
o
c
2:
w

31
 SYNOPSIS Age 4 yrs ·3 mos VITAL SIGNS • 5. Smokes or us es tobacco products D Yes GINo
I CASEII I
OF PATIENT Sex F Blood pres sure 100/64 6. Is pregn ant o Yes GrNo

HISTORY Hei ght 3'4 " Pulse Rat e 110/min

--. -,
< .

CASE I'e;ght -lbs : ~ Respi rat i on rat e 381m in

-kg: 20 \
Th~ well.developed fe male child has
1. Under care of a physi ci an . . . . . 0" Yes 0 No
MEDICAL HISTOR Y:
a history of a heart murmur. T h is murmur is secondary t o an
.:.:.:='-"==:.:.:.
Condition _ _ Heart probl em _ incomplete ly repaired vent ricular septa l def ect.

2. Hospitalized within the la st fi ve ye ars 0' Yes 0 No

Reason _-"n='-'-==="'-
" eart problem _
'.
3. Has or had the foll owing conditions DENTAL HISTORY : Pat ient has never been t o a denti st
before. She drinks we ll wate r con taining less th an 0.3 ppm
No flu or ide and brushes her teet h w ith a fluoridatedtoothpaste
@ D Heart rrurmur before going t o bed. One year ago, she lost her first " baby
o g' Heart attack
tooth" (maxillary left centr al incisor). Last week she had

o 0' Angina pect or is

a t oot hache on the upper right (it is asym pt om at ic now .].
OJ

'" o g' Hypertens ion

o g Di abetes mellitus
o Gr Hepatiti s
o
s
GI Bleeding di s order SOCIAL HISTOR Y: Th e pati ent has tw o old er broth ers,
o Asthma ages 6 and 8 . Both th e moth er and th e pat ient are fearful
D Allergy (medication, fo od> of the dentist. Both broth ers have had extractions and are
good pat ients.
All erg ;c t o ___

o D Other Congenital heart disease

4. Current medicat ions

CHIEF COMPLAINT: "M y daughter's tooth is co ming in
Yes No
o B' Ant i coa gula nt s
crook ed."

o g
go
Insul i n
D Anti bio t ic s
o g Aspirin
o Gr Nitrogl yc eri n
o g'
g--
Hi gh blood pres sure medicat io n
D Ste ro id s
D [0 Oral contracept ives
n rn>
 To o th .
1 ., . CLI N ICA L EXAMINATION
8 9 10 II 12 I) 14 I"J 10
I CASEII I
~
f I I I I I I I I I I I I
f\M
I

~~§, IW ~ J
I'

•, ~ ~ 'IW (I
'I..
~
r( 'VII
'I (
R
;> 9l~ 1( "\" ~ ~ ~
1 I'~ ~e \Q SUPPLEMENTA L ORA L

; nm
EXA MI NATIO N FINDINGS :

~
f
,

.....
11
~
'--
I
I
l I
I
I
~'
I
I
,~~ ~

I
I..<

I
.....
I
I
1.

2.
Malfo rmed t ooth er upt ing in t he po sit io n
of tooth " F,"

Oral hygiene is f air.

I 3. Pro bing dep th s are within norm al limits.

3I I
I
I
I
I
I I

-!
•,
~ ~ ij ..11\1, lnl ,.~rt-'·[\
~ ~ ~
'" ~ \ ~6 8 9 («:6 «if!.;:. E!It I~
R
'" 9) I

~8
;
, )
• ' (; ,
'\L
I
'lll'l\;IM, I'. ~l ~~
~ I I I
fr I I I I I I III I I I I I
11 Jl JO 1. 9 18 27 2b 1~ 24 2 ) 12 21 20 19 18 17
T o t,t h •

• r
rJ Clinically visible carious lesio n

•..c·..~

R
'iI: Cli nically missi ng tooth

• .-0 ..... .
L::,. Pu rcat ion

.... " Through-and-t hrough" f urcation

.' 004l.0'" Probe 1: init ial probing depth

R
Prob e 2 : fo llow-up pro bing dept h t aken one
.""'''' mon t h afte r scali ng and root p lan ing

• 5 R~ P O N :1 :'
 ..J

..J

..J

a:

a:

a:

34
 ...J

...J

a:

35
...J
w
~
U
L1.
o
Cl
Z
w

a:

...J

a:

36
 SYNOPSIS Age 9~mos VITAL SIGNS 5. Smokes or USe S tobacco product s . o Yes 0NO
ICASElli I
OF PATIENT Sex _F__ Blood pressure 110/60 6. I s pr egnant . • . . . . . . . . . o Yes 0NO
HISTORY Height 4'7" Pul se Rate 96 /min

CASE ~eight-lbs : ~ Respi ration rate 201m in

- Kg: ~
MEDICAL HISTORY: Unr emarkable
1. Under care of a physician .. 0 Yes 0NO
Concii t ion _

2. Hospital ized within the last five year s c=J Yes ~ No

Reason _
DENTAL HISTOR Y: Pat ient lives in a no n-fluorida t ed
3. Has or had the fo l lo wi ng condi tions co mmunity. An analysis of the drinking water reveals a
0.5 ppm fluor ide level.
Yes
0 G' Heart murlTUr
0 Gf Hear t attack.

...,
OJ
0 G2f Angina pector i s
0 [2]' Hypertensi on
0 0 Diabetes mellitus SOCIAL HISTOR Y: Unremarkab le
0 a
g
Hepatiti s
0 Bleeding di s order
0 0' Asthma
0 0 Al le rgy (medication, food)

Allerg ic t o CHIEF COMPLAINT: " My t eeth need st raighte ning so that

the y will fit ."
0 ~ Other

4. Current medi cati ons

Yes No
0 0' Anticoagulants
0 0 Insul in
0 0 Antibioti cs
0 g Asp ; r i n
0 0 Nitrogl ycer in
0 g High blood pres sure medicat io n
0 g St e ro i ds
0 g- Ora l contr acept i ves
D Gj Othe r
 To ot h .
2 ) 4
CLINICAL EXAM INATION
~b18 9 10 II 12 I ) 14 I ') Ib
I CASE ill I

R SUPPLEM ENTA L ORA L

EX A M INA T ION FI NOI NGS:

Mandibular arch analy sis indicates a · 1.5 mm

arc h-length deficie ncy. Probing pocket dept hs
do not exceed 3 mm.

~
f -

l:rii( 0J€33 ~~~~.

cc
cc
0000
~ I1if It,\} l!J ~~ ~ij
I
~
f
12 j I JO 29 18 27 26 2~ 2 4 2) 22 21 20 19 18 17
T U(.oth •

r
ro Clinically visible carious lesion

'a(;,..

R
~

'iJ: Clinically missing too th

.. ~
~,JOQu
/:::;. Furcat ion

... "Through-and-th rough" furcation

~,_ . ~

Probe 1: initia l prob ing depth

R
Probe 2 : follow-up prob ing depth take n one
' a.(; '''~ mont h after scaling and root planing
...J

c:

39
40
 w
~
o
LL
o
C
Z
w

....I

....I

a:

41
 SYNOPS IS Age 17 VITAL S IGNS 5. Smokes or us es t obacco products o Yes 0"No
I CASEIV I
OF PATIENT Sex M Blood pres sure 13 0/85 6. Is pregnant . o Yes gHo

HI S T O RY He i ght 5'S" Pul s e Rate ...mL-

C ASE Weight - lbs : ~ Respirat ion rate 15
-kg : 60
MEDICAL HISTOR Y: At age 7, t he patie nt was d iagnosed as
1• Under care of a physi cian . . . . . . . g Yes 0 No having juvenil e-on set diabet es th at was co ntrolled by insulin.
The patie nt self-ad ministe rs insulin in t he morn ing and evening.
nile onset diabetes
Cond i t i on _-,"",U"V"t""",-",="-,,,,,,,,,-~ _ His diabetes is "w ell-co ntrol led." The pat ient has a histo ry of an

~NO
allergic react ion to penicillin. Thi s allergic response con sists of a
2. Hos pitalized within the las t five years 0 Yes skin rash. He de velo ped severe acne at age 11 and has taken a
Reason _ t et racycline analogue min ocyclin e (M inocin® ), since age 15 .

3. Has or had the fo l lowi ng conditions

Yes Ho
o @ Heart murlTlJr
o Gr Hear t at tack
o Gd" Angi na pecto ris
DENTA L HISTORY: Th e pati ent says t hat he does not like to
brush his teet h. He has not visited a de ntist since preschoo l years.
e,

'" o g- Hypert ens ion Periodi cally, fo r the past 6 mon ths he has exp erienced spont aneous
o O
g-
Di abetes me l l i tus and t herm all y-indu ced pain in t he mand ibular right posterior

o Hepat i t i s
quadrant . This pain is exacerbated on chewing.

o G1" Bl eeding di sorder

o ~ As thma
Gr o All ergy (med i cat i on, f ood)

Allergic t o _===",--__
penicillin
CHIEF COMPLA INT: " I have a t oothac he on my lower right side,"
g" o Other Severe acne conglobat e

4. Current med i cations

Yes
o ~ Ant i c oagu l ant s
Gr o Insul in
B" og' Anti bio tics
o Aspir i n
o G3' Nit roglyceri n
o g' High bl ood pressure medica tion
o g' St eroids
o g-- Ora l contracept i ve s
o Gr Other _
 Tooth H ADULT CLINICAL EXAMIN ATION
I CASE IV I
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

SUPPLEMENTAL O RA L
EXA M INAT ION FINDINGS :

Generalized moderate gingivitis. Heavy deposits

R , of plaque on most t eeth .

At th e verm ilio n-skin juncti on along th e low er lip ,

an elevated , keratotic lesion of long duration
and asympto matic nature was noted.

