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The functional psychiatric disorder most commonly seen in elderly patients is which of the
following?

A. Antisocial personality disorder

C. Depression
E. Senility
F. Anxiety A. Antisocial personality disorder

1) Older people that seldom experience good social interactions are more prone to develop
antisocial personality disorder or ASPD.
During an initial exam appointment, the dentist should first...

B. Establish rapport
D. Gather informationB. Establish rapport

1) evaluate patient's concerns

2) build patient trust
The primary goal of the initial patient visit is.....

C. Diagnosis and treatment plan formulation

E. Determining the patient's chief complaint E. Determining the patient's chief complaint

1) build rapport and trust with the patient

2) understand the patient's needs and expectations
The first symptom usually felt by patients being administered nitrous oxide is which of the
following?

A. Euphoria
D. Tingling D. Tingling

1) Extremities and lips may experience tingling sensation as the nitrous oxide gas starts to take
effect.
To put the patient at east and increase the general comfort of the patient while at the dentist. The
dentist should....

A. demonstrate control through a directive interviewing style

C. provide an immediate evaluation of the patient's oral health
D. tell the patient what to expect during the appointment
E. Provide an immediate evaluation of the patient's oral health to the patient doesn't have to wait
and wonder "how bad it is" A. demonstrate control through a directive interviewing style
D. tell the patient what to expect during the appointment
Which of the following methods CANNOT be used to help patients control their experience of
pain?
A. Cortical depression
B. Depression of the autonomic pathways
C. Psychosomatic hypnosis
D. Raising their pain threshold
E. Blocking nocioceptive pathways B. Depression of the autonomic pathways

1) inhibiting pain signals from reaching the brain by blocking the nociceptive pathways help to
reduce pain

2) raise the pain threshold using medications like analgesics and sedatives

3) Psychosomatic hypnosis helps condition the mind and body of a patient to handle painful
stimuli better
4 minutes following the administration of an inferior alveolar nerve block. The patient develops
paralysis of their forehead muscles, eyelids, and upper and lower lips o nthe same side of their
face as the injection. These clinical signs are most associated with the flowing of the anesthetic
into which of the following structures.

A. Capsule of parotid gland

B. Motor branches of mandibular nerve supplying muscles of mastication
C. Ophthalmic division of trigeminal nerve (V2)
D. Otic ganglion
E. Auriculotemporal nerve A. Capsule of parotid gland

1) Deposition of anesthesia near the parotid gland caused a block of the facial nerve which
resulted to the drooping of the face, paralysis of the forehead muscles and eyelid paralysis.
Which of the following is typically prescribed to treat anxiety?

A. Haloperidol
B. Lorazepam
C. Methohexital
D. Zaleplon
E. PentazocineB. Lorazepam

1) Benzodiazepine effects:
a. anxiolysis
b. anterograde amnesia
c. sedation/hypnosis
d. anticonvulsion
e. antiemesis
f. muscle relaxation
Disabled and Medically Compromised Disabled and Medically Compromised Answers
Which of the following antibiotic regimens is indicated for a 20-kg pediatric patient with a
congenital heart defect requiring prophylaxis according to American Heart Association
standards?
A. 1 g oral amoxicillin 1 hour prior to dental treatment and 500mg 4x per day for 2 days
following the procedure
B. 1 g oral amoxicillin 1 hour prior to dental treatment and 500mg 6 hours after the procedure is
the antibiotic regimen recommended for a 20-kg B. 1 g oral amoxicillin 1 hour prior to dental
treatment and 500mg 6 hours after the procedure is the antibiotic regimen recommended for a
20-kg
Hospitalization is the MOST RECOMMENDED option to treat which of the following patients?

B. A patient being treated with anticoagulants with a prothrombin time of 3.5x the control time
requiring a single tooth extraction
D. A severe developmentally disable patient requiring a full mouth gingivectomy to treat
medication induced gingival hyperplasia D. A severe developmentally disable patient
requiring a full mouth gingivectomy to treat medication induced gingival hyperplasia

1) Full mouth gingivectomy is a serious periodontal surgical procedure requiring complete

patient compliance and support. In a disable patient, general anesthesia would be carried out in a
hospital set up and emergency equipment on hand.
Which of the following ocular conditions necessitate that extra precautions be taken when curing
composite resins with visible-light curing devices?

A. Myopia
B. Narrow angle glaucoma
C. Presbyopia
D. Wide angle glaucoma
E. Cataract removal E. Cataract removal

1) Following cataract removal, eyes are very sensitive to light.

Occult lesions are pathologies that....

B. Manifest no signs or symptoms

D. Cause pain B. Manifest no signs or symptoms
Epidemiology Epidemiology Answers
For a given population, the number of disease cases are divided by the total number of people.
Which of the following rates were calculated.

B. Prevalence
D. Incidence B. Prevalence
Prevention of Oral Disease Prevention of Oral Disease Answers
Addition to tobacco products is caused by which of the following agents?

D. Nicotine D. Nicotine

1) Nicotine
a. induces body to release epinephrine from the adrenal glands
b. stimulate the body thereby increasing heart rate, respiration, and blood pressure
To prove clinical effectiveness for American Dental Association (ADA) approval, an
antimicrobial agent must demonstrate.....

B. reduction in disease B. reduction in disease

Geriatric patients are LEAST likely to suffer rampant caries due to which of the following
factors?

A. Decreased salivary flow

B. Medication side effects
C. Poor oral hygiene
D. Changes in the oral microflora D. Changes in the oral microflora

1) Oral microflora of younger people is usually more cariogenic than older ones due to the
inclusion of sweets in their daily diet. Older people tend to eat less sweets in their diet making
them less prone to caries.
Evaluation of Dental Literature Evaluation of Dental Literature Answers
Which database contains current electronic dental literature?

A. Dental Absracts
B. index to Dental Literature
C. LEXIS-Nexus
D. Pubmed-MEDLINE D. Pubmed-MEDLINE

1) Pubmed-MEDLINE
a. US National Library of Medcine's (NLM) bibliographic database

2) LEXIS-Nexis
a. legal and public records related information
A clinician correctly classifies a group of patient as being free of disease based on a diagnostic
test results. These results demonstrate high...

A. Generality
B. Precision
C. Repeatability
D. Sensitivity
E. Specificity E. Specificity

1) Specificity = being free of disease based on results

2) Sensitivity = show the group of patients which are suffering from a particular disease
Each of the following are advantages to investigating the biocompatibility of a biomaterial using
in vitro testing EXCEPT one. Which is the EXCEPTION?

A. An in vitro test can be standardized

B. An in vitro test is excellent for examining mechanisms of interactions
C. An in vitro test is quick to perform
D. Relevance to the use of the material is assured in an in vitro test D. Relevance to the use of
the material is assured in an in vitro test

Advantages of an in vitro test

a. quick to perform
b. can be standardized
c. excellent for examining mechanisms of interactions
Which of the following terms describes the rate at which new disease occurs?

B. Extent
C. Incidence
E. Prevalence C. Incidence
Which type of failure would describe the situation where a diagnostic test failed to identify
several cases of true disease?

A. False positive
B. True negative
C. True positive
D. False negative D. False negative

1) True Positive: those who test positive for a condition and are positive (have the condition)

2) False Positive: those who test positive for a condition but are false (do not have the condition).
Test indicates presence of the disease when it is absent

3) True Negative: those who test negative and are negative

4) False Negative: those who test negative but are positive. The test indicates absence of the
disease when it is present.
Infection Control Infection Control Answers
Which of the following intervals does the United States Centers for Disease Control (CDC)
recommend sterilizing units be monitored and tested? weekly
Which of the following types of gloves should be utilized to provide the BEST protection during
the cleaning dental operators?

B. Latex
C. Utility
D. Vinyl C. Utility

1) Utility gloves are thicker than latex and vinyl gloves.

Advantages of gas sterilization include ...

A. Does not corrode instruments

B. Drying time is not necessary
C. Ecologically friend and safe to use
D. Short processing time C. Ecologically friend and safe to use
1) Ethylene oxide is considered safe with abatement technology
2) Hydrogen peroxide gas is ecologically safe to use.
Materials and Equipment Safety Materials and Equipment Safety Answers
Occupational Safety and Health Agency (OSHA) regulates the waste in a dental office

OSHA regulates the transport of waste from a dental office. Statement I is a true statement and
Statement II is false.
Which of the following does Occupational Safety and Health Agency (OSHA) "Blood Borne
Pathogens Standard: not regulate?

A. Exposure incident plan

B. Hepatitis B vaccination
C. Medical waste disposal
D. Nitrous Oxide scavenging systems
E. Instrument sterilization and storage D. Nitrous Oxide scavenging systems

1) Blood Borne Pathogens Standard involves:

a. Management of sharps and disposal of regulated wastes
b. Communication of hazards to employees
c. Training and Hepatitis B vaccination of employees
d. Exposure incident plan
e. Sterilization and storage of instruments
Which of the following personal protective equipment (PPE) would most effectively prevent
physical injury to a dentist when using caustic solutions?

A. a face mask
B. an apron
C. safety goggles
D. Utility gloves C. safety goggles

1) Wearing safety goggles would be the most effective way to prevent physical injury to a dentist
The Occupational Safety and Health Agency (OSHA) regulates each of the following through
the blood borne pathogen standard EXCEPT one. Which is the EXCEPTION?

A. Communicating hazards to employees

B. Performing housekeeping
C. Using barrier techniques
D. Using material safety data sheets (MSDS)
E. Obtaining hepatitis B vaccinationsD. Using material safety data sheets (MSDS)

1) MSDS is not regulated based on the blood borne pathogen standard.

Which of the following valve types should a dentist use on their hand pieces and water spray
hoses to prevent cross-contamination to patients from dental operatories?

A. Depressurization
B. Pressure
C. Retraction
D. Anti-Retraction D. Anti-Retraction

1) Anti-retraction valves
a. prevent retraction of fluid from a patient into the hand piece and water spray hoses.
b. create one way flow of liquids which prevent bodily fluids like saliva from being retracted
from the patient into the hand piece and water hose.
Professional Responsibility/Liability Professional Responsibility/Liability Answers
The ability of the patient to independently choose a treatment option (including no treatment)
represents the ethical concept of Autonomy

1) Autonomy
a. informed consent
b. treated in a manner that fits their personal principles, religion, or beliefs
Which of the following ethical principles requires clinicians to inform their patients about
treatment risks and benefits and to protect their confidentiality? Autonomy

1) right of the patient for their confidentiality

Which of the following describes a practice where dental patients receive care at specified
facilities by a limited group of clinician's on a prepayment basis? Select all that apply.

A. Open panel
B. Closed panel
C. Group practice
D. Solo practice A. Open panel
B. Closed panel

1) Closed panel practice

a. where dental patients receive care at specified facilities by a limited group of clinicians on a
prepayment basis

2) Prepayment plan
a. group of dentists sharing office facilities that provide stipulated services at a set premium to an
eligible group of patients
When a dentist thinks they know what is best for the patient and tries to control a patients
behavior, it is referred to as...

A. Autonomy
B. Benevolence
C. Competence
D. Justice
E. Paternalism
F. Nonmaleficence E. Paternalism

1) Paternalism
a. is displayed when we decide to follow what we think is best for out patient regardless of the
choice of treatment that the patient has made for themselves, thereby infringing on the patient's
right to autonomy.
American Dental Association (ADA) officially recognizes which of the following as a dental
specialty?

A. Dental public health

B. Esthetic dentistry
C. Geriatric dentistry
D. Implantology
E. Hospital dentistry A. Dental public health

1) dental specialization which focuses on epidemiology, analysis of social health policies, and
the dental needs of the general population
How many years should the dental records of an employee who just terminated their employment
in your office be kept?

A. 10 years
B. 20 years
C. 30 years
D. 5 years
E. 1 year C. 30 years

1) All dental records should be kept as long as possible

2) They are patient property.
3) They may be required for forensic identification by the police.
Which of the following has been NOT a common reason why dentists retire early?

D. Rotator cuff injury

E. Mercury toxicity syndrome E. Mercury toxicity syndrome

1) Dentists use suction to remove mercury vapor coming from the removal of amalgam. Cutting
of amalgam without water spray should be avoided.
Healthcare professionals who provide emergency treatment at the scene of an accidents are
legally protected by which of the following laws?

B. Good Samaritan Act

D. Patriot Act
E. States Human Rights Act B. Good Samaritan Act

1) Good Samaritan Act

a. protects healthcare professionals who provide emergency treatment at the scene of accidents
b. intended to reduce bystanders hesitation to help for the fear of being sued or prosecuted for
unintentional injury or wrongful/accidental death
Periodontics Quiz Periodontis Quiz Answers
Which of the following clinical findings is considered to have the greatest influence on the
design of periodontal flap surgeries?

D. Attached gingiva D. Attached gingiva

1) Attached gingiva
a. function is to keep the free gingiva in close contact with the tooth while also protecting the
soft and free moving alveolar mucosa
b. insufficient attached gingiva makes the mucosa more prone to trauma during function and
compromises the periodontal support of teeth
c. width of the attached gingiva must be preserved
Each of the following characterizes the experimental gingivitis model EXCEPT one. Which is
the EXCEPTION?

A. It demonstrates that gingivitis is a reversible disease

B. It demonstrates that the bacterial ecology changes as plaque accumulates
C. It demonstrates the relationship between plaque formation and gingivitis
D. It proves that gingivitis progresses to peridontitis
E. It support the non-specific plaque hypothesis D. It proves that gingivitis progresses to
peridontitis

1) Gingivitis does not always evolve to periodontitis

2) Experimental gingivitis model

a. supports the non-specific plaque hypothesis
b. demonstrates the relationship between plaque formation and gingivitis
c. demonstrates that the bacterial ecology changes as plaque accumulates
d. demonstrates that gingivitis is a reversible disease
A 33-year-old paint presents with swelling buccal to a mandibular 2nd premolar with only mild
discomfort and no severe pain. The involved teeth are vital and possess no periodontal pockets.
Radiographs reveal a round radiolucency in the middle 1/3 of the root. Which of the following
describes the most probable diagnosis?

A. Gingival abscess
B. Lateral periodontal cyst
C. Osteogenic sarcoma
D. Periodontal abscess
E. External root resorption B. Lateral periodontal cyst

1) Lateral periodontal cyst

a. arise from the epithelial rest of Malassez (a remnant of odontogenesis) that is more common in
middle-aged adult males
b. not associated with pain, and usually appears as a unilocular radiolucency on the side of
canines or premolar roots
c. most commonly seen in mandibular bicuspid area
d. involved tooth is usually vital and presents no indication for root canal treatment
e. typically treated by surgical enucleation
Which of the following treatment modalities should be included to ensure most favorable
prognosis for the management of localized aggressive periodontitis?

A. High doses of vitamin C

B. Peroxide rinses
C. Systemic antibiotic therapy
D. Xylitol lollipops
E. Free gingival graftsC. Systemic antibiotic therapy

1) Periodontal treatments through nonsurgical and surgical root debridement become more
successful when administered with systemic antibiotics.

2) Aggressive periodontitis is a rapidly progressing disease that can be better managed with
complete root debridement and antibiotic therapy.

3) Systemic antibiotics ensure that the antibiotic molecule reaches the site as compared with
local application.

4) Local antibiotics are not effective since it may not reach the deep pockets of the periodontal
disease
Which of the following does a 2-day-old plaque biofilm consist primarily of?

A. Bacteroides species
B. Filamentous organisms
C. Gram-positive cocci and rods
D. Treponema species
E. A non-mineralized pellicle without organization C. Gram-positive cocci and rods

1) During the initial formation of an undisturbed plaque, majority of bacteria present are gram
positive cocci and rods like streptococcus and actinomyces species.

2) Within the 2 day period of undisturbed plaque format, the gram positive cocci and rods cling
to each other and increase in number

3) Approximately 25% of other bacterial species may include gram negative rods and coci which
eventually will increase as plaque remains undisturbed.

4) S. Sanguinis is usually the first bacterial species to adhere to tooth structure.

Which of the cell types are phagocytic?

A. basophil and eosinophil

B. neutrophil and basophil
C. neutrophil and histiocyte
D. neutrophil and lymphocyte
E. plasma cell and lymphocyte C. neutrophil and histiocyte
1) Leukocytosis
a. is usually observed during acute infections
b. inflammatory reaction to acute bacterial and parasitic infections
c. occurs in the presence of cancer, hemorrhage and may be triggered by the application of
steroids
It has been suggested that daily cleaning of root surfaces by the patient may increase

A. Root resorption
B. Root sensitivity
C. Root surface remineralization
D. Epithelial attachment levelC. Root surface remineralization

1) Cleaning root surface on a daily basis with fluoride identifies may result in root surface
remineralization.

2) Consistent plaque removal prevents root demineralization by bacteria and enables the root
surface to remineralize.

3) Presence of minerals in saliva and fluoride from toothpaste also aid in the remineralization of
root surfaces
Each of the following devices are effective in removing surface plaque EXCEPT one. Which one
is the EXCEPTION?

A. Home water-irrigatin device (Water PIK)

B. Super-soft toothbrush
C. Toothpick
D. Dental floss A. Home water-irrigatin device (Water PIK)

1) The use or oral irrigation devices like Water-Pik helps remove plaque in shallow periodontal
pockets

2) Irrigation devices propel a pulsating, high pressure steam of water to flush sub gingival plaque
and debris out of shallow pockets.

3) They are ineffective if the periodontal pocket is too deep to be reached by toothbrush bristles
or a toothpick.

4) Dental floss is the most recommended oral hygiene method for proximal plaque removal, but
not capable of reaching deep into a pocket.
True/False: New junctional epithelium can form on either cementum or dentin after periodontal
surgery

Junctional epithelium is re-established as early as one week. Both are true statements
1) Junctional epithelium re-attached back to cementum and dentin after an apically repositioned
flap by re-establishing tight junctions

2) Regeneration of junctional epithelium takes about 10 to 14 days to complete ager surgical

procedure.

3) Regeneration of junctional epithelium may occur even after its surgical detachment as along
as the root surface is completely derided of plaque and calcular deposits.
Diagnosis Diagnosis Answers
Which of the following distinguishes periodontitis from gingivitis?

A. All answers apply

B. Bleeding on Probing (BOP)
C. Clinical Attachment Loss
D. Presence of purulence
E. Probing depth C. Clinical Attachment Loss

1) Gingivitis
a. inflammation of the gingiva

2) Periodontitis
a. inflammation of the gingiva associated with attachment loss
A patient has a 5mm probing depth on the medial of their maxillary first molar. 2mm of
recession was also charted in that area. Which of the following describes the attachment loss in
that area?

B. 3mm
E. 7mm E. 7mm

1) CAL = PD - (FGM-CEJ)
= 5 - (-2)
= 7mm

2) Health periodontium has a sulcular depth of 1-3mm

3) Health junctional epithelium is typically associated with an attachment of the junctional

epithelium at the cementoenamel junction (CEJ).
Which of the following is an example of non-keratinized gingival tissue?

A. Attached gingiva
B. Gingival col
C. Marginal gingiva
D. Outer gingival epithelium B. Gingival col

1) Gingival tissue
a. 75% parakeratinized epithelium
b. 15% keratinized epithelium
c. 10% nonkeratinized epithelium

2) Keratinized epithelium
a. attached gingiva
b. some portions of the outer gingival epithelium

3) Parakeratinized gingiva
a. marginal gingiva
b. portions of the outer gingival epithelium

4) Nonkeratinized gingiva
a. gingiva col
b. junctional epithelium
c. sulcular epithelium
Which of the following describes how the width of keratinized gingiva is measured. It is the
distance from the ...

A. Cemento-enamel junction (CEJ) to the depth of the sulcus

B. Cemento-enamel junction (CEJ) to the mucogingival junction
C. Free gingival groove to the mucogingival junction
D. Free gingival margin to the depth of the sulcus
E. Free gingival margin to the mucogingival junction B. Cemento-enamel junction (CEJ)
to the mucogingival junction

1) Band of keratinized gingiva

a. extends from the free gingival margin to the mucogingival junction

2) Attached gingiva
a. free gingival groove to the mucogingival junction

3) Free gingival groove (mucogingival line)

a. shallow line or depression on the gingival surface at the junction of the free and attached
gingiva

4) Free + Attached = Keratinized Gingiva

* Which of the following terms describes the distance from the CEJ to the depth of the gingival
sulcus/pocket?

A. Alveolar bone loss

B. Clinical attachment level
C. Clinical attachment loss
D. Gingival pocket depth
E. Gingival recession B. Clinical attachment level

1) Clinical attachment level

a. calculated as the distance from the CEJ to the depth of the sulcus

2) Clinical attachment loss

a. amount of attachment that has been lost and the gingival

3) Gingival pocket depth

a. distance from the free gingival margin to the depth of the gingival sulcus
Signs of occlusal trauma are evidence radiographically by each of the following EXCEPT one.
Which is the EXCEPTION?

A. Changes of the periodontal space

B. Hypercementosis
C. Root resorption
D. Vascular infiltration of the periodontal ligament
E. Changes of the lamina dura D. Vascular infiltration of the periodontal ligament

1) Vascular infiltration of the periodontal ligament is NOT seen in radiographs.

2) Radiographic images of trauma

a. funneling and widening of lamina dura
b. root resorption
c. hypercementosis
Which of the following is the MOST COMMON reason for maxillary incisors to become stained
orange and green?

A. Diet
B. Drugs
C. Fluoride ingestion
D. Poor oral hygiene
E. Trauma D. Poor oral hygiene

1) Prolonged poor oral hygiene allows the organic compounds from the food or drinks we ingest
to adhere to tooth pellicle. Once these colored compounds are oxidized, they remain as tooth
stains.

2) Organic compounds that adhere to tooth surfaces through oxidation are known as chromogens.
Stains can only be removed through professional dental prophylaxis.

3) Tetracycline stains are permanent bands of brown and gray NOT orange and green.

4) Dental trauma cause pulp necrosis and create a dull darkly colored tooth.
Each of the following is a clinical sign of gingivitis EXCEPT one. Which one is the
EXCEPTION?

A. Bleeding on probing
B. Erythema
C. Gingival stippling
D. Swollen tissues A. Bleeding on probing

1) Bleeding
a. probing erythematous inflamed tissue typically results in bleeding

2) Stippling
a. numerous small depressions in the surface of healthy gum tissue

3) Gingivitis causes
a. edema, which creates a loss of stippling
b. erythema
Which of the following is NOT an indication for posterior maxillary osteotoy?

A. Correction of mandibular retrognathism

B. Intrusion of the maxillary tuberosity to prepare for denture fabrication
C. Skeletal arch width discrepancies that require lateral positioning of posterior segments
D. Closure of the anterior open bite A. Correction of mandibular retrognathism

1) Posterior maxillary osteotomy

a. a surgical technique used to move the maxillary posterior bone segment into a more desirable
position in order to correct occlusal disharmony.
b. reposition the maxillary posterior segment in order to help correct occlusion problems but
CANNOT correct mandibular retrognathism
Which of the following is not classified as an infra bony defect?

A. Dehiscence
B. Interental crater defect
C. Trough
D. Hemiseptum A. Dehiscence

1) Infrabony defect
a. bone level is apical to the base of the periodontal pocket

2) Root dehiscence
a. bone defect where the root surface is covered only with soft tissue after bone destruction
occurred on the facial or the lingual aspect of the tooth

3) Interdental crater
a. bone defect where a concavity is found in the crystal bone

4) Trough
a. bone defects where a crater is formed on the proximal surfaces of the tooth

5) Hemiseptum
a. vertical or angler bone defects where one surface of the tooth root has bone support remaining
Which of the following is the MOST COMMON sign of occlusal trauma?

A. Abrasion
B. Attrition
C. Migration
D. Mobility
E. Tipping D. Mobility

1) Mobility
a. describes the amount a tooth moves when pressure is applied to it
b. fremitus describes tooth mobility when under function
c. another sign of occlusal trauma is a widened periodontal ligament
Sinus tract are MOST COMMONLY found in the gingiva of children because of which of the
following reasons?

A. Acute periapical abscesses

B. Chronic periapical abscesses
C. Lateral periodontal cysts
D. Periapical cysts
E. Periodontal abscesses B. Chronic periapical abscesses

1) Sinus tracts
a. commonly found due to the development of chronic periodical abscesses in the gingival of
children.
b. Dental abscesses can also be associated with trauma.

2) Acute periodical abscess are not abscessed long enough to create a sinus tract

3) Lateral periodontal cysts and periapical cysts DO NOT contain a tract, but are an epithelial
lined pocket.

4) Periodontal abscesses have room to expand into the gingiva, but do NOT commonly result in
a sinus tract.
Which of the following types of gingival periodontal disease is most prevalent in high school
aged children?

A. Localized acute gingivitis

C. Primary herpetic gingivostomatitis
D. Acute periodontitisA. Localized acute gingivitis

1) Adolescence induce a series of metabolic and hormonal changes that may affect periodontal
tissues.
2) Hormonal changes can affect the capillary permeability and thereby increase the fluid
accumulation in the gingiva.
3) Adolescents demonstrate a tendency to largely disregard good oral hygiene practices.
Which of the following is necessary to determine the exact form of an osseous defect?
A. Examining the gingival architecture in detail
B. Expose the area surgically
C. Make multiple radiographs from different angulations
D. Measure pocket depths from the cemento-enamel junction
E. Measure pocket depths from the free gingival margin B. Expose the area surgically

1) Surgically exposing an intrabony defect allows the examiner a complete access to evaluate all
the dimensions of an osseous defect directly.

2) Gingival architecture may appear normal radiographically despite the presence or a large
intrabony defect due to the nature of a radiograph being a 2-dimensional representation of a 3-
dimensional object.
Which of the following periodontal diagnoses is MOST COMMON in adults?

A. Generalized chronic periodontitis

E. Plaque associated gingivitis E. Plaque associated gingivitis

1) Plaque associated gingivitis (marginal gingivitis) is the MOST Common periodontal

diagnosis.
A 19 year old patient presents with oral pain, erythematous gingival tissues, blunted papillae,
spontaneous gingival bleeding, and no attachment loss. There is also a pseudomembrane
covering the gingiva. Which of the following is the diagnosis for this patient?

C. Necrotizing ulcerative gingivitis

D. Necrotizing ulcerative periodontitis
E. Plaque associated gingivitis C. Necrotizing ulcerative gingivitis

1) Necrotizing Ulcerative Gingivitis

a. predominance of the anaerobic fusobacteria and spirochetes within the oral cavity, specifically
underneath the gingiva.

2) Treatment
a. debridement of the affected gingiva
b. chlorhexidine 0.12%

3) Acute Necrotizing Gingivitis

a. pain
b. interproximal necrosis of the papilla (blunting of papilla)
c. bleeding of the gingiva
d. fetid odor
e. low-grade fever
f. pseudomembrane
Which of the following describes how a Miller Class I recession defect is differentiated from a
Miller Class II defect?
A. Involvement of the mucogingival junction
B. Location of inter proximal alveolar bone
D. Width of Keratinized gingiva A. Involvement of the mucogingival junction

Miller Classification
1) Class I
a. Recession does NOT extend to the mucogingival junction

2) Class II
a. Recession that extends to or beyond the mucogingival junction, but demonstrates NO loss of
inter proximal clinical attachment

3) Class III
a. Recession that extends to or beyond the mucogingival junction, with either loss of inter
proximal clinical attachment or tooth rotation

4) Class IV
a. Recession that extends to or beyond the mucogingival junction, with either loss of inter
proximal clinical attachment or tooth rotation that is severe
Which of the following are the classic signs of bruxism. Select all that apply.

A. Muscle soreness
B. Occlusal wear
C. Thickened lamina dura
D. Tooth mobility
E. Wear facets A. Muscle soreness
B. Occlusal wear
C. Thickened lamina dura
D. Tooth mobility
E. Wear facets

1) Bruxism
a. repetitive behavior of grinding of clenching or a person's teeth
b. induced by
1) stress
2) masseter tension
3) premature occlusion
4) medications
Etiology Etiology Answers
Each of the following is associated with acute herpetic gingivostomatitis EXCEPT one. Which is
the EXCEPTION?

A. A self-limiting disease lasting 10 days

B. A viral infection cause by the herpes simplex virus
C. Fever
D. Initial oral lesions start as vesicles
E. Mucosal scaring after lesions are healed E. Mucosal scaring after lesions are healed

1) Acute Herpetic Gingivostomatitis

a. MOST COMMON oral infection viral oral infection seen in children
b. lymphadenopathy and fever
c. vesicles appear 2 days later, which go on to pop and form ulcerations
c. preference for the hard palate
d. clear preference for keratinized tissues
e. treated with valcyclovir
Which of the following bacteria are commonly associated with acute necrotizing ulcerative
gingivitis (ANUG)?

A. Actinomyces viscosus
B. Aggregatibacter Actinomycetemcomitans
C. Bacteroids forsythus
D. Porphyromonas gingivalis
E. Treponema denticola E. Treponema denticola

1) Acute Necrotizing Gingivitis/Periodontitis (ANUG/ANUP)

a. Treponema Denticola
b. Risk factors
1) poor oral hygiene
2) smoking
3) malnutrition
4) fatigue
5) stress
6) immunocompromised patients

2) Aggregatibacter Actinomycetemcomitans
a. localized aggressive periodontitis

3) Porphyromonas gingivalis
a. chronic periodontitis

4) Actinomyces viscosus
a. healthy gingiva

5) Bacteroids forsythus
a. chronic periodontitis
Which cell is least associated with the chronic periodontitis?

A. All answers apply

B. B lymphocytes
C. Neutrophils
D. Plasma cells
E. T lymphocytes C. Neutrophils
1) Neutrophils (PMNs) are phagocytic cells that are the first white blood cells to arrive at infect
and injured tissues.

2) Chronic infections involve

a. macrophages
b. lymphocytes
c. plasma cells

3) B lymphocytes become activated and mature into plasma cells which produce antibodies

4) Purulence (pus) is composed of dead and dying neutrophils.

Primary occlusal trauma is described by

C. mobility caused by excessive forces on a normal periodontium

D. mobility caused by excessive forces on a periodontium with bone loss C. mobility caused by
excessive forces on a normal periodontium

1) Primary occlusal trauma

a. mobility caused by excessive forces on a normal periodontium
b. ove filled dental restorations
c. crowns with high occlusion
d. heavy biting of hard substances

2) Secondary occlusal trauma

a. where a tooth with a compromised periodontium may experience further trauma even under
normal occlusal loads
Gingival recession would MOST LIKELY be caused by which of the following?

C. Occlusal trauma
D. Toothbrush abrasion D. Toothbrush abrasion

1) Improper tooth brushing is the most common cause of gingival recession

Which of the following is the predominant etiology of fibrous gingival hyperplasia?

C. Leukemia
D. Medication
E. Puberty D. Medication

1) Fibrous gingival hyperplasia

a. MOST COMMONLY caused by
b. phenytoin = anticonvulsant
c. cyclosporin = immunosuppressant
d. nifedipine = Ca+2 channel blocker
A plaque that has been developing for 48 hours is primarily composed of...
A. Bacteroides species
B. Filamentous organisms
C. Gram-positive cocci and rods
D. Treponema species
E. A non-mineralized pellicle without organization C. Gram-positive cocci and rods

1) Plaque formation
a. within the 2 day period of undisturbed plaque formation, the gram positive cocci and rods
cling to each other and increase in number

2) S. Sanguinis
a. first bacterial species to adhere to tooth structure
Which of the following bacterial species is the most associated with localized aggressive
periodontitis?

C. Streptococcus mutans
D. Treponema denticola
E. Aggregatibacter Actinomycetemcomitans E. Aggregatibacter Actinomycetemcomitans

1) Aggregatibacter Actinomycetemcomitans is the primary etiologic pathogen of localized

aggressive periodontitis

2) Streptococcus gordinii is one of the early colonizers involved in plaque formation.

3) Streptococcus mutans is the most common oral bacteria and is highly associated with caries

4) Lactobacillus casei is commonly founding the intestines and oral cavity and produces acid
critical in enamel demineralization.
If a patient has not brushed for 2 days, the most common bacterial species found in the plaque
is...

A. Aggrigatibacter
B. Gram negative rods
C. Gram positive rods and cocci
D. Spirochetes
E. Fusobacterium C. Gram positive rods and cocci

1) As plaque matures, more gram positive rods and cocci popular the teeth creating gingival
irritation and gingivitis.

2) When tartar or calculus deposits --> gram negative bacteria increase in number
Which of the following medications may cause gingival overgrowth?

A. Calcium channel blockers, phenytoin, and cyclosporine A. Calcium channel blockers,

phenytoin, and cyclosporine
1) Gingival overgrowth
a. Calcium channel blockers
b. Phenytoin
c. Dilantin
d. Cyclosporine
Gingival hypertrophy, coarse facial features, increased hair growth are potential side effects of
which drug?

A. Carbamazipine
B. Hydrochlorothiazide
C. Phenytoin
D. Venlafaxine
E. Valproic acid C. Phenytoin

1) Phenytoin
a. antiepileptic agent that may induce gingival hypertrophy, increased hair growth, and coarse
facial features
b. used to treat trigeminal neuralgia if carbamazipine is contraindicated

2) Valproic acid
a. anticonvulsant
b. mood-stabilizing drug
c. major depression

3) Venlafaxine (Effexor)
a. serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression
Which of the following periodontal fibers are putatively responsible for relapse of orthodontic
rotation of teeth?

A. Diagonal
B. Horizontal
C. Oblique
D. Supracrestal
E. Transverse D. Supracrestal

1) Supracrestal Fibers
a. Orthodontic treatment of rotated teeth may experience relapse as the supracrestal periodontal
fibers try to revert to its original position.
b. possess a "memory" or tendency to recoil back to their normal position, causing the relapse
Which of the following is considered the primary etiology of gingivitis during pregnancy and
puberty?

A. Calculus
B. Estradiol
C. Estrogen
D. Plaque
E. Progesterone
F. Testosterone D. Plaque

1) Plaque
a. primary etiology of gingival inflammation because the bacterial aggregates from plaque
initiates the inflammatory reaction.

2) Calculus
a. predisposing factor for the formation of plaque
b. on its own DOES NOT cause gingivitis

3) Sex hormone level

a. induces vasodilation and increases permeability along capillary walls which allow more fluids
to extravasate and cause severe inflammation.
Which of the following bacterial species is considered a part of normal oral flora and is
associated with periodontal health?

A. Aggregatibacter Actinomycetemcomitans
B. Porphyromonas gingivalis
C. Streptococcus gordinii
D. Tannerela forsythia C. Streptococcus gordinii

1) Streptococcus gordinii
a. gram positive cocci
b. belongs to normal oral flora that adheres to tooth pellicle
c. considered one of the initial colonizers of the dental biofilm
d. creates a binding site for other bacteria to adhere = congregation
e. in normal amounts, helps maintain the balance between gram positive and gram negative
bacteria i nthe mouth

2) Periodontitis
a. Aggregatibacter Actinomycetemcomitans
b. Porphyromonas gingivalis
c. Tannerela forsythia
Which of the following bacteria has been identified as periodontal pathogens?

A. Lactobacillus casei
B. Porphyromonas gingivalis
C. Streptococcus mutans
D. Streptococcus gordinii B. Porphyromonas gingivalis

1) Porphyromonas gingivalis
a. etiologic pathogen of periodontitis
Which of the following conditions is associated with localized aggressive periodontitis?

A. Cyclic eosinophilia
B. Defects in neutrophil chemotaxis
C. Elevated phagocytosis
D. Lysis of neutrophils * D. Lysis of neutrophils

1) Defects in neutrophil chemotaxis

a. prevents the neutrophils from reaching the infected site of the periodontium
b. directs neutrophils to a specific chemotactic gradient where the concentration of bacterial
invasion is severe

2) Lysis of neutrophils
a. helps to recruit more neutrophils along the infection site

3) Elevated phagocytosis
a. active host defense mechanism
Which class of bacteria that is implicated in odontogenic infections is able to survive in both
high and low oxygen environments?

A. Enteric organisms
B. Facultative organisms
C. Microaerophilic organisms
D. Synergistic organisms
E. Obligate anaerobes B. Facultative organisms

1) Facultative organisms
a. can live with or without oxygen

2) Facultative anaeorbic bacteria

a. create their own energy source or ATP by aerobic respiration through oxidative
phosphorylation and anaerobic respiration through fermentation
b. require more energy to survive, so they can produce ATP at a faster rate through anaerobic
glycolysis
Pathogenesis Pathogenesis Answers
Which of the following is related to periodontal destruction involving primary teeth due to an
enzyme deficiency?

A. Aggressive periodontitis
B. Cyclic neutropenia
C. Hypophosphatasia
D. Necrotizing ulcerative gingivitis
E. Papillon Lefevre syndromeC. Hypophosphatasia

1) Hypophosphatasia
a. hereditary disease where there is a marked deficiency of the tissue non-specific alkaline
phosphatase enzyme.
b. deficiency in this enzyme affects the development and mineralization of bone and teeth
c. premature primary tooth exfoliation
d. severe destruction of the periodontium of permanent teeth
Acute pyogenic bacterial infections are known to result in a state of...

A. Leukopenia
B. Lymphocytosis
C. Lymphopenia
D. Neutropenia
E. Leukocytosis E. Leukocytosis

1) Leukocytosis
a. white blood cell count above the normal range
b. sign of inflammatory response that is most commonly the result of infection
c. observed with certain parasitic infections, cancer, after strenuous exercise, emotional stress,
pregnancy, anesthesia steroid, and epinephrine administration
Which of the following bacteria are associated with supra gingival plaque?

C. Gram Positive rods and cocci

D. Gram Positive filaments
E. Spirochetes C. Gram Positive rods and cocci

1) Supragingival plaque
a. consists of gram positive rods and cocci
b. collection of bacteria, proteins, carbohydrates, and glycoproteins

2) Subgingival plaque
a. non calcified mass of bacteria, proteins, and carbohydrates situated inferior to the gingival
margin
Which of the following describes the proper progression of stages of the pathogenesis of
periodontal lesions?

B. Incipient, early, established, and advanced

C. Initial, early, established, and advanced C. Initial, early, established, and advanced

1) Initial lesion
a. presence of acute inflammatory reaction as the normal healthy gingiva reacts to plaque
accumulation

2) Early lesion
a. occur when an infiltrate of lymphoid cells, particularly T lymphocytes appear on the site of
injury of accumulation

3) Establish lesion
a. B lymphocytes and plasma cells suddenly predominates the site of inflammation

4) Advance lesion
a. manifests itself a periodontitis and physiologically irreversible loss of bone
* The most rapid destruction of alveolar bone is caused by which of the following periodontal
diseases?

A. Necrotizing ulcerative gingivitis

B. Periodontal abscess
C. Pregnancy related gingivitis
D. Chronic periodontitis * B. Periodontal abscess

1) The most rapid destruction of alveolar bone occurs in the presence of a periodontal abscess

2) Periodontal abscesses
a. occurs when pus accumulates, causing pressure build up within the bone, resulting in bone
destruction
b. as the periodontal abscess increases in size, the area affected by the abscess is resorbed
Which of the following is the MOST numerous cell type observed in inflammatory infiltrate of
an acute periodontal abscess?

A. B-lymphocytes
B. CD-4 T-lymphocytes
C. CD-8 T-lymphocytes
D. Macrophages
E. Neutrophils
F. Plasma cells E. Neutrophils

1) Neutrophils (PMNs)
a. first to arrive at the site of inflammation
b. first line of defense against any foreign invader of the body
c. comprise about 50-60% of the total number of leukocytes circulating in the bloodstream
Which of the following antibodies is MOST prevalent?

A. IgA
B. IgD
C. IgE
D. IgG
E. IgM A. IgA

1) IgA
a. more prevalent in saliva
b. prevent adhesion of the bacteria to the oral tissues because it is bound to IgA instead.
c. known as the agglutinating antibody because it clumps or "glues" bacteria together

2) IgG
a. more associated with sulcular fluid
Which of the following does plaque accumulation DIRECTLY affect?

A. Accumulation of calculus
B. Gingivitis severity
C. Herpes outbreak severity
D. Materia alba level
E. Periodontitis severity B. Gingivitis severity

1) Plaque
a. The severity of gingival inflammation is directly related to the amount of plaque accumulation
b. when bacterial toxins are released by plaque, the gingiva become irritated, initiating a
defensive reaction through an inflammatory response

2) Material alba
a. soft debris on the tooth surface which is easily removed and does NOT cause gingivitis

3) Calculus = mineralized plaque

a. a presdisposing factor for plaque build up.
Which of the following accounts of the deleterious effects of calculus?

A. Attachment problems due to surface irregularities

B. Bacteria attached to the calculus release irritants
C. Mechanical irritation
D. The calculus releases irritants B. Bacteria attached to the calculus release irritants

1) Calculus
a. dental plaque that has become calcified and is often covered by a layer of uncalcified plaque
which releases exotoxins and other chemicals that cause inflammation
How many hours after mechanical debridement with a toothbrush is a mature dental plaque
found?

A. 1-2 Hours
B. 12-24 Hours
C. 24-48 Hours
D. 3-5 Hours
E. 6-10 Hours C. 24-48 Hours

1) Mature dental plaque is usually reformed on the teeth within 24-48 hours after plaque removal

2) 1st bacteria to attach to the pellicle glycoproteins are gram positive aerobic cocci such as
Streptococcus sanguinis.

3) After 24 hours, anaerobic gram negative cocci, rods, and filaments begin to colonize the
plaque.
Which of the following statements does NOT describe the experimental gingivitis model?

A. It demonstrates that gingivitis is a reversible disease

B. It demonstrates that the bacterial ecology changes as plaque accumulates
C. It demonstrates the relationship between plaque formation and gingivitis
D. It proves that gingivitis progresses to periodontitis
E. It supports the non-specific plaque hypothesis D. It proves that gingivitis progresses to
periodontitis

1) Gingivitis does not always evolve to periodontitis

2) Experimental gingivitis model

a. supports the non-specific plaque hypothesis
b. demonstrates the relationship between plaque formation and gingivitis
c. demonstrates that the bacterial ecology changes as plaque accumulates
d. demonstrates that gingivitis is a reversible disease
Treatment Planning Treatment Planning Answers
Which of the following patient conditions is the strongest indication for splinting?

A. Mobility with unilateral shift from centric relation to centric occlusion

D. Mobility with discomfort A. Mobility with unilateral shift from centric relation to centric
occlusion

1) Unstable teeth that cannot contain normal position during centric occlusion need additional
support to maintain position and therefore must be splinted to the adjacent teeth.

2) Discomfort associated with tooth mobility may be due to:

a. other periodontal conditions
b. to pulpal conditions
c. NOT be a direct indication for splinting
Which of the following should be part of an initial periodontal therapy in addition to scaling and
root plaint and oral hygiene instruction?

A 0.12% Chorhexidine gluconate instruction

B. Doxycycline 300mg BID for 10 days
C. Enameloplasty to achieve occlusal equilibrium
D. Referral to physician if diabetes is suspected D. Referral to physician if diabetes is
suspected

1) Diabetes Mellitus is considered a risk factor for the progression of periodontal disease which
must be addressed during the initial periodontal therapy.

2) 1st phase
a. remove causative factors, risk factors, and predisposing factors that may worsen the
periodontal condition of the patient.
Each of the following may be considered as an indication for gingivectomy EXCEPT one.
Which is the EXCEPTION?

A. Infrabony pocket reduction

B. Medication induced gingival hypertrophy
C. Pseudopocketing
D. Suprabony pocket reduction A. Infrabony pocket reduction

1) Gingivectomy
a. reduce redundant or hyperplastic gingival tissues and are indicated when there is excess
gingiva, preventing the patient from cleaning their mouth properly

2) Infrabony defects would NOT be helped by removing gum tissue, they can only be resolved
by bone augmentation
At which of the following sites is an apically repositioned flap procedure generally impossible to
perform?

A. Mandibular lingual
B. Maxillary facial
C. Maxillary Palatal
D. Mandibular facial C. Maxillary Palatal

1) Thickness of the gingival epithelium and its supporting attached gingiva make apically
repositioned flap procedures impossible for the maxillary palatal area.

2) Attached gingiva in the palatal area is difficult to differentiate with the palatal mucosa because
there is an unclear demarcation between the two.
Which of the following anatomical structures is the primary reason why the buccal aspect of
posterior teeth are difficult to surgically treat for periodontal defects?

A. External oblique ridge

B. Genial tubercles
C. Mentalis muscle
D. Medial pterygoid muscle A. External oblique ridge

1) External oblique ridge

a. Height of external oblique ridge causes difficulty in accessing the buccal aspect of posterior
teeth
b. limits the extent of cheek retraction and insertion of instruments into the periodontal defect
Each of the following procedures is a component of a typical initial periodontal treatment plan
EXCPET one. Which procedure is that EXCEPTION?

A. Home care instructions

B. Root planing
C. Surgical pocket reduction
D. Extraction of hopeless teeth (if any) C. Surgical pocket reduction

1) Initial periodontal treatment

a. reduces the risk of progression of periodontal disease by removing the predisposing factors,
risk factors, and causative factors

2) Surgical pocket reduction

a. treatment performed to address deep pockets and is a part of the corrective phase of
periodontal treatment
Prognosis Prognosis Answers
Which of the following would suggest that a lesions is MORE likely to be periodontal THAN
endodontic?

A. Acute pain to percussion with no swelling present

B. Pain to lateral percussion and a wide sulcus
C. Pain to palpation near the apex of that tooth on the buccal gingiva
D. Probe extending to the apex of the tooth B. Pain to lateral percussion and a wide sulcus

1) Wide sulcus
a. indicates attachment loss

2) Pain on lateral percussion

a. pressure on the inflamed periodontal ligament, not an apical infection
Which of the following bone defects typically demonstrates the BEST outcome with regenerative
therapy?

A. Class II Furcation defect

B. Crater
C. Four-Walled
D. One-Walled
E. Three-Walled
F. Two-Walled * C. Four-Walled

1) Prognosis
a. BEST prognosis for regenerative periodontal therapies or osseous grafting is associated with
defects possessing more walls

2) Craters
a. 2-walled defects where the buccal and lingual walls remain while the proximal wall is
destroyed

3) Furcations
a. have the worst prognosis
Ideal bone grating material should perform each of the following roles EXCEPT one. Which is
the EXCEPTION?

A. Induce osteogenesis
B. Produce an immunologic response
C. Withstand mechanical forces
D. Be replaced by host bone B. Produce an immunologic response

1) Bone grafting materials

a. biocompatible
b. should NOT produce an immunologic response
c. strong enough to withstand mechanical actions
d. osteoproliferative
e. induce osteogenesis
The success rate of the free gingival graft procedures is affected MOST by which of the
following factors?

A. Immobilization of the graft at the recipient site

B. Presence of a periosteal fenestration
C. Whether the donor tissue contains periosteum
D. The thickness of the blood clot between the recipient and donor tissue margin A.
Immobilization of the graft at the recipient site

1) Immobilization
a. enables the formation of blood vessels and better diffusion of nutrients from the recipient site
to the graft
b. donor tissue can gain attachment to the recipient site as long as the graft is adapted and placed
properly at the recipient site
c. formation of new capillaries from the recipient site to the do not site will only occur within 2-3
days after the surgical procedure in the process known as capillary inosculation
A patient should control the amount of plaque in their mouth before undergoing any periodontal
surgery; BECAUSE plaque-infected teeth demonstrate a higher incidence of disease recurrence
after surgery?

A. Both the statement and reason are correct and related

1. Plaque
a. aggregation of bacterial species that may infect the surgical wound after a surgical procedure
b. plaque accumulation along the tooth surface predisposes the open wound to pathogens and
opportunistic bacteria

2. Surgical Procedure
a. patients should strictly follow a proper daily oral hygiene regimen to ensure that they are
capable of maintaining good dental health after surgery
b. surgical wounds are open areas where bacterial species can easily penetrate and infect the
body
Which of the following variables is considered the MOST important for determining the
prognosis of a tooth?

A. Alveolar bone level

B. Attachment level
C. Bleeding on Probing (BOP)
D. Probing depth
E. Tooth sensitivity B. Attachment level

1) Clinical attachment level (CAL)

a. MOST important variable when determining the prognosis of the tooth

2) Bleeding on Probing (BOP) and Pocket Depth

a. can be found on with gingivitis and periodontitis
b. less important than CAL when determining the prognosis

3) Variable connection between alveolar bone height and clinical attachment level.
Autogenous tooth transplants most commonly fail by their 3rd year in which of the following
ways?

A. Development of root caries

B. Idiopathic chronic root resorption
C. Inflammatory resorption of the periodontal supporting structure
D. Ankylosis of the roots B. Idiopathic chronic root resorption

1) Idiopathic chronic root resorption

a. occurs in patients who underwent autogenous tooth transplantation that exhibit resorption with
an unknown cause
b. procedure if conducted properly have a relatively high success rate
c. Causes
1) replacement resorption
2) trauma
3) resorption due to inflammatoin
4) marginal periodontitis
5) dental caries
True/False

After an apically re-positioned flap procedure is performed, junctional epithelium can establish
itself on both cementum and dentin

The junctional epithelium is re-established within 10 days following surgery. Both

statements are TRUE

1) Junctional epithelium
a. re-attached back to cementum and dentin after an apically repositioned flap by re-establishing
tight junctions
b. takes about 10-14 days to complete after surgical procedure

2) Regeneration of junctional epithelium

a. may occur after its surgical detachment as long as the root surface is complete derided of
plaque and calcular deposits
Improvements in the oral hygiene of patients suffering from nutritional deficiencies affects the
incidence of chronic inflammatory periodontal disease. Improvements in oral hygiene also affect
the severity in cases of chronic inflammatory periodontal disease. Both statements are TRUE

1) Chronic inflammatory periodontal disease

a. elimination of chronic inflammatory periodontal disease is possible with the help or
improvement in oral hygiene conditions
b. improved oral hygiene measures = key to solving most of the periodontal problems

2) Incidence
a. as well as severity of chronic inflammatory periodontal disease is lessened by taking proper
oral hygiene measures regularly
Which method of treatment should be utilized to increase the rate of success in case of localized
aggressive periodontitis?

A. Free gingival grafts

B. Peroxide rinses
C. Systemic antibiotic therapy
D. Xylitol lollipops
E. High dose of vitamin C C. Systemic antibiotic therapy

1) Systemic antibiotics
a. periodontal treatments through nonsurgical and surgical root debridement are more successful
when administered with systemic antibiotics
b. ensure that the antibiotic molecule reaches the site as compared with local application

2) Localized aggressive periodontics

a. better managed with complete root debridement and antibiotic therapy

3) Local antibiotics
a. sometimes ineffective because it might not reach the deep pockets of the periodontal disease
Which of the following is the MOST critical factor determining the prognosis of a periodontally
involved tooth?

A. Mobility of tooth
B. Presence of furcation involvement
C. Probing depth
D. Amount of attachment loss D. Amount of attachment loss

1) Attachment Loss
a. determines the prognosis of periodontally compromised teeth
b. higher the quantity of attachment, the better the prognosis
c. teeth with severe attachment loss and vertical mobility presents a hopeless prognosis and must
be extracted to avoid infection that may compromise other teeth
Freeze dried bone is characterized by which of the following?

C. It has osteogenic potential

E. It will be replaced by the host bone eventually E. It will be replaced by the host bone
eventually

1) Freeze dried bone allografts

a. demonstrates osteoconductivity, which it means that it provides a scaffold or matrix for the
repairing host bone to replace it
b. help support new bony defects by forming new bone and periodontal attachment through
providing a scaffold as it is being replaced by the newly formed host bone
c. does not have osteogenic potential but DOES help to repair bone through osteoconduction
Which of the following furcation classes are most commonly treated by utilization of guided
tissue regeneration procedures?

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

1) Furcation Classes
Grade I
a. incipient bone loss
b. Nabor's probe can feel the depression of the furcation opening

Grade II
a. partial bone loss
b. Nabor's probe enters under the ceiling of the furcation
c. have the best prognosis for guided tissue regeneration because they are the least severe of
pathos's

Grade III
a. total bone loss
b. through and through opening of the furcation
c. entrance to the furcation is not able to be seen clinically

Grade IV
a. through-and-through
b. furcation where entrance is clinically visible
Which of the following defects has the WORST prognosis for bone grafting?

A. Class III furcation defect

B. Class IV furcation defect
C. One-walled
D. Three-walled
E. Two-walledB. Class IV furcation defect

1) Furcation Defects

Class I
a. concavity just above the furcation entrance can be felt with the probe tip
b.furcation probe (Nabor's) cannot enter the furcation area
Class II
a. probe is able to partially enter the furcation - extending approximately 1/3 of the width of the
tooth = but it is NOT abel to pass completely through the furcation

Class III
a. in mandibular molars, the probe passes completely through the furcation between the medial
and distal roots
b. in maxillary molars, the probe passes between the mesiobuccal and distobuccal roots and
toughs the palatal root.

Class IV
a. same as Class III furcation involvement except that the entrance to the furcation is visible
clinically due to tissue recession
Therapy Therapy Answers
Which of the following describes the BEST approach a dentist should use to elevate a flap to
prevent exposure of a dehiscence or fenestration on a prominent root?

A. Apically repositioned flap

B. Full thickness flap
C. Partial or split thickness flap
D. Stripping procedure C. Partial or split thickness flap

1) Concept: Using a partial thickness flap, a dentist may utilize use the elevate flap to cover up
the dehiscence or fenestration of a root.

2) Partial thickness flaps

a. enable the repositioning of the elevated flap without exposing the bone.
b. With partial thickness flaps, the periosteum is NOT included in the elevated flap and serves to
cover the bone and tooth root.

3) Apically repositioned flap

a. in this case will only expose more bone and tooth structure and is NOT a good option for teeth
with dehiscence and fenestrations

4) Full thickness flaps are NOT a good choice since they will expose the whole bone surface
including the dehiscence and fenestration of tooth.
If a hygienist in your office leaves an ultrasonic tip on one spot on a tooth for too long which of
the following is most likely result?

A. Burnish calculus onto tooth

B. Damage tooth surface
C. Irreversibly damage pulp
D. Dull the instrument B. Damage tooth surface

1) Concept: Vibrations of ultrasonic instruments may cause damaged to the tooth when the
ultrasonic tip is left on one spot for prolonged period of time
2) Ultrasonic instruments must be limited 4-6 minutes per tooth; otherwise harm might be
incurred to the surrounding tissues.

3) Other probable sources of tissue damage include:

a. use of inappropriate ultrasonic tip
b. excessive power range
c. excessive pressure
d. inadequate water coolant
e. use of broken instrument tip
Which of the following characterizes the primary source of nutrients of a free gingival graft for
the first 24 hours?

A. Diffusion of nutrients from the vessels of the periodontal ligament

B. Primary vascular anastomosis
C. Residual nutrients within the graft
D. Diffusion of nutrients from the underlying connective tissue D. Diffusion of nutrients
from the underlying connective tissue

1) Concept: Free gingival grafts gain their nutrients from the recipient site through plasmatic
diffusion.

2) During the first 24 hours, there is no vascular connection between the free gingival gray and
the recipient site.

3) The forming capillary anastomoses provides the source of nutrients for free gingival grafts
after 3 days post surgically.
An apically repositioned flap margin on the palatal aspect of molar teeth is allowed for by which
of the following?

A. Avoiding an initial incision that contacts bone

B. Trimming the flap margin to the proper length during the procedure
C. Utilizing only a continuous suture type for closure of the surgical site
D. Utilizing only a sulcular incision in the initial incision B. Trimming the flap margin to the
proper length during the procedure

1) Concept: Apically repositioned flap margins on the palatal aspect need to be placed exactly to
its predetermined position during the procedure because the palatal mucosa has no unattached
mucosa that can be displaced.
b. An apically repositioned flap usually requires displacement of the gingiva to a more apical
position, requiring vertical releasing incisions except when the flap is made on the palate.

2) Palatal Mucosa
a. firmly attached to the palatal bone and due to its thick nature displacement is not possible
A buccal flap used to cover an oroantral communication associated with tooth #1 would receive
nourishment from which of the following arteries?
A. Facial
B. Greater Palatine
C. Nasopalatine
D. Posterior superior alveolar D. Posterior superior alveolar

1) Concept: The buccal flap will receive its nourishment from the blood vessel that supplies
tooth #1 which is the posterior superior alveolar artery

2) Posterior Superior Alveolar Artery

a. blood vessel that provides blood supply to the lining of the maxillary sinus, the alveolar bone,
the molars and premolars of the maxilla and the gingiva

3) Facial Artery
a. branches out and supplied blood to several parts of the face which includes the lips, portions of
the nose, sub mental areas and some portions of the tonsils.

4) Nasopalatine Artery (Sphenopalatine Artery)

a. branches off to the walls of nasal septum.

5) Greater palatine Artery

a. gives off blood supply to the nasal septum and the hard palate
Which of the following alterations does free gingival graft epithelium undergo?

A. Degeneration
B. Dysplasia
C. Keratohyalin granule formation
D. Orthokeratinization
E. Proliferation A. Degeneration

1) Concept: Free gingival grafts may undergo degeneration since they are harvested from a donor
site and are suddenly transferred to the recipient site

2) Free gingival graft procedures

a. performed to increase the keratinized gingival tissue support of an implant material or to cover
up areas of gingival recession
b. usually harvested along the palatal area and is later transplanted and sutured into place at the
recipient site.
c. during the first few days, the free gingival graft, it may undergo slight degeneration due to the
lack of direct blood and nutrient supply. The free gingival graft is able to survive through the
help of the underlying connective tissues bed that provides nutrition to its surviving epithelial
cells.
Which of the following conditions would be best treated by antibiotics?

A. Angina pectoris
B. Herpangina
C. Necrotizing ulcerative gingivitis
D. Recurrent aphthous stomatitis
E. Verruca Vulgaris C. Necrotizing ulcerative gingivitis

1) Concept: According to the microbial basis of ANUG, antibiotics seem to be a logical

treatment option.

2) Penicillin and metronidazole have been used for treating ANUG.

3) Latest treatment of ANUG involves periodic scaling and root planing accompanied by topical
chlorhexidine gluconate.
Which of the following statements describe the key objective of the internal bevel incision used
in flap procedures?

A. All answers apply

B. Allow for better adaptation of the gingiva to the junction of the alveolar bone meets the tooth
C. Conserve gingival tissue
D. Remove the epithelial lining of the periodontal pocket. A. All answers apply

1) Concept: The internal bevel incision helps reflect the flap to expose the underlying alveolar
bone.

2) Internal bevel incision

a. Conserves gingival tissues not affected by the pocket
b. Remove the epithelial lining of the periodontal pocket
c. Allows for better adaptation of the gingiva tot he junction of the alveolar bone meets the tooth
Debridement of an intraoral lesion should be performed with which of the following solutions?

A. 0.12% Chorhexidine
B. 1% Iodine tincture
C. 10% Hydrogen peroxide
D. 3% Hydrogen peroxide
E. Betadine Solution D. 3% Hydrogen peroxide

1) Concept: Debridement of intraoral lesions are performed to remove dead and infected surfaces
through the use of 3% hydrogen peroxide.

2) A mild concentration of hydrogen peroxide provides antimicrobial properties through the

release of oxygen as it is applied to the infected wound.

3) Prolonged hydrogen peroxide use is NOT advised due to its ability to cause harm and
irritation to oral tissues.

4) Higher concentrations of hydrogen peroxide are used as disinfectants in hospitals, as

bleaching agents, and even in water waste management.
5) 1% tincture of Iodine or also known as Lugol's solution is a great antiseptic agent that has a
wide spectrum of antimicrobial activity. It is used as a pre and post surgical mouth rinse to
reduces chances of bacterial infection over the surgical site.

6) Chlorhexidine is an antibiotic rinse that would NOT help to remove dead tissues.
Which of the following describes a decalcified and freeze-dried bone graft donated from a
human to be graft to another human patient?

A. Alloplastic graft
B. Autograft
C. Xenograft
D. Allograft D. Allograft

1) Concepts: Allograft are grafts taken from one person (usually a cadaver) and given to
ANOTHER person. Bone allografts are often freeze-dried.

2) There are three types of bone allograft available:

a. Fresh or fresh-frozen bone
b. Freeze-dried bone allograft (FDBA)
c. Demineralized freeze-dried bone allograft (DFDBA)

3) Autografts
a. grafts taken from a part of the body of an individual and is transferred to another area of the
body of the SAME person

4) Alloplasts
a. an inert or non-reactive foreign material which is transplanted or implanted inside the body

5) Xenografts
a. graft taken from a member of a certain species and is transferred to a recipient from a different
species
The apical extent of a gingivectomy procedure should be placed...

A. Above the mucogingival junction

B. At the mucogingival junction
C. In the buccal mucosa
D. Coronal to the periodontal pocket A. Above the mucogingival junction

1) Concept: gingivectomy is a periodontal surgery that involves excision of the gingiva. The
apical extent of gingivectomy may be equal or apical to th bottom of the periodontal pocket as
long as the termination point is above the mucogingival junction.

2) Gingivectomy may be used to:

a. Treat suprabony periodontal pockets
b. Treat gingival enlargement/hypertrophy
c. Treat supra bony periodontal abscesses
d. Provide visibility and accessibility for calculus removal and cleaning

3) Extent of the gingiva to be removed is identified with the use of a periodontal probe
Each of the following can occur during scaling and root planing procedures EXCEPT ONE.
Which is the EXCEPTION?

A. Calculus removal
B. Cementum removal
C. Dentin removal
D. Enamel removal
E. Soft tissue Damage D. Enamel removal

1) Concept: Enamel removal during scaling and root planing is NOT possible since enamel is
highly mineralized structure that is too hard to be removed by such dental procedure.

2) The primary role of scaling and root planing is to remove all plaque and calculus that is
attached to the tooth surface and to be able to create a surface and glass-like root surface which is
conducive for good gingival health.

3) Creating a smooth and glass like root surface during the root planing procedure allows the
formation of new cementum and reattachment of the supporting gingiva through the formation of
long junctional epithelium.

4) The scaling and root planing procedure should aways be performed under local anesthesia
since it involves removal of calculus and plaque along the cementum. Soft tissue damage,
removal of some cementum and dentin are some time inevitable during the scaling and root
planing process.
Which of the following statements describe the key objective of surgery as part of a patient's
overall periodontal therapy?

A. Decrease the depth of the periodontal pocket

B. Eliminate all of the bacteria associated with periodontal disease
C. Make is so the patient no longer needs scalding and root planing
D. Remove calculus A. Decrease the depth of the periodontal pocket

1) Concept: The main goal of respective or regenerative surgery as part of periodontal therapy is
to reduce pocket depths.

2) Osseous surgery
a. includes the recontouring of both hard and soft tissues

3) Resective surgeries
a. include gingivectomy and flap surgeries

4) Regenerative surgeries
a. include grafting and the use of barrier membranes
Dental indications for systemic antibiotics include each of the following EXCEPT one. Which is
NOT an indication for systemic antibiotics?

A. Extraction of a mandibular 3rd molar in a patient with acute pericoronitis

B. Full mouth extractions for a patient with severe periodontal disease
C. Localized alveolar osteitis following mandibular 3rd molar extractions
D. Extraction of a tooth for a patient with an acute periodical abscess C. Localized alveolar
osteitis following mandibular 3rd molar extractions

1) Concept: Localized alveolar osteitis (dry socket) does not necessitate the use of systemic
antibiotics

2) Dry socket is a painful condition that usually occurs after a traumatic extraction and accidental
early dislodgment of the blood clot inside the extraction site.

3) Alveolar osteitis is treated by rinsing the affected tooth socket with warm saline solution and
placement of a sponge with an antiseptic dressing.
Ultrasonic instruments are indicated for each of the following types of patients EXCEPT one.
Which is the EXCEPTION?

A. Active infectious disease

B. Controlled diabetic
C. Deep periodontal pockets
D. Edematous tissue
E. Mildly uncontrolled diabetic A. Active infectious disease

1) Concept: Ultrasonic instruments should NOT be used for patients with active infectious
disease because the aerosol created by the instruments serves to spread the infection around the
operator.

2) Diabetes and deep periodontal pockets are indications that ultrasonic instrumentation.
During an ostectomy procedure, the surgeon always...

A. Performs a block graft

B. Performs an allograft
C. Performs an autograft
D. Removes non-tooth supporting bone
E. Removes tooth-supporting bone E. Removes tooth-supporting bone

1) Concept: Ostectomy
a. is a surgical procedure that removes supporting bone in order to help reduce or eliminate
periodontal pockets

2) Osteoplasty
a. a surgical procedure that removes non-supported bone
b. completed before the ostectomy in order to allow for the most conservative removal of bundle
bone (supporting bone) around the teeth

3) When pocket depth is decreased, the effectiveness of oral hygiene measures increases.
Barrier or Teflon membranes are utilized by dentists to treat osseous defects through attempting
to restrict which of the following?