-'"
w

~ ~.; .3>J 1 ~ ~ e '4

i~0J0J ' ~~ J

R I(£) ~~ ~ ~ ~0<Z ~() ~ rJ Cl inicall y visible carious lesion

•c
~

u
'$. Clini cally missing tooth

~ Furcati on

... "Through-and-through" furcation

~ Bi~l l ~~ J~1~ r~rj I I " ~ Probe 1: ini t ial probi ng depth

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 Probe 2: fol low-up probing depth taken one

month afte r scaling and root planing
Tooth U
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45
 SYNOPSIS Age ..1L.. VITAL SIGNS 5. Smokes or uses t obacco products o Yes 0NO
I CASEV I
OF PATIENT Sex _F__ Blood pre ssure 12QLZP 6. Is pregnant • •• •• • • . • • o Yes GrNO
HISTORY Hei ght 5'4" Pulse Rate ..11..-
CASE !Veight-lbs: ~ Respiration rat e ---l.9..-
-kg: ~
MEDICAL HISTORY: The patient takes ora l cont raceptives
1. Under care of a physi ci an .. 0 Yes [if No and has no com plicatio ns wit h th em. She also t akes aspirin for
headach es occas ionally,
Condi t ion _

2. Hospitalized within th e last f ive year s c=J Yes ~ No

Reason _

3. Has or had th e foll owing condit ions

DENTAL HISTOR Y: The pat ient has not seen a de ntist
Yes No sinc e early childhoo d du e t o lack of f inances. Now, however,
she has accepted a new job as a co mp ut er program mer and has
0 0 Heart murmur
dental insura nce . Occasion ally, she has t hro bb ing pain in th e
0 121 Heart attack. upper left jaw. Curre nt ly she has no pain.
A
0 Ga Angina pector i s
en 0 [2] Hypertensi on
0 0 Diabetes mellitus
0 0 Hepatiti s
0 [2] Bleeding di sorder SOCIAL HISTORY: Unremarkab le
0 [2] Asthma
0 0 Allergy (medication, food)

Allergic to

0 0 Other CHIEF COMPLAINT: "My gums bleed. and I have bad breat h,"

4. Current med i cat i ons

Yes No
o 0' Anticoagulant s
o ~ Insul in
o ~ Antibioti cs
o 0 Aspirin
o 0 Nitrogl ycer i n
o 0
High bl ood pres sure med ication
o
Stero ids c;a
G1 0
Oral cont racept ives
____,D__@__ othe r I I
 Toot h N ADULT CLIN ICAL EXAMINAT ION
I CASEV I
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

SUPPLEMENTA L ORAL
EXAMIN ATION FINDING S:

1. Patient has poor plaque contr ol.

2. Maxillary left posterior teet h are not

sensit ive t o palp ation or percussion.

3. VI TALITY TESTS
Teeth # ', 12 13 14 15
+ + - +

4. Gingival tissues are red and swoll en. They

bleed profusely upon gentle probing .
... 5. Buccal muco sa has appearance as see n in
'"'
~ Ee;lW
phot ograph .
&<37 1 797 1 6. Class II mob ilit y : Teeth #', 2, 14, 17

0J0J~ , ~~
R laEBffi 6 e ~ e 0 0 0 & rJ Clinically visible cariou s lesion

'iI:.
{JD0J~~B~~ ~~
Clinically missing to oth

~ Fur cat ion

... " T hrouqh-and-t hrc uqh" fur cation

~ EL~~ It31 1777 I Probe 1: initial probingdept h

Probe 2: fo llow-up prob ing dep th taken one

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 mo nt h aft er scaling and root planing
Toot h U

T I
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49
 SYNOPSIS Age 35 VITAL SIGNS 5. Smokes or uses tobacco products o Yes B'"No
J CASE VI I
OF PATIENT Sex F Blood pres sure 130/85 6. Is pregnant • • • • • • • • • • o Yes Ga'NO
HISTORY Height 5'4" PuLse Rate ...J..:L
CASE Weight-l bs: ...ill- Resp ir ation rate --19--
-kg: ~
MEDICAL HISTORY: Th e pat ient develop ed rash afte r
1. Under care of a physician . . • . . . [0' Yes 0 No taking penicillin for strep thr oat. For th e past 9 months, she
has t aken 40 mg t.i.d. of propranolol (Inde ral®) for high
'-"'"""''-'''==
Cordi t i on _ _ Hvoert enslon _ blood pressure and 0.5 9 per day of chlorothiazid e (D iuril® )
as a diuretic . She uses Lo/Ovral-21 (0.3 mg norgestr el, 0.03 mg
2. Hospitalized within the la st fi ve years c=J Yes ~NO ethin yl estradiol) for birth control.
Reason _

3. Has or had the following conditions

Yes No
B'" 0 Heart munrur
DENTA L HISTOR Y: Rout ine dental care
0 9 Heart attack

(jO
0 0" Angina pector i s
0
0 0 Hypertensi on
0 g- Diabete s mellitus
0 0" Hepatit is
0 Gr Bleeding di sorder SOCIAL HISTORY : She has no financial limit ati on s or tim e
0 Gr Asthma constraints.
B'" 0 Allergy (medication, food)

Allerg;c to penicillin

0 GY Other

4. Current medications CHIEF COMPLAINT : " I don 't like th e appearance of my

front teeth."
Yes No
0 g' Anticoagulants
0 0" Insul in
0 Gr Antibiotics
0 Gr Aspi rin
0 [?' Nit roglycerin
Gr 0 High blood pres sure medicati on
0 Gr St er oids
g- O Oral contracept ives
D__ Gr'_ othor
 Tooth # A DUL T CLIN ICAL EXAMINATION
I CASE VI I
2 3 4 5 6 7 8 9 10 " 12 13 14 15 16

~~
fh ~

~ a~~ - BeJ
R I~ ~.
@ @ ~ (F\ ~()~ l
gm!!1~ SUPPLEMEN TAL ORAL
EX AMINATION FIN DINGS:

Th e patient's plaqu e co nt ro l is fair; need s

improvement interpro x imall y. Th er e is
'" - n
~

_
- i t- -" , n
A
'-'AI .'\./
..
\J
...
\a.U ' generalized moderate gingival inflammation
with bleeding upon prob ing fr om most

lja n~8t}ti~~;
~
int erprox imal areas .
":> Tooth # 10 is in crossbite ; all other ante rio r

~ t~_
~
teeth are in a Class I relation ship . Th e
maxillary anterior te eth are discolor ed
and have large mes ial and d ist al rest oration s.
II' ,. . ~.;,c,j l :Jd..!J
~I ~
I
Vo i i i T he patient has a high sm ile line.
"
&
• •
'" Radiographic examination revea led no signif icant
find ings .

rJ Clinica lly visib le cari o us lesion

'I: Clinically missing toot h

,6,. Furcat ion

.... "Thro ugh-and -through" fureati on

Probe 1: initia l probing dept h

32 31 30 29 28 27 26 25 24 23 22 2I 20 19 Probe 2 : fo llow-up probing dept h ta ken on e

18 17
mo nt h after scaling and root plan ing
Tooth U

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52
 SYNOPSIS Age 65 VITAL SIGNS 5. Smokes or uses tobacco products [2( Yes o No
(CASEVll I
OF PATIENT Sex M Blood pressure 136/86 6. Is pregnant . . . . • . • . . . o Yes 0'No

HISTORY He;ght 5'10" Pulse Rate 78

CASE l'eight-lbs: ~ Respi rat i on rate 14

-kg : 77

1. Under care of a physician • . . • • o Yes 0 No

MEDICAL HISTORY : This patient has taken 6 to 8 aspirin
tablets per day for the past 5 years for his arthritis.
Osteoarthritis
Cond i t i on _-''''-'-'''''''''"''-"-'-''-'- _

2. Hospitalized within the last five years c=J Yes ~ No

Reason _

3. Has or had the following conditions DENTAL HISTORY: Tooth #9 was fractured in an accident
15 years ago. A root canal treatment was performed and a
Yes No post and crown was made at that time. The post and crown
o G:r Heart murmur has been dislodged and recemented "5 or 6 times" since then.
o Gr Heart attack
o g- Angina pectoris
ct
cc o Gr Hypertens i on
o g Diabetes mellitus
o Gr Hepatitis
o o Bleeding disorder
SOCIAL HISTORY : The patient smokes 10 to 12 bowls of
pipe tobacco daily and has done so for 40 years.
o Gr Asthma
o G3' Allergy (medication, food)
Allergic to _

0' o Other _==='--

Arthritis _ CHIEF COMPLAINT: "My front tooth hurts when I chew
4. Current medications or when I tap on it with my finger. I avoid chewing on the left
side because a lower left tooth is loose."
Yes No
o @ Anticoagulants
o Gr lnsul in
oQ" g- Antibiotics
O Aspirin
o Gr Nitroglycerin
o g0- High blood pressure medication
o g- Steroids
o g- Oral contraceptives
o g- Other _

1 I
 Tooth H A DULT CLI N ICA L EXAMINATI DN
I CASE VII ,

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

~
:: 2
.....±:-:----:-I--:-------:-+
:-o ~---J--,---+-~~f~::-+T1-::
, t - 33 ' W Ide. ~tt "'Ie '.3,1 _ _~::I< t~ ~

j!~ rn~ ~ ~gq( SUPPL EMEN TAL ORA L

EX A MI NATI ON FINDI NGS:

1(;> 6969 8G @@ @ ~ ~ ~ EiQffi@

1. Tooth # 9 is sensitive to percussion .

R 2. Sensitive to palpation at the apex of

tooth #9

!~ !!mAAI1 ~ ~ , A~gt1
3. White lesion of hard palatal mucosa

4. Generalized, moderate gingival inflammatio n

II w it h exten sive bleeding

~ ~~I (" 5. Class I mobi li ty -- teet h #'s 7, 8, 9, 10, 13

E
• •
'"
+> 6, Class II I mobil ity -- toot h #17

~J Cli nically visible carious lesion

'iJ: Clinicall y missing too t h

~ Furcati on

.. " T hrough-and-through" fu rcati on

Ht tfiil~ _~ rOlo') Probe 1: initial probing depth

Probe 2 : fo llow-up probing depth taken one

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 mo nth after sca ling and root planing
Tooth H

I I
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55
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56
 5. Smokes or us es tobacco product s 0' Yes DNo
leASE vm I
SYNOPSIS Age 65 VITAL S I GNS - - - --

OF PATIENT Sex M Blood pressure 140/78 6. Is pregnant • • . . . . . . . . D Yes ~ No

HISTORY Height 6'3" Pulse Rate 70

CASE Yleight- lbs: ~ Respiration rat e ~

-kg: ~
MEDI CAL HISTO RY : Th e patient t akes propranol ol
1. Under care of a physician . . . . . . 0' Yes 0 No (100 mg b .i.d .) for t he general t herapy of his angina pecto ris.
He has occasional chest pain o n physical exert ion. These
==.....""""'''-
Conditi on _ _ Heart disease _ symptoms are easily controlled with sublingual nitroglycerin.
A small squamous cell carcinoma has been removed f rom his
2. Hospital iz ed within the last f ive years 0' Yes D No lower lip.
Reason Removal of squamous cell carcinoma

3. Has or had the fo l lowi ng condi t i ons

Yes No
D ~ Heart III .JrlllJf DENTAL HISTOR Y : For th e past 25 years, t he pat ient has
had em ergency care on ly. Althoug h he is interested in a
0 ~ Heart attack
complete maxillary denture, he w ould prefer to avoid a
Gf 0 Angina pectori s com plete mandibular de nture.
'"
-.J
0 @ Hypertens ion
D 0' Diabetes mellitus
0 g Hepat i t is
0 g' Bleeding di sorder
0 g' Asthma SOCIAL HISTOR Y : Th e pati ent has lim ited f inancial
g' resources and desires a treatm ent approach that wi ll
D All ergy (medicat i on, food>
provide a predict able long-t erm solut io n t o his dent al
ALLe rgic to needs. He is willing to make the necessary investment
to avoid a complete mandibular denture. He has smoked
0 0" Other
o ne pack per day fo r the past 40 y ears.