A. Connective tissue attachment

B. Coronal migration of cells from the periodontal ligament
C. Epithelium from sticking to the bone
D. Long junctional epithelium formation
E. Osseous regeneration D. Long junctional epithelium formation

1) The reattachment of gingiva to the cementum through the formation of long junctional
epithelium should be restricted in order to allow the newly formed periodontal ligament fibers to
interlock with the cementum and create new attachments.

2) Barrier or Teflon membranes are placed to allow cultivation and growth of new attachments
without any interference from the long junctional epithelium.

3) Guided tissue regeneration procedure requires the use of barrier membranes in order to guide
or direct the growth of new forming bone and soft tissue.

4) Barrier membranes also stops the possible migration of epithelial cell toward the newly
formed cementum layer, thus preventing the formation of the long junctional epithelium.
Each of the following describe the modes of action for cavitrons EXCEPT one. Which is the
EXCEPTION?

A. Cavitation
B. Lavage
C. Piezo movement
D. Vibration C. Piezo movement

1) Concept: Ultrasonic instruments (cavitrons) move in a rapid pulsating manner that creates
vibration, cavitation, and rinsing water used to cool and lavage tissues.
b. Ultrasonic dental scalers use vibration and pulsation in order to break down the mineralized
plaque.
c. Ultrasonic cleaners produce cavitation, where rapid movement creates tiny vacuum bubbles in
the liquid which burst once they comes in contact with contaminants. This reaction is able to
scrub particles of bacteria and calculus off of tooth surfaces.
d. Ultrasonic lavage action is used for hard to reach areas like endodontic canals.

2) Piezo movement uses different mechanism of action (forward and backward linear motion
instead of ovoid movement).
b. Piezo instruments can create ultrasonic movements.
Which of the following osseous grafting materials is harvested from a human donor and placed
in another human?

A. Allograft
B. Allolastic
C. Autograft
D. Xenograft A. Allograft

1) Concept: Allografts
a. describe bone that is taken from another human being and placed in another person

2) Autografts
a. describe bone taken away from one patient and placed in that very same patient

3) Xenografts
a. describe bone taken from an animal like a horse, pig, or cow, and placed in a human

4) Alloplastic/synthetic grafts
a. describe inert biologic fillers such as hydroxyapatite, different polymers like PMMA
Root planing should be avoided during modified Widman flap procedures BECAUSE the margin
of the modified Widman flap will be placed apically to the level of altered root surfaces?

A. Both the statement and the reason are incorrect.

1) Concept: Modified Widman flaps are a periodontal flap that is performed to reduce
periodontal pockets.

2) The modified Widman flap provides better access and visibility of the root surface, making
the root planing procedure easier as well as also increasing the level of success of the procedure.

3) Pocket depth elimination helps patients maintain better plaque control which will reduce the
chances of disease recurrence.
Each of the following statements about partial thickness flaps is correct EXCEPT one. Which is
the EXCEPTION?

A. It is indicated when a bone dehiscence or fenestration is present

B. It is indicated when there is <2mm attached gingiva
C. The flap include the mucosa and the periosteum
D. The flap is raised with an internal bevel incision
E. The flap should be uniformly thick C. The flap include the mucosa and the periosteum

1) Concept: Partial thickness flaps

a. include the epithelium and connective tissue, while the periosteum is left attached to the bone.
b. used for free gingival grafts and when bone dehiscence or fenestration is present
c. an internal bevel is used to reflect the flap about 2mm thick or more.
2) Full thickness flaps
a. include the periosteum
Each of the following is mode of action for a magneto restrictive ultrasonic instrument EXCEPT
one. Which is the EXCEPTION?

A. Acoustic turbulence
B. Cavitation
C. Lavage
D. Linear movement
E. Vibration D. Linear movement

1) Concept: Magnetostrictive ultrasonic instruments (cavitrons) are used to remove heavy

deposits of calculus and stain via an elliptical motion.

2) Cavitrons work by:

a. Lavage: flossing of the pocket
b. Cavitation: ultrasonic movement creates air bubbles that knock deposits off tooth structure
c. Vibration: mechanically removes deposits and debris
d. Acoustic turbulence: agitation observed in fluids by mechanical vibrations disrupts bacterial
cell walls

3) Piezo instruments
a. uses a linear movement to create a back-and-forth motion to crete their ultrasonic movement
Each of the following is associated with full-thickness flaps EXCEPT one. Which is the
EXCEPTION?

A. Apical repositioning
B. Dissection of the tissue with a blunt instrument
C. Osseous recontouring
D. Periosteum stays on the bone D. Periosteum stays on the bone

1) Concept: Full thickness flaps

a. includes stripping all of the soft tissue (epithelium, connective tissue, periosteum) from the
bone.

2) Following placement of the incisions, the flap is dissected using blunt instruments like a #9
molt to separate the soft tissue from the bone.

3) Full thickness flaps are used when recontouring the osseous structures below of when the
gingiva are repositioned apically.
Which of the following procedures should be performed after a dentist reflects a flap, debrides 2
and 3-walled defects, and scales and root planes the teeth of a 55-year old male with deep
fibrotic pockets and angular bone loss?

A. Apically repositioned flap

B. Bone grafting
C. Crown lengthening
D. Gingivectomy
E. Modified Widman flap B. Bone grafting

1) Concept: Bony defects with 2 or 3 walls in the alveolar bone and teeth that exhibit angular
bone loss are considered good candidates for bone grafting.

2) Prognosis of bone grafting success increases for bony defects having 2 or more supporting
walls

3) Apically repositioned flaps and crown lengthening procedures are NOT indicated for cases
having angular bone loss and large bony defects.

4) Gingivectomy is only indicated for patient having excessive gingival exposure and is NOT
used for eliminating deep pockets.
The suggested initial treatment for a patient that presents to your office with HIV associated
necrotizing ulcerative gingivo-periodontitis is which of the following?

A. Debridement with prescription of chlorhexidine 0.12%

B. Gingivectomy
C. Scaling and root planing with curettage
D. Debridement A. Debridement with prescription of chlorhexidine 0.12%

1) Concept: Necrotizing ulcerative gingivo-periodontitis associated with HIV+ patients should be

handled with utmost care specially because of the immunosuppressed condition of the patient.

2) Necrotizing ulcerative gingivitis and periodontitis usually occurs because of the predominance
of the anaerobic fusobacteria and spirochetes within the oral cavity, specifically underneath the
gingiva.

3) Debridement of the affected gingiva with an adjective prescription of chorhexidine 0.12% rise
will help stop the progression of necrotizing ulcerative disease.

4) Necrotizing Ulcerative Gingivitis/Periodontitis

a. Sloughing Gingiva
b. Blunted papillae
c. Fetid Odor
d. Bone Loss with Perio
When designing a flap for periodontal surgery, which of the following findings is most
influential?

A. Vestibular depth
B. Presence of intrabony defect
C. Probing depth
D. Quantity of attached gingiva
E. Frenum attachment level D. Quantity of attached gingiva
1) Concept: Attached Gingiva
a. maintains a tight contact with the periosteum of the bone and certain areas of the tooth root.
b. its function is to keep the free gingiva in close contact with the tooth while also protecting the
soft and free moving alveolar mucosa.
c. insufficient attached gingiva makes the mucosa more prone to trauma during function and
compromises the periodontal support of teeth
d. in order to avoid periodontal problems after surgery, the width of the attached gingiva must be
preserved.
Prevention and Maintenance Prevention and Maintenance Answers
Which of the following locations does new plaque principally accumulate after a patient brushes
their teeth?

A. Buccal
B. Interproximal
C. Lingual
D. Occlusal B. Interproximal

1) Concept: Plaque usually accumulates along the areas hardly reached by toothbrush like the
inter proximal area.

2) Plaque
a. Newly formed plaque may form on all surface of teeth but typically stays longer within areas
that are rarely disturbed by oral hygiene practices
b. may form alone the buccal and lingual aspects of tooth, but with proper brushing these areas
are easily cleaned
c. occlusal area may demonstrate some plaque accumulation, but most of the time plaque is
dislodged during mastication and brushing
True/False:

The duration a prescribed therapy has an effect on patient compliance. Disease severity as
perceived by the patient has an effect on patient compliance. Both statements are TRUE

1) Concept: Patients undergoing a treatment with a long duration have greater tendencies of
becoming less compliant and less dedicated to treatment procedures due to the lack of a
immediate treatment result

2) Treatments that last for a very long time also make patients tired of routine medication and
causes them to be less compliant.

3) Patients who are hopeful and expect good results from medical treatment are more receptive
to taking medication and are more compliant.

4) Patients who perceive that their disease severity is hopeless tend to be less receptive and less
compliant with their medication.
Cleaning root surfaces daily has been indicated to result in...
A. Root resorption
B. Root sensitivity
C. Root surface remineralization
D. Increased epithelial attachment level C. Root surface remineralization

1) Concept: Cleaning root surfaces on a daily basis with fluoride dentifrices may result in root
surface remineralization.

2) Consistent plaque removal prevents root demineralization by bacteria and enables the root
surface to remineralize.

3) Presence of minerals in saliva and fluoride from toothpaste also aid in the remineralization of
root surfaces
The principal goal of the maintenance phase of periodontal therapy is described by which of the
following?

A. Complete the remaining procedures on the treatment plan

B. Finish off secondary surgical procedures
C. Maintain a relationship with the patient
D. Precent recurrent disease
E. Re-evaluate the results of the initial therapeutic treatment D. Precent recurrent disease

1) Concept: Maintenance Phase

a. The maintenance phase of periodontal therapy focuses on keeping the patient in stable
periodontal health and the prevention of disease recurrence.
b. Re-evaluation of the results of initial therapeutic treatment is performed during the pasha I or
cause-related therapy phase around 6-8 weeks after instrumentation.
c. The maintenance phase utilizes a well planned schedule of maintenance visits customized and
designed for the needs of each patient on a case-by case basis.
d. Surgical procedures are usually performed during the corrective phase of treatment.
The most widely used method of removing or disrupting bacterial plaques in the mouth is which
of the following?

A. Antibiotics (penicillin, tetracyclines)

B. Chemical (mouthwashes)
C. Mechanical (Brush and floss)
D. Using a surfactant to prevent bacteria from adhering to teeth C. Mechanical (Brush and
floss)

1) Concept: Brushing and flossing

a. Mechanical disruption through brushing and flossing remains the best method of stopping the
growth of plaque and other bacterial pathogens in the mouth
b. the tooth pellicle is where initial bacteria colonizes. By disrupting the newly formed plaque,
calculus, and dental caries can be prevented.
2) Antibiotics
a. wide spectrum medications are intended to kill bacteria
b. however, it is not intended for plaque control
c. excessive use of antibiotics will NOT prevent plaque formation but may lead to bacterial death
in the oral cavity. This will then cause imbalance in the normal flora of our mouth and allow
fungi like candida to take over.
New attachment is defined as the attachment of the gingival epithelium to the root surface and
the embedding of new periodontal ligament fibers into new...

A. Bone
B. Cementum
C. Epithelium
D. Dentin B. Cementum

1) Concept: Formation of new attachment occurs when the newly formed periodontal ligament
fibers embed themselves into the cementum of a preciously derided root surface.

2) New attachment is the reunion of connective tissue with a root surface that has been deprived
of its periodontal ligament.

3) The formation of periodontal ligament in the new cementum can only be achieved through
guided tissue regeneration.
Which of the following describes the MOST EFFECTIVE method for managing post surgical
root sensitivity after periodontal surgery is performed?

A. Application of calcium hydroxide

B. Application of mineral trioxide aggregate (MTA)
C. Plaque control
D. Using a desensitizing dentifrice C. Plaque control

1) Concept: The best way to manage post surgical root sensitivity is to address the central
etiology (dental plaque).

The acidic metabolites from plaque may cause sensitivity to the exposed root surface after
periodontal surgery.

Desensitizing dentifrice may provide a temporary relief from root sensitivity but takes up to 2
weeks to take effect. Adequate removal of plaque along the tooth surface will provide a MORE
permanent solution to sensitivity.

Mineral trioxide aggregates is NOT indicated for addressing root sensitivity but is rather used as
a filling material for endodontic treatment.
When using only standard floss, the mesial root surface of which of the following teeth is
typically NOT totally cleaned?

A. Mandibular 1st molar

B. Mandibular 1st premolar
C. Mandibular central incisor
D. Maxillary 1st premolar
E. Maxillary central incisor D. Maxillary 1st premolar

1) Concept: The mesial root surface of the maxillary 1st premolar is typically NOT thoroughly
cleaned using ONLY the dental floss due to the medial root concavity.

2) Mesial root surface of the maxillary 1st premolar

a. because of the lack of cleansibility of the mesial of this tooth
b. it is advised to use interdental brushes, end tuft brushes, tooth pick in holders, rubber tips, and
powerful floss to clean these inter proximal areas. This is because of the type of gingival
embrasure space on the mesial aspect of the maxillary 1st premolar.

3) Gingival Embrasures
a. Type I: Having NO inter dental papilla loss
b. Type II: Partial loss of inter dental papilla
c. Type III: Complete loss of inter dental papilla

4) The mesial surface of the maxillary 1st premolar typically has a Type II or Type III gingival
embrasure, resulting in moderate to severe recession with exposure of the root concavity.
Interdental brushes clean the root concavity better than dental floss.
Each of the following devices are effective in removing surface plaque EXCEPT one. Which is
the EXCEPTION?

A. Home water-irrigating device (Water Pik)

B. Super-soft toothbrush
C. Toothpick
D. Dental floss A. Home water-irrigating device (Water Pik)

1) Concept: Home water-irrigating device (Water Pik)

a. The use of oral irrigation device like Water-Pik helps remove plaque in shallow periodontal
pockets.
b. Irrigation devices propel a pulsating, high pressure stream of water to flush sub gingival
plaque and debris out of shallow pockets.
c. They are ineffective if the periodontal pocket is too deep to be reached by toothbrush bristles
or a toothpick.
d. The use of dental floss is the most recommended oral hygiene method for proximal plaque
removal, but is not capable of reaching deep into the pocket.
Theoretically, the most effective tooth brushing technique is which of the following?

A. Side-to-side
B. Stillman
C. Sulcular
D. Charter C. Sulcular
1) Concept: Sulcular brushing technique
a. The sulcular brushing technique effectively eliminates plaque from the sulcular and cervical
areas of the teeth thereby preventing the occurrence of periodontal disease.
b. Sulcular brushing allows the round ended brush fps o each about 0.5mm subgingivally to
effective disrupt plaque buildup in the cervical area
c. Sulcular brushing reduces the chance for abfraction that may happen from improper brushing
strokes that cause cervical cavities that are prone to plaque retention, tooth sensitivity, and tooth
decay.
Which of the following describes the intended function of a home dental water irrigation systems
(Water Pike)?

A. Reduce bacteria on the gingiva

B. Reduce biofilm on the tooth
C. Reduce pocket depth
D. Remove supragingival calculus A. Reduce bacteria on the gingiva

1) Concept: home water irrigation systems are designed to reduce the biofilms present on the
gingiva, NOT the tooth surface
2) Gram+ bacteria produce dextrans levs, and glucans which allow them to better adhere to tooth
structure
3) Gram- bacteria produce alginates to help them to adhere to adhere
4) Spirochetes cannot produce the same adherence factors as gram negative and gram positive
bacteria, so they can be flushed from the pocket.
True/False:

A minor traumatic injury can result in enamel breaking-off of the underlying dentin.

Traumatization of odontoblasts will eventually lead to pulpal degeneration. The first

statement is FALSE, the second is TRUE

1) Enamel fractures are defined as damage to the enamel layer of the tooth causing partial or
total removal of the enamel structure which may expose the dentin layer underneath.

2) Small enamel fractures can be recontoured and smoothened with enameloplasty. Extensive
enamel fractures are better restored with composites, crowns, inlays/onlays, and veneers

3) Trauma to odontoblasts over a very short period of time will not degenerate the pulp.
However, continuous trauma to odontoblasts may result in pulpal irritation and eventually the
initiation of tertiary dentin formation.
Which of the following disorders is associated with a chromosomal abnormality which can occur
as the result of either chromosomal nondisjunction or translocation?

A. Klinefelter syndrome
B. Trisomy 21 (Down syndrome)
C. Turner syndrome
D. Ehler-Danlos syndrome B. Trisomy 21 (Down syndrome)
1) Trisomy 21 occurs because of meiotic nondisjunction, which is a situation where a gamete
from a parent contains excess chromosomes.

2) Patients with Down's syndrome possess 3 copies of chrosome 21 instead of 2 copies. This
condition is considered the most commonly occurring chromosomal abnormality in humans.
Waiting for intruded permanent central incisors to re-erupt in an 8-year-old child will likely
result in

A. Ankylosis
B. Calcific metamorphosis
C. External resorption
D. Hypocalcificaton spots on the tooth upon eruption
E. Internal resorption
F. Re-eruption F. Re-eruption

1) An intruded permanent central incisor will eventually start to re-erupt within a period of
approximately 2-3 weeks.
Pulpal necrosis and damage Intrusive luxation

1) Intrusive luxation
a. of primary teeth among children alway result to pulpal necrosis
b. occurs when tooth is pushed into the socket, directly damaging and severing the vascular
supply of the tooth, immediately results to pulpal necrosis

2) Avulsed primary tooth

a. better chance of revascularization when implanted immediately and will not always result in
pulp necrosis

3) If tooth is replanted after a long period of time, the changes of ankylosis will increase.
In patient suffering from multiple sclerosis

A. A single cartridge of anesthetic will most likely not last as long as it would for a normal
patient
B. Epinephrine is contraindicated in local anesthetic
C. The amount of anesthetic needed for a given procedure is more than for a normal patient
D. The amount of anesthetic needed for a given procedure is less than for a normal patient
B. Epinephrine is contraindicated in local anesthetic

1) Epinephrine should not be used for patients suffering from multiple sclerosis because
epinephrine can aggravate the condition by regulating the activation of blood lymphocytes.

2) Epinephrine is a cetecholamine and neurotransmitter responsible for the body's flight- or flight
response.
3) Elevating the levels of epinephrine also increases blood lymphocyte activity which could
cause further damage to the myelin sheaths of the neurons thereby aggravating multiple sclerosis
condition.
A child presents with a noticeably sore ulceration of their lower lip and no history of obvious
trauma. The ulceration appeared several hours after the patient received dental treatment. Which
of the following is the most probable diagnosis?

A. Herpes labialis
B. Post-anesthetic lip bite
C. Type IV allergic reaction to the latex in the rubber dam
D. Aphthous ulcer secondary to stress B. Post-anesthetic lip bite

1) Due to the feeling of numbness after anesthetic delivery, a child may either intentional or
unintentionally bite on his/her lips.

2) Children under anesthesia should be supervised by their parents and instructed not to eat on
the anesthetized side of the jaw to prevent accidental lip biting while anesthesia is still present.
A clinical examination of a 7-year-old patient reveals a fractured right central incisor with a 2-
mm exposure of a "bleeding pulp" that occured 3 hours ago. The suggested treatment is

A. One-appointment root canal treatment

B. Pulpectomy and apexificatin
C. Pulpotomy with calcium hydroxide
D. Direct pulp cap with calcium hydroxide C. Pulpotomy with calcium hydroxide

1) Pulpotomy procedures prevent unnecessary extraction of central incisors by removing only the
portion of the pulp that was exposed during the trauma.

2) A partial pulpotomy for traumatic exposures is also called a Cvek pulpotomy.

3) The root apex of developing permanent central incisor is still open. By performing a Cvek
pulpotomy, the root of the central incisor will have extra time to complete its root development.
Which of the following describes an injury where a tooth is damaged but NOT displaced?
Concussion

1) Concussion
a. injury within the supporting structures
b. loosening and possible displacement among traumatized teeth is not observed

2) Subluxation
a. involves displacement of a tooth from its socket and may require additional dental treatment of
the affected tooth

3) Luxation
a. denotes displacement of tooth to any direction away from its original position in the dental
arch
Individual Tooth Pathology Individual Tooth Pathology Answers
A 7-year-old boy presents to you office after fracturing his left central incisor 3 hours ago.
During your examination, you find 2mm o exposed, bleeding pulp tissue. There is no mobility
noted. What treatment is indicated?

A. One-appointment root canal treatment

B. Pulpectomy and apexification
C. Pulpotomy with calcium hydroxide (Svek Pulpotomy)
D. Direct pulp cap with calcium hydroxide C. Pulpotomy with calcium hydroxide (Svek
Pulpotomy)

1) Concept: Pulpotomy procedures prevent unnecessary extraction of central incisors by

removing only the portion of the pulp that was exposed during the trauma

2) Cvek pulpotomy
a. a partial pulpotomy for traumatic exposure

3) The root apex of developing central incisor is still open. By performing a Cvek pulpotomy, the
root of the central incisor will have extra time to complete its root development.

4) Pulpotomies
a. performed as a temporary treatment option in permanent teeth while you wait for the roots of
the tooth to fully develop so a root canal treatment can be performed
Of the following anomalies, the one which normally has a bacterial etiology is:

A. Compound odontoma
B. Dentinogenesis imperfecta
C. Fusion
D. Hutchinson's incisors
E. Enameloma D. Hutchinson's incisors

1) Congenital Syphilis
a. associated with Hutchinson's incisors occurring in month 4-6 in utero before calcification
begins.
b. Incisors and 1st molars are most commonly affected because they are the only permanent teeth
at this stage of development
c. incisors : have a notch in the center of the incisal edge, making them appear like a screwdriver
d. 1st molars: typically appear with poorly developed cusps and gnarled enamel, giving arise to
the name "mulberry molars"
e. primary teeth are topically NOT affected
f. esthetics is the primary concern of patients with this condition

2) Enamelomas (Enamel pearls)

a. form during tooth development when the cells of the epithelial root sheath remain stuck to
predentin
b. then they differentiate into ameloblasts and deposit enamel where it normally would not.
A traumatic injury is possibly etiologic agent in:

A. All answers apply

B. Dwarfed roots
C. Gemination
D. No answers apply
E. Dilaceration E. Dilaceration

1) Concept: Dilaceration describes a severe angular or curve in the root or crown of a tooth that
is thought to result from trauma during development.

2) Dilaceration
a. trauma during tooth development may result in the poison of calcified portion of the tooth
being changed so the remainder of the tooth is formed at an angle.
b. curve or bend occur anywhere along the length of the tooth and depends on the amount of root
that is already formed when the injury is sustained.
c. An injury resulting in dilaceration may often occur when a deciduous predecessor is driven
aplically into the jaw and applies force to the permanent tooth below
d. may make future endodontic procedures more difficult
The alterations in the continuity of the occlusal plane after a tooth is ankylosed is primarily
caused by which of the following?

A. Ankylosed teeth moving apically as the root becomes incorporated into the alveolar bone
B. Differential eruption sequences
C. Localized inhibition of alveolar process growth
D. Continued eruption of nonankylosed teeth and growth of the alveolar process D. Continued
eruption of nonankylosed teeth and growth of the alveolar process

1) Concept: When teeth are ankylosed, they usually lie below the occlusal plane because the
supporting alveolar process does not grow

2) Alveolar process growth occurs simultaneously with the eruption of teeth. Ankylosed teeth do
not experience alveolar process growth because of their failure to erupt the same way as the other
non-anklyosed teeth due to a lack of periodontal ligament.

3) Ankylosed teeth are teeth with roots completely embedded into the bone without periodontal
ligament.
The condition known as "twinning" normally:

A. Is the result of a bacterial etiology

B. Occurs only in posterior teeth
C. Results in one less than the normal number of dental units in the involved arch
D. Is also called gemination
E. Is the result of a complete fusion of two teeth D. Is also called gemination

1) Concept: Gemination (twinning)

a. developing tooth splits off into two distinct teeth that are attached to each other by pulp or
dentin
b. Think of twinning as Siamese twin teeth
c. have same number of tooth and two separate root canals

2) Fusion
a. where two separate buds join together
b. This leaves one tooth less than normal in the dentition
c. have one less tooth (in the normal dentition) separate root canals
The proper treatment for a tooth with an uncomplicated/incomplete crown fracture (pulp is not
exposed) would be...

A. Be vitality tested to determine the extent of pulpal damage

B. Have a stainless stell crown placed
C. Have the chipped enamel recontoured and smoothed
D. Not need to be evaluated with thermal and electric pulp tests
E. Immediately direct pulp capped and restored A. Be vitality tested to determine the extent
of pulpal damage

1) Concept: It is important to immediately evaluate tooth vitality as well as the extent of the
crack, which in this case is suspected of being an incomplete crown fracture

2) The results of pulp vitality tests will help you to know if the pulp is still vital and unaffected
by the fracture. It is essential to determine extent of the incomplete fracture and its cause.

3) If the tooth is vital an the incomplete fracture cause some discomfort, the fractured tooth
surface must be restored.

4) The patient should regularly visit the dentist for re-evaluation of the tooth structure and the
tooth vitality.

5) Crazing is when there is a fracture line that does not extend to dentin.
Which of the following is the term for when a tooth is traumatized without displacement of the
tooth that increases the mobility of the tooth?

A. Concussion
B. Extrusion
C. Intrusion
D. Subluxation
E. Luxation D. Subluxation

1) Concept: Subluxation describes trauma to a tooth, supporting structures resulting in increased

mobility, but without displacement of the tooth. Bleeding from the gingival sulcus confirms the
diagnosis. This trauma may require immediate dental treatment of the affected tooth.
b. increased mobility and pain to percussion
c. without displacement of the tooth
d. bleeding is evident

2) Concussion
a. there is an injury within the supporting structures of a traumatized tooth
b. does NOT demonstrate bleeding from the sulcus
c. loosening and possible displacement among traumatized teeth is NOT observed in concussion
cases
d. an injury without increased mobility or displacement of the tooth
e. with pain on percussion
f. without gingival bleeding

3) Luxation
a. used to denote displacement of tooth in any direction away from its original position in the
dental arch

4) Extrusion
a. partial displacement of the tooth out of its socket and that is characterized by partial or total
separation of the periodontal ligament resulting in loosening and displacement of the tooth.
b. alveolar socket bone is intact

5) Intrusion
a. displacement of the tooth into the alveolar bone and is accompanied by comminution or
fracture of the alveolar socket
Loss of a tooth letter L in a 3 year old patient requires...

A. Distal shoe placement

B. Lower lingual holding arch
C. No answers are correct
D. Band and loop placement D. Band and loop placement

1) Concept: Placement of a band and loop may help prevent the mesial movement of K into the
space created by extracting L.

2) It is important to keep or maintain this space to prevent tooth crowding when the
succedaneous counterpart erupts.

3) Keeping the remaining teeth in proper position will also guide the eruption of permanent 1st
molar and prevent it from moving medially.

4) The space of tooth letter L can be maintained by placing band/crown loop on tooth K-M. This
should be replaced later with lower lingual holding arch as soon as the other lower permanent
incisors erupt.
An anomaly in which there is a distortion of only the root of a tooth, which may be in the form of
a right angle bend, is:

A. Consecrence
B. Dilaceration
C. Dwarded root
D. Segmented root
E. Flexion E. Flexion

1) Concept: Flexion is distortion of the ROOT portion ONLY

2) Dilaceration:
a. distortion of the root and crown from their normally linear relationship

3) Consecrence
a. union of the root structure of two or more teeth through CEMENTUM ONLY.

4) Dwarfed root
a. exists when normal sized crowns have abnormally short roots

5) Segmented root
a. two separated root segments due to break in Hertwig's sheath
A 9 year old presents to your office after he fracture maxillary 1st molar 3 hours ago. After
testing vital, you noticed an exposed inflamed coronal pulp in Tooth #14. The recommended
treatment of choice is...

A. Direct pulp cap

D. Pulpotomy D. Pulpotomy

1) Concept: Pulpotomy
a. The pulp exposure was caused by the tooth being fractured and its not due to caries making it a
good candidate for pulpotomy
b. exposed and inflamed coronal pulp can be removed and the remaining healthy radicular pulp
will be left unharmed

2) Direct Pulp Cap

a. cannot be performed because the prognosis is POOR if the pulp was exposed for MORE
THAN ONE HOUR

3) Pulpectomy
a. only indicated for primary teeth having infected coronal and radicular pulp because the apexes
of primary molars are still open

4) Indirect Pulp Cap

a. not possible since the pulp is already exposed
Pulpal necrosis is the MOST COMMON outcome of which primary tooth trauma?

A. Concussion
B. Mid-root horizontal root fracture
C. Intrusive luxation
D. Avulsion C. Intrusive luxation

1) Concept: Intrusive Luxation

a. Intrusive luxation of primary teeth among children always result to pulpal necrosis
b. occurs when the tooth is pushed into the socket, directly damaging and severing the vascular
supply of the tooth, immediately results to pulpal necrosis

2) Avulsion
a. avulsed primary tooth will have a better chance of revascularization when implanted
immediately and will not always result in pulp necrosis
b. If the tooth is replanted after a long period of time, the chances of ankylosis will increase.
In the permanent dentition, which of the following injuries is most likely to cause pulp necrosis?

A. Extrusion
B. Intrusion
C. Luxation
D. Subluxation
E. Concussion B. Intrusion

1) Concept: Intrusion of a tooth into its socket may sever the nerve and blood vessels that supply
the tooth, resulting in pulp necrosis
a. Intrusion of teeth due to trauma may also cause replacement resorption of the roots or
ankylosis

2) Concussion, extrusion, luxation, and subluxation are accidents that are less likely to involve
the vascular supply of the tooth.
A 5 year-old presents to your office with spontaneous pain in their maxillary 1st molar and is
responsive to cold. The radiograph shows an intact furcation and caries extending to the pulp
chamber. What is the treatment of choice?

A. Direct Pulp cap with Zinc-Oxide Eugenol

B. Extraction
C. Pulpotomy
D. Pulpectomy C. Pulpotomy

1) Pulpotomy
a. indicated for a primary tooth where infection has reached the coronal pulp but has not yet
reached the radicular pulp
b. removal of coronal portion of infected pulp to prevent bacterial invasion of the radicular pulp
c. coronal pulp is usually excavated with a large spoon excavator or slow speed hand piece with
a large round bur in reverse. The pulp stumps are then dabbed with a cotton pellet soaked in
2.6% NaOCl and the tooth is then restored.

2) Pulpectomy
a. are performed when pulp completely infected by bacteria and involve the complete removal of
pulp tissue
When examining a patient for the first time, the dentist notices that there is an abnormally wide
permanent mandibular incisor, and that there are only three total mandibular incisors, counting
the abnormal wide one. The condition most likely is due to the anomaly:

A. Consecrence
B. Dilaceration
C. Fusion
D. Gemination
E. Flexion C. Fusion

1) Fusion
a. 2 buds fuse
b. must have confluent (connected) dentin
c. less teeth in the mouth than expected

2) Gemination
a. still have a normal number of teeth in the mouth
b. is when ONE tooth bud splits so that there are two crowns but only one shared root (Siamese
twin like)
c. with gemination patients there is an extra tooth

3) Flexion
a. a deviation or bend at the root of tooth
b. less than 90 degree bend
c. results from trauma during development

4) Dilaceration
a. Severe angulation or curve in the root or crown of tooth
b. Bend is at junction of crown and root
c. Usually results from trauma during development.

5) Concrescence
a. a condition where the cementum overlying the roots of at least 2 teeth connects to join the
teeth together
Of the following dental anomalies, the one in which there is great potential for the premature loss
of the affected tooth, is:

A. Consecrence
B. Dwarfed root
C. Flexion
D. Gemination
E. Enameloma B. Dwarfed root

1) Concept: Dwarfed root characteristics:

a. normal size crowns have abnormally short roots
b. normally found in anterior teeth only (maxillary central incisors is most common)
c. teeth may be lost at an early age due to passive eruption or periodontal disease
The current dents literature suggests that the transport media that offers the greatest PDL
longevity following avulsion is...?