4. Current medicat ions

Yes
o &' Anticoagul ant s
o o Insul in
CH I EF COMPL AINT : " My t eeth hurt, and I don't lik e
the ir appearance."

~
D Antibiotics

~
Asp; rin
o Nitroglycerin
o G? Hi gh bl ood pressure medicat ion
D G? Ste roids
D Gr Oral cont racept iv es
Gt o Other Prop ranolol (Ind eral®)

r I
 leASE VIlli
Tooth H ADULT CLINICAL EXAMINATION

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
w
•o: 2 I I I I I I I I I I I I I I
•"' I 173 7 17"% 1737 t7sl5~t.I }J'7 I 7~t 16zs-Im. ! .z> l5"3? I t6? 16ft I I
~ ~
~a~ ~~ L ~l-t)~U~'I~'
If,
~
~ SUPPLEMENTAL ORAL
u EX A MI NAT ION FINDINGS:
~
•
i 'I V ery poor oral hygiene
R
rBfB([j~~ ~ @@ @ ~ © ~ fjQEB~' Max illary arch:

~.J !!~ A~ ,0 ~ Ul ~ ~ t} A~ t!Litt

Numerous broken down teeth
Severe attrit ion thr oughout his dentition
~
~ Sinus tract noted in the maxillary vest ibule
:>
adjacent to tooth # 14
"!'
~
(\ I
r: C
j j) J Mandibular arch:
Occlu sal plane com promised by ext rusion
w
•o I 7f7 777 lP 177~ (,771777 7~ 7 ('J(' 6"77 f~t.lsill 7f 7 I 7 9&, I teeth # ', 28 and 29

ct
"• 12 I I I I I Tooth # 2 1 .. suppuratio n evident in the
co distal sulcus. The site is asympto mat ic.
w
o• 2 I I I
"• I ns (,,77 ~.rM<I 'l'1"y' i'~'! 13# {,;,! i¥ f/~ f'J ,£ I I

~
~ "'I cY' <-..........
- ~, - ~ ~"l
I FI()IO)
c-- "J. ~ 1~11 ~1~4;
:> / l/' ~ I-"
~
e
z
:;

:J ~BE a60·~()0 00& );<E Ie ~ ffi.G ~

I

R
f- ~ Clinically visible cario us lesion
,'-
'JJ:
}I,~ /~~: B~ ~~: ~\"
~
~ Clinicall y missing toot h
!
4~
u )
· ~) I'~ L::. Fureat ion

w
1/ ~ ... "Through-and-through" fureation
•o I I I SK5 67e. If'.IJI/JdI,;,;,t lAG I/7/lyy' ';1 ~ I I J:~,t I Probe 1: initi al prob ing depth
"• 2 I J ____ _ ... __-1 ___ I I I I
Probe 2: follow-up probing depth take n one
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 month afte r scaling and root planing
Tooth U

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60
 SYNOPSIS Age 68 VITAL S I GNS 5. Smokes or us es toba cc o product s g Yes o No
I CASE IX I
OF PATIENT Sex M Blood pres sure 124 /6 6 6. Is pregnant . . . . . . . . . . . . . . . . DYes 0NO
HISTORY Height 5'11" Pulse Rate .zs.,
CASE \Veight-lbs: ~ Respi ration rat e ...1.L
- kg: 74
MEDICAL HISTORY: Severe gastric ulcer th at last flared-up
1. Under care of a physici an . . . . . 0' Yes D No two years ago ; appears to have healed. Aspirin causes "flare-up."
,, -- - -,IUII-- O- .I fl are-up of gast ric ulcer Physician prescribed cimetidine (Tagamet®). Patient too k penicillin
Cond i t ion V ,-,I,,;Cl;)
fo r strep throat 10 years ago and had an allergic response that
consisted of urticari a and difficulty in breathing. This response
2. Hospit aL ized within th e l ast fi ve yea rs 0 Yes Ci?'No was cont rolled by the administratio n of epinephrine and
Reason _ diphenhydramine (Benadryl®). The patient reacted to codeine
with a skin rash.
3. Has or had the f oll owing condit io ns

Yes No
D Gr Heart murmur
D Gr Heart attac k:
D ~
-'" D
0
Gr
Gr
Angina pectori s
Hypert ens i on
Diabet es mel litus
DENTAL HISTORY:
symptoms.
Infrequent dental visits precipitated by

D Gr Hepati t i s
D g Bleeding di sorder
D Gr Asth ma
g" 0 AL lergy <medicati on, food)
SOCIAL HISTORY: Limited finances; limited appointment
All ergic to penicillin, times. Patient has smoked one pack of cigarettes per day for
....codeine 45 years.
D Gr Other

4. Current medic ations

Yes No
D g' Antic oagulants
D Gr Insu l i n
CHIEF COM PLAINT: " I want dentures,"
0 G1 An t i biat i cs
0 r;:;r Aspirin
D Gr Nitr ogl ycer in
D Gr High bl ood pres sure medi cation
D Gr Ste roi ds
D ~ Oral cont racept iv es
Gd" D Other Cimetidine (T agamet®)

I I
 Too th H ADULT CLI NI CA L EXAM INATION
, CASE IX I
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
:: r.;2;---.--r--.--~--r--r-r--~-.,.----,r--.---Y--,r--,r--,r----,
o F---t-~'--~f---+df-----+-t--~ ~:-:-f-+:-:lf-+-J-----jI----1--I
: fI ----'L---L_....L......J.!..-..:.::.

j
SUPPLEMENTAL ORA L
:!
.
u
~
EXAMI NA T ION FIN DI NGS:

T eeth #'5 5 and 28 occlude in centri c relation

at an accepted vertic al d imension of occlusion.
R
Teeth #'5 5 and 29 have bee n tempo rarily
resto red with stainless-steel crowns.
.
j

::>
o An asympto mat ic bluish-red so ft tissue lesion
i!:
j
of long d urat ion was not ed near th e left lat eral
margin of the tongue.

•0
II:
C>
rc
•
~

•0
II:
•

R ro Clin icall y visible cario us lesion

'JJ: Clinically missing toot h

,6. Fur cat ion

... " T hrough-and-t hrough" fur cati on

~ ~~L=:r==+~~~~qIZij~ij~,_~~_~~~_~,~~.t,U~.~'U~,ji,~.?i1[&~~~_C_l:l~l~I====1 Probe 1: initial probing dept h

Probe 2 : follow-up probing depth taken one

32 31 30 29 28 26 25 23 22 21 19 18 17 month aft er sca ling and root planing
Toot h U

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65
 Pilot Part II Examination
National Board Dental Examinations

REVIEW DOCUMENT

Thi s Review Docum ent prov ides rationales for each keyed response in Comp onent A and Component B of th e
Examination Booklet .

COMPONENT A

It em
Number Answer Rationale

1. B In accordance with the Henderson-Hasselbalch relationship, a w eak organic acid, such

as salicylic acid w ith a pKa of 3.0 , w ill become (1 ) more ionized as the medium in
w hich it is dissolv ed becomes more alkaline and (2) less reabsorbed by th e prox imal
t ubules,

2. B X radiat ion occurs wh en high velocity electrons are suddenly deaccelerated.

Electrons are produced at t he cathode Ifilamentl and accelerated t o the anode ttarqet):
wh en the electrons collide w ith the tungsten target, the kinetic energy of the electrons
is converted into X radiation.

3. B Th e formation of the primary tooth-bud begins between the third and sixth we ek in
utero. T he primary mandibular and maxillary central incisors do not begin to calcify
unti l abou t 3 1/2 months in utero. All 20 primary teeth have begun to calci fy by
approximately 4 1/2 months in utero. T he permanent first molars begin to calcify at
approximately the t ime of birth.

4. C Although chi ldren with Dow n syndrome are usually mentally retarded, they are known
to be smiling, affec tionate, and easily distracted.

5. B Wh en th e co-worker uses assertive messages, he or she t ells th e other person th e

observable behavior that is perceived as a problem, the wa y it makes the co-wo rker
feel, and th en w hy it is a problem.

6. C Attempts to prepare post space eithe r by grinding away part of the silver cone or by
preparation alongside it introduce two risks. T he first is root perforation and the
second is loss of seal. The best choice is to remove the silver cone w hile it is
accessible and then to provide an apical seal using gutt a-percha w ith sealer, because
it can be more closely adapted to the canal wall. It also allows easy preparat ion of
t he post space.

7. B A healthy patient w ho becomes unconscious af te r receiving an injection of a local

anesthetic , especially if accompanied by brief convulsion, has almost surely had a

66
 psychogeni c reaction to th e inject ion ex perience. This anxiety react ion is seen as a
syn copal episode, which will be easily reversed.

Th is pati ent is healthy; t heref ore, the possib ility of a grand mal epileptic seizure is
unlik ely . Epinephrin e is not th e cau se of th is type of reaction, as it causes exc itement
and palpitations. It does not tend to cause conv ulsions or loss of consciousness.
Intr avas cular injection of a single cartridge of a local anesthetic is not like ly to cause
unconsc iou sness in a healthy adult patient, as th e to tal quantity of anesthetic
necessary would be more th an is co nt ained in a singl e cart ridge.

8. A While ensuring for adequate resistance form for t he am algam, this allows for
placement of retentive dentin .

9. c Th e passive lingu al arch is an effect ive space maintainer f or mandibular arch . The
distal shoe is used only t o guid e th e eruption of permanent first molars. The acry lic
button of the Nance holding arch makes it appropriate only fo r space manageme nt in
th e maxillary arch. The removabl e acrylic fun ctional appliance has the disadvantage
of requiring additi onal patient cooperation.

10 . c Bonded brackets with intertooth traction provid e a cont rolled mechanism for closing a
diastema effecti vely. A rubber elastic should not be placed around two teeth. This
w ould have a tend ency to cause apical mi grati on and sev eral bon e loss areas around
th e two teeth . It co uld cause loss of t he teeth th emselves. A steel ligature does not
have th e elasti city to provid e an eff ect ive orthodontic f orce .

11 . A A nasolabial cyst is a soft ti ssue cy st that does not inv olv e the alv eolu s of the
maxi lla . Since there is no bony involvement , th is cyst does not produ ce
radiographically det ectab le changes.

12. A The questi on sugg ests that th e ste ps involved in th e cast t ry-in have been verifi ed, i.e.,
A . interprox ima l co ntac ts,
B. marginal ridg e heights,
C. margin /fini sh-lin e integ rity (tac tile, vi sual, imaging), and
D. occlusal harmony .
The re is an intimate margin /finish -line integrity . Th e wa xing procedures have been
completed with anat omi cally -corre ct axial relationships. The restoration fits the to oth
and its adjacent env ironme nt . Only the occlu sal surfa ce is inco rrect, and the occlusal
surf ace environm ent is heavily influenced by th e opposing to oth /teeth . With th ese
result s, ther efore, th e only plau sible answe r is answ er " A " .

13 . A The Health 8 elief Mod el assert s that health behavior is motivated by two things: (1)
by th e seriousn ess of th e perceived con sequen ces , should the acti on not be
perf ormed, and (2) by th e perceiv ed benefits, should the behav ior be carried out.

14 . 8 Although each of th e methods suggested might be effect ive in behavioral change ,

research suggests that posit ive reinf orcement is th e most effec t ive .

15. o Th e prin cipl e of retenti on form as espoused by G.V . Black applies in this situation.
Retention along th e axl e-occlu sal and axio-qinqival line angl es rather than along the
mesioaxial and disto axial line angles (Response A) maximizes retention

67
 form since wa ll div ergence is less pronounced; it also allows for initial
insertion/retention of restorative m at erial that is "w edged" between occ lusal and
gingiva l wa lls, thus, f acilitatin g manipulation of amalgam .

Ret ention at t he expense of occlusal and gingival wa ils, rath er th an of th e axial wa il

(Response C), maximi zes resistance to f acial displacemen t and minimizes pote ntia l
enc roachme nt upon pulpal ti ssue .

16. A A genet ic defi ciency in th e C- ' esterase inhibito r of the first compone nt of
compleme nt results in excessive acti vat ion of compleme nt com ponents distal to C'· ' .
In th e case of angioedem a, increased and prolonged capillary permeabili ty
due to excess ive C-3 convertase ac tivity causes rapid and seve re edema .

17 . o Th e mu scular attac hme nts to the ante rior mandible are the genioglossus, geniohyoid,
right and left anterior bellies of th e digastri c muscles; contractio n of t hese m uscles
will displace an anterior fr agm ent w ith frac tu res t hrough bot h canine regions.

18. C A pproximately 30,000 persons develop oral cance r annually. T his represent s abou t
4% of all cancers. Each year 8,000 - 9 ,000 deaths are caused by oral cancer (8,6 00
in 19891 . The death s are highest among th ose aged 4 5 - 74 years and in black
persons. Ab out 7 4 % are relat ed to t obacco or alcohol.

19 . A Intrinsic activity or effic acy is a drug charac te ristic that manifest s after the drug has
been distribute d to its site of act ion, not before. T heref ore, this drug prope rty does
not affec t drug distribution.

20 . o A t-test math em ati cally assesses wh eth er th e mean of seve ral values diff ers
significa ntly from th e mean of some other va lues. A chi-square is mos t a ppropriate
f or testing wh eth er two or more distributi ons diff er. Mu ltipl e regression is best used
when seve ral f actors need to be eva luate d simulta neously. Correlation coeff icients
reveal the degree of associatio n between tw o factors.

2 1. B When calculat ing percentage of a specif ic drug given, the practitioner should
det ermin e th e tot al fl ow and divide that into th e number of lit ers of fl ow of t he gas in
quest ion. In thi s particular case, th e t ot al fl ow is 6 lit ers (4 I. of O2 + 2 I. of N20) .
Th e percent of nitrous ox ide then is 2 liters divided by 6 liters. Thi s equals 33% .

22 . B Once the partial dentu re is sea ted, all retainers must be passive. Th ey should activate
only wh en dislodging forces need resisting. Constan t horizont al pressure on abutment
teeth will cause periodontal ligam ent dam age.

23. C Carbon dioxide in t he blood is th e sti mulant t hat drives t he respiratory cent er. In th e
presence of morphine and opio ids, the cells are not as easily stim ulated. Th eref ore,
respiration is depressed wi th reduced response to blood CO 2 lev el.

24. B By definit ion, the " clinical gingiva l sulcus" is the clinically meas ured dista nce from the
gingival ma rgin t o the most a pical penetration of a properly used periodontal probe
(i.e., choice "B" ). Thi s definition is approved by t he Am erican Aca demy of
Periodont ology and is based on data provi ded fr om several studies.

68
 The " clinical" gingival sulcus is to be distinguished from th e "hist ological" gingival
sulcus ." Th e latt er is t he distance from th e gingiv al ma rgin to th e base of th e sulcus
in histologic sect ions (choice D). Choice A has no clin ical meaning unless th e ging ival
ma rgin is apical to th e cementoe namel junct ion . In such cases, th is measured
distance is referred to as "gingival recession. " Choice C has no clinic al meaning.

25 . C A major w eakness of amalgam as a rest orativ e mat erial is its relativ ely low edge
stre ngt h. Th eref ore, principles of outline and resistance form suggest th at , w herever
possibl e, cavosurf ace margins should be at right angles to t he cav ity preparat ion
wa lls . W hen compared w ith right angles, beveled margins I"feath er edges" ) are
m uch more suscept ible t o fracture.

26. B A clo sed panel is a thi rd-party dent al-care program t hat enables patien ts to receive
care f rom speci fied dentis ts . The lim ited numb er of dentists who provide t his care
are selected by t he program administrator . If care is provid ed by dentis ts who are not
associa ted w ith th e program, pat ient s are not reimbursed fo r dental servi ces through
th e pro gram.

27. B Incr ease in arch length in the maxilla af ter age six results fr om appos it ional grow th in
the post erior tub erosit y.

28 . D The most effecti ve w ay to prevent problems in imp lem enting preventive health
behavi ors is to ask t he patient to ant icipate and discuss th em.

29. C Scrap amalgam has been identified as a pot ential source for th e release of me rcury
v apor in t he dental office . Laboratory studies have shown that sulf ide solutions are
effect ive agents in suppressing or elim inati ng the emission of mercury vapor from
ama lgam scrap. Other liquid storage media have limited effective ness.

30 . C Num erous histological studies of postsu rgical soft tissue-tooth interfac es clearly show
t hat th e most commo n union betw een tooth and gingiv a is via a "long juncti onal
epit helium" . Collagen adhesion can occ ur, but only rarely and far a v ery shor t
dist ance along th e previous ly exposed root surface . Reatt achment by scar does not
occu r. A new connecti ve tissue attachmen t (i.e., new cementum with funct ionally
oriente d collagen fi bers) is a rare oc currence along previously exposed root surfaces
unless guided tissue regenerat ion procedures are performed.

3 1. D Observ at ion and pedigree analyses of families w ith wh ite sponge nevus support t he
inher ited basis of this disease. No such conclusions are evident in relati on t o
analyses of large numbe rs of cases of lich en planus, bullous pemph igoid,
pemph igus v ulgaris, and t he acquisit a form of epidermolysi s bullosa .

32. E Root planing is th e deliberate instrumenta tio n of root surfac es until t hey become
smoot h and hard to tacti le inspection. Alth ough som e dentin (Choice 81 is rem ov ed
during the process, this only occ urs afte r all of the cementum has been rem oved.

Choices A, C, and D are incorrect since they represent the exte rnal accre tions on t he
teeth th at are mos tl y removed during an ins t rumen tation proce ss called " scaling."
Scaling is th e removal of these deposits and has no special effort directe d tow ard
mak ing the root smooth.

69
33 . o Each of t he options are relat ed to t he potent ial for prolonged bleeding into soft tissues
adjacent to the extraction site . Althoug h both th rombocy topenia and capillary fragility
may lead to ecchymosis, the prior history and physica l examination should have
elicited t he diagnosis. Black-and-blue marks on the neck, below the surgical site, are
ca lled ecch ymosis and can occur especially after exte nsive oral surgery procedures,
such as a full mouth extraction, in an elderly individua l.

34. C The first sentence is TRUE because all epidemiologic studies of gingivitis in children
indicate that this disease can be found in 50-90% of children under the age of 15.
The second sentence is FA LSE; there are no data to suggest that specific nutritional
fac tors are of any major significance in the pathogenesis of gingivitis . Indeed,
gingivitis in children has a strong association with dental plaque accumulation
and has essentially no association with nutritional factors.

35 . C Chrom a is the satu ration or strength of a hue. For example, a red and a pink may be
the same hue. The red has a high chroma, w hile t he pink, which is actua lly a weak
red, has a low chroma .

36 . B Th e m andibular cen tral incisor and maxillary seco nd premolar have zones of facial
keratinized gingiva that are among the w idest of all teeth. Th e mandibular first
prem olar has th e narrow est zone of facia l keratinized gingiva of all teeth . Th is is
based on dat a from seve ral studies that have exa mined th e issue.

37. C Irreversible pulpitis (advanced pulpalgia) can be definitiv ely diagnosed based on th e
classic therm al responses identifie d in the question. In addition, the sensitivity to
percussion would indicate periapical pathosis commonly observed wit h pulpal necrosis.

38 . A Inf ecti ons that cause a syste mic reac tion almos t always cause an eleva ted te mpe rature.
T achypnea is a sign of an ove rwhelming infec tion. It is ~ound only in severe situations
and not in an ave rage systemic infection. Minor problems such as an acute gingivitis or
ot her clinical infect ion can cause regional lym ph node enlargement in the absence of a
sys temic reaction to the infection. Abscess formation is usually a well- localized
phenomenon that does not elicit a system ic reaction. Cellulitis formatio n might or might
not ca use a systemic reaction; therefore, it is an inconsistent finding in infec tions.

39. B In addition to obtain ing the mean value of a series of measurements, the researcher
m ight also observ e the range of values abou t this mean. This variabili ty around the mea n
is expressed as the standard deviation. It forms the basis for many statistical tests and
is an integral part of the concept of the "normal or bell curve".

40 . E Literall y hundreds of studies on the histopathologic features of chronic gingivitis suggest

that its major histologic characteristics are those listed in choice E. Choice A is
w rong because loss of ret e pegs is not observed in most cases of chronic gingivitis.
Choice B is wrong because macrop hages are neve r a predominant cell ty pe in gingiva l
tissues. Choice C is wrong because mast cells are neve r a predominant cell ty pe in
gingival tissues. Choice D is w rong becau se the principal fibers are the most resistan t to
dissolution in diseased gingiva l tissue.

4 1. o W hen tee th wit h infected necrotic pulp tissues are ove rinst rumen ted , a t ransient
bact eremia occ urs th at is usually cleared in 20 minutes. This is suff icient tim e t o

70
 permit bacteria to lodge on damaged heart valves and to begin colonization. It has
been demonstrated that wh en instrum entation is confin ed within th e root canals of
necrotic pulps, the tran sient bacteremia does not occur.

42. 8 Whil e the sponta neous incidence of thyro id cancer is low, the best ava ilable
epidemiologic al data on ex posed human populati ons rev eal th at the prevalence of
radiation-induced cancer, when compared to all other tissues. is very high. Indeed, it
is the highest of the four alterna tives offe red in this question.

4 3. 8 The effects of variable s are best account ed for in co ntrolled clinic al tr ials . In th is
manner, results can be most strongly linked to specific causes. Correlational studies
can only suggest associations. Case reports are usually too few in numb er and the
cau ses of condi tions cannot be well establi shed. Epidemi ologic surv eys can only
reveal cross-sectional or preval ence informati on and cannot establish cause-and-eff ect.