A. Hank's balanced salt solution

B. Milk
C. Saliva
D. Warm Water
E. Buffered saline A. Hank's balanced salt solution

1) Concept: Hank's Balanced Salt Solution

a. most ideal and reliable storage media for an avulsed tooth
b. has the ability to keep the cells surrounding the root viable
c. has rich amount of metabolites like Ca, K, glucose and phosphate ions sufficient to provide the
cells with the energy to sustain their normal cell metabolism until replantation can occur

d. has a balanced pH and is known to replenish lost metabolites within the PDL cells of an
avulsed tooth
e. helps to improve the prognosis of replantation and decrease the chances of having replacement
resorption
Tetracycline staining occurs in which stage of tooth development?

A. Histodifferentiation
B. Mineralization
C. Morphodifferentiation
D. Proliferation
E. Apposition B. Mineralization

1) Tetracycline
a. incorporated into the tooth structure during the mineralization of the tooth because it forms a
chelate with calcium
b. tetracycline staining occurs after the ingestion of tetracycline antibiotics during tooth
development and is diagnosed by degrees of horizontal bands of color ranging from gray to gray-
brown and even some shades of green.
c. tetracycline staining is found in both the enamel and dentin
d. when first incorporated into the tooth structure, tetracycline produces a yellow color that
changes to brown and gray with the addition of sunlight over time.
In primary teeth, which of the following is least reliable in assessing the pulp vitality?

A. Extraoral swelling
B. Internal resorption
C. Intraoral swelling
D. Pulp testing
E. Spontaneous pain D. Pulp testing

1) Concept: Pulp Testing

a. can only provide information about the pulp's sensitivity to stimulation, which may result in a
tendency for false positive results

2) Presence of spontaneous pain and a possible intramural swelling associated with a primary
tooth indicates the presence of irreversible pulp damage and that the infection has probably
reached the periodical region.

3) Extraoral swelling and internal resorption suggests that the pulp has become necrotic and that
the infection has reached the periodical region.
True/False:

A minor trauma to a tooth can lead to enamel fracturing and separating from the dentin beneath it

The trauma to the odontoblasts will eventually result in pulpal degeneration. The first
statement is TRUE, the second is FALSE.

1) Concept: Enamel fractures

a. defined as damage to the enamel layer of the tooth causing partial or total removal of the
enamel structure which may expose the dentin layer underneath.
b. commonly due to accidental dental trauma, abnormal eating habits, and biting of substances
that are harder and tougher than enamel itself
c. are relatively small that can be recontoured and smoothened with enameloplasty.
d. too extensive are better restored with composites, crowns, inlays/onlays and veneers

2) Trauma to odontoblasts over a short period of time

a. will not degenerate the pulp
b. continuous trauma to odontoblasts may result in pulpal irritation and eventually the initiation
of tertiary dentin formation.
When would a periodical radiograph be indicated for a pediatric patient? Select all that apply.

A. Extraction
B. Occlusal caries
C. Pulpal therapy
D. Space maintenance
E. Trauma
F. Interproximal caries A. Extraction
C. Pulpal therapy
D. Space maintenance
E. Trauma

1) Concept: Periapical Radiographs

indicated for the following:
a. extractions
b. pulpal therapy
c. trauma
d. space maintenance
e. pediatric patients may need to have a periodical x-rays taken prior to fabricating space
maintainer to determine if space maintenance is necessary or if the successor will erupt in time
f. periapical x-rays serves as a guide an diagnostic tool during pulpal therapy
g. dental trauma in children necessitates periodical x-rays to help identify possible root fractures
as well as the condition of the supporting bone which is involved in the trauma.
Which of the following describes the condition where teeth are joined only by cementum?

A. Dilaceration
B. Fusion
C. Gemination
D. Hypercementosis
E. Concrescence E. Concrescence

1) Concrescence
a. condition where the cementum overlying the roots of at least 2 teeth connects to join the teeth
together
b. surgical separation of the teeth may be necessary if one is to be extracted, which may result in
damage to the adjacent tooth root
c. incidence of concrescence can sometime be attributed to trauma or crowding of teeth
1) most common in the permanent molars
2) different from fusion because it occurs following eruption and involves ONLY CEMENTUM
A 5-year-old presents to your office complaining of spontaneous pain associated with their
mandibular 2nd molar. Clinical testing suggest that the pulp is necrotic, and radiographs suggest
NO periodical pathosis. What is the best treatment option of this child?

A. Direct pulp cap

B. Indirect pulp cap
C. Pulpectomy
D. Pulpotomy
E. Extraction C. Pulpectomy

1) Pulpectomy
a. The spontaneous pain from necrotic pulp signifies the presence of infection inside the primary
tooth which can only be treated with a pulpectomy procedure
b. involves the complete removal of necrotic or partially necrotic pulp and placement of
medicaments inside the cavity in order to avoid premature extraction of teeth
c. indicated for primary teeth with infection and inflammation that has already reach beyond the
coronal aspect of the pulp
d. teeth indicated for pulpectomy must also exhibit no pathology resorption along the alveolar
bone and its roots
Fusion of teeth is an anomaly which normally involves:

A. A bacterial etiology at the morphodifferentiation stage of tooth development

B. Anterior teeth
C. One more dental unit in the arch than is normal
D. The splitting of a tooth bud
E. The union of two teeth through cementum only B. Anterior teeth

1) Fusion
a. result of an union of two adjacent tooth buds
b. usually found in anterior teeth
The most likely outcome of waiting for intruded permanent central incisors to erupt in an 8 year
old is...

A. Ankylosis
B. External resorption
C. Hypocalcification spots on the tooth upon eruption
D. Internal resorption
E. Re-eruption E. Re-eruption

1) Concept: Re-eruption
a. An intruded permanent central incisor will eventually start to re-erupt within a period of
approximately 2-3 weeks
b. Deciding for the mode of treatment for an intruded tooth may vary depending upon the
severity of tooth intrusion and the maturity of its roots
c. The modalities of treatment for an intruded tooth include:
1) Passive repositioning (PR): provides enough time for the re-eruption of intruded tooth
2) Active repositioning is performed through surgical repositioning (SR)
3) Orthodontic repositioning is achieved with the use or removable or fixed appliances (OR)
Which of the following tooth surfaces requires the least amount of reduction for a stainless steel
crown for primary mandibular 1st molar?

A. Lingual
B. Mesial
C. Occlusal
D. Buccal A. Lingual

1) Concept: Lingual surface

a. of a primary mandibular 1st molars are prepared with the least amount of reduction to ensure
an adequate cervical bulge to help retain the stainless steel crown
b. mesial and distal proximal surfaces are prepared to facilitate crown placement
c. cervical bulge located along the buccal and lingual surfaces of primary posterior teeth provides
retention for the stainless steel crown
d. lingual cervical bulge is smaller than that of the buccal aspect, so the lingual reduction must be
minimal.
When a tooth is completely removed from the alveolus, it is termed...

A. Ankylosis
B. Avulsion
C. Subluxation
D. Luxation B. Avulsion
1) Concept: Avulsion
a. happens when a tooth is forcefully dislodged or removed from its socket as a result of an
accident
b. avulsed teeth should be immediately replanted back to its socket and be splinted to adjacent
teeth for increased stability before further procedures are performed on the tooth

2) Ankylosis
a. occurs as the alveolus forms reparative bone (callus) to surround the tooth and replace the
damaged PDL fibers.
Permanent maxillary 1st molars may show evidence of congenital syphilis by exhibiting a
mulberry shape. Which of the following teeth are most likely to exhibit anomalous form due to
congenital syphilis?

A. Mandibular 2nd premolar

B. Mandibular canine
C. Mandibular lateral incisor
D. Maxillary 1st premolar
E. Maxillary central incisor E. Maxillary central incisor

1) Concept: Hutchinson's Teeth and Mulberry Molars

a. caused by a prenatal Treponema Pallidum (Syphilis) infection that disturbs the calcification of
the teeth during the morphodifferentiation of ameloblasts.
b. incisors and 1st molars are most commonly affected because they are the only permanent teeth
at this stage of development
c. incisors typically exhibit a notch in the center of the incisal edge, making them appear like a
screwdriver
d. 1st molars typically appear with poorly developed cusps and gnarled enamel, giving arise to
the name "mulberry molars"
1) primary teeth are typically NOT affected
2) esthetics is the primary concern of patients with this condition
Supporting Tooth Pathology Supporting Tooth Pathology Answers
A patient presents to your office for a routine examination where note a bilateral grey-white
lesion of the buccal mucosa that diapers when stretched. Which of the following is the most
probable diagnosis?

A. Leukoedema
B. Leukoplakia
C. Lichen planus
D. White sponge nevus
E. Hairy Leukoplakia A. Leukoedema

1) Leukedema
a. disappears when the mucosa is stretched
b. presents as an asymptomatic blue, grey, or white appearance on the mucosa and is seen
predominantly in the buccal mucosa
c. occurs bilaterally on the buccal mucosa and is less often on the labial mucosa, the palate, or
the floor of the mouth
d. acquired condition caused by local irritation and is found more commonly in black skinned
people and in those who smoke
e. surface of the affect area may appear folded, creating a wrinkled, white streaked lesion
Following receiving dental treatment, a very sore ulceration is noticed on a child's lower lip. The
child has no history of labial trauma before entering the dental office. Which of the following
most likely explains this ulceration?

A. Herpes labialis
B. Post-anesthetic lip bite
C. Type IV allergic reaction to the latex in the rubber dam
D. Aphthous ulcer secondary to stress B. Post-anesthetic lip bite

1) Post-anesthetic lip bite

a. due to a feeling of numbness after anesthetic delivery, a child may either intentional or
unintentionally bite on his/her lips
b. should be supervised by parents and instructed not to eat on the anesthetized side of the jaw to
prevent accidental lip biting while anesthesia is still present
A 14-year old boy presents to your office stating that an area of his left anterior mandible has
been slowly and progressively growing over the last two years. Radiographs reveal a radiolucent
lesion 2cm in diameter with a ground glass appearance. Which of the following represents the
most probable diagnosis?

A. Fibrous dysplasia
B. Osteosarcoma
C. Paget's disease of the bone
D. Florid ossesous dysplasia A. Fibrous dysplasia

1) Fibrous dysplasia
a. normal bone is replaced with fibrous bone tissue causing a "ground glass" appearance
radiographically
b. bones of the skull, thigh, shin, ribs, upper arm and pelvis are most commonly affected
c. 70% of cases is monostotic and involved one bone
d. occurs 50% more frequently in the mandible than in the maxilla

e. Radiographic Features
1) usually unilocular
2) radiopaque (usually) or radiolucent with a ground glass appearance
3) cortex is thinned and may be displaced
4) displaces anatomical structures and may or may not be displace teeth
5) poorly defined with no corticated border
6) loss of lamina dura
Which of the following dental sequelae would be MOST PROBABLE for a child to experience
if they exhibit growth failure "failure to thrive" in the first 6 months of their life?
A. Enamel hypoplasia
B. Mandibular hypoplasia
C. Microdontia
D. Midface hypoplasia
E. Dentinogenesis imperfecta A. Enamel hypoplasia

1) Enamel Hypoplasia
a. having signs and symptoms suggesting failure to thrive like enamel hypoplasia might also be
suffering from ectodermal dysplasia
b. Ectodermal hypoplasia
1) may affect all types of tissues that originated from the ectodermal embryonic layer
2) incomplete development of the following
a. hair
b. nails
c. sweat glands
d. enamel of teeth
e. oil glands
Which of the following types of dental anomalies manifests form a disturbance during the
initiation and proliferation stages of tooth development? Select all that apply.

A. Calcification
B. Mineralization
C. Number
D. Shape
E. Size A. Calcification
C. Number

1) Initiation and Proliferation Stages

a. hypodontia
b. oligodontia
c. anodontia
d. hyperdontia
e. supernumerary teeth

2) Initiation
a. Hyperdontia = patient has more than the normal amount of teeth = supernumerary teeth
b. cleidocranial dysplasia =
An examination of a 22-year-old healthy patient reveals a solitary, asymptomatic, flat, round
3mm x 3mm brown lesion on the patient's lower lip. The duration of the lesion is unknown.
Which of the following describes the most probable condition?

A. Focal melanosis
B. Malignant melanoma
C. Papilloma
D. Peutz-Jeghers syndrome
E. Compound nevus A. Focal melanosis
1) Focal melanosis
a. flat, asymptomatic brown to black pigmentations of the lip or other oral sites which develop
for unknown reason

2) Pigmented Nevi (common skin moles) and malignant melanoma

a. occur on the oral mucosa
b. melanotic macule is more more common than either conditions

3) Melanotic macules
a. oval-shaped brown
b. smooth-bordered and flat lesions
c. less than 8mm in diameter (3-4)
d. mostly on the lower lip near the midline
Which of the following periodical conditions is associated with vital pulps most often?

A. Acute apical abscess

B. Apical Cyst
C. Chronic apical abscess
D. Condensing Osteitis
E. Apical Scar D. Condensing Osteitis

1) Condensing Osteitis
a. periapical inflammatory disease resulting from a reaction to an infection of PERIODONTAL
origin, leading to bone apposition near root apices
b. common in premolars and molars
c. lesion appears as a radiopacity in the periodical area due to sclerotic reaction
d. sclerotic reaction results from a strong resistance of the patient and a low degree of virulence
of the offending bacteria
A patient who places aspirin directly into the oral vestibule, often sees a well-circumscribed
white patch on the mucosa where the aspirin was placed. What is the most likely description for
disease process in the affected tissue?

A. Atrophy
B. Focal hyperkeratosis
C. Focal hyperplasia
D. Hypertrophy
E. Tissue Necrosis E. Tissue Necrosis

1) Aspirin
a. contains acetyl salicylic acid which can cause acid burns within the mucosa of the oral cavity
b. acid within the aspirin binds to the lining epithelium and causes protein destruction that results
in acid burns of the mucosa
c. affected mucosa experiences burning pain as a result of coagulation necrosis
Which of the following conditions does an anterior crossbite usually indicate is present?
A. A Class II-division I malocclusion
B. A digit sucking habit
C. A self-correcting condition
D. A skeletal growth problem
E. A Class II-division II malocclusion D. A skeletal growth problem

1) Anterior crossbite
a. typically caused by a skeletal growth problem which affects the positioning of upper and lower
front teeth
b. cause by insufficient growth of maxilla while the mandibular growth appears to be normal
c. could also be due to the more forward position and growth of the mandible compared to the
maxilla
A 6-year0old patient presents to your office with acute primary herpetic gingivostomatitis, which
of the following would not help your patient?

A. Encourage the child to drink plenty of fluids

B. Prescribe penicillin
C. Prescribe a topcial anesthetic rince for use before meals
D. Suggest bed rest and minimal contact with others
E. Encourage a bland diet B. Prescribe penicillin

1) Gingivostomatitis
a. inflammation of the oral mucosa and gingiva
b. cause by HSV-1 that affects children and leads to painful oral ulcerations
c. often the initial presentation during the primary herpes simplex infection
d. numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations
covered by yellow-grey membranes
e. findings
1) sub-mandibular lymphadenitis
2) halitosis
3) refusal to drink

f. most common oral infection of the mouth

g. Prodromal symptoms
1) fever
2) anorexia
3) irritability
4) malaise
5) headache
Which of the following conditions is Lymphangioma related to MOST CLOSELY?

A. Cystic hygroma
B. Hemangioma
C. Hemangiopericytoma
D. Angiosarcoma A. Cystic hygroma
1) Cystic Hygroma
a. lymphatic malformations
b. congenital multiloculated lymphatic lesion that can arise anywhere, found mainly in the left
posterior triangle of the neck in children
c. considered the most common form of lymphangioma
d. contain large cyst-like cavities contain lymph and decrease in size as they approach the surface
of the skin surface
e. benign
f. can be disfiguring

g. Types
1) Macrosystic lymphatic malformations (large cysts)
2) Microcystic (small cysts)
Delayed eruption of permanent teeth can be cause by which of the following conditions?

A. Peutz-Jeghers syndrome
B. Hyperparathyroidism
C. Hyperthyroidism
D. Paget's disease of bone
E. Cherubism E. Cherubism

1) Cherubism
a. bony prominence in the lower portion in the face and uneruption of permanent teeth
b. associated with premature deciduous tooth loss due to the sponge-like quality of bone
c. associated with the uneruption of permanent teeth due to displacement of cysts and lesions
d. loss of bone in the mandible replaced with excessive amounts of fibrous tissue
e. condition should fade as child grows but may continue to disform the patient's face
Dentofacial Variations Dentofacial Variations Answers
Which of the following describes the MOST COMMON reason speech problems associated with
cleft lip and palate are observed?

A. Inability of the soft palate to close airflow into the nasal area; Inability of the tongue to stop
airflow from the epiglottis
B. Missing teeth that are involved in the articulation of sounds formed by the tongue difficult to
make
C. Poor lip musculature or heavy scars of the lips that limit vowel sound production
D. Poor tongue control and producing lisping A. Inability of the soft palate to close
airflow into the nasal area; Inability of the tongue to stop airflow from the epiglottis

1) Concept: In cleft lip and palate patients, an inability of the soft palate to close the nasal
passageways results in speech problems

2) Improper speech sounds are produced if the soft palate fails to prevent the flow of air into the
nasal passageways
3) It is important to close the nasal air passageways for producing distinct and understandable
sound.

4) The soft palate closes the nasal area for sound production.
Which of the following best describes adjunctive orthodontic treatment?

A. Early intervention using orthodontic therapy to prevent a more serious future malocclusion
B. Orthodontic therapies completed with only simple removable appliances
C. Orthodontic treatment to enhance the outcome of periodontal, prosthodontic, or operative
therapies
D. Limited orthodontic treatment of only anterior teeth for esthetics only C. Orthodontic
treatment to enhance the outcome of periodontal, prosthodontic, or operative therapies

1) Concept: Adjunctive orthodontic treatment integrates favorable orthodontic tooth movement

into a treatment plan together with other dental procedures.

2) Orthodontic treatment is completely simultaneously with other dental procedures to improve

the result of the overall treatment procedure.

3) Adjunctive orthodontics also eliminates unnecessary tooth attractions, tooth preparations, and
other periodontal, pre-prosthetic, or pre-restorative treatment to achieve more optimal outcomes.
A child with a distal step during the primary dentition will most likely develop into which of the
following permanent molar relationships?

A. Class II
B. Class III
C. Class I A. Class II

1) Concept: Distal Step

a. Presence of a distal step during the primary dentition usually results in Class II molar
relationship

2) Mesial Step
a. Mesial step occlusion usually results in either Class I or Class III molar relationship after
eruption of permanent teeth

3) Flush Terminal Plane

a. Children with a flush terminal plane occlusion however end up in a Class I, Class II, or end to
end type of molar relationship
The position of the maxilla in relation to the cranial base can be determined from which of the
following cephalometric measurements?

A. Frankfort Horizontal
B. SN-Pog
C. SNA
D. SNB
E. ANB C. SNA

1) Concept: SNA or Sella-Nasion A

a. A point angle is the parameter used to determine the relation of the patients maxilla to their
cranial base.
b. SNA values below the normal range corresponds to a retruded maxilla and probably a Class
III skeletal relationship
c. SNA values above the normal range corresponds to a protruded maxilla and Class II skeletal
relationship
d. ANB value is a useful guide in determining the relation of maxilla to the mandible
Which of the following teeth is most like to NOT erupt into the arch due to overcrowding?

A. 1st premolar
B. Central incisor
C. Lateral incisor
D. 2nd premolar
E. Canine E. Canine

1) Concept: Canines are the anterior teeth that are most likely to be unable to erupt within a
crowded dentition because the canine erupts after the incisors and premolars have already
erupted.

2) Tooth crowding may occur in patients with teeth that are too wide mesiodistally or if their
dental arch is too small to accommodate all the erupted teeth.

3) Tooth crowding carries a genetic predisposition because it is often a matter of tooth size vs.
arch size.
Malocclusion is classified by using which of the following planes of space?

A. Anterio-posterior, coronal, sagittal

B. Antero-posterior, sagittal, vertical
C. Antero-posterior, transverse, vertical
D. Horizontal, sagittal, vertical; Horizontal, transverse, coronal C. Antero-posterior,
transverse, vertical

1) Concept: Malocclusion Planes

a. The three planes of space which are used to classify malocclusion are:
1) Antero-posterior
2) Transverse
3) Vertical

2) All these are the orientation planes or the reference planes used to communicate the
dimensions of orthodontic problems.

3) Sagittal plane is used to describe the anterior-posterior relationships

4) Vertical plane is used to give the super-inferior relationships

5) Transverse plane describes right to left relationships.

Tooth calcification begins during which of the following time periods?

A. 2nd trimester
B. 3rd trimester
C. Birth
D. 1st trimester A. 2nd trimester

1) Concept: Tooth formation begins 6-8 weeks in utero

2) During tooth formation, calcification of dental layers occurs within the 14th to 19th week in
utero.

3) Calcification of teeth in utero occurs during the 2nd trimester.

A 6 year old child presents with a posterior unilateral crossbite with a functional shift. This
child's 6 year molars have NOT yet erupted. When should you intervene to correct this?

A. Immediately without waiting for the permanent 1st molars to erupt.

B. Wait until the 1st permanent molars have fully erupted and are in occlusion
C. When the child is approximately 9 years old
D. After all of the succedaneous teeth have erupted A. Immediately without waiting for the
permanent 1st molars to erupt.

1) Orthodontic evaluation and monitoring of a pediatric patient may be helpful in preventing

possible orthodontic problems.

2) Preventive orthodontics involves the evaluation and monitoring of the developing dentition of
patents ages 6 and below.

3) Normal occlusion can be achieved through the use of appliances to guide the growth and the
development of the developing dentition, bone, and musculature.

4) Crossbites can be corrected immediately during the primary dentition will help gain and
maintain the space for the secondary dentition.
A 9-year-old patient presents to your office with a unilateral posterior crossbite with a functional
shift. What is the appropriate timing for correction of the crossbite?

A. After the permanent 1st molars have fully erupted.

B. Immediately, when the child is approximately 9 years of age
C. Without waiting for the eruption of permanent 1st molars
D. After all the primary teeth have been exfoliated. B. Immediately, when the child is
approximately 9 years of age

1) Concept: Unilateral poserior crossbones are best treated immediately after their diagnosis.
2) Treatment is most appropriate for children who are currently in the late deciduous stage or
mixed dentition stage.

3) Correction is suggested at this time because arch expansion is most successful at this age and
more space is created to correct the malalignment.

4) Early orthodontic intervention and treatment of unilateral posterior crossbite offers a better
prognosis and a higher treatment success rate.
In order to effectively translate the roots of teeth, orthodontic appliances must be which of the
following?

A. Capable of exerting a positive intermittent force

B. Capable of exerting a torque/moment
C. Extremely gentle in action
D. Used with an extraoral force B. Capable of exerting a torque/moment

1) Concept: Orthodontic appliances must be capable of exerting torque/moment of force in order

to effectively translate the roots of the teeth

2) If the line of action of force passes through the center of resistance of a tooth, the tooth will
respond to pure bodily movement or translation of the roots.

3) All of the PDL is uniformly loaded during the translation movement. Approximately 100-
150g of force is needed to produce this movement.
The closure of which of the following spaces results in the late mesial shift of permanent 1st
molars?

A. Canine
B. Extraction
C. Interocclusal
D. Leeway
E. Primate D. Leeway

1) Concept: Leeway space is closed as the 1st permanent molars move medially after the
exfoliation of the primary 2nd molar and is usually seen among children from 11-12 years of
age.

2) Leeway space:
a. created from the difference of sizes between the primary canine and molars compared to the
erupting premolars and permanent canines
b. The discrepancy in size of primary molars and premolars created a free space that allows the
late medial migration of permanent 1st molar after the exfoliation of the primary 2nd molar.
A 6-year old presents to your office for extraction of L and S. The mandibular incisors have not
yet erupted. The indicated method of space maintenance for this patient is...
A. Band and loop
B. Distal shoe
C. Lower lingual holding arch
D. Nance appliance
E. No treatment needed, only observation A. Band and loop

1) Concept: Band and Loop

a. Band and loop is the best space maintainer for the early loss of a mandibular primary 1st molar
when mandibular permanent incisors are not yet present
b. fixed appliance made to prevent the medial movement into extraction sites and:

1) are durable since they are cemented to tooth structure

2) remain in the patients mouth until its permanent successor erupts
3) demonstrate high compliance rate since it is a fixed device

2) Lingual holding arch

a. are contraindicated in cases where mandibular permanent incisors have not yet erupted

3) Nance appliances
a. are cemented on the maxillary permanent 1st molars and have an acrylic button that rests on
the palate to resist forward movement

4) Hawley appliances
a. are used to actively move teeth, not necessarily maintain position in the dental arch
In the transitional analysis, which of the following dimensions are compared?

A. Leeway space to Bolton variable

B. Leeway space to freeway space
C. Space available to space required and Space available to leeway space
D. arch width to arch length C. Space available to space required and Space available to leeway
space

1) Concept: A mixed (transitional) dentition analysis is performed to predict the probability of

tooth crowding before the permanent canines and premolars erupt.

2) Predicting the sizes of unerupted permanent canine and premolars provide important
diagnostic information so the most appropriate treatment can be provided

3) Mixed dentition analysis is performed by determining the space available for the erupting
permanent teeth and comparing it to the appropriate size of the unerupted permanent canine and
premolars.
Which permanent teeth must erupt to prevent the mandibular intercanine width from increasing?

A. 1st premolar
B. 2nd premolar
C. Central Incisor
D. Lateral Incisor
E. Canine E. Canine

1) Concept: When permanent mandibular canine erupts, it moves mesially and maintains a stable
position within the corner of the mandibular arch.

2) Mandibular canines
a. are the corner tooth which, by definition, establishes the inter canine width of the mandibular
arch
b. As the mandibular canine push the lateral incisors in a mesial direction, they also prevent any
further increase in the intercanine width.
Which of the following is a mandibular plane angle that is higher than average associated with?

A. A vertical growth pattern and a Class II division 2 malocclusion

B. A vertical growth pattern and a long lower anterior face height
C. Deep overbites with a Class I Division II malocclusion
D. Deep overbites with a long lower anterior face height
E. Deep overbites with a vertical growth patterns B. A vertical growth pattern and a long
lower anterior face height

1) Concept: Because of a vertical growth pattern, the mandibular plane angle becomes steeper
and the lower anterior face height also simultaneously increases

2) Patients with deep overbites and a vertical growth pattern may exhibit steep mandibular plane
angles but NOT a long lower anterior face height due to the type of dental occlusion that the
patient demonstrates.

3) High mandibular plane angles elongate the face because of a lack of distinction between the
jaw line and the jaw angle.
A 10-year-old patient presents to your office with a 2.5mm diastema and low attached maxillary
labial frenum. Which of the following is the best option for this patient?

A. Observe until after eruption of permanent canines

B. Place a 6x6 edgewise appliance to close the space
C. Provide treatment before complete eruption of maxillary incisors
D. Perform a frenectomy when first observed A. Observe until after eruption of permanent
canines

1) Concept: Eruption of maxillary canines in children ranging from age 11 to 12 usually will
close the diastema between the maxillary central incisors.

2) Diastema
a. Diastemas in between maxillary central incisors normally occur during the mixed dentition
stage.
3) Frenectomy will be indicated if the maxillary canines had already erupted and were unable to
close the diastema due to a lowly attached or fibrous maxillary labial frenum.
Which of the following teeth are measured to predict the size of the unerupted canines and
premolars when performing a Moyers mixed dentition analysis?

A. Deciduous molars and canines

B. Mandibular incisors
C. Maxillary incisors
D. Maxillary incisors for the maxillary arch and mandibular incisors for the mandibular arch
D. Maxillary incisors for the maxillary arch and mandibular incisors for the mandibular
arch

1) Concept: Moyer's Mixed Dentition Analysis

a. uses the total mesiodistal width of the central and lateral incisors of a certain arch to predict
the size of the unerupted canines and premolars
b. Moyer's mixed dentition analysis measures the total mesiodistal width of central and lateral
incisors of an arch and matches the measurement with a table of values that corresponds to the
predicted size of the premolar and canine
c. The prediction chart of Moyer holds possible values or measurements of canines and
premolars in proportion wight present permanent central and lateral incisors
d. Mixed dentition analysis can be performed once the predicted values are taken by comparing
the space available in the arch and the space needed by the erupting canines and premolars.
Which of the following facial dimensions remain MOST stable from birth to maturity?

A. Depth
B. Height
C. Width C. Width

1) Concept: Of all the facial dimension, the width of the face remains constant throughout life.

2) The depth and height of a face undergo remarkable changes over the course of life due to loss
of teeth, loss in occlusal/vertical dimensions, and skin wrinkling from age.
Space for the mandibular 2nd and 3rd molar eruption is created through the bone...

A. Apposition of the anterior border of the ramus

B. Resorption at the anterior border of the ramus
C. Resorption of the posterior border of the ramus
D. Apposition of the alveolar processB. Resorption at the anterior border of the ramus

1) Concept: The anterior border of the ramus undergoes resorption while bone is simultaneously
deposited of at the posterior border of the ramus.

2) Resorption of the ramus along its anterior border creates sufficient space for the eruption of
the 2nd and 3rd permanent molars.
3) The continuous resorption and deposition of bone along the borders of the ramus during the
growth stages helps maintain the ramus width while providing extra alveolar bone space for the
erupting molars.
Approximately what percentage of a permanent tooth's root structure has typically developed
when the tooth first emerges into the oral cavity?

A. 33%
B. 66%
C. 80%
D. 90%
E. 25%B. 66%

1) Concept: Approximately about 2/3 of the root should already be formed before the tooth
erupts into the oral cavity

2) Based on Nolla's stage of tooth eruption, the tooth begins to erupt when the root reaches about
2/3 of its complete form.
Which of the following teeth typically drift mesially?

A. Mandibular 2nd premolars

B. Permanent mandibular central incisors
C. Permanent maxillary 2nd molars
D. Primary mandibular canines
E. Primary maxillary 2nd molars C. Permanent maxillary 2nd molars

1) Concept: Permanent maxillary 2nd molars typically drift medially following the loss of the
permanent maxillary 1st molar

2) The permanent maxillary 1st molars are among the first erupting teeth in the oral cavity.
Permanent maxillary 1st molars often decay and become unrestorable, or their extraction is
planned by an orthodontist to relieve crowding.

3) In such cases, permanent maxillary 2nd molars have a tendency to drift medially and take the
space of the permanent maxillary 1st molars. These teen quickly establish good contact with 2nd
premolars.

4) Mesial drift principles

a. when a tooth is extracted, the neighboring teeth will typically drift to the extraction space
b. mesial drift movement of the unerupted teeth (within the bone) is similar to the bodily
movement experienced during orthodontics, especially in the upper arch
c. due to the long axis of the teeth, the spontaneous closure of the extraction space in the upper
arch is better than the lower arch
d. timing of extraction is important
The cusp of Carabellis is most commonly found on which primary tooth?

A. Mandibular 1st molar

B. Mandibular 2nd molar
C. Maxillary 2nd molar
D. Maxillary 1st molar C. Maxillary 2nd molar

1) Concept: The cusp of Carabellis is a feature of the primary maxillary 2nd molar.

2) It is usually positioned at the mesiolingual cusp of the primary 2nd molar which could appear
as a small cusp or a triangular protrusion.

3) The cusp of Carabelli is most common among Europeans.

4) In PERMANENT dentition, the cusp of Carabelli is associated with the maxillary 1st molar.
How many roots are typically possess by the primary maxillary 1st molar

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

1) Concept: Primary maxillary molars like permanent maxillary molars also present with three
roots.

2) The premolars that replace the maxillary molars usually have one of two roots.

3) Primary mandibular molars typically present with two roots.

Which of the following primarily contributes to the increase in height experiences by the
maxillary bones?

A. Apposition of the tuberosity

B. Apposition of the anterior surface
C. Sutural growth
D. Alveolar growth D. Alveolar growth

1) Concept: Increases in maxillary height are due to the growth of alveolar bone which provides
enough space for the development and the eruption of teeth

2) Alveolar bone support the tooth as it erupts into the oral cavity.

3) Alveolar bond remodels and grows simultaneously with tooth eruption.

Which of the following eruption sequences is usually observed in the primary dentition?