44. A Spontaneous osteog enic sarcoma arises in approxima te ly 2 percent of Pag et's disease
cases, w hile in the other diseases listed the same risk or propensity does not exist .

45 . D Propranolol blocks adrenerqicallv-acti va ted 8 1 recept ors (heart rat e an d for ce). Of th e
dru gs listed, proprano lol will prov ide th e most speci f ic th erapy and is, th erefore, th e
druq- ot -choice.

46 . 8 At usual th erapeutic dos es, both the opioid analgesics (f entanyl and meperidine) and th e
barbiturat es (th iopent al and pent obarbital) suppress th e respir atory ce nte r's
responsiveness to pC0 2 . Th is is not an effec t seen with diazepam at the doses used in
conscious sedation.

4 7. 8 Changing film speeds results in a two-fold reduction in risk. Chan ging to rectangular
collimation result s in about a five-fold reduct ion in risk. Th e cervica l collar reduces the
dose to th e thyroid gland by approximately 50·80% . Wh en perf orm ed co rrec tl y, the
type of processing has no effect on risk .

48 . D Wh en there is insuffic ient space for the four perman ent mand ibular incisors, th e path of
eruption of th e lateral incisors ofte n causes resorpt ion of the primary canine roots and
th eir premature exfoliation.

49 . C T he non-w orking condyle's ini tial lateral movement is a translation down and forwa rd
along the slope of the eminence. Simultaneously, its medial mov ement is determined
by an arc of mo t ion whose radius is ce ntered in the working co ndyle and modified by
the bone, muscles, and ligament s surrounding the condyl es.

50. 8 Wh en gold alloys are cast, th e observed shrinkage is du e t o t he th erm al contraction of

th e alloy from the solidus temp erature (i.e., t he temp eratur e at whi ch th e alloy becom es
solid fr om t he mol ten sta te ) to th e ambi enttemp erature. Comp ensation for thi s
shrinkage is provided by the inve stment mold expansion.

51. D The high modul us of elasticity (high rig idit y) of poly et her mater ials can make th e
impression diff icult to remove, especially from seve rely undercut areas in the oral

71
 cavity. The hydrophilic property is an advantage during the making of an impression
since, in the absence of adequate mo istu re control, an im pression can still be made
with some water contamination present. However, when stored under humid
conditions, moisture absorption can result in expansion of the impression.

52. A S. mutans produces a gela tinous matrix th at provides a v ehicle for attachment . S.
mulans m et abolizes sucrose and ca rbohyd rate de rivatives obtai ned from foods, not
from saliva or ename l. S. mutans can co-exis t but t heir relat ion ship is not sy mb iotic.
In fact, it is th ought to be co mpet itive, in th at an abundance of L. acidophilus results
in th e crea tion of an enviro nment (low pH) that is host ile to S. mutans.

53 . A Hiqh-copper amalgams are charac terized by the tin-mercury phase being absent or
substantially reduced. This results from t in pre ferentially reacting with coppe r rath er
than w it h mercury .

54. c Gardner syndrome and cleidocranial dysplasia are hereditary disorders that result in a
number of distinct soft and hard tissue abno rmalities, yet share a common de fect in
the development of multiple supernumerary teeth.

55. o After an infer ior alveola r nerv e block injecti on, post -anesthetic bit ing of anes the tized
t issues (e.g., tongu e, lip, or inner cheek ) fr equentl y occ urs in young ch ild ren. It is
diffic ult for th em to understand th at th ey can hurt themselv es by bit ing anest hetize d
tissues.

56. c The mos t impo rta nt factor in managi ng avulsed teet h is the maintenance of the
vit ality of t he periodontal ligament fragments that are attac hed to the roo t of t he
toot h. Excessive ext raora l time has been shown to result in necros is of the
pe riodontal fragm ents. Af ter replantat ion, this necrosed tissue promotes an
inflammatory response in the suprabony st ructures of the tooth resulting in external
resorpt ion to a greater or lesser extent .

57. B D ental-composite restorative materials are made wi th glass-filler particles . T hese

particles are placed in the resin matrix. The chemical coup ling agent is used to treat
th e glass. In th e co mpos ite material, th e coup ling agent promot es a chemica l
adhesion bet wee n th e f iller part icles and th e resin matrix . The co upling agent
prevent s the filler parti cles from sett ling out of the resin ma trix.

58 . o The shielded open-ended co ne can reduce most of th e stra y radiat ion reachi ng the
pat ient' s gonads. Th e only major source of expos ure left is sca tter from th e pat ient 's
face.

59. c There is no practical procedure for determining w hether or not all items processed
th rough a ste rilizer are free of living microo rgan isms. But. the best gua ran tee is to
routinely demonstrate the death of bacterial spores, the mos t di fficult of all
microorganisms to kill. This provides the highest probability that all othe r
m icroorganism s have also been killed. A lt hough the use of chemical indicators and
reading gauges is im port an t, each of these tests the ste rilizing process, not t he ac tua l
killing of microo rganisms . T he hepatiti s B virus and the tub erculosis bac terium are
easier to kill than bacterial spores .

72
60. D Of the opt ions listed, the single rem aining m axillary molar tooth is t he nearest to the
floor of th e m axillary sinus. T he rem aining edentulous alveo lar ridge provid es littl e
bone st rength agains t alveola r fract ure w ith av ulsion of the antral fl oor during rem oval
of this toot h.

6 1. c Research on int erpersonal behavior strong ly sugges ts that eye contac t is th e most
inf luentia l nonverbal cue.

62 . B Interocclu sal dist ance is the distance betwee n the occ luding surfaces of the maxillary
and mandibular teeth wh en the mandible is in a specifie d position. During the
fabrication of dentures, the occlusal rims are formed to develop the desired
charac teristics of th e completed dentitio n and to serve as a substitute for the
occluding dental surfaces.

63. c Open-end ed questions--those that canno t be answered w ith a simple "yes" or

" oo" --are the most effective in helping patient s to ex press their understa nding.

64 . D The st ylohyoid is a ligament that extends fro m the sty loid process to th e hyoid bone.
It lies lateral to t he superior cons trictor mu scle, as does t he m edial pte rygoid mu scle .
T he lat eral pter ygoid is orient ed more horizon tall y at a highe r level between the
sphenoid bone and the condyle. Of the choices listed, only the superior constricto r
muscle bears a relat ionship to the distolingual borde r of a complete denture .

65. B The dev e lopm ent of auto-a ntibodies to ace tylcholine receptors in mya sthenia gravis
results in the blocking of nerve impulses across the neuromuscular junction. None of
the othe r neurom uscular disorders result from defective neuromus cular transmission.

66 . A Tr ismus, or limi ted ability to open one's mou th, occasionally occurs after inferior
alveo lar nerve block injec tions. The reason for this is t hat the needle ad vanced too far
medially and injured the medial pterygoid muscle, w hich lies adjace nt to the mandibl e .
The medial pterygo id muscle actually fo rms the medial boundary of the
pteryg omandibular space, w hich is the target space for t he inferior alveolar nerve
block . Penetration of this mu scle m ay cause a reflex, prot ectiv e spasm of the muscle,
or possibly some minor inflammatory infiltrati on afte r the inject ion.

The stylomandibular ligament is too far to the posterior aspect of the space to be
injured. The masseter muscle is on the lateral aspect of the mandible and, therefore,
is im mune to penetra tion by the needle. The poste rior belly of the digastric muscle
and the inferior head of the lateral pt erygoid mu scle are too distan t.

67. B Th e exist ing da ta base show s a repeat ed and reproducible relat ionship betwee n the
recurrence and anat om ical rest riction to tightl y -attached areas of oral mucos a.

68 . c The enamel hatchet is the only instrument that w ill allow the operator to have proper
access t o the ma rgins and t hat w ill impart t he proper ca vos urface angle to the
m argins.

6 9. A By assessing inflamma tion and bleeding, severa l studies have revealed that plaque
control programs w ill result in improved gingival health. T he benef its of these

73
 programs, how ever, ten d t o be transie nt. After seve ral months, the y disappear.
Th ere are few long-t erm gains and littl e evidence of any effect on caries.

70. C In th e United St at es and Western Europe, oral and pharyng eal squamo us cell
ca rcinoma is most preva lent in men ages 50 to 70. Ma ny st udies ove r the past 20
years hav e revealed a relationship betwee n cance rs of th e upper aerodigestive tract
(the oral cavity, pharynx, larynx, and esophagus) and lungs, and the use of cigarett es
and alcohol. Non-drinking smokers have two to four times the risk of developing
cance r com pared w ith t hose w ho abstain from both alcohol and tobacco. The risk of
smoke rs who are heav y drinkers is six to 15 tim es that of absta iners.

71 . D Clinical studies have concluded that broke n instr ume nts separate d within th e root
canal spaces with no periapical pathosis evident have no significant differences in
lonq -terrn success rat e as compared w ith similar cases w ithout broken instruments .

7 2. C Wh en t here are not any radiographs avai lable of root cana l-trea ted t eeth with
periapical radiolucencies and when there are no sym ptoms. it is virtually impossible to
determine if th e radiolucency reflects a progressively enlarging lesion, w hich w ould
indicate a failing treatment. If, howeve r, the condition indicat es progressively
diminishing lesion, this w ould suggest successful treat me nt. The refore, the dentist
should observe the tooth ove r a period of 6 to 12 mo nt hs, obtai n subsequent
radiographs, then compare th ese radiographs wi th the current radiograph. In so doing,
th e practiti oner could det ermine whether th e lesion we re becom ing larger or smaller.

73. D A com mon compo nent of polycarboxy late and glass ionomer is polyacrylic acid.

74 . C T rapping bacteria beneath sealants is inevitable. A lso, inadverten t sealing of initial

ca rious lesions can occu r. Neit her of these events enhance s the chance of caries
developing or progressing beneath the seala nt.

Th e ability of bact eria to surv ive under sealants is considerably impai red because
in gested carbohydrates cannot reach th em. Sev eral inves tigato rs have found th at the
numb er of bacteria in sealed carious lesions decreases dram ati cally with tim e.
Radiographs of fr ank occ lusal lesions that w ere deliberat ely sealed for inv esti gat ional
purp oses failed to show lesion enlargeme nt seve ral years aft er being sealed. Th ese
fi ndings suggest not only th at caries will not progress beneath a properly placed
sealant, but also that a lesion that is inadverten tly sealed w ill arrest.

7 5. A The surface hardness , strengt h, and proporti onal limit of t he metal are inc reased w it h
strain hardening (burnishing), whereas the ductility and resistance to corrosion are
decreased. Th e elast ic modulu s (stiffness) is not changed appreciably .

76. C St udies hav e shown th at th e visible light used in polymerization of phot o-activated
materials can cause ret inal dam age.

77 . B Children' s positive behaviors can be reinforced by responses that tell children

specifically w hat they are doing well. Because th ey can be interpreted in va rious
wa ys, complime nts of a general nature are usually less effective.

74
78 . C Because t he toot h has been trea ted endodontically, t he restorat ion-of-choice should
complete ly cove r th e occ lusal surface . Th is will protect th e tooth fr om fra cture.
An sw er C conserves tooth structure and periodont al health .

79. B App licati on of OSHA requirements, ADA guidelin es, and CDC recommendations are
based upon the con cep t of universal precautions.

80 . B Th e treat ment -of- ch oice in ske leta l abnor m alities is t o perf orm an osteotom y and to
mov e the abnorma l bone element into th e norm al anatomic posit ion; with a skelet al
Class III m alocclusion that result s from a m axillary de ficie ncy , the maxilla in its
entirety needs to be repositioned.

COMPONENT B

1. C Reinforcem ent tends t o increase t he lik eiihood of a behavi or (desirable or undesirable)

continuing or being repeat ed; while lac k of reinf orcem ent ten ds to decrease th e
likelihood of a beh av ior continuing or being repea te d.

By acknowledging the child' s cry ing and then disregarding it, the dentist failed to
reinfo rce it and, thereby, " extinguished" t he undesi rable behavio r--i.e., cry ing. Had
the dentist persisted in comme nt ing abo ut the cry ing, i.e ., in continually telling the
child to sto p cryi ng, t he dentist wou ld have reinforced t he undesirable behav ior and
increased the likelihood of it continuing.

2. B Gender has not been found to inf luence dental phobia. T he othe r options, howeve r,
hav e been linked to th is phobia.

3. B Hydroxy zine (V istaril®) is an excellent and safe anx iety control agent for children w ho
are fearful but not co m bati ve . It has a saf e dose ran ge and , rath er than putting the
chiid to sleep and not heiping th e c hild learn to cope with a dental v isit, it merely
reduces anxiety . Th is st rateg y perm its th e dent ist to teach the child an appropriate
coping behavior.

Ketarnine (Ketel ar®1 is a general anesthe tic. Because pentobarbital (Nembutal ® ) and
chlorprom azine (Thorazine® 1produ ce undesirable side effect s, t hey are not
recomm ended for sedating children; M eperidine (Demerol®) is indicated for child ren
who are mo re com bat ive.

4. D Becau se space has already been lost fr om th e prem ature loss of th e primary
mandibul ar left second mola r and fro m the consequent mesial drif t of th e permanent
mandi bular lett first mola r, space maintenance is CONTRAINDICA TED_ An active
space -rega ining appliance is required to regain the lost space .

5. D No treatment is indica ted at th is tim e. The radiograph s rev eal th at the roots of the
primary ce nt ral incisor s are resorb ing. Since this pati ent is frighten ed of going to a
dentist an d has had a fright ening experience wi th an ex trac t ion prev iously, it would be
appropriate to observe th e patient fo r a period of time to perm it the primary incisors to
exfolia te . In cases such as t his, t he permanent incisors gen erally erupt satis fa ctor ily
and move labially into the availabl e space by the action of the tongue. No treatment
or applianc e therapy is usually necessar y.

75
6. A Pulpal infection (abscess) in a primary molar is usually first evident radiographic ally in
the furcati on area, rather than in the periap ical area as in permanent tee th. Th e
examination findings do not indicate any periodontal pockets in this area.

7. o A primary molar with a large fu rcati on radiolucency, such as is evident on th e

radiograph, makes t he prognosis for pulp t herapy very poor. Extract ion, the
treatrn ent-ot-choice, should be f ollow ed by a space maintainer.

8. c Stainless steel crow ns have been shown to be more cost effec tive than multi-surfaced
amalgam restorations in primary teeth. Because of its high failure rate, an MOD
amalgam restoration is not recommended for primary molars.

9. c At thi s child's age lapproximat ely 6 years), and with th e presence of deep cari ous
lesions in the primary molars, two bite-wing radiographs, plus either the four periapi cal
films or the panographic film, are indicated··but not both. Therefore, these
radiographs are excessive in number.

10 . c The maxillary right first molar is the most cariously involved and is most in need of
immediate treatment. The maxillary arch is the most desirable arch in which to
introduce a child to general anesthesia, and extraction should be avoided as t he first
form of treat ment for a new child pati ent whenever possible.

11. c The mesial step primary molar relationship involves the distal of the mandibular
second molar occluding slightly mesial to the maxillary second molar. This can be
seen in the photographs.

12 . B These teeth exhibit only occlusal caries w ithout interproximal, buccal or lingual
involvement making a stainless steel unnecessary. Sealants should not be placed over
obvious open carious surfaces. Zinc oxide-eugenol is not an appropriate restorative
material at any time except as a temporary seal.

13. E This child is over th e age of three, and th e flu oride lev el of th e w ell-water fall s into th e
lowest concentration category « 0 .3 ppm). Consequently, in order to meet the
recomm ended daily level of fluoride intake, this child needs to ingest an added 2.2 mg
of sodium flu oride 11 .0 mg of flu oride ion} per day.

14 . B In the maxillary incisor area, the radiographs reveal tw o supernumerary teeth that are
peg-shaped. One tooth is erupted in th e left maxill ary space; t he second is
superimposed over the unerupted permanent maxillary right central incisor. A normal
number of developing permanent -tooth buds are evident on the films provided.

15 . B The most frequent sequela of a supernumerary t ooth in th e maxillary incisor area is

th e ecto pic or delayed erupt ion of th e permanent incisorl s).

16 . o The extra ction of this supernum erary t ooth at this time will permit the permanent
maxill ary left cent ral incisor to erupt into position at its appropriate tim e and in it s
normal sequence.

76
17 . C The A me rica n H eart A ssociat ion recomm ends one half of the adu lt penicilli n V dose for
a child w ho we ighs less than 60 Ibs. (27 kg .). Response A wo uld be appropriat e for a
penicillin -allerqic patient. Response B w ould be recommended for an adult . Response
o conta ins too m any postoperat ive doses; and Response E is used for pat ient s with th e
more severe cardiac problems (e.q ., heart valve prost heses).

18 . B Giv en an equal volu me dose (mg) of a local anesthe tic, a healthy patien t who has a
greate r blood volume w ill have a lower level of anest het ic in his blood strea m th an will
a pati ent, such as a child, who has a lesser blood volume. Therefore, th e maximal
dose should be based upon weig ht t o wh ich blo od vo lume is, in large part, relate d.

The ADA Council on T herapeutics recom m ends 3 mg per pound as the m axim al dose
of lidocaine 2%. Malamed (1986) and the Physic ians Desk Reference (199 0) each
recom mends 3 .2 mgllb (7 mglkg) for 2% lidocaine w ith epinephrine and 2 mgll b
(4 .4 m g/kgl for 2% lidocaine without epinephrine. The dose range of 90·130 mg falls
closes t to th e range recommended by both authori ties for thi s 44 lb. (20 kg) child
(88 to 134 mg).

19 . B The radiographs reveal no evidence of infect ion. Theref ore, a pulpotom y is the
tr eat ment -of -choice fo r a primary tooth that has a cariouslv -exposed pulp. Because t he
tooth crow n will become brittle and will not be able to support an amalgam restoration,
a sta inless-stee l crow n is recom mended for a post erior primary too th t hat is trea ted
wi th a pulpotomy . Calcium-hvdroxide pulp capping is not recom mended for a primary
t ooth that has a carious exposu re. Such treatm ent leads t o a high incidence of inte rna l
root resorption.

20 . B The perm anent first mo lars and incisors are erupted . Thi s suggest s a dental age of
more than 7 yea rs. The primar y canines ami mola rs have not yet exfoliated. Thi s
suggests a denta l age of less than 10 years.

2 1. A In th e mixed dent ition, a unilateral post erior cross bite is usually the result of a later al
fun ctional shift of th e mandibl e, whi ch causes th e mandibular dental midlin e to deviat e
to th e side of t he shift .

22 . D In th e mixed dentition, a unilatera l poster ior crossbite is usually the result of a bilat eral
symmetrica l const rict ion of the maxill ary posterio r teet h. This cons trictio n causes a
lateral functi onal shift of the mandible. A unila teral con stri ction of the maxillary
poste rior t eeth is uncom mon .

23. A Th e panora mic radiograph portray s an overlap of th e permane nt m axillary canine s and
lat eral incisors th at is excessi ve . Th e crow ns of the permanent max illary canines
should erupt against the dist al root surfaces of the permanent max illary lateral incisors .

C and 0 are incorrect. From a panoram ic radiograph, one canno t make the
de te rminat ion of w hether t eeth are erupting fac ially or palatally .

24 . A Expa nsion of th e maxillary arch will allevi ate the fun cti onal shift of th e mandible.
There is no space available for correc ting the crossbite of the perm anent ma xillary
lateral incis ors. Because t he permanent max illary canines are eruptin g ectopicall y,
correctih g this crossbite is addit ionally contraindicated. There is no indicat ion f or
ex traction of either the primary mandibular can ines or the primary maxillary first
m olars.

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25. 8 A 1.5 mm mandibular arch-lenqth discrepancy is minimal. A t this stage of th e
m ixed -dentition dev elopm ent, definitive ort hodont ic treatm ent is not required .

26. C The c hild is more th an 3 years old. Her drinking w ater is not opt imally fluoridated; it
contains 0 .5 ppm flu oride. Therefore, th e recomm ended supplemental fluoride dose,
accor ding to the ADA Council on Dental Therapeuti cs, is 0.5 mg of flu oride ion per day
or 1.1 mg of sodium flu oride.

27 . B The photographs very clearly portray gingiv al sw elling and color change, i.a., gingivitis.
Altern ativ e C is wrong because there is no periodontitis, i.e., no clinical or radiographic
evidence of bon e loss.

28 . B This pati ent has several deep carious lesions on Teeth #'s 3, 18, 19, 3D, and 31 .
Theref ore, his plaque fl ora probably cont ain high levels of Strept ococcus mutans, a
w ell-kn own ca rioge nic organism .

An sw ers A, C, and D are all believed to be associated with periodontitis . This patient
has gingivitis only . Consequently , there is no reas on to ex pec t that such bact eria
w ould be elevat ed in this patient's plaque.

29. D Acu te apical periodontit is is th e only choice that is consisten t w it h th e signs and
symptoms. Pulpiti s and hyp eremic pulp suggest a vital pulp. The pati ent 's
non-response to vitality tests, however, is consistent with a necrotic pulp. Acute apical
periodontitis and chronic apica l periodontit is are usually both associated with a
necroti c pulp. Chroni c apical periodont itis is usually associ ate d w ith a radiographic
lesion an d no sym ptoms . Acut e apical periodontiti s is usually associa ted with no
radiographi c lesion or, at most, a slight t hickening of th e periodont al ligament, and
sensitivi ty to chewi ng, percu ssion and/or palpat ion.

30 . D Acute apical periodontitis occurs as th e result of th e irritants liberated by a necroti c pulp

int o the periapical tissues. Symptom s dev elop becau se th e body 's natur al def enses are
unabl e to elim inate the irritants. Debriding the root cana l of necroti c ti ssue enables
healing to occur. The root canals are debrided during root canal treatm ent. None of the
ot her choices will debride th e necroti c tissue from the root ca na l.