A. 1st molar, central incisor, lateral incisor, 2nd molar, and canine
B. 1st molar, central incisor, lateral incisor, canine, 2nd molar
C. Central incisor, lateral incisor, 1st molar, canine, and 2nd molar
D. Central incisor, lateral incisor, canine, 1st molar, and 2nd molar C. Central incisor, lateral
incisor, 1st molar, canine, and 2nd molar
1) Concept: Central incisor, lateral incisor, 1st molar, canine, and 2nd molar

2) Guidelines for eruption of deciduous teeth

a. incisors: 6 months
b. 1st molars: 12 months
c. canines: 18 months
d. 2nd molars: 24 months

Note: this is an easy way to remember eruption sequences for deciduous teeth (6 month
intervals). Remember that mandibular dentition is normally before maxillary eruption.
Which of the following cephalometric measurements is likely to increase as a 13-year old child
with a Class III malocclusion ages?

A. SN
B. SNA
C. SNB
D. Y-Axis
E. ANB C. SNB

1) Concept: SNB angle will increase in value when the B point of the mandible extends more
anteriorly as demonstrates in a growing child with Class III malocclusion

2) SNB angle is the angle created by the intersection of Sella - Nasion plane and the B point of
the mandible.

3) SNB angle value is lower among patins with a Class I or Class II skeletal relationship as
compared with skeletal Class III patients.
Using a cervical pull headgear in the case of an 11-year-old prepubertal child should create each
of the following conditions EXCEPT one. Which is the EXCEPTION?

A. The forward growth of the mandible will be increased

B. The forward growth of the maxilla will be decreased
C. The permanent maxillary 1st molars will move distally
D. The child's bite will open A. The forward growth of the mandible will be increased

1) Concept: Cervical pull headgear is an appliance used to REDUCE the forward growth of the
maxilla and DOES NOT increase mandibular growth.

2) Cervical pull headgear is composed of the neck strap, and inner and outer face bow
a. The neck strap acts as an extra-oral anchorage
b. The outer bow connects the face bow assembly with the backstrap
c. The inner bow is inserted into the tubes found on the molar bands
d. inhibits the growth of the maxilla and causes the maxillary molars to extrude lessening the
deep bite
e. The headgear must be worn regularly for 14 hours per day for optimum results.
Which proper is most important for defining a tooth's character and individuality?

A. Color
B. Texture of enamel
C. Translucency
D. Shape B. Texture of enamel

1) Concept: Enamel texture is the most important factor in determining the individual character
of teeth.

2) As enamel ages, it becomes:

a. thinner
b. less translucent
c. worn

3) Changes in enamel are due to ear, abrasion, erosion, and attrition

4) Younger teeth exhibit thicker, more translucent, and rougher enamel

5) Adult teeth appear smoother, shorter, and darker

Hypertrophy of the mandibular condyle may lead to each of the following scenarios EXCEPT...

A. Anterior crossbite
B. Anterior open bite
C. Asymmetric facial appearance
D. Ipsilaeral posterior open bite
E. Unilateral Class III malocclusion B. Anterior open bite

1) Concept: Condylar hypertrophy can affect the occlusal harmony of teeth and could even result
in facial asymmetry

2) Condylar hypertrophy may occur with one or both condylar heads.

3) With unilateral condylar hypertrophy the enlarged condyle lowers the jaw angle. The
symphysis of the affected jaw will then move towards the non affected side.

4) This can cause unilateral malocclusion, asymmetric facial appearance, possible anterior
crossbite, and ipsilateral posterior open bite

5) Condylar hypertrophy can NOT lead to anterior open bite.

How many hours should a cervical pull headgear be worn to be most effective?

A. 10
B. 12
C. 14
D. 6
E. 8
F. 4 C. 14

1) Concept: Cervical pull headgear is an appliance used to correct Class II malocclusion with
deep bite.

2) Cervical pull headgear is composed of the neck strap, and inner and outer face bow
a. The neck strap acts as an extra-oral anchorage
b. The outer bow connects the face bow assembly with the backstrap
c. The inner bow is inserted into the tubes found on the molar bands
d. inhibits the growth of the maxilla and causes the maxillary molars to extrude lessening the
deep bite
e. The headgear must be worn regularly for 14 hours per day for optimum results.
Which of the following area is primary responsible for the vertical growth of the mandible?

A. Condylar Head
B. Coronoid process
C. Mental protuberance
D. Sigmoid Notch
E. Alveolar Process A. Condylar Head

1) Concept: Growth of the condylar head is most responsible for the increase in mandibular
vertical height
2) Growth of the alveolar process, coronoid process, mental protuberance, and sigmoid notch do
not push the mandible away from the cranium, and therefore are not responsible for the increase
in vertical facial height
The facial profile of most people change as they age and mature through becoming...

A. Less convex
B. More convex
C. The same level of convexity
D. Less concave A. Less convex

1) Concept: The facial profile may vary as we age due to the loss of facial fat, muscle atrophy,
and loss of skin elasticity.

2) The buccal fat pad is gradually lost in the cheeks, causing the skin to adapt itself to the
underlying muscles and bone

3) During the aging process, metabolism slows down and the production of skin, collagen, and
muscle fibers is reduced.

4) The constant pull of gravity also contributes to the sagging of the face.
Behavior Behavior Answers
Alec is hyperactive child that has trouble paying attention, which medication might be prescribed
to help him?
A. Alpraxolam
B. Clonadine
C. Methylphenidate
D. Doxapram C. Methylphenidate

1) Mehylphenidate
a. psychostimulant approved in treating people with attention-deficit hyperactivity (ADHD)
b. reduces the dopamine and norepinephrine reuptake, increasing their levels thereby improving
their function as neurotransmitters in the brain.
c. similar pharmacological effect to cocaine but lower potency and the duration is longer
When communicating with pediatric patients which principle should be employed?

A. Both parent and dentist communicate with the child at the time
B. IM ketamine 20mg/kg
C. Immediately use voice control so that you can establish a power dynamic from the beginning
that the child will respect
D. Substitute easily understandable words and concepts for dental terminology (e.g. make your
tooth fall asleep for anesthesia)
E. Only have the parent answer questions since they know what is happening and can accurately
report D. Substitute easily understandable words and concepts for dental terminology (e.g. make
your tooth fall asleep for anesthesia)
Which of the following agents is the MOST APPROPRIATE to administer to a 5-year-old child
that is shy, fearful, and timid?

A. Promethazine only
B. Fentanyl
C. Hydroxyzine hydrochloride
D. Nitrous oxide/oxygen
E. Promethazine and meperidine D. Nitrous oxide/oxygen

1) Nitrous oxide sedation

a. generally acceptable to shy and fearful children
b. most clinicians find it appropriate to administer nitrous oxide sedation before carrying out
treatment in pediatric patients because it helps in the elimination of anxiety and dental treatment
phobia
c. most children feel more comfortable when being treated under nitrous oxide sedation and are
often enthusiastic about its administration
Broad knowledge of which of the following pairs is imperative to understand the development of
human behavior?

A. Dependence and independence

B. Ethnicity and Gender
C. Facilitation and generalization
D. Learning and maturation D. Learning and maturation
1) Learning and maturation
a. importan pre-requisites for understanding the development of human behavior
b. growth of the structure of the human body makes it possible to perform several activities and
these activities make learning possible
c. learning is extremely important for acquiring new knowledge, skills, and attitudes that are
necessary for an effective life
d. maturation is developmental process within which a person from time to time manifests
different traits present in his cells
Which of the following types of parenting styles usually leads to children that are shy and
submissive?

A. Empathetic
B. Overindulgent
C. Overprotective
D. Under-affectionate
E. Under-attentive C. Overprotective

1) Overprotective parents
a. overprotective nature of parents leads to shyness in children
b. show submissive behavior in society and their social circle
c. personality development of these children remains incomplete
d. produce a lack of confidence in their children which results a permanent psychological trauma
in them which they carry with them forever
Which of the following is NOT one of the 5 domains of pediatric patient management?

A. Aversive (punishments)
B. Linguistic
C. Pharmacological
D. Physical
E. Reward oriented
F. Authoritative D. Physical

1) Physical
a. physical means to control patient misbehavior and promote positive behavior of pediatric
patient
b. usually achieved using papoose boards, belts, tape and cloth wraps to keep them restrained

2) Pharmacological
a. anesthetics, sedative drugs and inhalers to make a child calm during dental treatment

3) Rewards
a. uses rewards to reinforce good behavior from pediatric patients

4) Aversive
a. parental spanking and the hand-over-mouth technique
5) Linguistic
a. requires the dentist to be a good communicator, a coach and a friend for the pediatric patient to
promote good patient behavior
b. necessitates that the child be able to comprehend language
Which of the following is a general description of children exhibiting what is classified as
defiant behavior?

A. They are also regarded as stubborn and spoiled

B. They are usually 4 years of age or younger A. They are also regarded as stubborn and
spoiled

1) Defiant behavior
a. too much pampering by parents makes their children act spoiled and stubbornly
b. want to get things done in their own way in spite of the consequences
c. do NOT like to be advised by their elders
d. must be death with positive reinforcement
Which of the following methods describes the MOST CONVENIENT way to conduct an
examination of an 18-month-old child?

A. A parent sitting in the dental chair with the child sitting on their lap facing forward
B. This child sitting in the dental chair with a parent sitting chair side
C. The clinician and a parent in a knee-to-knee position with the child's head in the clinician's lap
D. The clinician and a parent in a knee-to-knee position with the child's head in the parent's lap
C. The clinician and a parent in a knee-to-knee position with the child's head in the
clinician's lap

1) Knee-to-knee position
a. helps to build a relation of trust and confidence between the clinician and the patient
b. child feels more comfortable and safe while facing his/her parent
c. dentist gets maximum visibility to examine the oral cavity and facial structures
d. most convenient way for carrying out examination of an infant
Familiarization is a technique to best manage fearful pediatric patients who

A. Are diagnosed with schizophrenia

B. Have an aggressive behavior problem
C. Have had previous traumatic medical experience
D. Mirror the behavior of parents who are fearful of dentists
E. Are physically handicapped D. Mirror the behavior of parents who are fearful of
dentists

1) Familiarization
a. psychological behavior management technique meant to help children relax while inside the
dental clinic
b. introducing the dental setting and the common instrument that are used in the clinic in order to
remove the fear from pediatric patients
c. demonstrates the dental instruments and that there is not anything to fear by their use is the
child's mouth
Systemic Pathology Systemic Pathology Answers
Which of the following is NOT a MAJOR sign/symptom of rheumatic fever based on Jones
criteria?

A. Carditis
B. Chorea/dyskinesia
C. Fever
D. Polyarthritis
E. Erythema marginatum C. Fever

1) Concept: Rheumatic fever is an inflammatory disease that occurs after a Strep progenies
infection or scarlet fever and is caused by antibody cross reactivity from the Strep M protein

2) Fever is considered a MINOR criteria under the Jones classification, not a MAJOR criteria.

3) Major criteria under the Jones classification are:

1) Polyarthritis
a. a temporary migrating inflammation of the large joints, usually starting in the legs and
migrating upwards

2) Carditis
a. inflammation of the heart muscle (myocarditis) which can manifest as congestive heart failure
with shortness of breath, pericarditis with a rub, or a new heart murmur

3) Subcutaneous nodules
a. painless, firm collections of collagen fibers over bones or tendons.
b. They commonly appear on the back of the writs, the outside elbow, and the front of the knees

4) Erythema marginatum
a. a long-lasting reddish rash that begins on the trunk or arms as macules, which spread outward
and clear in the middle to form rings, which continue to spread and coalesce with other rings,
ultimately taking on a snake-like appearance

5) Chorea (St. Vitus' dance)

a. characteristic series of rapid movements without purpose of the face and arms that can occur
very late in the disease for at least three months from onset of infection
What is the greatest risk to a patient with adrenal insufficiency if they are subjected to a highly
stressful situation?

A. Atrial fibrillation
B. Cardiovascular collapse
C. Hyperventilation
D. Hypoxia
E. Hypotension B. Cardiovascular collapse

1) Concept: Patients suffering from adrenal insufficiency are at risk of cardiovascular collapse
when subjected to highly stressful situations

2) Continuous low cortisol levels during stressful events, contribute a lower cardiac output and
low blood pressure that could eventually lead to cardiovascular collapse.

3) Adrenal insufficiency occurs when the adrenal glands produce insufficient amount of steroid
hormones like cortisol and aldosterone

4) Cortisol
a. stimulate gluconeogenesis in the liver. Cortisol also helps maintain normal blood pressure
during stressful situations and creates additional energy to cope up with such stress.
b. increases blood pressure by increasing the vasculature sensitivity to epinephrine and
norepinephrine which stimulate cardiac output
A patient's radiographs display bulbous crowns, obliterated pulps, and shortened roots. Which of
the following conditions is described by these findings?

A. Gardner's syndrome
B. Osteogenesis imperfecta
C. Pierre Robin syndrome
D. Scleroderma
E. Amelogenesis imperfecta B. Osteogenesis imperfecta

1) Concept: Osteogenesis imperfecta

a. is suggested radiographically by a thin bone cortex and bulbous crowns, obliterated pulps, and
shortened tooth roots
b. most common congenital bone disorder where patients are born with defective connective
tissue, or without the ability to make it usually because of a deficiency of Type-I collagen.
c. teeth are described as shell-like because enamel may fracture off and increased wear will occur

2) Types
1) Type I
a. collagen is of normal quality but is produced in insufficient quantities
b. blue sclera
c. bones fracture easily

2) Type II
a. collagen is not of a sufficient quality of quantity
b. most cases die within the first year of life due to respiratory failure or intracerebral
hemorrhage
c. severe respiratory problems due to underdeveloped lungs
d. severe bone deformity and small stature
Which of the following has not been proved to be a causative factor in human pro-facial clefting?
A. Anticonvulsant drugs
B. Malnourishment
C. Tylenol
D. Vitamin imbalance C. Tylenol

1) Concept: Potential causes of orofacial clefting

a. maternal nutrition low intake of folic acid
b. alcohol and cigarette use
c. nitrate compounds and organic solvents
d. lead
e. medications

2) Cleft lip
a. occurs when the frontomaxillary process and maxillary processes that form the upper lip fail to
fuse together

3) Cleft palate
a. occurs when the palatal shelves that grown medially towards each other fail to fuse

4) During the sixth week in utero, the embryo undergoes these processes ad is very sensitive to
environmental pollutants and malnutrition
For patients suffering from type I diabetes, which of the following precautions should be
observed.

A. No special precautions are necessary

B. The appointment should begin after a meal and insulin injection
C. The patient should be seen after a meal and postpone the insulin injection until after the
procedure
D. The patient should have an empty stomach and postpone the insulin injection until after the
procedure
E. The patient should have an empty stomach and should take insulin before the procedure
B. The appointment should begin after a meal and insulin injection

1) Concept: Diabetic patients must maintain a normal serum glucose level before, during and
after the dental treatment to prevent any further complications.

2) The intake of food will prevent the diabetic patient from having hypoglycemia. Severe
hypoglycemia if not properly managed will result in patient's unconsciousness, seizures, and
even death if not managed properly.

3) Insulin administration maintains a consistent blood glucose level to prevent hyperglycemia.

Which of the following conditions is characterized by chronic respiratory infections, functional
disturbances in the secretory mechanisms of various glands, and steatorrhea?

A. Cystic fibrosis
B. Diabetes Type I
C. Mercury poisoning
D. Acquired immune deficiency syndrome A. Cystic fibrosis

1) Concept: Cystic fibrosis is a genetic disorder resulting in the inability of the body to bring salt
and water in and out of cells.

2) The situation results in the excessive production of sticky and viscous mucus in the lungs and
digestive tract.

3) Cystic fibrosis also affects the production of digestive enzymes that break down fats, causing
them NOT be absorbed, resulting in a fatty stool called steatorrhea.

4) Cystic fibrosis also affect the reproductive system and alters the function of sweat glands in
the body.
Which of the following disorders is characterized by a delayed ossification of midline structures
and supernumerary teeth?

A. Cleidocranial dysostosis
B. Ectodermal dysplasia
C. Neurofibromatosis
D. Osteogenesis imperfecta
E. Amelogenesis imperfecta A. Cleidocranial dysostosis

1) Concept: Cleidocranial dysostosis (dysplasia)

a. autosomal dominant disorder where there is delayed ossification of midline structures
(clavicles), supernumerary teeth, and a prognathic mandible.
b. general skeletal condition named by the collarbone (cleido-) and cranial deformities which
patients with this disorder often exhibit
c. Clavicle presence can range from partly missing to completely missing in 10% of cases, which
allows hyper mobility of the shoulders including ability to touch the shoulders together in front
of the chest
d. mandible is typically prognathic due to hypoplasia of maxilla (micrognathism) and other facial
bones
e. Pantomographs typically demonstrate multiple unerupted supernumerary teeth resembling
premolars, missing genial angles and underdeveloped maxillary sinuses
f. Supernumerary teeth often appear unless they reabsorb before adolescence, otherwise they will
crown the permanent teeth in an already underdeveloped jaw and will need to be extracted to
make space for the permanent dentition
g. Bossing (bulging) of the forehead is also observed in these patients.
h. A soft spot on the top of the head may appear because the fontanelle failed to close, or closed
late.
Which systemic disease lowers the patients' immune system capacity and decreases wound
healing potential?

A. Beriberi
B. Diabetes Mellitus
C. Pelegra
D. Polycystic kidney disease
E. Systemic lupus erythematosus B. Diabetes Mellitus

1) Concept: Diabetes Mellitus is a systemic disease that lowers the body's immune response
because of an altered cell mediated immune response

2) Effects
a. Impaired neutrophil chemotaxis, causing slower reaction against pathogens and faster rate of
progression of infection
b. Impaired would healing potential since blood flow to tissue is decreased
c. Peripheral and autonomic neuropathy
d. Chronic kidney disease
e. Cardiovascular disease
f. Eye related problems
Which disorder is a considered a chromosomal abnormality that is a result of either chromosomal
nondisjunction or translocation?

A. Ehler-Danlos syndrome
B. Klinefelter syndrome
C. Turner syndrome
D. Trisomy 21 (Down syndrome) D. Trisomy 21 (Down syndrome)

1) Concept: Patients with Down's syndrome possess 3 copies of chromosome 21 instead of 2

copies. This condition is considered as the most commonly occurring chromosomal abnormality
in humans.

2) Trisomy 21 occurs before of meiotic nondisjunction, which is a situation where a gamete from
a parent contains excess chromosomes.

3) Affected gametes posses 24 chromosomes instead of only 23 which upon combining with a
"normal" gamete, will form an embryo that has 47 chromosomes with three set of chromosomes
21.
Which of the following is not a characteristic of ectodermal dysplasia?

A. Atrophic skin
B. Blue sclera
C. Defective hair
D. Hypoplastic sweat glands
E. Hypodontia (oligodontia) B. Blue sclera

1) Concept: Blue scleras are NOT a characteristic of Ectodermal dysplasia, but are a clinical sign
that usually manifests in diseases like Osteogenesis imperfect, Ehlers-Danlos syndrome, and
Marfan syndrome

2) Ectodermal dysplasia
a. group of genetic disorders which occur due to poor development of organs and body structures
that are ectodermal in origin
b. may cause abnormal development of failure of formation of the structures within the body that
originate from the ectoderm which includes the teeth, skin, hair, and sweat glands
In patients suffering from multiple sclerosis...

A. Anesthetic dosage required for a given procedure is more than for a normal patient
B. Anesthetics do not last as long as it would for a normal patient
C. Epinephrine in local anesthetics are contraindicated
D. Anesthetic dosage required for a given procedure is less than for a normal patient C.
Epinephrine in local anesthetics are contraindicated

1) Concept: Epinephrine should not be used for patients suffering from multiple sclerosis
because epinephrine can aggravate the condition by regulating the activation of blood
lymphocytes.

2) Epinephrine is a cetecholamine and neurotransmitter responsible for the body's flight- or flight
response.

3) Elevating the levels of epinephrine also increases blood lymphocyte activity which could
cause further damage to the myelin sheaths of the neurons thereby aggravating multiple sclerosis
condition.
Which of the following age groups is most likely to incur primary herpetic gingivostomatitis?

A. 11-15 years
B. 16-20 years
C. 21-25 years
D. 6-10 years
E. 1-5 years E. 1-5 years

1) Concept: Vesicles commonly appear on the gingiva, oral mucosa, and vermilion border and
usually affects children 5 years old or less.

2) Herpetic gingivostomatitis
a. an acute viral disease cause by the herpes simplex virus

3) Primary herpetic gingivostomatitis

a. is an infection transmitted through direct contact or through aerosol droplet that clinically
apparent as yellow fluid-filled vesicles that leave ulcers when the vesicles rupture.

4) Secondary herpetic gingivostomatitis

a. a reactivation of the latent virus due to trauma, stress or immunosuppression.
b. The vesicles maybe found intramurally or extra orally on keratinized surfaces.
Which of the following permanent teeth cause concern about the eruption sequence in serial
extraction cases?
A. Mandibular 1st and 2nd premolars
B. Mandibular canines and 1st premolars
C. Maxillary canines and 1st premolars
D. Mandibular 1st molars and incisors B. Mandibular canines and 1st premolars

1) Concept: The canines often erupt before the mandibular premolars and crowding of anterior
teeth may occur if the normal eruption sequence is disrupted.

2) Serial extraction procedures are performed to prevent the crowding of teeth.

3) In serial extraction cases, primary canines are extracted when a child reaches age 8 of 9 to
facilitate incisor alignment. The primer 1st molars are extracted after one year to speed up
eruption of 1st premolars. The erupted 1st premolars are then extracted to facilitate canine
eruption and alignment in the arch.
Which of the following clinical signs is indicative of acute herpetic gingivostomatitis?

A. Discrete spherical vesicles

B. Necrotic ulceration of interdental papilla
C. Solitary, localized, edematous gingival lesion
D. Cold-sensitive teeth A. Discrete spherical vesicles

1) Concept: Gingivostomatitis is an inflammation of the oral mucosa and gingiva caused

predominantly by HSV-1. Herpes presents as numerous pin-head vesicles, which rupture rapidly
to form painful irregular ulcerations covered by yellow-gray membranes.

2) Primary herpetic gingivostomatitis

a. is an infection transmitted through direct contact or through aerosol droplet that clinically
apparent as yellow fluid-filled vesicles that leave ulcers when the vesicles rupture.

3) Secondary herpetic gingivostomatitis

a. a reactivation of the latent virus due to trauma, stress or immunosuppression.
b. The vesicles maybe found intramurally or extra orally on keratinized surfaces.

4) Prodromal symptoms include

a. Fever
b. Anorexia
c. Irritability
d. Malaise
Which of the following are considered an adverse side effect of corticosteroid use EXCEPT one.
Which is the EXCEPTION?

A. Depression
B. Gastro-intestinal disturbance
C. Moon face
D. Striae
E. Weight gain
F. Buffala Hump B. Gastro-intestinal disturbance

1) Concept: Cushing's syndrome DOES NOT include gastrointestinal disturbances

2) Cushing's syndrome describes the signs and symptoms associated with prolonged exposure to
inappropriately high levels of the hormone cortisol
b, can be caused by taking glucocorticoid or diseases that result in excess cortisol,
adrenocorticotropic hormone (ACTH), or CRH levels.
c. Signs and symptoms include:
1) Extreme weight gain
2) Buffalo hump (fat deposition in the upper central back)
3) Moodiness, irritability, or depression
4) Muscle and bone weakness
5) Memory and attention dysfunction
6) Osteoporosis
7) Diabetes Mellitus
8) Hypertension
9) Immune suppresion
10) Sleep disturbances
11) Menstrual disorders such as amenorrhea in women and decreased fertility in men
12) hirsutism
13) baldness
14) hypercholesterolemia
15) edema

Corticosteroid Adverse Side Effects: "CUSHINGS BAD MD":

C: Cataracts
U: Up all night (sleep disturbances)
S: Suppression of HPA axis
H: Hypertension
I: Infections
N: Necrosis (avascular)
G: Gain Weight
S: Striae
B: Buffalo Hymp
A: Acne
D: Diabetes
M: Myopathy, moon faces
D: Depression and emotional changes
Which of the following describes the MOST common form of leukemia observed in pediatric
patients?

A. Granulocytic
B. Lymphoblastic
C. Monocytic
D. Myelomonocytic
E. Eosinophilic B. Lymphoblastic

1) Concept: Acute lymphoblastic leukemia (ALL) is also called acute lymphocytic leukemia
accounts for 3/4 of the cases of childhood leukemia

2) Almost all cases of childhood leukemia are acute, which means they develop rapidly. A very
low number are chronic and develop slowly.

3) Types of childhood leukemia include:

a. Acute lymphoblastic leukemia (Acute lyphocytic leukemia) is the most common type of
childhood leukemia
b. Acute myelogenous leukemia (AML) is the 2nd most common type of childhood leukemia
c. Chronic myelogenous leukemia (CML) is rare in children
d. Chronic lymphocytic leukemia (CLL) is very rare in children
e. Juvenile myelomonocytic leukemia (JMML) is a rare type that is neither chronic nor acute and
occurs most often in children under age 4.
f. Hybrid or mixed lineage leukemia is a rare leukemia with features of both ALL and AML
Of the following pathologies, which disease may modify the inflammatory process?

A. Hemophilia B
B. Hypoparathyroidism
C. Leukemia
D. Sickle cell anemia
E. Hemophilia A C. Leukemia

1) Concept: Leukemia
a. type of cancer of the blood or bone marrow characterized by an abnormal increase of
immature white blood cells
b. white blood cells or leukocytes are involved in the immune response of the body to infection
and inflammation
c. Due to the central role of leukocytes in the development and propagation of inflammation,
defects in leukocyte function often result in a decreased capacity for inflammatory defense with
subsequent vulnerability to infection.

2) Hemophilia
a. describes an abnormality in the clotting pathway, which does not interfere with the
inflammatory process

3) Sickle cell anemia

a. is a defect or red blood cells where they are unable to carry oxygen as efficiently, and has no
effect on the inflammatory process
The inferior concha is composed of all or part of which of the following bones?

A. Maxilla
B. Palatine
C. Sphenoid
D. Turbinate
E. Ethmoid D. Turbinate

1) Turbinate
a. narros and sea-shell appearing bone that extends ion the nasal air passage
b. have 4 grooved air channels which divides and forces the inspired air to flow steadily into the
nasal passages
c. responsible for warming, humidifying, and filtering the inhaled air
The major reason for loss of transplanted autogenous 3rd molars is

A. immune rejection
B. inadequate root length
C. traumatic occlusion
D. infection C. traumatic occlusion

1) The failure of autogenous tooth transplants which include chronic root resorption,
inflammatory resorption, marginal and apical periodontitis, dental caries and occlusal trauma.

2) 3rd molars used for autogensou tooth transplant procedures most commonly fail due to their
inability to withstand the heavy occlusal forces that exist in the posterior during mastication

3) Due to the mechanical advantage of a type III lever like the jaw, occlusal forces increases as
you move posteriorly in the mouth (closer to the fulcrum/condyle).
The primary symptoms to demonstrate when midazolam (Versed) has been injected intra-
arterially rather than intravenously is:

A. rapid decrease in blood pressure

B. rapid decrease in respiration rate
C. severe cardiac arrhythmia
D. severe pain in the extremity
E. exaggerated sedation due to the more direct effect of the drug D. severe pain in the
extremity

1) Intra-arterial injection of midazolam stated that some of the patients experiences moderate to
severe pain within the extremity where it was administered.

2) Adverse reactions from accidental intra-arterial injection can be localized within the site of
injection or systemic.
A 14-year-old patient presents with an indurated and asymptomatic swelling in the mandibular
premolar area. All teeth tested vital. Radiographs reveal a discrete 41mm radiolucency in the
premolar area. Which of the following diagnostic procedures should be done to discern the
proper diagnosis?

A. Alkaline phosphatease determination

B. Complete blood cell count
C. Computed tomography scan
D. Excisional biopsy
E. Aspiration/needle biopsy E. Aspiration/needle biopsy

1) After evaluating the diagnostic data, the next step is to determine the type of cells within the
lesion through needle biopsy.

2) Histopathologic examination of cells within a lesion can determine if the lesions neoplastic or
not.

3) Combining the radiographic, visual, physical and histopathologic assessment of the lesion
improves the changes of arriving at a correct diagnosis and the proper treatment.
A chronic infection of the mandible of a middle-aged female patient was treated with oral Pen
Vk for 3 weeks. The primary infections appears to be resolved, but the patient now has white
patches on the dorsum of her tongue and buccal mucosa. Which of the following is the suggested
treatment for this patient?

A. Discontinue Pen Vk and prescribe nystatin troches.

B. Discontinue Pen Vk treatment and prescribe a broad spectrum antibiotics
C. Discontinue all antibiotics only
D. Discontinue Pen Vk and prescribe a mouthwash containing metronidazole A.
Discontinue Pen Vk and prescribe nystatin troches.

1) Prolonged intake of antibiotics disturbs the balance of the microflora in the mouth by killing
the "normal" bacteria, allowing the fungal species like Candida albicans to grow unhindered by
competition.

2) The white patches on the dorsal surface of the tongue that appeared after prolonged antibiotic
uses are caused by the increased number of Candida albicans.
Surgery Surgery Answers
Which of the following does a clinician place a mucosal graft onto in order to directly increase
the anterior mandibular vestibular depth?

A. Bone
B. Epithelium
C. Mucosa
D. Muscle
E. Periosteum E. Periosteum

1) Mucosal Grafts
a. clinicians place a mucosal graft directly onto the periosteum in order to increase the anterior
mandibular vestibular depth
b. have good prognosis with minimal chances of graft rejection
c. periosteum has a rich blood supply that promotes healing and a quick connection to the graft
d. less successful when placed directly over the bone, mucosa, muscle, or epithelium
Which of the following portions of a forceps is most likely to accidentally crush the lip of a
patient?

A. Beak
B. Balde
C. Handle
D. Hinge
E. Shank D. Hinge

1) Hinge
a. of the forceps lies nearest to the lips during the extraction procedure and is the most likely
portion to cause lip injury
b. adaptation of the forces beak and blade into the tooth will have the hinge approximating the
lower lip, especially during the extraction of posterior teeth

2) Handle
a. is held by the dentist and will less likely cause lip damaged when properly handled.
A patient presents with a large facial laceration with irregular/necrotized wound margins. Which
of the following surgical principles should you follow when making an elliptical incision to
achieve primer closure?

A. The excision of the use or irregular/necrotic tissue should be as conservative as possible

B. The incision should be 3 times longer than it is wide
C. The incision should be parallel to the dermatologic tension lines
D. The wound margin tissue should be undermined to achieve primary closure
E. Only silk sutures can be used due to their strength C. The incision should be parallel to
the dermatologic tension lines

1) Incision lines should be made parallel to the dermatologic skin tension lines
a. to reduce scar visibility after wound healing
b. necrotized margin should be removed minimally
c. enables the most optimal primary wound closure and will not distort the skin's normal flow,
allowing the scar to blend in better
d. length of the elliptic incision should be 3 times its width in an ideal guide for making an
elliptical incision
e. will create a better esthetic appearance after wound healing
Which of the following describes the structure where the beaks of extraction forceps are
designed to transmit extraction pressure to?

A. Cementoenamel junction
B. Crowns of teeth being extracted
C. Roots of the tooth
D. Alveolar bone C. Roots of the tooth

1) Roots of tooth
a. optimal place to apply apical force in order to not fracture the crown during the extraction
procedure
b. enables the apical force to be transmitted effectively along the long axis of the tooth, which
results in the expansion of the alveolar bone and the eventual extraction of the tooth
Which of the following describes an alveoloplasty procedure?

A. Bone is smoothed to remove ridge undercuts A. Bone is smoothed to remove ridge

undercuts

1) Alveoloplasty
a. smoothing and recontouring of alveolar bone to create a typography favorable for proper
wound healing and denture support

2) Types
3) Post extraction alveoloplasty
a. removes the alveolar ridge to remove knife edge residual ridges and spiny bony projections
which are not good denture stress bearing areas
b. remove undesirable ridge undercuts which alter the path of denture placement and
consequently affect retention

4) Cortical alveoloplasty
a. recontours and smooths bone so that no spiny bone projections or sharp bone margins are
present to ensure optimal healing

5) Intraseptal alveoloplasty
a. removes labial undercuts, reduces maxillary over-ject and recontours cortical bone by
removing interradicular bone and collapsing the cortical plates preserving dentures stress bearing
area
Which of the following is the goal of alveoloplasty procedure?