31 . A Th e carious lesion s in Teeth # 's 3 , 18 , 19 . and 30 are ext ensive . Priority t reatm ent for
contro lling th e ca ries is esse nt ial to prev ent carious exp osure .

32. A Since the adjacent t eeth are free from carie s and restorati ons, th e resin fixed part ial
denture is cost effe ctive . rev ersible, and non-inva sive . A rem ovabl e partial denture
can comp romise oral hygi ene. Because of t he poor oral hyg iene and of th e potenti al
healing problems that are secondary to his diab etes, a single tooth implant does not
represent an appropriate choice at th is time.

33. A This y oung adult has a relat ively high inci dence of dental caries. Because of
its phys ical prop erties and ex pec ted length -of-servi ce during th e ca ries-cont rol
phase of tre atm ent , an amalg am is the restorati ve rnat erial-of -cboi ce.

78
34. C Before dismissing the patient, the dentist should obtain an additional periapical
radiograph of this tooth. Th is radiograph is essential for det ermining the changes in
pulp size and periapical condition at subsequent visits.

35 . B V erruca vulgaris appears eleva ted and has a granular "cauliflowe r" surface pattern .
In cont rast. lichen planus (alte rnative A) and actinic cheilitis (alternative C) are flat.
Th e fibrom a (alternativ e 01 is elevated and remov able, arid is primar ily a muc ous
membrane lesion.

36. C The lesion is small. Its small size allow s for an excisional biopsy and subsequent
diagnosis. An incistonst biopsy. {altern ative BJ in contrast . wo uld provide info rma tion
only and, in addition, w ould require a second surgical procedure. "Observat ion only"
(alterna tive A) w ould permit the grow th to continue or allow the virus-induced lesion
to spread. Steroids (alternative E) woul d play no role in either eliminati ng or curing
this typ e of lesion; in fact, by local drug-induced immunosuppression, th ey could
induce furth er or more rapid growth.

37 . B Insulin-dependent diabetics , w ho act normally w hen th ey arrive at th e dental off ice,

but w ho t hen become pale and swea ty, etc ., are usually hypogly cemic. If they are
able to sw allow , these patients should be given a sugar solution (two to three
teaspoons of sugar in a glass of w ater).

38 . C Third molars that will not erupt into functional occlusion should be removed. If the se
molars w ere to partially erupt, pericoronitis infections w ould be likely to occur. Such
infect ions are especially likely and potentially severe in insulin-dependent diabetics. If
th e t eeth we re remov ed af ter t he crow n has formed, or afte r t he roots have
completel y for med, t he surgical procedure w ould be more diff icult than if the t eeth
w ere removed af ter their roots we re only one-half formed.

39. A This inf ection is most probably caused by qram -neqative anaerobes such as
Bacteroides and/or Fusobacterium. Th ese microorganisms will be resistant to
tetra cy cline (the patient has been t aking it for prolonged time). Furth ermore, the
pat ient is allergic to penicillin. Eryt hromy cin is pot enti ally effec tive against
Bacteroides and Fusobacterium.

40. A A pulpless tooth is more subject to fractur e. The radiograph reveals that much of th e
tooth's coronal port ion has been destr oyed by caries. Current oral hygi ene habits
cont raindicate the selection of a cast onlay. Of the tr eatm ent options offered, an
amalgam core and complete crow n offe r th e best prognosis.

4 1. B Although this is th e patient 's fir st visit as an adult to th e dent ist , she has giv en no
indication to th e denti st th at she is afraid or anxio us. Th e first and best st ep is for
th e denti st to learn th e patient's views about dental care. After acquiring th is
information, th e dentist can th en decide whether or not other alternatives are
needed-l.e., opt ions such as th ose listed in A or C.

42. D This medicatlv -healthy young adult has advanced periodontitis. Thi s is referr ed to as
rapidly progressive periodontitis. Alternative B is incorrect since the patient has
severe gingival inflamm ation and heavy calculus. Th ese do not occur in localized
juvenile periodontitis. Alt ernative C is incorrect since the patient has advanced, not
marg inal, bone loss.

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43 . B Nutrient cana ls have regular borde rs and, w hen seen, usually occur in multiples .
There are no synchondroses in t he alveolar process. The patient has no history of
fractu re and f ractu res usually hea l wi thout a scar .

44 . o The photog raph portra ys discrete, lace -like, whitish striae over the buccal mu cosa . Thi s
appea rance, coupl ed with the information offered in the quest ion, i.e ., asymptomati c
whi te lesions, makes lichen planus the best and only answer.

45 . B Tetracy cline is a chelating agent; it interferes with such metalloprote inases as

collagenase .

46. A Normally the gut flora hydro lyzes estrogen met abolites to estrogen, which is then
absorbed back into the blood. Ant ibiotic therapy alters gut flora, which results in a
dec reased conve rsion of estrogen metab olites t o estrogen , and in low er plasma lev els.
Since contraception depends upon elevated estrogen plasma levels, a low ered plasma
leve l can result in ovula tion .

47. A Patient s who take antibiotics for prolonged periods can expe rience an overg rowth of
Candida organisms . Candidiasis (thr ush) appea rs upon clinical examination as white
plaques that can be easily rubbed off. When rubbed off , the plaques leave a red, raw
surface. Antimicrobial the rapy with nystatin lozenges will kill the yeast organisms.
Clindamycin, acidophilus table ts , and acyclovi r have no effect on yeasts . Amp hotericin B
is ver y toxi c and is indicated only in the Candida infections of deeper tissues .

48. A 8ecause of severe bone loss, moving Tooth # 1 into the former space of Tooth #2 is
inappropriate; Toot h #1 is periodontally compromised . Because the opposi ng Tooth #3 2
will be extracted, Tooth #1 will be nonfun ctiona l; therefore , Tooth #1 should also be
ext racted.

49 . C Because of ( ll th e patien t's history of symptoms, (21no response to vitality tests of

Toot h #14, and (31 the radiographic evidence of periapical pathosis, a diagnosis of pulp
necrosis is appropriate . In t he absence of any oth er obvi ous et iology for pulp necrosis , it
must be concluded t hat thes e lesions are primarily periodontal. There is ample eviden ce
to suggest t hat there is a relat ionship between periodontal and pulpal disease. Th e
relat ionship is established th rough the apical foramen, lat eral canals, and accessory
canals. Ther e is a high incidence of accesso ry cana ls in t he furcation of mo lar teeth.
These canals are th e communication by which pulp disease involves the periodontium and
periodon tal disease involves the pulp.

50. o The position of Tooth # 18, l.e., its mesial inclination, will make it difficult for the denti st
to place a partial -coveraqe retainer . Converse ly, the other options listed (A, B, C, and EI
wi ll NOT inte rfere wi th t he placement of t hree-quart er crow ns: both the crown
circ umferences and lengt hs are adequate; the span is SUfficiently short; and the car ies
rate is sufficientl y low.

5 1. o The patient has expressed inte rest in appea rance of tee th . It is best t o indiv idualize
mo tivationa l messages.

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52 . c The correct answer, C. represents the recommendation of the American Heart
Association for a penicillin-allergic patient who w eighs 60 pounds or more.
Alternatives A and 8 are inappropriate because the patient is allergic to penicillin.
Although 0 does contain ery thro myci n, as recomm ended, it has poor preoperativ e
timing and too many postoperative doses.

53 . A There is evidence in the literature to conclude that estrogens and prog esterones act as
growth factors for black -pigment ed bact eroides . They are thought to do so by
substituting for the menadione--the menadione that th ese bact eria need for
proliferation.

54 . B The periodontal infect ion (gingivitis/e arly periodont iti s) should be t reat ed f irst . This
allows for movement of the tooth into a relatively healthy site. Answ er A is incorrect
because this w ould result in movement of Tooth # 10 into an infected site. Answ er C
is also incorrect because there is no indication that periodontal surgery is necessary;
the deepest pocket in the area is only 4 mm.

55. B There is no space available for correcting the patient's midline deviation. Correction
of the midline w ould require unnecessary removal of additional tooth structure andlor
a mo re complex orth odontic appliance than a mod ified Haw ley.

56 . B Ther e is not enough space available t o move Tooth #10 into alignment ; th erefore, th e
mesi odist al width of this t ooth needs to be reduced prior to orth odontic movement.
Because Tooth # 10 will be crow ned, it is acc eptable to reduce its mesiodistal wid th .

5 7. B Subgingiv al-margin placement (Al ternat ive A) is DESIRABLE and w ill meet esthe tic
requirements. A 3 mm vertical overlap and minimal horizontal overlap (Alternative CI
are also desirable; they w ill maint ain orthodo ntic placement . This crow n placement
will also retain tooth placement ; t heref ore, it is NOT necessary to splint the crow ns.
In addit ion, th e splint ing of th e crow ns (Alternative B, or th e EXCEPT/OM would make
oral hygi ene more difficult and would be cont raindicated for patients (such as this
person) who are prone to periodontal disease.

58. c Stomatitis nicotina is a site-speci fic diagnosis and is seen in heavy smokers--usually
pipe smokers. This patient fits into this clinical scenario very well.

59 . o The red spots represent infl amed min or salivary gland ducts . These ducts cont rast in
color to th e surrounding hyp erkeratosi s. Additi onally, th e saliv ary duct epit helium has
not keratinized; this lack of keratinization also contributes to the clinical presentation.

60. o As evide nced by t he periodontal examina tion (pocket depths ) and the radiographic
exam inati on (ext ensiv e bone loss), thi s patient has advanced periodontiti s. A.
viscosus is NOT believed to be an etiologic agent in periodontitis; it is strongly
associated with gingivitis.

The bact eria listed in A, B, C, and E are puta t ive periodontitis -producing pathogens.

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 6 1. A T ooth # 17 has an ext remely poor prognosis and should be ex trac ted.
Radiographically, it has bone loss approaching th e apex of the me sial root. T he
periodont al chart ill ustrates that Tooth # 17 has ext remely deep probing depth s (i.e.,
10 mm.) on most surfaces.

Because splinting the tooth w ill not resolve the periodontal infection, answ ers B and
C are both inappropriate. Answ er 0 will also not resolve th e infec tion. Amputation of
the mesial root (Answer EI does not represent a suitable option; th ere has been
ext ensive bone loss into th e furcation and on the mesial aspect of the distal root.

6 2. B Th e first sta tement is FALSE because the pat ient has adult periodontitis. Many
studies have suggeste d that with such patients, ant ibiotics do not add to th e
th erapeuti c effect of scaling and root planing. Th e second sta t ement is also FALSE.
Candida albicans is not diminished by tetracy clines . In fac t. C. albicans proliferat es
during tetracycline administration.

63. B Because they cannot gain sufficient access to subgingival flora, m outhrinses do not
aff ect these flora. Oral bacte ria do not readily deve lop resistance to chlorhexidine .

64. B Alt ernativ e B is correct; the surgery will provide access for adeq uate ly cleaning th e
te eth and for reducing th e pocket s. In spite of th is pati ent's exc ellent plaque cont rol
efforts, his periodont itis has not responded to scaling and root planing. Therefor e,
more intensive efforts at controlling the infection are indicat ed. Altern ativ e A is
clearly inappropriat e; it suggests placing the patient on a maintenance program when
there is every indication th at there is still an infection. Alt ernat ives C and D are also
wrong; splinting will have no effec t on the existing infection. Repeatin g the root
planing is likely to fail because of access problems.

65. B Prolonged bleeding result s from acety lsalicylic acid interfe rence w ith platelet
aggregati on.

6 6. c In olde r patien ts , the impacted asymptomatic teeth tha t are cove red w ith tissue are
usually left alone. The difficult y of extraction is excessive, the patient 's suffering is
excess ive, and the healing is often incomplete . Incomp let e healing e xpo s ~ s the root
of the second molar.

57 . c Pulpless teeth that have no radiographic evidence of periapical pathosis and th at

exhibit sensitivity to palpati on andlor percussion will most likely have an infl amed
apical periodontal ligament. All of th e other possible choices are usually
asymptom atic and exhibit radiographic evidence of periapical pathosis.

68 . c t 1) Conf ining instrumentat ion and obturation to w ithin the root canal spaces, and (2)
th oroughly debriding th e canals, are th e most likely con tributors to th e healing and
success f ollow ing root canal tr eatm ent. A number of studies have shown that
instrumen ting to the radiographic apex is actually inst rumen ting beyond th e
anatomical apex , the reby injuring the periapical tissues. T hese same studies have
shown that a higher rat e of success can be achiev ed by confining all instrumen ta tion
and obturation to the root canal and by not invading the periapical tissues. Oth er
stud ies have clearly demonstra ted that necrot ic andlor infecte d tis sue from th e root
canal is the principal contributor to persistent periapical disease. Debriding the
canals of this tissue contributes to healing . There is no evidence to suggest that th e
use of an intracanal medicam ent plays any role in the succes s following root canal
treatment.

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 69. C A s stated earlier. the int roduction of irritants into t he periapical tissues will result in
the persistence of periapica l disease . The repeated loss of the coro nal sea l in this
case most likely result ed in th e deteriorati on of th e seal of th e root canal filling and
permitted th e int roduc tion of irrita nts fr om th e oral cavity. Once t he co ronal seal has
been compromised, it is only a matt er of time until the periapical tissues become
irritat ed.

70. C Once t he root canal system has been recon taminated and the periapical tissues have
been injured by the irritants, the only means 01 reversing the situation is t o either
remov e the irritants by re-debridinq and re-obtura ting the cana l or by sea ling the
contaminants in the canal by periapical surgery includ ing a ret rofilling .

T he mos t prudent cou rse of trea t men t is to re-treat the root ca nal and to spare th e
pat ient unnecessary surgery.

7 1. B The post length is too short; it should eithe r extend to 2/3 of th e roo t or occ upy all
but the apica l 4 mm. In addit ion to the adaptation being inadequat e, the size appears
to be at or larger t han 1/3 the diameter of the tooth t hat is too large.

72. A Due t o the presen t size of the post space in t he occlusal half of the roo t. there is a
need to leng then the ne w post. As previous ly mentioned. the post length is too short
and needs to be lenghtened . A n adaptation of t he custom cas t post w ill prov ide the
mos t intimate fit th roughout the cana l space resultin g in a bet te r prognosis for
ret ent ion.

73. B The locat ion of t his lesion (lat eral and dorsal tongue surface), in addi tio n to its red
atroph ic component. is significant. This patient has been smoking one pack of
cigarettes a day for 40 years . White lesions with lichenoid, erosive featu res must
include squamous cell ca rcinoma as part of a differential diagnosis .

74. D Focal osteoporo tic de fec ts are most commonly associated w ith areas of prev ious
ex trac tion. T hey represent aber rant bone regeneration sites tha t are radiolucent in
man if estat ion. The radiograph in th is case has nicely portra yed suc h a lesion at th e
height of th e alve olar crest . It is directiy at the extraction site of Tooth #19.

7 5. A A lthou gh some of the maxillary t eeth could be saved (in particula r, Tee th # 's 4 and
13 ) and an overdenture could be constructed for this pat ien t, (1) the teeth would have
a poo r prognos is (the patient has periodontal disease and has had poor oral hygiene) .
and (2) the cost would be escalated . Consequenti y, the complete denture meets the
patient's requiremen ts and w ill have a predictable prognos is.

76 . D A chronic periapical abscess draining t hrough a sinus tract is pathognomonic for

suppurative apical periodontiti s. None of the ot her choices are assoc iate d with a sinus
tract .

77 . B As ymptomatic suppu ration through the gingiva l sulcus, associated with

radiog raphically wide. ex tensive vertical bone loss adjacent to a root surface and
ex te nding to the apex, combined w ith clinica l probings of 9-12 mm. are strongl y
suggestive of a v ertical root fracture . The other choices do not present with the same
radiographic and clinica l picture and are more likely to be sympto matic.

83
 78. A T he tooth has an ill-fittin g crown, has grossly compromised periodontal support, and is
not key to the prosthe t ic replacement .

79. B The med ical emergency that is the most likely to occur with this patient is angina .
A ngina is best prevented by reducing the st ress of the appointment with a varie ty of
methods.

80. B Wh en a patient has a history of angina, the amount of epinephrine used per visit
should be kept to a low level. The max imal dose usually recomm ended is 0 .0 4 mg.
This is equivalent to approxim ately tw o cartridges of local anesthetic w ith a
concentration of 1: 100,000 epinephrine.

81. A Th e initial deter minant of the plane of occlusion is the position of the mandibular teet h
and retromolar pads. The final determinatio n of this plane should include the maxillary
occlusal rim. This will aid in setting the anterior teeth and in establishing a proper
vert ical dimension. The teeth of both dentu res should be set at the same time.

82 . B Alt hough Toot h # 18 is periodontally sound, it is severely broken dow n. A crow n will
restore the vertical height of the tooth, as well as correct the too th's conto urs.
Teeth #'s 22 and 27 exhibi t moderate to marked wea r and have a poor crown-to -root
rat io. Crow ns for these teeth w ill restore th eir vertical height.

83 . A Since gingival recession is apparent on all thr ee of these teeth , it is possible to place
th e crow n margins supragingivally. When a clinical situat ion such as this permit s it,
supragingival crow n placement is the treatme nt-at-choice.

84 . B Th e correct response is B; rotation on the straight bar represents th e ideal design.

Any design other than Figure 2 will place a to rquing force on t he abut ment teeth.
Wh en planning for the tutu re removable-partia l-denture design, the dentist can
anticipate the loss of Tooth # 18 . Consequently, the mandibular dentu re wi ll need to
rotate around the rests on Teeth #'s 22 and 2 7 and around the tissue bar, when t he
posterior saddles are depressed and/or lift ed.

8 5. D Th e removable part ial denture w ill rotate around the two most dista l rest s. The
occlusal rest (Location 41 and the cingulum rest (Locat ion 2 1w ill determine the
fulcrum line, wh en pressure is placed on the right distal exte nsion saddle area .

8 6. B The denti st has placed the canine in a slight vert ical and horizonta l overlap. This
placement necessit ates th at th e dentur e have bilat eral balanced occ lusion. The Curv e
of Spee (Answ er Al descri bes a natural dentitl on-not dentures. The dropping of th e
right second molar w as due to th e lack of arch length.

8 7. C Answ er C acknowledges the patient' s depression and the reason for it. In addi tion to
offering him a choice about the current appointment, this response also extends
empathy.

88 . C Although alternatives A and D appear to be logical, the issue here is th at of v ert ical
dimension. The correct response is C . In order to preserve ce ntric relation and
verti cal dimension, the dentist must mainta in Teeth #'s 5 and 28 t hrough jaw
relations and a set- up try -in. In th e construction of complete dentures, errors in
dim ension and in ce ntric relat ion are the two most comm on.

(CONTINUED)
84
89 . D M eperidine is poten t and can be used for patients w ith gast ric ulcer. Aspirin and
ibuprofen should be avoided because th e pat ient has a histo ry of gastric ulcer.
Acet am inophen alone wo uld not be sufficient ly effec tive. Oxycodo ne should also be
avo ided because the patient is allergic to code ine.

90. A Of the options presented, the complete maxillary denture is the treatment-of-choice.
Limited finances eliminates the possibility of doing implants. Th e crown-to-root ratio,
along w ith the number of rem aining t eeth, elim inates the option of a remo vab le parti al
dentu re. Furthermore, a treatm ent plan th at comb ines fixed and removab le dentur es
is too expensive for this patient.

9 1. A By responding in this manner, the dentist is lettin g the pati ent know that th e patient's
feelings are important and that th e dentist wi shes t o understand th e pati ent 's
perspect ive.

92. c Exposure of the root surfaces by surgery is necessary to visualize and gain access to
the subgingival calculus for removal.

93. D Because of its through·and-through fur cation and it s deep probing dept hs, Too th #30
has th e poorest prognosis of th e mandibular t eeth .

94. c Tee th #'s 20 and 29 both have radiographically unsatisf act ory crow ns and are likely
to become removable partial dentur e abutments. T hey have an acceptable periodo ntal
prognosis. It w ould be a significant compromise to construct a cast removable partial
denture on the existing crow ns.

95. A This patie nt 's history reports no evidence of sym ptomatology f or Teeth #'s 6 and 11.
Consequently, it may be safe ly assumed that these teeth are vital. Since root canal
therapy on vital asymptomatic teeth is very predictable, no w aiting period is required.

96. A It is essential to have periodo ntal sta bilization and to have estab lished a proper plane
of occlusion at the time of jaw relation records. The maxillary teet h may or may not
be removed. Tooth 115 could be retained for vertica l and centric recording ease, but
could also be removed. Endodont ic tr eatment should be completed prior to this step ;
set -up try -in should foll ow jaw relati ons.

97. B Of the three restorative-material options, ama lgam produces the best marginal seal to
dentin. This seal minimizes rnic roleakaqe and recurrent caries.

98 . c The location, duration, and overall appearance of this lesion favor the diagnosis of
hem angioma. T he absence of symp toms and the lesion's duration argue against a
pyogenic granuloma (Alt ernativ e A I. T he appearance of thi s lesion suggest s th at a
papilloma (Alternat ive BI is also inappropriat e. Finally, t he lesion' s locati on and its
lack of pigmentation rule out a diagnosis of melanoma (Alternative D) .

99 . c Because the lesion is Qui te small, excisional biopsy is indicated. Cytology and
observation w ill not provide additional useful inform ation. Inject ing steroids into this
ty pe of lesion w ould not be helpfu l.

85
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