C. To make sure that undercuts that interfere with the denture seating are removed
D. To make the residual ridge as broad as possible even if undercuts are still present C. To
make sure that undercuts that interfere with the denture seating are removed

1) Alveoloplasty
a. promote better denture support and stability during function be creating an ideal alveolar ridge
form
b. removes undesirable undercuts that impede proper seating of dentures and round-off knife
edge alveolar ridges to provide better support during function
If there is insufficient oral mucosa to achieve closure when repairing an alveolar cleft, the most
common method to achieve closure is...

A. Dermal transplant
B. Freeze-dried dura
C. Stem cell pack
D. Teflon-proplast
E. A tongue/pedicle flap E. A tongue/pedicle flap

1) Pedicle Flap
a. indicated in cases where mucosa quantity is insufficient to securely cover the wound opening
or cleft
b. created with a portion of its base remaining attached from the original site so that a blood
supply is still present within the flap even after repositioning it to cover the wound opening
c. best option for wound closures and carry a high rate of success
10 days following an incision and drainage of a submandibular space abscess, the patient returns
to your office. The swelling has slightly increased even though the patient was prescribed high
dose antibiotics. Which of the following treatments is indicated for this patient?

A. Insert a larger drain into the abscess

B. Order a complete blood count (CBC) with differential
C. Repeat the culture and sensitivity assay
D. Use proteolytic enzymes so the antibiotic can move effectively penetrate the abscess C.
Repeat the culture and sensitivity assay

1) Culture and sensitivity assay

a. incorrect identification of the causative microorganisms seem to be the reason for increased
swelling
b. mandatory to repeat the culture and sensitivity tests in order to correctly identify the casative
microorganisms so that proper antibiotic can be prescribed
When removing 4_ adjacent teeth, a dentist removes the remnants of the intraradicular bone and
compress the cortical plates. This procedure is an example of a method for treating...

B. Severe facial undercut

C. Severe lingual exostosis B. Severe facial undercut

1) Cortical plates can be compressed after the interradicular bone is removed to remove ridge
undercuts

2) Interradicular bone provides the thickness of separation between the labial and palatal cortical
bone
A vestibuloplasty procedure is performed by...

A. Apically repositioning the muscular and mucosal attachments of the mandible

C. Reflecting the gingiva and using Rongeurs to remove bone from the alveolar crest A.
Apically repositioning the muscular and mucosal attachments of the mandible

1) Vestibuloplasty
a. procedure performed to lengthen the residual ridge and deepen the oral vestibule
b. relocating or repositioning the muscle attachments and mucous membranes covering it into a
deeper or more apical position
c. also accompanied with the use of a mucosal graft or a skin graft
Which of the following surgical procedures is MOST COMMONLY used to correct maxillary
retrognathia?

A. Inverted L osteotomy
B. LeFort I Osteotomy
D. Bilateral sagittal-split ostetomy
E. Lefort III Osteotomy B. LeFort I Osteotomy

1) LeFort I Osteotomy
a. most commonly used surgical treatment intervention for maxillary repositioning
b. complete mobilization of the maxillary segments is carried out and repositioning is done
c. bleeding control and vascular preservation are important to avoid macular necrosis during the
procedure
d. characterized by an abnormal growth of jaws in which the maxillary growth becomes retarded.
Maxilla becomes short and mandible looks forward in relation to it.
Skin grafts provide which of the following functions after a vestibuloplasty procedure is
completed?

A. prevent reattachment of muscle to periosteum

C. provide an adequate amount of nonkeratinized tissue A. prevent reattachment of muscle to
periosteum

1) Vestibuloplasty
a. surgeon displaces the muscle attachments in the periosteum of the jaw to deepen the vestibule
and expose more alveolar bone needed to create a residual ridge that will provide more denture
support
b. in detaching a portion of these muscles, more residual ridge becomes more exposed and a new
vestibular depth is established
c. muscles that were detached have a tendency to readapt to the previous location within the
periosteum. In order to maintain the new positioning and prevent muscular reattachment as the
previous spot, a skin graft is placed that attaches to the periosteum of the exposed alveolar bone.
The graft with the greatest osteogenic potential is which of the following?

C. Hemopoietic marrow
D. Corticocencellous block C. Hemopoietic marrow

1) Hemopoietic marrow
a. contains cells that possess osteogenic potential and can differentiate into bone or cartilage
depending on what is needed by the body

2) Freeze-dried allografts and xenografts

a. are both osteoinductive = induce the formation of new bone through the stimulation of the
stem cells in the body
b. both DO NOT contain cells that can form bone
A fracture of the maxillary tuberosity occurred during the extraction of #2. The periosteum of
broken piece of bone remains with intact blood vessels. What treatment is indicated?
B. Remove the bone fragment
C. Reposition the fragment and stabilize with sutures C. Reposition the fragment and
stabilize with sutures

Procedures
1) Facture maxillary tuberosity can be repositioned and held in place with a suture provided that
there is evidence of an intact blood supply
2) Recovery rates of fracture bone fragments are higher if they are properly repositioned within
the fracture site with an adequate blood supply
3) Bone fragments that are completely detached and devoid of blood supply will result in bone
necrosis
Paraympathetic innerviation is carried by which of the following cranial nerves?

A. II, V, IX, X
B. III, V, VII, IX
C. III, VII, IX, X
D. IV, VII, VIII, X
E. II, III, VII, IX C. III, VII, IX, X

1) CN III = occulomotor nerve

a. constricts the pupil

2) CN VII = facial nerve

a. innervations to the lacrimal gland as well as the sublingual gland and submandibular salivary
glands

3) CN IX = glossopharyngeal nerve
a. innervate the parotid salivary gland

4) CN X = vagus nerve
a. innervation to the digestive organs and the heart
What type of flap is most commonly indicated for the surgical removal of a mesiodens?

A. Facial flap with releasing incision

B. Facial flap without relaxing incisions
C. Full thickness palatal
D. No answers are correct
E. Envelope C. Full thickness palatal

1) Full thickness palatal

a. mesiodens are usually found palatal to the area in between the maxillary central incisors and
can be extracted with a full thickness palatal flap
b. allows for adequate visualization of the bone surrounding the mesiodens
c. provide better blood supply for the flap than partial thickness flaps, rendering the procedure
less traumatic and reduces bleeding
A 17-year old female presents to your office with an indurated swelling in her mandibular
premolar area that is asymptomatic. Radiographic analysis reveals a 35mm radiolucency
associated with the mandibular premolar area. All teeth test vital. What is the next step of our
clinical analysis?

A. Alkaline phosphatase determination

B. Aspiration/needle biopsy
C. CT scan
D. Excisional biopsy
E. Complete blood cell count B. Aspiration/needle biopsy

Steps
a. evaluate all the diagnostic data, the next step in diagnosis is to determine the type of cells
within the lesion through needle biopsy
b. histopathologic examination of cells within a lesion can determine if the lesion is neoplastic or
not
c. combine the radiographic, visual, physical, and histopathologic assessment of the lesion
improves the chances of arriving at correct diagnosis and the proper treatment
A periosteal elevator is NOT normally used to...

B. luxate teeth
C. protect the tissue flap from instruments B. luxate teeth

1) Periosteal elevator
a. not designed to adapt to the tooth deep in the alveolar socket
b. tips of periosteal elevators are thin and wide and are designed to elevate the soft tissue from
the bone
c. used to elevate the interdental papilla during surgical and non-surgical extractions
d. can also be used as retractors and protect tissue flaps from other dental instruments during an
operation
When removing a mandibular lingual torus from the premolar region of a patient, the flap should
include which of the following?

A. Incised at the junction of the attached gingival tissue and free mucosa
B. No vertical components
C. Possess only a posterior component
D. Anterior and Posterior vertical components B. No vertical components

1) Vertical incision
a. is NOT necessary because the small amount of attached gingiva on the lingual aspect as well
as the proximity of the tori to the floor of the mouth
b. placed along the lingual aspect are difficult to suture due to the thickness of mucosa and its
proximity to the tongue and accessibility of the incision
c. contraindicated within areas that have inferior concavities or bony prominences
d. full thickness envelope flaps are sufficient to provide adequate access for the removal of the
mandibular tori
The most common postoperative concern following bilateral sagittal split osteotomy procedures
is...

A. Devitalization of mandibular dentition

B. Infection
C. Neurosensory disturbances
D. TMJ pain
E. Periodontal defects C. Neurosensory disturbances

1) Bilateral sagittal split osteotomy (BSSO)

a. orthognathic surgical procedure performed by splitting the lower jaw bilaterally to reposition it
in a more anterior or posterior position and achieve better function and esthetics
b. high risk of having neurosensory disturbances like prolonged numbness of the chin and lips
while others experience either extreme sensitivity or reduce sensitivity to touch
A split thickness or mucosal skin graft used in a vestibuloplasty receive its nourishment and
oxygenation primarily from...

A. The exposed periosteum that forms the graft bed

B. The mucosa surrounding the graft
C. The vasculature in the sub epithelial or submucosal layer moved to the site within the graft
D. The exposed bone directly beneath the graft A. The exposed periosteum that forms the
graft bed

1) Mucosal skin grafts

a. receive nourishment from the vascular supply coming from the expose portion of the
periosteum where the graft is adapted and placed
b. attached to the recipient site through fibrin layer formation
c. nutrients for the graft are taken from the recipient bed through a process known as plasmatic
imbibition
d. end capillaries of the graft and the recipient bed then form a vascular network which will
provide nourishment to the whole graft later.
External splints are better than internal splints primarily because which of the following?

A. Increased retention
B. Increased rigidity
C. Increased strength
D. More tooth structure is conserved D. More tooth structure is conserved

1) External splints
a. always recommended for use when conservation of tooth structure is of prime importance
b. less retention
c. less rigidity compared to the internal splints

2) Internal splints
a. require removal of tooth structure in order to be used
During the extraction of a mandibular molar, he medial root is fractured. The coronal portion,
distal root, and half of the medial root were delivered intact. What instrument should be used to
remove the remnants of the medial root?

A. Crane pick
B. Cryer elevator
C. Rongeurs
D. Straight elevator
E. Lower universal forceps B. Cryer elevator

1) Cryer elevator
a. can be used to gain access by easily removing the intraradicular bone and elevating the
remaining root fragment

2) Crane picks
a. indicated for the delicate removal of smaller root fragments

3) Rongeurs
a. indicated for bone removal, not extraction of teeth
Which of the following correctly describes the position of the mandibular condyle during a
procedure to correct mandibular prognathism?

A. Advanced
B. Intruded
C. Protruded
D. Retruded
E. Unaltered E. Unaltered

1) Condyle Position
a. Recording of the position of the mandibular condyle during correction of mandibular
prognathism should be done without any alteration
b. In normal practice, the mandibular condyle position is recorded in protrusion.
c. Patients of mandibular prognathism have condyles already in a protruded state.
Elevators are instruments that are designed to...

A. Engage the tooth coronal to the cementoenamel junction

D. Engage the tooth apical to the cementoenamel junction D. Engage the tooth apical to the
cementoenamel junction

1) Elevators
a. instruments used to elevate the tooth out of its socket
b. designed to engage the root portion of the tooth below the cementoenamel junction
c. inserted into the periodontal ligament space, create more room for tooth movement, and help
elevate the tooth out of its socket
Which of the following is the principal reason dressings are used to treat localized alveolar
osteitis (dry socket)?
A. to enhance blood clot formation
B. to prevent salivary contamination of the surgical site
C. to promote epithelial growth
D. to provide a vehicle for the obtundent medication
E. to stimulated osteoblastic reconstruction of the surgical site E. to stimulated osteoblastic
reconstruction of the surgical site

1) Dressings
a. placed inside the dry socket to stimulate the osteoblastic reconstruction of the surgical site
b. promote clot formation in the socket and enhance healing
c. changed on alternate days to speed up the healing process

2) Localized alveolar osteitis (dry socket)

a. occurs when the blood clot fails to form or is lost from the socket
b. bone lining the empty alveolar socket gets exposed
c. condition associated with increased pain and delayed healing time
* Following a non-surgical extraction, alveolopasties are usually performed with a...

A. #1 Woodson
B. Bone file
C. Highspeed handpiece
D. Rongeur
E. Finger * C. Highspeed handpiece

1) Non surgical extractions with sharp bone margins and spiny interseptal bone present indicate
cortical alveoloplasty should be performed.

2) Bone is recontoured and smoothened into a more desirable contour to enable a better wound
healing, using a surgical hand piece.
Bone marrow grafts for jaw defects are typically harvested from which of the following sites?

A. A cadeaver
B. A rib
C. Illiac crest
D. Mandibular parasymphysis
E. Maxillary tuberosity C. Illiac crest

1) Iliac crest
a. most suitable location for harvesting grafts for jaw defects because of its large size as well as
the fact that it contains both cortical as wells the cancellous bone

2) Cortical bone
a. present on the outside while cancellous bone is located inside
b. best for load bearing areas
3) Cancellous bone
a. has a rich blood supple
b. high surface area
Each of the following should be used by a dentist to assess the dental fears of a patient EXCEPT
ONE. Which is the EXCEPTION?

A. Personality
B. Physical response
C. Verbal statements
D. Behavior A. Personality

1) Personality
a. gives the dentist an idea of the patient's character and capacity to cooperate or interact but
cannot be used to assess their dental fears

2) Behavior
a. provides relevant information on their perception of dental treatment

3) Physical response
a. provides significant cues to their dental fears

4) Verbal cues
a. may directly or indirectly suggest the patient's fears and concerns before and during dental
procedures
Which of the following instruments can be used to hold soft tissue that is not to be excised?

A. Adson forceps
D. Allis forceps A. Adson forceps

1) Adson forceps
a. designed with a small tip used to hold tissue that will not undergo excision
b. have a fine tip, they are best used in holding soft tissues that are located along the small spaces
inside the mouth
c. have small teeth that allows it to hold and grip the soft tissues in a precise manner
d. can be used in holding suture during suture cutting and removal
Which of the following is NOT an oral surgery technique/principle that can be used to minimize
the likelihood of a buccal plate fracture?

A. Making a trough around the tooth

B. Preoperative assessment of oral structures
C. Strong pressure to make sure that the forceps do not slip off the crown of the tooth
D. Use of slow, fluid, careful, and controlled use of instruments
E. Using digital palpation to assess the amount of pressure exerted on the alveolus C. Strong
pressure to make sure that the forceps do not slip off the crown of the tooth

1) Buccal plate
a. brittle cortical plate that fractures during oral surgical procedure when too much and abrupt
force during lunation is applied in a buccal direction

2) Cortical bone
a. cannot withstand too much pressure during the luxation of tooth, unlike cancellous bone that
expands with pressure

3) Buccal plate fracture can be minimized with

a. thorough examination of the oral structures
b. slow and fluid control of instruments during tooth extraction
c. Using digital palpation to assess the amount of pressure exerted on the alveolus
d. Sectioning a tooth can help in reducing the force applied to a molar tooth that is strongly held
in its alveolus
e. making a trough around the tooth creates a wider space for tooth luxation that does not
necessitate forceful extraction of tooth
Using the split thickness graft technique for vestibuloplasty typically results in...

B. Limited vestibular extension in the anterior lingual mandible

C. Only a temporary increase in vestibular depth because the skin graft contract during healing
D. The maximum ridge that is available for use in any given patient D. The maximum
ridge that is available for use in any given patient

1) Split Thickness Graft Technique

a. increases the alveolar ridge length that may be used for denture fabrication
b. vestibuloplasty in general helps to create longer residual ridge and a deeper flange area to
improve the resistance of fabricated dentures for displacement
c. increases the available stable soft tissue that can support a denture while also increases its
retention
During the extraction of #3, a large portion of the palatal root is fracture and forced into the
antrum and is not able to be seen. The adjacent teeth and alveolus is normal and not damaged.
Which of the following describes the most appropriate method to recover the root though?

A. The canine fossa above the level of the premolar roots

B. The hard palate in the canine area
C. The nasoantral wall above the middle conca/turbinate
D. The extraction site of #3 after enlarging the oral-antral communication A. The canine fossa
above the level of the premolar roots

1) Caldwell-Luc operation
a. incision is made in the area of canine fossa above the canine or premolar roots
b. an opening or window is made in the anterior wall of the maxillary sinus.
c. root is retrieved through this opening and the opening is sutured

d. Indications for
1) retrieval of a broken tooth root from the maxillary sinus
2) removal of abnormal tissue growths
3) treatment of maxillary infections
The primary etiology of for the failure of tooth replantation is which of the following:

B. external resorption
C. infection
D. internal resorption
E. pulp necrosis
F. ankylosis B. external resorption

1) External Resorption
a. most common cause of failure of tooth replantation
b. Types
1) External replacement resorption
2) External inflammatory resorption
a. caused by infection following a failed root canal treatment
b. external resorption also depends upon the degree of PDL damage
Loops and helices are incorpated into arch wire to...

A. facilitate bodily tooth movement

B. improve activation range
C. improve anchorage
D. provide a center of rotation
E. decrease the modulus of elasticity B. improve activation range

1) Loops and helices

a. are incorporated to increase the range of its activation
b. activation is created by slightly closing the loops and helices with a pair of pliers
c. archwires to be activated to achieve the desired results as it becomes loose after moving teeth
in the desired direction, decreasing the tension of the arch wire
d. closing the loops and helices result in the tightening of the arch wire
The beaks of a needle holder compared to the beaks of a hemostat are...

A. Longer and thicker

B. Longer and thinner
C. More curved
D. Short and thinner
E. Shorter and thicker E. Shorter and thicker

1) Needle holder
a. beaks are shorter and thicker
b. designed to provide grip and stability while holding the needle in place during suturing

2) Hemostats
a. beaks are a bit longer and thinner
b. designed to hold the tissues together to control bleeding
All or part of which of the following muscles is detached when a clinician lowers the floor of the
mouth of a patient?

A. Genioglossus and hyoglossus

B. Mylohyoid and genioglossus
C. Mylohyoid and geniohyoid
D. Mylohyoid and hyoglossus
E. Genioglossus and geniohyoid B. Mylohyoid and genioglossus

1) Lowering the floor of the mouth

a. mylohyoid and genioglossus muscle attachments are detached

2) Mylohyoid muscle
a. paired muscle running from the mandible to the hyoid bone, forming the oral cavity

3) Genioglossus
a. muscle which runs from the chin to the tongue
Which of the following methods should NOT be used in the extraction of a mandibular 1st molar
with severe coronal decay?

A. Elevating the root sections with an east-west elevator

B. Reflecting a modest buccal flap and removing the buccal bone
C. Splitting the tooth into medial and distal root sections
D. Using a cow horn forceps
E. Removing the thin lingual cortical plate of bone E. Removing the thin lingual cortical plate
of bone

1) Lingual cortical plate

a. is very thin and close to the lingual nerve and should not be removed

2) Mandibular 1st molar extraction

a. removed easier with the use of cowhorn forceps that engages the tooth in a furcation area or by
sectioning the root
b. buccal plate can be reduced with a buccal trough to provide adequate access and purchase
area.
Anxiety and Pain Control Anxiety and Pain Control Answers
Which of the following effects are commonly observed with drugs like diazepam, meperidine,
and pentobarbital?

A. Anticonvulsant and hypnotic

B. Amnesia and skeletal muscle relaxation
C. Analgesia and anxiolysis
D. Sedation and dependency risk D. Sedation and dependency risk

1) Diazepam
a. good sedative but a very addictive drug as well
b. prolonged use may lead to dependency, tolerance, and physical dependence

2) Pentobarbital
a. barbiturates and is known as depressant of the nervous system
b. due to its potent effect, it is used in sedation and for people suffering from insomnia and even
reported seizures
c. its continuous use could cause drug dependency and is therefore prescribed in a well
controlled and limited period

3) Meperidine
a. opiate sedative drug that is less addictive but still could pose a tendency for dependency when
used frequently
b. it could also cause euphoria making it more tempting to be abused
Administration of a schedule 2 narcotic with an anti-psychotic drug creates...

A. Conscious sedation
B. Neuroleptic analgesia
C. Psychotomimetic analgesia
D. Dissociative anesthesia B. Neuroleptic analgesia

1) Neuroleptic analgesia
a. combined effect of using narcotics with antipsychotic agents
b. patients under neuroleptic analgesia show some degree of quiescence (quietness), alteration of
awareness, and some analgesia
Which of the following patient health histories would make the use of nitrous oxide sedation
CONTRAINDICATED?

A. Controlled hypertension
B. Dental anxiety
C. Diabetes Type I
D. Diabetes Type II
E. Psychotic care E. Psychotic care

1) Nitrous oxide sedation

a. contraindicated in patients who are undergoing psychotic care
b. can be administered to patients with
1) controlled hypertension
2) dental anxiety
3) diabetes type I
4) diabetes type II

2) Various CONTRAINDICATIONS of nitrous oxide sedation are

a. severe emotional disturbance
b. severe drug-related dependence
c. COPD-bronchitis, emphysema, or Upper Respiratory infection (URI)
d. Otitis Media
e. Claustrophobia or irrational fear of "gas"
f. Maxillofacial deformities or nasal obstructinos
g. Pregnant patients - especially in first trimester
h. Sickle cell disease
i. Patients being treated with bleomysin sulfate
j. Methylenetetrahydrofolate reductase deficiency
Ventricular arrhythmias can be treated by an intravenous injection of which of the following
agents?

A. Lidocaine
B. Lisinopril
C. Propranolol
D. Quinidine
E. Verapamil A. Lidocaine

1) Lidocaine
a. Intravenous injection of lidocaine may be useful to suppress symptomatic ventricular
arrhythmias.
b. Routine lidocaine use can reduce the occurrence rate of primary ventricular fibrillation to
some extent.
c. intravenous lidocaine prophylaxis for patients with acute myocardial infarction in a coronary
care unit is not recommended
The settings for the nitrous oxide oxygen sedation devices are: 4 liters/min oxygen and 3
liters/min nitrous oxide. At what concentration is the oxygen being administered?

A. 43%
B. 57%
C. 75%
D. 98%
E. 33%B. 57%

1) The nitrous oxide and oxygen ratio having 4 liters/min oxygen and 3 liters/min nitrous oxide
shows a 57% oxygen concentration.

2) In order to determine the percentage of oxygen use in the nitrous oxide administration, you
must divide the liters/min of the gas desired by the total amount of gas being delivered/minute.

(4L/min) / (4L + 3L/min) = 4L/min / 7L/min = 0.57*100 = 57%

What percentage of liquid oxygen is in an "E" cylinder showing that it is 50% empty

A. 25%
B. 50%
C. 95%
D. 100% B. 50%
1) The pressure regulator measure the gas pressure of the cylinder, and when the pressure shows
50% because oxygen remains as a gas when it is compressed at room temperature and does NOT
become a liquid like N2O.

2) Oxygen cylinders come in a variety of sizes and each use and size is designated by a series of
numbers and letters.

3) The number on the side of the tank denotes the number of liters of oxygen the cylinder holds.
The letters A, B, C, D, and E designate the size of the cylinder.

The "A" cylinder is the smallest cylinder with 34 liters of compressed oxygen; and E cylinder is
one of the largest (680 liters).
Nitrous oxide sedation of a patient should always be concluded with the administration of 100%
oxygen to prevent...

A. Hypercarbia
B. Hyperventilation
C. Hypoxia
D. Tachycardia
E. Hypotension C. Hypoxia

1) Hypoxia
a. Administering oxygen immediately after nitrous oxide sedation increases the concentration of
oxygen in the blood thereby diminishing the occurrence of hypoxia.
b. Hypoxia may occur with patients sedated with nitrous oxide with the gas mixture administered
has a low oxygen concentration.
c. After being sedated with nitrous oxide, 100% oxygen is administered to completely clear the
nitrous oxide in the system and help the patient recover faster from sedation.
Which of the following does NOT describe nitrous oxide sedation?

A. It alters cardiac output minimally

B. It is explosive
C. It is not significantly metabolized
D. It is used frequently by anesthesiologists
E. It is heavier than air B. It is explosive

1) Nitrous oxide gas

a. used to provide anesthesia, anxiolysis, and vasodilation (for IV placement)
b. stable and combustible, but does not explode
c. very safe and effective
d. its effects in the body are immediately removed once the nitrous oxide gas is completely
expired by the patient, making anesthetic recovery time faster.
A patient independently maintaining a patent airway describes which type of anesthesia?

A. Deep sedation
B. General anesthesia
C. Conscious sedationC. Conscious sedation

1) Conscious sedation
a. can independently act and respond to verbal instructions
b. allows the patient to relax and remain calm and cooperative by reducing their sensitivity to
pain
c. patient is awake but feeling lightly drowsy
d. patient maintains a patient airway independently

2) Deep sedation
a. characterized by a depressed consciousness such that the patient is unable to continuously and
independently maintain a patent airway and experiences a partial loss of protective reflexes and
ability to respond to verbal commands or physical stimulation.

3) General anesthesia
a. medically induced coma leading to a loss of protective reflexes resulting from the
administration of one of more general anesthetic agents.
Which of the following agents is NOT an opioid utilized in outpatient anesthesia?

A. Fentanyl
B. Meperidine
C. Sufentanil
D. Diazepam D. Diazepam

1) Diazepam
a. anxiolytic
b. anticonvulsant
c. hypnotic
d. sedative
e. skeletal muscle relaxant
f. amnestic properties
g. has several pharmacologically active metabolites, thus has a long pharmacologic half-life
h. has a long duration of action, this drug is available in low doses to prevent drug accumulation
and an unnecessarily prolonged effect

2) Opioids
a. molecules that are known to bind to the opioid receptors to cause
b. anesthesia
c. sedation
d. respiratory depression
e. constipation
f. strong sense of euphoria in patients
The duration of action for a single IV bolus dose of diazepam is most dependent on...

A. Alpha half-life
B. Beta half-life
C. Enzymatic degradation
D. Hepatic biotransformation
E. Renal excretion D. Hepatic biotransformation

1) Diazepam
a. undergoes oxidative metabolism by demethylation, hydroxylation, and glucuronidation in the
liver as part of the cytochrome P450 system
b. has several pharmacologically active metabolites, the chief one being desmethyldiazepam
c. metabolites are conjugated with glucuronide and are excreted in urine
d. highly lipid-soluble
e. widely distributed throughout the body after administration
f. primarily distributes to muscle and adipose tissue
A posterior superior alveolar nerve block performed correctly will not anesthetize...

A. 3rd, 2nd, and 1st molars (except mesiobuccal root)

B. Buccal plate and overlaying gingival tissue posterior of premolars
C. Soft palatal mucosa
D. Maxillary sinus mucosa above the maxillary molars C. Soft palatal mucosa

1) Mucosa of the soft palate is innervated by

a. lesser palatine nerve
b. pharyngeal branch of vagus nerve
c. medial pterygoid merve

2) Posterior superior alveolar nerve block only affects the structures that are innervated by the
posterior superior alveolar nerve:
a. Maxillary sinus mucosa
b. Buccal plate and the overlying gingival tissue posterior to the premolar area
c. All the upper molars except the mesiobuccal root of the permanent 1st molar which is
innervated by the middle superior alveolar nerve.
Immediately following a procedure with prolonged high levels of nitrous oxide, a patient
immediately removes the breathing apparatus. What is the most likely consequence?

A. Carbon dioxide retention

B. Diffusion hypoxia
C. Respiratory depression of apnea
D. Vasovagal syncope
E. Hyperventilation syndrome B. Diffusion hypoxia

1) Diffusion hypoxia
a. may occur when a patient is recovering from N2O anesthesia, large quantities of this gas cross
from the blood into the alveolus (down its concentration gradient) and so for a short period of
time, the O2 and CO2 in the alveolus are diluted by this gas.
b. Diluting the O2 and CO2 can cause the partial pressure of oxygen to decrease, temporarily
inducing hypoxia. The decrease in CO2 could also potentiate this effect as ventilation would be
suppressed, leading to potential hypoxemia.
Which of the following can a clinician modify with nitrous oxide administration?

A. Pain stimulus
B. Pain threshold
C. Referred pain
D. Pain reaction B. Pain threshold

1) Pain threshold
a. modified by nitrous oxide because it sedates patients, thereby relieving them of the pain from
the operation
b. reduces patient anxiety by inducing a temporary state of euphoria which makes them less
aware of the sensations of dental treatment

2) Pain reaction and referred pain

a. response of the body to certain pain stimuli and are not directly modified by nitrous oxide
A patient undergoing general anesthesia with phenobarbital will pass through which stage of
anesthesia?

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

1) Phenobarbital
a. IV drug that is used to control seizures and convulsions and also shortens the time in passing
through stage 2 of general anesthesia
b. Barbiturate with longest duration
c. most widely used anticonvulsant drug in the world
d. used in general anesthesia to limit stage 2 anesthesia

2) Stage 2 anesthesia
a. patients may exhibit involuntary excitement, delirium, apnea, and exaggerated reflect response
leading to possible vomiting
Which of the following is NOT an endogenous opioid?

A. Dynorphin
B. Endorphin
C. Enkephalin
D. Bardykinin D. Bradykinin

1) Endogenous Opioid
a. Endorphine
b. enkephalin
c. dynorphin
d. endomorphine
e. all the above are endogenous opioid peptides created naturally within the human body
f. help increase the pain threshold and also have a potent analgesic effect in the body

2) Bradykinin
a. is NOT an endogenous opioid but rather a kinin, or active polypeptide in the body that is
created in the blood
b. is a mediator of the inflammatory reaction that can also induce vasodilation and increase
vascular permeability
While diazepam is being administered via I.V. to a patient for sedation, the patients begins to
displays ptosis of the upper eye-lid (Verrill's sign). Which of the following should the clinician
think?

A. Administer flumazenil to the patient

B. Consider the patient to be adequately sedated
C. Immediately assist the patient with respiration
D. Place the patient in the Trendelenburg position
E. Administer additional diazepam and begin the procedure B. Consider the patient to be
adequately sedated

1) Verill's sign
a. indicates that the effective sedative drug dose has already reached and dose must be kept
unchanged to maintain the level of sedation
b. during this stage of sedation, the patient can still understand verbal cues and can still respond
to them
c. administering additional diazepam during the displaying of verill's sign would cause overdose
of the drug
d. benzodiazepine receptor antagonist like flumazenil must be administered in cases of diazepam
drug overdose.
If a patient that is sedated with nitrous oxide suddenly becomes irrationally excited, which of the
following is the most likely explanation?

A. The patient exhibits drug seeking behavior from nitrous oxide

B. The patient is entering Stage 2 anesthesia
C. The patient really likes you
D. The patient is entering Stage 1 anesthesia B. The patient is entering Stage 2 anesthesia

1) Stage 2 anesthesia (excitatory stage)

a. describes the moment when the patient begins to exhibit uncontrolled movements, excited
actions and possibly delirium
b. characterized by
1) irregular respirator patterns and hear rate, pupillary dilation, and uncontrolled body
movements
2) this stage is very dangerous and potentially life threatening, fast acting drugs are utilized to
pass this stage and attain the third stage of anesthesia as quick as possible.
Which of the following describes Verrill's sign in regards to IV conscious sedation using
diazepam?

A. It is not recommended since few patients are adequately sedates at that level
B. It is not recommended since it can indicate a too-deeply sedated patient
C. It is recommended as an end-point
D. It is usually not attainable with diazepam alone C. It is recommended as an end-point

1) Verill's sign
a. during IV sedation helps the anesthesiologist determine the depth and adequacy of sedation
b. helps in determining a safe limit in administering the IV conscious sedation drug such as
diazepam
c. is similar to Ptosis, a condition where there is drooping of the upper or lower eyelid
d. the level of sedation can be evaluated by checking several parameters including the Verill's
sign or the dropping of the eyelid which signified the effect of anesthesia to the muscles that
controls the eyelid
e. presence of Verill's sign indicates that the anesthesia needed for the procedure is already
adequate and the safely limit has already been reached.
Each of the following is indicative of an intra-arterial injection EXCEPT one. Which is the
EXCEPTION?

A. Aspirated blood is bright red in color

B. Injection of the test dose elicits acute pain
C. Penetration of the vessel is met with resistance and elicits pain
D. The needles moves with the rhythm of the heartbeat
E. Vessels tend to collapse and obstruct E. Vessels tend to collapse and obstruct

1) No obstruction or collapse of arteries is experienced during administration of an intra-arterial

injection
2) Resistance is met during administration due to blood flow.
3) Aspirated blood is bright red in color due to the high concentration of oxygen in blood passing
through the arteries
4) Intra-arterial injections are painful in nature.
Which of the following determines the correct total flow of nitrous oxide and oxygen?

A. A standard of 6 liters/minute flow rate

B. The amount necessary to keep the reservoir bag 1/3-2/3 full
C. The largest volume that the patient's lungs can exchange in 1 minute
D. The metabolic oxygen requirements of the patient B. The amount necessary to keep the
reservoir bag 1/3-2/3 full

1) It is recommended to fill the reservoir bag up to 1/3-2/3 of the total volume. This amount
produces the necessary vacuum required for the optimum flow of nitrous oxide and oxygen.
2) Keep some portion of the reservoir bag empty and free from air to produce the current flow of
nitrous oxide and oxygen.
Which of the following is NOT an advantage of oral sedation?

A. Less training and costly equipment

B. Lower rate of adverse drug reaction
C. Shorter drug half life
D. Differences in gastrointestinal drug absorption rate D. Differences in gastrointestinal
drug absorption rate

1) Differences in the rate of gastrointestinal drug absorption among patients account of the
greatest disadvantage of oral sedation

2) Drug absorption and metabolism varies widely between individuals, so the duration of effect
can only be estimated.

3) Oral sedation is still useful because:

a. well regulated drugs
b. shorter drug half-life
c. less chance of drug toxicity and adverse reactions
d. does not require expensive equipment
For a dentist to perform a block of the maxillary division of the trigeminal nerve (V2), what
anatomical space is the anesthetic injected?

A. Buccal space
B. Masseteric space
C. Pterygopalatine space
D. Retropharyngeal space
E. Pterygomandibular space C. Pterygopalatine space

1) From the foramen rotundum, the maxillary division of the trigeminal nerve (V2) passes
through the pterygopalatine fossa
2) During the maxillary nerve (V2) block, the needle is bent at a 45 degree angle to facilitate
insertion into the pterygopalatine space located medially and posterior to the maxillary 2nd
molar.
3) The needle is inserted medially into the pterygopalatine fossa and about 0.9 to 1.8cc of
anesthesia is deposited to ensure efficacy of the maxillary nerve block technique.
Seizures induced by a lidocaine overdose can be treated by which of the following options?

A. Epinephrine (EpiPen)
B. Flumazenil (Roamzicon)
C. Meperidine (Demerol)
D. Naloxone (Narcan)
E. Diazepam (Valium) E. Diazepam (Valium)

1) Diazepam
a. rapid acting and highly efficacious anticonvulsant drug indicated to treat anxiety, panic, and
acute seizure attacks such as those induced by lidocaine
b. injecting lidocaine which may reach a concentration beyond 8 to 9 ug/mL is said to pose
greater risk for acute convulsions.
c. intravascular Diazepam administration can stop a seizure attack triggered by lidocaine
d. intramuscular injection of diazepam one hour prior to lidocaine injection can help prevent
lidocaine induced-seizure attacks
The purpose of a reservoir bag in an anesthesia machine is to

A. All answers are correct

B. No answers are correct
C. Provide a means of mixing N2O and O2 in measured amounts
D. Provide for urinary incontinence in the sedated patient
E. Provide resistance when the patient breathes out so more absorption of N2O is achieved in the
lung
F. Make up for the difference between the constant gas flow from the machine and the cyclic
breathing pattern of the patient F. Make up for the difference between the constant gas
flow from the machine and the cyclic breathing pattern of the patient

1) Reservoir bag
a. part of the anesthesia machine that allows accumulation of gas and serves as a gas reservoir
that can be used to supply gas when controlling the ventilation manually.
b. act as a visual guide to evaluate the breathing depth and the rate of depression of the patient
c. balances the difference between the patient's breathing pattern and the available gas that is
constantly flowing from the machine.
d. manages to balance off the difference between the patient's breathing pattern and the available
gas that is constantly flowing from the machine.
Each of the following drugs are used for IV conscious sedation in dental offices EXCEPT one
due to its unusually long duration. Which drug is the EXCEPTION?

A. Lorazepam
B. Diazepam
C. Hydroxyzine
D. Midazolam
E. Propofol A. Lorazepam

1) Lorazepam
a. very potent intermediate acting benzodiazepine anxiolytic agent with a very long duration that
makes it less useful in the dental setting
b. ideal sedative and anti-anxiety drugs used in dental settings are those that are short-acting and
allows for rapid recovery of the patient
c. sometimes prefer proposal over benzodiazepines because of its unique ability to provide a
recovery time of about 5 minutes of less.
Nitrous oxide abuse may result in...

A. Acute narrow angle glaucoma

B. Deep vein thrombosis
C. Systemic myopathy
D. Peripheral neuropathy D. Peripheral neuropathy

1) Nitrous oxide toxicity

a. demonstrated to produce neurotoxicity similar to other NMDA antagoniss with prolonged use
b. long-term exposure can cause vitamin B12 deficiency, numbness, and reproductive side
effects (in pregnant patients)
Each of the following is considered a reason for sedating a patient EXCEPT one. Which reason
is the EXCEPTION?

A. To allay the stress experience by a severely medically compromised patient

B. To be able to complete surgeries that would not be able to be normally tolerated by an anxious
patient
C. To decrease the amount of local anesthesia required
D. To assuage the anxiety, apprehension, and fear exhibited by the patient C. To decrease the
amount of local anesthesia required

1) Sedation
a. can diminish the stress and fear of the patient but does NOT affect the amount of anesthesia
that should be administered to the patient
b. used to relax or calm anxious patients through the use of medication or a sedative agent
c. is induced for uncooperative patients or those with anxiety or fear of the treatment
d. allows the patient to have a higher pain threshold, allowing them to be capable of tolerating
painful treatment procedures
When your nitrous oxide an oxygen tanks have been half emptied, what is the pressure in psi of
each cylinder? (The starting gas pressure are O2 [2,000]; N2O [800])?

A. 1,000 400
B. 2,000 400
C. 2,000 800
D. 1,000 800 D. 1,000 800

1) N2O tank
a. gas pressure in the N2O tank remains constant due to the amount of gas in each cylinder that it
still in liquid for, exerting no pressure
b. as the tank is emptied, the liquid gas vaporizes into gas as per Boyle's law, keeping the gas
pressure constant
c. at room temperature, N2O will exist as a liquid in the bottom of the tank whereas oxygen
exists as a gas making the pressure decrease directly over emptying
d. Because the starting pressure is 2000psi O2 and 800psi N2O, they remain at 1000psi O2 and
800psi N2O.
Which of the following explains the MOST probable reason for a patient to experience truisms
following an inferior alveolar nerve block?

A. Accidental injection of the anesthetic near a motor branch of the V3 trigeminal nerve
B. Failure to aspirate
C. Injection of the anesthetic between the periosteum and the bone
D. Piercing the medial pterygoid muscle with the needle D. Piercing the medial pterygoid
muscle with the needle

1) Trismus
a. can occur following administration of an inferior alveolar nerve block if the needle is placed
too medially
b. is given in the space within the pterygomandibular fossa
c. limited ability to open one's mouth
d. Normal mouth opening ranges from 35 to 45mm
e. Males usually have slightly greater mouth opening than females (40-60mm) = average is
35mm
f. The normal lateral movement is 8-12mm

2) Trismus Classifications
a. Mild Trismus: 20-30mm
b. Moderate: 10-20mm
c. Severe: > 10mm

3) Placing the needle too far medially can inject the anesthetic solution in the medial pterygoid
muscle

4) Impairment of the movement of medial pterygoid muscle results in inability to open the
mouth.
Assessment and Emergency Care Assessment and Emergency Care Answers
What should you do first if you happen upon a collapsed or unconscious person?

A. Examine the person for signs of trauma

B. Assess the person's pulse
C. Establish if the person is unconscious
D. Open airway with head tilt/chin lift
E. inject 10mL 1:1000 epinephrine into the persons myocardium
F. Take a blood glucose reading C. Establish if the person is unconscious

1) Concept: If you see a collapsed or unconscious person, the most important step is to make sure
that the patient is truly unconscious.

2) Conscious
a. can be determined by the person's reaction to your voice or through the coordination of their
movements

3) Unconscious
a. cannot be roused and is unaware of his or her surroundings
b. will not remember what has happened to them and may not be coherent
c. one way to check is by tapping them on their shoulder and asking "Hey, are you okay?"
4) Next Steps
a. after establishing unconsciousness, assess the person's airway, breathing, and pulse before
providing first aid
In which of the following patients is inhalation of 100% oxygen CONTRAINDICATED?

A. Acute bronchitis
B. Acute viral pneumonia
C. Chronic obstructive pulmonary disease (COPD)
D. Pneumonthorax D. Pneumonthorax

1) Concept: Pneumonthorax: Inhalation of pure 100% oxygen or any other gas is contraindicated
in a patient of pneumothorax because it can worsen the condition of the patient and can be life-
threatening.
a. is basically an abnormal collection of air or gas in the pleural space.

2) It is advised to insert a needle with an underwater seal to get rid of the entrapped air.

3) Oxygen interferes with normal breathing and is dealt as an emergency.

It is indicated that each of the following types of syncope is treated with the administration of
high-flow 100% oxygen EXCEPT ONE. Which is the EXCEPTION?

A. Neurogenic
B. Orthostatic
C. Vasovagal
D. Hyperventilation Syndrome D. Hyperventilation Syndrome

1) Concept: Hyperventilation Syndrom (HVS) is a condition of insufficient CO2, NOT O2, so

additional oxygen is CONTRAINDICATED.

2) Hyperventilation Syndrome (HVS) is a psychologically or physiologically based respiratory

disorder involving a patient breathing too deeply and/or too rapidly. HVS may present with chest
pain and a tingling sensation in the fingertips and around the mouth and may accompany a panic
attack.

3) HVS patients
a. have roughly the same oxygenation in the arterial blood (98% for hemoglobin saturation) and
insufficient CO2 in their blood and other tissues.
b. while oxygen is abundant in the bloodstream, HVS reduces effective delivery of that oxygen
to vital organs due to low-CO2-induced vasoconstriction and the suppressed Bohr effect.
Which of the following patient health histories would be more prone to postoperative bleeding
after multiple extractions? Select all that apply.

A. Angina
B. Asthma
C. Cirrhosis
D. Diabetes Type I
E. Diabetes Type II
F. Renal disease C. Cirrhosis
E. Diabetes Type II

1) Concept: Patients with diabetes type II and liver cirrhosis are more prone to undergo
postoperative bleeding in such cases.

2) Diabetes Mellitus Type II

a. less platelet aggregation and impaired wound healing results in prolonged bleeding after
multiple extractions

3) Cirrhosis
a. impairment of vitamin K dependent clotting factors and prolonged prothrombin time occurs in
liver cirrhosis
b. Vitamin K dependent clotting factors II, VII, IX, and X are formed and stored in the liver.
Fabrication of an "emergency" occlusal separator device is indicated for patient with...

A. Degenerative arthritis
B. Hemarthrosis
C. Myositis
D. Unilateral condylar hyperplasia B. Hemarthrosis

1) Concept: Further damage and bleeding of the joint is avoided through the use of an occlusal
separator to relieve the injured TMJ from contact.

2) Hemarthrosis
a. a condition wherein bleeding occurs in the joint or joint space.
b. injuries to joints are the most usual cause of hemarthrosis which results in joint pain and
inflammation
Methanol poisoning can be treated by administration of ethanol because ethanol...

A. All answers are correct

B. Has a higher affinity for alcohol dehydrogenase
C. It prevents injury to cranial nerve I (optic nerve) by methanol metabolites
D. Inhibits metabolism of methanol into formaldehyde A. All answers are correct

1) Concept: Ethanol reverses or prevents methanol poisoning because it competitively inhibits

alcohol dehydrogenase, preventing methanol from being turned into formaldehyde.

2) Alcohol Dehydrogenase
a. has higher affinity for ethanol than methanol

3) Unmetabolized methanol is excreted immediately by the kidneys after ethanol is administered.

4) Ethanol administration also prevents optic nerve injury caused by metabolic acidosis during
methanol poisoning.
Which clinical sign is consistent with Verrill's sign?

A. Nystagmus during lateral glaze

B. Ophthalmoplegia after exposure to light
C. Paresis due to CNS depression
D. Ptosis of eyelid D. Ptosis of eyelid

1) Concept: Verill's sign is similar to Ptosis, a condition where there is drooping of the upper or
lower eyelid.

2) The level of sedation can be evaluated by checking several parameters including the Verill's
sign or the drooping of the eyelid which signifies the effect of anesthesia to the muscles that
controls the eyelid.

3) Ptosis
a. occurs when the eyelid muscles becomes incapable of holding or raising the eyelids properly.
It can be due to trauma, aging or degenerative diseases that can be neurogenic or myogenic or
may even be genetic.
If during a large MOD caries removal, your patient loses consciousness. You should first
assess...

A. Airway and pulse

B. Blood pressure and airway
C. Pupil size
D. Blood pressure and pulse A. Airway and pulse

1) When a person suddenly loses consciousness, it is important to assess ABCD's

2) Airway
a. check for obstruction

3) Breathing
a. check for rise and fall of chest

4) Circulation
a. check the person's pulse

5) Diabetes
a. check blood sugar if patient is diabetic

6) It is important for the doctor to not feel panic when a person loses consciousness, they must
think clearly and decisively to properly restore the person to health and consciousness.
A patient presents with an odontogenic infection evidence by a temperature of 102oF and
fluctuant mass in their submandibular space. Which of the following is indicated course of
treatment?

A. Application of heat and cold to the area to improve circulation

B. Aspirin should be administered to decrease the temperature
C. Incision and drainage and an antibiotic sensitivity test
D. Administration of penicillin Vk to reduce the swelling only C. Incision and drainage and
an antibiotic sensitivity test

1) Concept: The increased number of bacteria built-up by the infection results to its spread into
the submandibular space causing the fever of the patient.

2) Incision and drainage:

a. allows the accumulated and pressure that build up within the submandibular space to be
removed

3) Antibiotic sensitivity testing

a. helps to determine the putative etiologic bacteria and guide the clinician to the appropriate
antibiotic treatment
Which of the following agents does NOT produce vasoconstriction?

A. Levonordefrine
B. Norepinephrine
C. Phenylephrine
D. Epinephrine
E. Nitrous oxide E. Nitrous oxide

1) Concept: Nitrous oxide is converted into nitric oxide, which is known to induce
vasoDILATION not vasoCONSTRICTION.

2) Epinephrine, levonodefrine, norepinephrine, and phenylephrine all induce vasoconstriction

when administered parenterally.
Which of the following clinical CNS signs suggests that a patient is suffering from oxygen
deprivation?

A. Dilated pupils with light reflex

B. Dilated pupils without light reflex
C. Pinpoint pupils without light reflex
D. Pinpoint pupils with stronger light reflex B. Dilated pupils without light reflex

1) Concept: Patients suffering from oxygen deprivation will demonstrate dilated pupils without
light reflex because the brainstem that controls pupillary response lacks oxygen, causing the cells
to die or be damaged.

2) Routine assessment of the pupillary reflex

a. utilized by physicians for checking brain stem function
b. Pupils normally dilate equally to allow more light to enter the eyes allowing vision even in the
dark
c. Pupils constrict when there is too much light needed by the eyes to see.

3) Lack of pupillary reflex or an unusual abnormal pupillary reflex could be a result of brainstem
cell damage, optic nerve damage, occulomotor nerve damage or due to depressant drugs like the
barbiturates.
Fluoride ions are most likely to be inactivated by which of the following dentifrice components.

A. Dicalcium phosphate
B. Monofluorophosphate
C. Polyacrylic spheres
D. Anionic detergents A. Dicalcium phosphate

1) Concept: The interaction of fluoride ion and dicalcium phosphate dehydrate results in the
formation of insoluble fluoride compounds that reduce the amount of free and available fluoride
ions.

2) Fluoride ions that interact with dicalcium phosphate dehydrate form calcium fluoride.

3) IN order to make more fluoride ions interact with teeth, incorporating dicalcium phosphate
dehydrate within the fluoride pastes must be limited.
Which of the following is the primary characteristics indicating an intra-arterial injection of
midazolam (Versed)?

A. Rapid decrease in blood pressure

B. Rapid decrease in respiration rate
C. Severe cardiac arrhythmia
D. Severe pain in the extremity
E. Exagerrated sedation due to the more direct effect of the drug D. Severe pain in the
extremity

1) Concept: Some accounts of intra-arterial injection of midazolam stated that some of the
patients experienced moderate to severe pain within the extremity where it was administered.

2) There are some isolated reports which noted seizure activity occurring after intra-arterial
injection of midazolam. However, the reason for such reaction was not established.

3) Limited reports have been documented with regards to the effects of intra-arterial injection of
midazolam. Adverse reaction from accidental intra-arterial injection can be localized within the
its of injection or systemic.
Which muscle is responsible of the displacement of the proximal portion of the mandible
following an unfavorable angle fracture.

A. Hyoglossus
B. Medial pterygoid
C. Mylohyoid
D. Lateral pterygoid B. Medial pterygoid

1) Concept: The medial pterygoid muscle inserts into the lower posterior portion of the
mandibular ramus and the angle of the mandible and serves to help close the jaw.

2) Medial pterygoid
a. pulls on the angle of the mandible and posterior ramus in order to help facilitate jaw closure
b. during an unfavorable mandibular fracture, the medial pterygoid that inserts at the mandibular
angle pulls in the same direction as the vector of the displacement
A patient in your chair is suffering from xerostomia, tachycardia, and gastrointestinal inactivity,
and you are suspecting atropine poisoning. What should you administer to your patient to treat
this condition?

A. Physostigmine
B. Pilocarpine
C. Prednisone
D. Romazicon
E. Epinephrine A. Physostigmine

1) Concept: Physostigmine inhibits acetylcholinesterase enzyme from breaking down

acetylcholine in the neuromuscular junction, allowing acetylcholine to function properly.

2) Atropine
a. competitive inhibitor of muscarinic receptors M1-M5

3) Physostigmine
a. is an agent that can reverse atropine overdose
In which order should an airway obstruction be managed in an unconscious patient?

A. Clear the pharynx, check breathing, extend the patient's neck, protrude the tongue and
mandible
B. Extend the patient's neck, Protrude the tongue and mandible, clear the pharynx
C. Extend the patient's neck, clear the pharynx, protrude the tongue and mandible
D. Protrude the mandible and tongue, clear the pharynx, extend the neck A. Clear the pharynx,
check breathing, extend the patient's neck, protrude the tongue and mandible

1) Concept: The proper management of airway obstruction of an unconscious patient should be

done in the following order:
a. Visually or tactilely examine any presence of food, vomit or any foreign object that may
obstruct the airway.
b. Observe and check the rise and fall of the chest as indicator of breathing. Listen to the mouth
and nose for signs of breathing.
c. Extend the patient's neck by tilting their chin upwards.
d. Protrude the tongue and mandible to provide better mouth opening an to pharynx will open
further and improve the patients breathing.
Which of the following would most likely be the immediate concern of the clinician following
the extraction of tooth T of a 3-year-old patient?

A. Prevention of localized alveolar osteitis

B. Prevention of post-operative lip biting
C. Prevention of postoperative swelling
D. Space maintenance
E. Alleviating postoperative pain B. Prevention of post-operative lip biting

1) Concept: The prolonged numbness of the mandible after a lower molar extraction in children
may cause accidental cheek and lip biting.

2) Children experiencing numbness of the mandible after tooth extraction also have a tendency to
experiment and play around their numb lips and cheeks.

3) In order to avoid lip and cheek biting, it is best to instruct the parents to guide their child and
teach them to refrain from chewing foods while the lower arch is still numb.
Treatment Plan Treatment Plan Answers
Which two preoperative tests should be performed before deciding if general anesthesia should
be administered to a patient?

A. Complete blood count and bleeding time

B. Bleeding time and clotting time
C. Complete blood count and urinalysis
D. Hemoglobin level and prothrombin time
E. Total white blood cell count and prothrombin time C. Complete blood count and
urinalysis

1) Concept: Preoperative tests are essential to ensure optimal health conditions of the patients
prior to any surveil procedure

2) Complete blood count

a. Assessing the overall health of the patient by evaluating their complete blood count will
provide sufficient information about the physiologic health of the body
b. Urinalysis provides information about the efficiency of the kidneys, liver and other organs
within the body

3) Complete blood count and urinalysis

a. Complete blood count and urinalysis both help identify the presence of infection within the
body and abnormal conditions that may contraindicate surgical procedures.
Which weight loss supplement is considered dangerous due to reported case of sudden cardiac
death?

A. Ephedra
B. Garlic
C. Ginseng
D. Resveratrol
E. Echinacea A. Ephedra

1) Concept: Reports of serious side effects and ephedra-related deaths caused the U.S. Food and
Drug administration (FDA) to ban the sale of ephedra-containing supplements on April 12, 2004.

2) The stimulant and thermogenic effects of Ephedra are due to the presence of ephedrine and
pseudo ephedrine, which stimulate the brain, increase heart rate, and constrict blood vessels
(increasing blood pressure).
A 36 year old woman, Betsy, presents with a badly broken down #19 with a necrotic pulp and an
acute apical abscess. Which of the following medical histories would create the most
complication in her surgical extraction treatment?

A. Asthma
B. Epilepsy
C. Hypertension
D. Mitral valve prolapse
E. Undergoing chemotherapy
F. Chronic Obstructive Pulmonary Disorder (COPD) B. Epilepsy

1) Concept: Epileptic disorders vary widely in etiology and manifestation, so management of

these patients is performed on a case by case basis. Dental treatment may trigger seizure attacks
at any time during the visit. Dental treatment should be deferred if a patient has an epileptic
episode.

2) Epileptic seizures occur because of excessive or abnormal neuronal activity in the brain.
Epilepsy can be treated but not cured with medication. Approximately 30% of medicated
epileptic patients cannot control seizure attacks.

3) Anticonvulsant side-effects may differ among individuals. Epileptic seizures may manifest
differently with different signs and symptoms, so this should be taken into consideration prior to
performing procedures.

4) The suggested method to manage generalized tonic-clonic epileptic seizure is:

a. Roll the person on their side to proven fluid ingestion into the lungs which if not prevented
could cause irawy blockage and death
b. The person should be moved away from sharp edges with their head supported with a soft
cushion of pillow if possible.
c. Emergency services should be contacted immediately if seizure lasts for more than 5 minutes,
or if it occurred more than once without regaining unconsciousness.
Which of the following conditions indicates excisional biopsy MOST?

A. A 10mm dome shaped fluctuant lesion in the labial mucosa

B. A 20mm asymptomatic ulcer present for 9 weeks
C. A 30mm submucosal indurated lump
D. A white surface lesion covering most of the buccal mucosa
E. A 6mm exophytic mass on the buccal mucosa E. A 6mm exophytic mass on the buccal
mucosa

1) Concept: Exophytic masses

a. are proliferating tissues that enlarge in its size as they grow outward from its origin.
b. may become tumors and sometimes may turn malignant

2) Excisional Biopsy
a. involve the complete removal of lesions and is most appropriate for small and accessible
lesions amenable to surgery
b. should be performed to rule out malignancies and avoid involvement of other structures in the
mouth
c. should be performed instead of incisional biopsies if:

1) The lesion is < 1cm (10mm)

2) The lesion is pedunculated
Which of the following procedures can stone casts NOT be used for regarding maxillofacial
surgery?

A. Fabrication of occlusal splints

B. Identification of skeletal deformity
C. Visual aid for patient education
D. Practice of surgical procedure B. Identification of skeletal deformity

1) Concept: Stone casts are accurate positive copies of a patient's oral structures that enable
dentists to study and diagnose the oral conditions of the patient even when the patient is not
present.

2) Stone casts
a. study models for diagnostic purposes and is used to pan and practice the surgical procedure
b. good visual aid to explain the oral condition and proposed procedure to the patient
c. models for fabrication of occlusal splints
d. limited to providing information of the intraoral structures, and can't provide information on
skeletal deformities not the final curve of Wilson of a patient
The most common procedure for treating chronic recurrent TMJ dislocation is...

A. An interpositional arthroplasty often combined with a coronoidectomy

B. Corrective orthognathic surgery with articular eminectomy usually combined with capsular
placation
C. Total joint replacement
D. Coronoidectomy and release of temporal is muscle from the mandible A. An interpositional
arthroplasty often combined with a coronoidectomy

1) Concept: Interpositional arthroplasty procedures

a. separate the non-mobile portion and mobile portion of the TMJ to ensure that the condyle and
the temporal bone do not directly contact each other.
b. recontours the bones within the temporomandibular joint and uses fascia, cartilage, or any
suitable substance in between the two bones to correct the damaging and painful friction between
them
c. reduces painful movements and re-establishes motion within the TMJ

2) Coronoidectomy
a. also performed to manage trismus and pseudoankylosis
When treating Actinomycosis of the jaw, which of the following is the most accepted dosage
schedule?

A. 10 million units IV per day for 10-14 days followed by a long-term oral antibiotic
B. 250 mg oral tablets q6H, 7 days
C. 500 mg oral tablets q6h, 7 days
D. 600,000 units IM Q12H, 14 days followed by an oral antibiotic A. 10 million units IV per
day for 10-14 days followed by a long-term oral antibiotic

1) Concept: Actinomycosis of the jaw is best treated with penicillin antibiotics intravenously for
a period of 2-6 weeks

2) Actionmycosis
a. requires long term antibiotic treatment in oral doses that may last form 6-12 months depending
on the disease severity
b. Actinomycosis infection elicits suppuration and inflammation
c. Swellings caused by actinomycosis drain pus containing sulfur granules
Each of the following is a reason a clinician may section an impacted 3rd molar during the
extraction procedure EXCEPT one. Which is the EXCEPTION?

A. Minimize exertion of force necessary to extract the tooth

B. Minimize quantity of bone removed *
C. Minimize the time of the procedure *
D. Allow tooth to be delivered from the occlusal aspect D. Allow tooth to be delivered from
the occlusal aspect

1) Sectioning
a. Sectioning an impacted molar makes the extraction procedure easier and faster for both the
clinic and the patient
b. By sectioning the roots of the impacted 3rd molar, each root can be easily luxated and
removed in the best manner possible without exerting too much force, thereby preventing trauma
to hard and soft tissues
c. Too much bone reduction can also be avoided with a planned root resectioning procedure of
impacted teeth
Which of the following orthognathic surgeries is LEAST stable?

A. Genioplasty
B. Inferior movement of the maxilla
C. Mandibular advancement
D. Maxillary advancement B. Inferior movement of the maxilla

1) Concept: Inferior movement of the maxilla is the LEAST stable because the vertical occlusal
force of the masticatory muscles often cause it to relapse.

2) Maxillary orthognathic surgeries like LaFort I, II, and III typically have a higher relapse rate
than mandibular orthognathic surgeries because the bone of the maxilla is thinner and less sold
than the mandible.
Diagnosis Diagnosis Answers
Bleeding under the conductive may indicate...

A. Frontal sinus fracture

B. Le Forte II fracture
C. Le Forte III fracture
D. Nasal bone fracture
E. Zygomaticomaxillary complex fracture
F. Le Fort I fracture E. Zygomaticomaxillary complex fracture

1) Concept: Zygomaticomaxillary complex fracture or tripod/malar fracture involves fracture of

a. Maxillary sinus and its walls and orbital floor
b. Zygomatic arch
c. Lateral orbital rim and the lateral orbital wall
d. caused by a direct blow to malar eminence during a fight, a sport or vehicular accident, or due
to a fall.

2) Clinical features
a. flattened malar eminence
b. facial bruising/swelling
c. bleeding under the conjuctiva
d. facial sensation loss below the orbit in an infraorbital nerve involvement and trismus
Which of the following teeth responds the LEAST to rotational forces during extraction
procedures due to its root structure?

A. Mandibular 1st premolar

B. Mandibular 2nd premolar
C. Mandibular central incisor
D. Maxillary 1st premolar
E. Maxillary central incisor
F. Mandibular canine D. Maxillary 1st premolar

1) Concept: The buccal and lingual placement of the roots and tendency to fracture decreases the
usefulness of rotational extraction forces.

2) Maxillary 1st premolars

a. are known to fracture during extractions due to the presence of 2 thin roots.
b. have variable root forms and normally have two root canals and two roots
c. due to the thinness of the tooth root of maxillary premolars, the roots are easily fractured
during extraction
A 40 year old patient diagnosed with an acute apical abscess presents to your office for the
extraction of tooth #3. Penicillin prophlaxis was administered because the patient had a history
of rheumatic fever and valve replacement. Periorbital and labial edema were discovered 15
minutes following administration of penicillin. What is the most likely diagnosis for what this
patient is experiencing?

A. Angioneurotic edema
B. Congestive heart failure
C. Hematoma formation
D. An acute anaphylactoid reaction A. Angioneurotic edema

1) Concept: Angioneurotic edema was initiated due to an allergic reaction to penicillin

2) As the mast cells in the body being to react against an allergen, histamine release occurs,
resulting in an allergic reaction and angioedema.

3) Symptoms of angioneurotic edema include

a. swelling of the periorbital area, lips, and tongue
b. urticaria
c. shortness in breathing in severe cases
Fracture of which of the following would be suggested if a patient experiences paresthesia of
their left upper lip, cheek, and left side of the nose after they suffered a midface fracture.

A. Maxillary sinus
B. Nasal bone
C. Zygomatic arch
D. Infraorbital rim D. Infraorbital rim

1) Concept: Paresthesia of the upper lip, cheek, and left nose is due to the damage incurred by
the infraorbital nerve.

2) Infraorbital nerve exits the infraorbital foramen and branches out to innervate the upper lips,
cheeks and nose up the nasal vestibule.

3) A fracture along the infraorbital rim may result in damaged to the infraorbital nerve which
causes paresthesia of the structures it innervates
The predominant cause for failure of autgenous 3rd molar transplants is...

A. Immune rejection
B. Inadequate root length
C. Infection
D. Traumatic occlusion D. Traumatic occlusion
1) Concept: Autogenous tooth transplantation is the process of utilizing the freshly extracted
impacted or erupted teeth from its original position in the arch and transferring them into the
recipient site of the same person.

2) There are several reason to explain the failure of autogenous tooth transplants which include
chronic root resorption, inflammatory resorption, marginal and apical periodontitis, dental caries,
and occlusal trauma.

3) 3rd molars used for autogenous tooth transplant procedures most commonly fail due to their
inability to withstand the heavy occlusal forces that exist in the posterior during mastication.

4) Due to the mechanical advantage of a Type III lever like the jaw, occlusal force increases as
you move posteriorly in the mouth (closer to the fulcrum/condyle)
Trochlear nerve dysfunction is indicated by...

A. Eyes fil to move down and out

B. Eyes fail to move laterally
C. Proptosis
D. Dilated pupil A. Eyes fil to move down and out

1) Concept: The trochlear nerve (CN IV) is a motor nerve which innervates the superior oblique
muscle.

2) The superior oblique muscle allows rotation of the eyes within the vertical plane and the
rotational movement of the eyeball towards and away from the medial plane.

3) Trochlear nerve dysfunction will prevent the eyes from moving up and down.
Following a difficult surgical extraction, a patient was diagnosed with a postoperative infection
and has been placed on oral penicillin for three weeks. At her exam today, you notice that the
surgical site is well healed, but there are white patches on the dorsum of her tongue that scrapes
off. What is the recommended course of treatment?

A. Discontinue all antibiotics only

B. Discontinue penicillin and prescribe nystatin troches
C. Discontinue penicillin treatment and prescribe a broad spectrum antibiotic
D. Discontinue penicillin and prescribe a mouthwash containing metronidazole B. Discontinue
penicillin and prescribe nystatin troches

1) Concept: Prolonged intake of antibiotics disturbs the balance of microflora in the mouth by
killing the "normal" bacteria, allowing the fungal species like Candida albicans to grow
unhindered by competition.

2) The white patches on the coral surface of the tongue that appeared after prolonged antibiotic
use are caused by the increased use are caused by the increased number of Candida albicans.

3) Nystatin troches are considered an effective treatment modality for Candida infections.
Acute suppurative osteomyelitis is commonly associated with each of the following EXCEPT
ONE. Which if the following is the one EXCEPTION?

A. Deep and intense pain

B. High or intermittent fever
C. Paresthesia or anesthesia of the inferior alveolar
D. Loose teeth with suppurative drainage from the periodontium D. Loose teeth with
suppurative drainage from the periodontium

1) Concept: Loose teeth with suppurative drainage from the periodontium is caused by
periodontitis, NOT acute osteomyelitis.

2) Acute osteomyelitis
a. a disease that mostly affects children and is usually correlated with a Staphylococcus aureus
infection.
b. may also occur in adults with compromised immune system, immunosuppressive therapy, or
steroid therapy.
Each of the following is a characteristic of advanced osteoarthritis of the TMJ EXCEPT one.
Which is the EXCEPTION?

A. Antegonial notching
B. Crepitus
C. Tendency toward apertognathia
D. Tendency toward prognathism
E. Flattening of articular surface C. Tendency toward apertognathia

1) Concept: Advanced cases of osteoarthritis of the TMJ may exhibit crepitus, flattening of the
articular surface of the condyle, limited jaw movement, and pain on mouth opening.

2) Advanced osteoarthritis
a. could not cause apertognathia which is the dental malocclusion whee the posterior teeth
occlude prematurely resulting in an open bite.
b. could result to a pseudoprognathic appearing mandible and could also cause deviation of jaw
movement, further aggravating the condition
Clinical signs/symptoms of insulin shock do NOT include...

A. Cold sweat
B. Nausea
C. Seizures
D. Weakness
E. Confusion C. Seizures

1) Concept: Insulin shock

a. can be induced by insulin overdose, skipped meal, or a strenuous exercise that lowers the
blood sugar in a very rapid manner in a diabetic patient.
b. clinical signs and symptoms of insulin shock do not include seizures.
b. Signs and symptoms

1) Cool moist skin

2) Sweating
3) Weakness
4) Confusion
5) Nausea
6) Dizziness
7) Hunger
8) Tachycardia
Which of the following is the most likely etiology of a sudden increase in temperature one week
after surgery?

A. Atelectasis
B. Subacute Bacterial Endocarditis
C. Urinary tract infection
D. Wound infection D. Wound infection

1) Concept: Sudden increases in body temperature is an indication of fever which are typically
initiated when infection is present in the body

2) A patient experiencing fever one week after a surgical procedure indicates a presence of
infection.

3) After one week, the surgical wound should have reduction or total absence of swelling and
should demonstrate a decrease in the redness of the wound.

4) Patients who experiences swelling and fever that does not subside after the 3rd or 4th day after
the surgical procedure should seek care as it may be due to infection.
Which bone makes up all or part of the inferior concha?

A. Ethmoid
B. Maxilla
C. Palatine
D. Sphenoid
E. Turbinate E. Turbinate

1) Concept: Tubrinates are narrow and sea-shell appearing bone that extends into the nasal air
passage.

2) Turbinates
a. have four grooved air channels which divides and forces the inspired air to flow steadily into
the nasal passages.
b. responsible for warming, humidifying, and filtering the inhaled air.
Which of the following anatomical spaces would a needle tract infection following an inferior
alveolar nerve block infection involve initially?
A. Pterygomandibular
B. Pterygopalatine
C. Sublingual
D. Submandibular
E. Lateral pharyngeal A. Pterygomandibular

1) Concept: The pterygomandibular space will most probably be affected by a needle tract
infection after an IAN nerve block.

2) The pterygomandibular space is the anatomical space containing several blood vessels and the
mandibular branch of the trigeminal nerve.

3) In order to anesthetize the jaw, the inferior alveolar nerve block is performed with the needle
passing into the pterygomandibular space, which may serve later as an opening for infection to
set in.
What structure(s) must be cut in order to enter the superior joint space of the TMJ?

A. Capsular and discal ligaments

B. Capsular and retrodiscal ligaments
C. Discal ligament only
D. Capsular ligament only D. Capsular ligament only

1) Concept: The superior joint space is encompassed by the capsular ligament and must be cut in
order to access the superior joint space.

2) The capsular ligament completely encircles the temporomandibular joint and prevents over
extensive movements that may cause the TMJ to dislocate.
Which of the following is the most like fracture site if a patient present to you after receiving a
heavy blow to the chin that causes their mandible to deviate to the left upon opening?

A. Left body of the mandible

B. Right body of the mandible
C. Right subconydylar region
D. Left subcondylar region D. Left subcondylar region

1) Concept: Suncondylar fractures are diagnosed in trauma cases by a deviation of the mandible
to the side of a fracture because subcondylar fractures leads to improper translation of the
mandible, creating deviation.

2) Protrusive, extrusive, and opening movements can be produced by the contraction of the
lateral pterygoid muscles.

3) During right excursive movements when the mandible moves to the right, the left lateral
pterygoid contacts pushing the mandible downward and forward. The right lateral pterygoid is
relaxed and does not antagonize the voce, causing the asymmetrical depression and protrusion of
the mandible.
The classification of an impacted mandibular 3rd molar is usually based on which of the
following factors? Select all that apply.

A. Extent of soft tissue and/or bone coverage

B. No answers are correct
C. Position of the tooth in relation to the long axis of the 2nd molar
D. Position of the tooth to the opposing 3rd molar A. Extent of soft tissue and/or bone
coverage
C. Position of the tooth in relation to the long axis of the 2nd molar

1) Concept: The classification of 3rd molar impaction is based on their spatial positioning in
relation with the long axis of the adjacent 2nd molar and the amount of tooth structure covered
by bone or soft tissue.

2) Winter's classification of tooth impaction

a. based on the position of the long axis of the 3rd molar in relation to the long axis of the 2nd
molar

3) Pell and Gregory classification of tooth impaction

a. deals with the position of the lower 3rd molar impaction within the ramus in relation with the
2nd molar.
Each of the following nerves have branches which innervate the temporomandibular joint (TMJ)
except one. Which nerve is the EXCEPTION?

A. Auriculotemporal
B. Deep temporal
C. Mandibular division of the trigeminal (V3)
D. Marginal mandibular
E. Masseteric D. Marginal mandibular

1) Concept: The marginal mandibular branch is located within the anterior aspect of the face and
neck and supplies the lower lip muscles and chin.

2) The mental is, depressor anguli iris, and depressor labii inferiors are muscles that are
innervated by the marginal mandibular branch of the facial nerve.

3) The masseteric nerve, auriculotemporal nerve, and mandibular division of the trigeminal nerve
have branches that innervate the TMJ.
How many days will it usually take for a patient to notice post extraction alveolar osteitis (dry
socket) if it occurs?

A. 3
B. 5
C. 7
D. 9
E. 1 A. 3

1) Concept: Dry socket (Localized Alveolar Osteitis) is a painful condition that occurs 2-3 days
following tooth extraction and is self limiting in nature.

2) Dry socket
a. have several predisposing conditions but usually occurs due to the dislodgment of the blood
clot in the extraction site.
b. elicits pain that may last for 2-3 days and may even radiate to other areas of the face.
What is the only structure in the TMJ to exert posterior traction on the articular disc?

A. Inferior head of the lateral pterygoid

B. Inferior retrodiscal lamina
C. Superior retrodiscal lamina
D. Superior head of the lateral pterygoid C. Superior retrodiscal lamina

1) Concept: Superior retrodiscal lamina functions by pulling the articular discs posteriorly
against the lateral pterygoid that pulls it forward.

2) Superior retrodiscal lamina provides posterior traction as it connects the articular disc to the
tympanic plate.

3) During mouth opening, the retrodiscal lamina is extended preventing overextension and
anterior dislocation of the articular disc.
Which of the following directions would a mandibular 2nd molar move if the 1st molar was
extracted?

A. Distally
B. Lingually
C. Mesially
D. Buccally C. Mesially

1) Concept: Teeth may tend to move into an edentulous area recently occupied by an adjacent
tooth.

2) Edentulous spaces exhibit thinner bone support, so the adjacent 2nd molar may tilt or move
medially into the space.

3) Teeth tend to move medially towards the midline, especially when the adjacent tooth is
missing.
Which of the following directions would a mandibular 2nd premolar move if the 1st molar was
extracted

A. Distally
B. Lingually
C. Mesially
D. None A. Distally

1) Concept: Mandibular premolars will move distally because of the presence of space distally
and the resorption of the interseptal bone that separates i from the mandibular molar extraction
site.

2) The alveolar bone between the mandibular 2nd premolar and 1st molar will resorb, causing it
to become thinner and weaker there by providing less support to the mandibular 2nd premolar.

3) The 2nd premolar will have a tendency to collapse into the bony area that is thin, weak, and
less resistant.
A surgical extraction of impacted 3rd molars would be contraindicated if the patient had...

A. A fever of undiagnosed etiology

B. A history of anemia
C. A necrotic pulp
D. An oral ulcer of unknown origin
E. Hemophilia or was taking blood thinners D. An oral ulcer of unknown origin

1) Concept: Oral ulcers of unknown origin

a. can indicate an underlying systemic condition that needs to be diagnosed prior to any surgical
procedure.
b. oral ulcers can be associated with viral infections like herpes and HIV, fungal disease,
bacterial infections or might be due to mucosal trauma.

2) Surgical extractions can be performed for the following patients with an appropriate medical
clearance from the patient's physician.
a. Hemophiliacs
a. patients can be managed with medications involving transexamic acid and infusion of clotting
factor VIII or IX prior to extraction improves clotting time and reduces bleeding time

b. Anemic
a. Patients can be managed through prophylactic antibiotics prior to extraction with antibiotics
post extraction to avoid the possibility of having bacterial endocarditis.

c. Fever of undiagnosed etiology

a. Patients should be evaluated by their physician first to determine the etiology of the fever.
Tooth extraction may be performed only if the patient is already cleared by the physician and is
afebrile.

d. Necrotic pulps are not a contraindication to dental extraction.

Nociception from the face is transmitted on all of the following pathways EXCEPT one. Which
pathway is the one EXCEPTION?

A. Autonomic nerves
B. Cervical spinal nerves
C. Ninth cranial nerve
D. Fifth cranial nerve A. Autonomic nerves

1) Concept: Autonomic nerves are related to muscular or motor reflexive functions including
peristalsis, breathing, and heart beat and are not involved in pain perception.

2) Nociception
a. process of transmitting and identifying noxious stimuli from the nociceptors of the peripheral
nervous system

3) Cranial nerve V and IX are both sensory and motor nerves that transmit nociceptive stimuli
from the face.
Contraction of which of the following muscles can cause the forward displacement of the
condylar head if the condyle is fracture off?

A. Lateral pterygoid
B. Medial pterygoid
C. Stylohyoid
D. Temporal
E. Buccinator A. Lateral pterygoid

1) Concept: Protrusive and extrusive movements are produced mostly by the contraction of the
lateral pterygoid muscles.

2) During right lateral excursive movements when the mandible moves to the right, the left
lateral pterygoid contracts pushing the mandible downward and forward. The right lateral
pterygoid is relaxed and does not antagonize the force, causing the asymmetrical depression and
protrusion of the mandible.

3) When both lateral pterygoids contract at the same time, it causes a protrusive movement.

4) The lateral pterygoid originate in the infra temporal fossa and attaches to the TMJ disk and the
neck of the mandible.
Each of the following diagnostic aids is helpful in distinguishing between a case of maxillary
retrusion and mandibular protrusion in cases presenting with a Class III malocclusion EXCEPT
ONE. Which of the following diagnostic aids is the EXCEPTION?

A. Clinical evaluation
B. Photography
C. Study casts
D. Cephalometry C. Study casts

1) Concept: Stone casts are accurate positive copies of a patient's oral structures that enable
dentists to study and diagnose the oral condition of the patient when the patient is not present.
2) Stone casts are used in maxillofacial surgical procedures as:
a. study models for diagnostic purposes and is used to plan and practice the surgical procedure
b. good visual aid to explain the oral condition and proposed procedure to the patient
c. models for fabrication of occlusal splints.
d. are limited to providing information of the intraoral structures, and can't provide information
on skeletal deformities
In which of the following procedures is the dentist least likely to utilize TMJ arthroscopy?

A. Diagnosis of disk perforations

B. Disk manipulation
C. Lysis of adhesions
D. Repair of disk perforations
E. Therapeutic lavage D. Repair of disk perforations

1) Concept: Repairing a disk perforations requires that a flap incision is made in order to fully
access the temporomandibular disk.

2) Lavage of the temporomanidbular joint space, removing adhesions, and disk manipulations
can all be complete using arthroscopy.

3) Diagnosis of disk perforations is best completed using T2 weighted Magnetic Resonance

Imaging (MRI)
Which of the following directions would a mandibular 2nd molar move if the 1st molar was
extracted?

A. Distally
B. Lingually
C. Mesially
D. None
E. Buccally C. Mesially

1) Concept: Teeth may tend to move into an edentulous area recently occupied by an adjacent
tooth.

2) Edentulous spaces exhibit thinner bone support, so the adjacent 2nd molar may tilt or move
medially into the space.
Which of the following tooth varieties are most known for susceptibility for fracture during
extraction procedures?

A. Mandibular 2nd premolars

B. Maxillary 1st premolars
C. Maxillary 2nd premolars
D. Mandibular 1st premolars B. Maxillary 1st premolars

1) Concept: Maxillary 1st premolars are known to fracture during extractions due to the presence
of a very thin root.
b. Maxillary 1st premolars have variable root forms and normally have two root canals and 2
roots.
c. Due to the thinness of the tooth root of maxillary premolars, the roots are easily fracture
during extraction.
When performing incisional biopsies of soft tissue, the clinician should do each of the following
EXCEPT one. Which is the EXCEPTION?

A. Obtain some adjacent normal tissue when possible

B. Place a suture through the specimen when removing it.
C. Place the specimen in saline if 10% formalin is not available
D. Infiltrate local anesthetic around the intended siteC. Place the specimen in saline if 10%
formalin is not available

1) Concept: Saline cannot be used as a fixative for the incisional biopsy specimen

2) Incisional biopsy is a procedure that removes a portion of a lesion for laboratory examinations
in cases when complete excision is contraindicated.
a. are performed on lesions > 10mm in size

3) Placing a suture in the specimen is done to localize the areas to be included in the incision and
prevent contamination of the specimen
A longer gray scale of contrast can be achieved in a radiograph by:

A. Decreasing the filtration

B. Increasing the focal spot-skin distance
C. Increasing the kilovoltage (kV)
D. Increasing the milliamperage (mA) C. Increasing the kilovoltage (kV)

1) Increasing the kV causes the radiographic image to have low contrast and longer gray scales

2) Low kV creates low energy x-rays responsible for producing high contrast and shorter gray
scales.
A 35-year-old female patient complains of a painful, rapidly developing ulcer on the left side of
her hard palate. This lesion appears crater-like and measures 3.5cm. Which of the following is
the most likely diagnosis for her current condition?

A. Adenoic cystic carcinoma

B. Necrotizing sialometaplasia
C. Pleomorphic adenoma B. Necrotizing sialometaplasia

1) Necrotizing sialometaplasia is a rapidly expanding ulcerative lesion that mostly occurs on the
posterior area of the hard palate.

2) Necrotizing sialometaplasia is usually benign and is often painless, and is usually self-limiting
and resolves in about 6-10 weeks.
3) Trauma to the minor salivary glands located in the hard palate causes this condition.
Mucous retetion cysts 1) Mucous retention cysts
a. dome-shaped radiopaque entities seen on the floor of the maxillary sinus
b. represent focal accumulation of inflammatory exudate that lifts the epithelial lining of the
sinus and the periosteum away from the underlying bone
c. are benign inflammatory reactions, so there is NO need for surgical treatment
A 21-year-old male patient complains of a dull pain in their posterior left mandibular region with
a radiograph that reveals not only a radiolucency around the 1st molar roots, but also a
radiopacity of bone peripheral to this radiolucency. Which of the following is the best diagnosis?

A. a manifestations of systemic bone disease

B. a reaction to an apical inflammatory disease B. a reaction to an apical inflammatory
disease

1) Radiolucency is from the tissue destruction that occurred within the periodical area and the
radiopacity that denotes the boundary set by the inflammatory cells as they try to confine the
infection.

2) Once the infection is completely confined by the inflammatory cells, a periodical cyst or a
granulation tissue may form and the damaged bone begins to remodel.

3) The continuous remodeling of the bone creates the solid, well-defined and radiopaque border
around the periphery of the periodical cyst or of the granulation tissue.
Anterior disc displacement 1) Anterior Disc Displacement with Reduction
a. articular disc is attached anteriorly to the superior head of the lateral pterygoid muscle and
posteriorly to the retrodiscal tissue
b. moves anteriorly out from between the condyle and the fossa, so that the mandible and
temporal bone contact is made on something other than the articular disc and the disc slides back
into place
c. sliding of the disc back into place creates the characteristic popping or clicking noise

2) Anterior Disc Displacement without Reduction

a. the disc stays anterior to the condylar head upon opening, so mouth opening is limited and
there is no "pop" or "click" sound on opening
b. no sliding of the disc back into place
A pantomograph examination reveals a radiopacity in a patient's maxillary sinus. The patient is
asymptomatic. The differential diagnosis should contain each of the following EXCEPT one.
Which option is this EXCEPTION?

A. Antrolith
B. Odontoma
C. Osteoma
D. Periapical Cyst
E. Mucus retention pseudocyst D. Periapical Cyst

1) Periapical cyst
a. localized radiolucencies associated with the apex of a tooth that previously suffered chronic
pulpal or periodontal infection

2) Odontomas
a. radiopaque lessons that may occur along the anterior and posterior teeth

3) Osteomas
a. radiopaque benign lesions or bone growth within a membranous bone

4) Antroliths
a. calcified lesions or masses which is usually located along the maxillary sinus

5) Mucous retentoin pseudocysts

a. collection of mucous deposits within the paranasal sinuses
b. appear radiopaque because the air that surrounds the pseudocyst is radiolucent, making the
mucous more radiopaque
Internal derangement 1) Internal derangement
a. condition within the TMJ
b. involves displacement or slipping of the articular disc

2) Internal derangement with reduction

a. articular disc is moving and sliding in and out of its normal limiting structure as the condyle
head functions during the jaw opening and closing movements.

b. clicking sound due to articular disc that slides back and forth.
Nasopalatine duct cyst 1) Nasopalatine duct cyst
a. heart-shaped radiolucency often found in the median aspect of the hard palate anterior to the
1st molars
2) considered the most prominent odontogneic cyst within the oral cavity
Soft Tissue Soft Tissue Answers
Which of the following will provide the MOST ACCURATE diagnosis for a patient with a large
cyst-like lesion (14mm) in area of their posterior mandible?

A. Incisional biopsy and histologic analysis

B. Needle aspiration biopsy
C. Radiographic examination
D. Visual clinical examination
E. Exfoliative cytology A. Incisional biopsy and histologic analysis

1) Concept: Histology of the tissue and cystic fluid will aid in the definite diagnosis of the lesion.
Incisional biopsy is indicated because it is a large lesion (>10mm)

2) Incisional biopsy
a. of the large cystic lesion should be carried out and sent to the laboratory for histologic
examination
3) Definitive diagnosis
a. is necessary to determine which treatment should be provided for the best results
Which of the following reactive lesions of gingival tissue histologically reveals bone formation?

A. Peripheral giant cell granuloma

B. Peripheral ossifying fibroma
C. Pyogenic granuloma
D. Traumatic neuroma
E. Irritation fibroma B. Peripheral ossifying fibroma

1) Concept: Peripheral ossifying fibromas

a. Peripheral ossifying fibromas appear microscopically as a combination of a mineralized
product and fibrous proliferation.
b. The mineralized portion may be bone, cementum-like, or dystrophic calcifications.
c. an overgrowth of gingival tissue caused by mucosal irritation or trauma and are similar in
appearance to pyogenic granulomas and peripheral giant cell granulomas
d. Peripheral ossifying fibromas range from red to pink, and are frequently ulcerated. They may
appear as sessile or pedunculated with a size of cm or less.
e. They occur 66% in females with a prevalence highest around 10-19 years of age.
Which of the following conditions describes a benign, non-painful appearance of the tongue with
multiple grooves and bad breath?

A. Fissured tongue
B. Hairy tongue
C. Lingual laceration
D. Oral squamous cell carcinoma
E. Benign migrating glossitis A. Fissured tongue

1) Concept: Fissued Tongue

a. also known as Scrotal tongue, lingua plicate, Plicated tongue, and furrowed tongue is a benign
condition characterized by deep grooves (fissures) in the dorsum of the tongue
b. grooves may appear unsettling, the condition is typically painless although some individuals
may complain of an associated burning sensation due to inflammation caused by poor oral
hygiene.

c. estimated prevalence of 2-5%

d. may be seen at any age
e. becomes more accentuated with age
f. appearance varied in orientation, number, depth, and length of the fissure pattern
g. usually multiple grooves/furrows 2-6mm in depth present
h. food particles stuck in fissures may cause halitosis and irritation.

2) Hairy Tongue (lingual villosa)

a. is a commonly observed condition of defective desquamation of the filiform papillae that
causes the tongue to appear "hairy" and can often create a habitat for bacteria to reside and cause
bad breath
3) Benign migrating glossitis (geographic tongue)
a. non-painful inflammatory condition of the mucous membrane of the tongue, usually on the
dorsal surface that affects approximately 2-3% of the general population.
Degeneration of the basal cell layer, a mononuclear inflammatory cell infiltrate in the sub
epithelial connective tissue, and "Saw-tooth" tete pegs are indicative of which of the following
mucocutaneous disorders?

A. Dermatitis herpetiformis
B. Erytheme multiforme
C. Keratosis follicularis
D. Lichen planus
E. Benign mucus membrane pemphigoid D. Lichen planus

1) Concept: Lichen Planus

a. Lichen Planus is a chronic mucocutaneous inflammatory disease that affects the skin, tongue,
and oral mucosa of unknown origin and presents with 3 variations.
b. name refers to the dry and undulating, "lichen-like" appearance of affected skin
c. It is sometimes associated with oxidative stress, certain medications and diseases

2) Reticular Lichen Planus

a. most common and manifests as white lacy streaks on the mucosa (known as Wickham striae)
or as smaller papules.. The lesions tend to be bilateral and are symptomatic.

4) Bullous Lichen Planus

a. presents as fluid-filled vesicles which project from the surface

5) Erosive Lichen Planus

a. presents with painful erythematous ulcerated lesions which may occur in many areas of the
mouth, but mostly on the posterior buccal mucosa and may resemble desquamative gingivitis.
Wickham's striae may also be seen near these ulcerated areas

6) Biopys
a. is recommended to rule our precancerous (premalignant) change of persistent lesions similar to
erosive lichen plans that do not respond to topical corticosteroids
Which of the following cancer diagnoses has the best 5-year survival rate?

A. Stage 1 well-differentiated squamous cell carcinoma involving the floor of the mouth
B. Stage 1 well-differentiated squamous cell carcinoma involving the right lateral tongue
C. Stage 1 well-differentiated squamous cell carcinoma involving the soft palate
D. Verrucous carcinoma of the floor of the mouth
E. Verrucous carcinoma of the right lower posterior vestibule E. Verrucous carcinoma of
the right lower posterior vestibule

1) Concept: Verrucous carcinoma

a. Verrucous carcinoma is a slow forming tumor that is usually seen along the mandibular
vestibule, buccal mucosa, floor of the mouth, and mandibular gingiva.
b. usually seen among people who had a long history of chewing tobacco
c. usually appears as a white, papillary exophytic mass which is non-ulcerated
d. prognosis of vestibular verrucous carcinoma is better than the ones in the floor of the mouth
because there are many other important intraoral structures underneath the floor of the mouth to
which the carcinoma may extend.
e. With complete surgical removal of the carcinoma, patients become disease free over a five
year period at about 90% of the time.
A 20-year-old female presents to you with diffuse gingival erythema and scattered isolated ulcers
on the tongue and oropharynx. The marginal gingiva appears inflamed and edematous. The
patient states that she has been in pain for three days duration and demonstrates a fever and
malaise. Which of the following is the most probable diagnosis?

A. Acute necrotizing ulcerative gingivitis (ANUG)

B. Apthous stomatitis
C. Burning mouth syndrome
D. Erosive lichen planus
E. Acute herpetic gingivostomatitis E. Acute herpetic gingivostomatitis

1) Concept: Gingivostomatitis
a. is an inflammation of the oral mucosa and gingiva caused predominantly by HSV-1
b. Primary herpetic gingivostomatitis is an infection transmitted through direct contact or
through aerosol droplet that clinically apparent as yellow fluid-filled vesicles that leave ulcers
when the vesicles rupture.

c. Secondary herpetic gingivostomatitis is a reactivation of the latent virus due to trauma, stress
or immunsuppression. The vesicles and ulcerations may be found intramurally and extra orally
on keratinized surfaces.
d. Herpes presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular
ulcerations covered by yellow-grey membranes.

e. Prodromal symptoms include

1) fever
2) anorexia
3) irritability
4) malaise
5) headache
A 60-year old female "Connie" presents to your office with a 8mm x 8mm blue-black soft
fluctuant lesion of her lower lip. She states that the lesion is asymptomatic and has exhibited
persistent growth over the last 10 years, and bleeds profusely when she bites her lip. Which of
the following is the most likely diagnosis?

A. Lipoma
B. Neurofibroma
C. Nodular melanoma
D. Verrucous carcinoma
E. Cavernous hemangioma E. Cavernous hemangioma

1) Concept: Cavernous hemangiomas

a. class of blood vessel malformation characterized by a large blood-filled space and contain
blood, not tissue
b. Hemangiomas can arise virtually anywhere in the body and are considered to be benign
neoplasms.
c. Unlike capillary hemangiomas, cavernous hemangiomas can be disfiguring and do not tend to
regress.
d. Cavernous hemangiomas may lead to spontaneous or traumatic bleeding.
Each of the following conditions is characterized by an ulcerations that are preceded by a
vesicular lesion EXCEPT ONE. Which condition is the EXCEPTION?

A. Coxackie virus infection (Hand-foot-and-mouth-disease)

B. Herpangina
C. Herpes zoster
D. Herpetic stomatitis
E. Apthous stomatitis E. Apthous stomatitis

1) Concept: Apthous stomatitis is characterized by the repeated formation of ulcers in the mouth,
in otherwise healthy individuals.
b. Apthous stomatis ulcers occur periodically and heal completely between attacks with pain
symptoms ranging from a minor nuisance to interfering with eating and drinking.
c. Ulcerations present in apthous stomatitis cases are NOT preceded by vesicular lesions.
d. All other conditions listed are characterized by the presence of ulcers with vesicular lesions.
The most serious effects of repeated exposure to X radiation in low doses is characterized by
which of the following?

A. Carcinogenesis
B. Diarrhea
C. Pupura
D. Radionecrosis
E. Alteration of oral microflora A. Carcinogenesis

1) Concept: Carcinogenesis
a. Repeated low doses of ionizing radiate may induce irreparable DNA damage which leads to
errors in replication and transcription that result in carcinogenesis
b. Persistent low dose radiation can induce a type of genomic instability in cells that may trigger
viral interactions leading to pre-mature aging and carcinogenesis
c. Ionizing radiation results in the enhancing of the frequency of mutation and other genetic
changes in the descendants of the irradiated cell after many generations of replication.
d. Gap junction mediated cell-cell communication and activation of the p53 damaged response
pathway may result in carcinogenesis.
Infection, loss of interocclusal (intermaxilary) space, and vitamin B12 deficiency, are all possible
etiologies of which of the following conditions
A. Angular chelitis
B. Apthous stomatitis
C. Atrophic glossitis
D. Media rhomboid glossitis
E. Xerostomia A. Angular chelitis

1) Concept: Angular cheilitis

a. Angular cheilitis has a common etiology of infection, loss of interocclusal/intermaxilary space,
or vitamin B deficiency.
b. Characteristics of angular cheilitis include:
1) erythema
2) moist maceration
3) soreness
4) pain
5) burning
6) pruritis
7) ulceration and crusting at the corners of the mouth
8) There may also be inflammation of the vermillion commisures and adjacent mucous
membranes.

2) Angular cheilitis is also known as angular cheilosis, commisural cheilitis, angular stomatitis
and perleche.
Each of the following conditions is characterized by an ulcerations that are preceded by a
vesicular lesion EXCEPT ONE. Which condition is the EXCEPTION?

A. Apthous Stomatitis
B. Coxackie virus infection (Hand-foot-and-mouth disease)
C. Herpangina
D. Herpes zoster
E. Herpetic stomatitis A. Apthous Stomatitis

1) Concept: Apthous stomatitis is characterized by the repeated formation of ulcers in the mouth,
in otherwise healthy individuals.
b. Apthous stomatis ulcers occur periodically and heal completely between attacks with pain
symptoms ranging from a minor nuisance to interfering with eating and drinking.
c. Ulcerations present in apthous stomatitis cases are NOT preceded by vesicular lesions.
d. All other conditions listed are characterized by the presence of ulcers with vesicular lesions.
Which of the following is the best treatment of generalized acute herpetic gingivostomatitis?

A. Begin regimen of diluted vericelli zoster vaccine administrations

B. Increase liquid intake, gentle debridement of the mouth, and good oral hygiene
C. Prescribe 2g penicillin
D. Take a culture of the bacteria to confirm or distinguish your diagnosis from acute necrotizing
ulcerative gingivitis (ANUG) B. Increase liquid intake, gentle debridement of the mouth, and
good oral hygiene
1) Concept: The best treatment for generalized acute herpetic gingivostomatitis is:
a. Increased liquid intake
b. Gentle debridement of the mouth
c. Sustaining good oral hygiene conditions

2) The herpes simplex virus causes generalized acute herpetic gingivostomatitis.

3) Generalized soreness of the oral cavity results in the interference of eating and drinking

4) The ruptured vesicles are focal sites of pain and are sensitive to touch.

5) The condition is self-limiting and subsides within 1o to 14 days. Pallative treatment includes
a. topical viscous xylocaine
b. benadryl for pain relief
c. kaopectate to help coat the mouth
d. balanced diet to compensate for insufficient nutrition
e. Acyclovir, an antiviral may be administered in extreme cases to inhibit the virus. "Magic
Mouthwash" contains an anesthetic, benadryl, kaopectate and may congaing the antibiotic or
antiviral.
Which of the following lesions has the highest propensity for malignancy?

A. Junctional nevus
B. Leiomyoma
C. Lymphangioma
D. White sponge nevus
E. Granulocytoma A. Junctional nevus

1) Concept: Most junctional nevi are non-cancerous in nature but are capable of transforming
into malignant melanoma if changes are seen in their appearance
b. Junctional nevi or moles are a benign skin growth whose appears flat, round, and mostly dark
brown in color, and originate from multiple skin layers.
c. Junctional nevi arise from cells at the junction of the epidermis and dermis meet.

2) Early signs of melanoma can be diagnosed by "ABCDE"

A: Asymmetry
B: Borders (irregular)
C: Color (multicolored)
D. Diameter (greater than 6mm, about the size of a pencil erase)
E: Evolving over time

3) The most dangerous form of melanoma, nodular melanoma can be diagnosed with "EFG"
E: Elevated above the skin surface
F: Firm to the touch
G: Growing
Severe dysplasia or carcinoma in situ is MOST OFTEN associated histologically with which of
the following clinical lesions?

A. Hairy leukoplakia
B. Leukoplakia
C. Lichen planus
D. White sponge nevus
E. Erythroplakia E. Erythroplakia

1) Concept: Erythroplakia
a. Erythroplakia are red lesions that considered to be one of the most common premalignant
lesions in the oral cavity
b. Histopathological examination of erythroplakias exhibit severe dysplasia, carcinoma in situ
and invasive squamous cell carcinoma

2) Erythroplakias are MOST COMMONLY found:

1) Floor of the mouth
2) Tongue
3) Soft Palate

3) Erythroplakia appears red due to the following premalignant changes:

a. Absence of keratin production
b. Reduced number of epithelial cells
c. Increased vascularity due to inflammation
d. Thin and neoplastic epithelium
Which of the following areas is the MOST COMON site where adenomatoid odontogenic
tumors occur?

A. Anterior Maxilla
B. Posterior Maxilla
C. Posterior Mandible
D. Soft Palate
E. Anterior Mandible A. Anterior Maxilla

1) Concept: Adenomatoid odontogenic tumors are found most commonly in females under 20
years of age in their anterior maxilla and are associated with an unerupted tooth.
b. Adenomatoid odontogenic tumors are a benign epithelial tumor of bone that may or may not
mineralize.
c. They manifest radiographically as a well-defined radiolucent lesion which sometimes contains
radiopaque areas.
The diagnosis of which of the following conditions is an oral cytology smear MOST indicated?

A. Mucous membrane pemphigoid

B. Papilloma
C. Pseudomembraneous candidiosis
D. Squamous cell carcinoma
E. Lichen planus C. Pseudomembraneous candidiosis

1) Concept: Definitive diagnosis of candidosis requires specialized tests such as a cytologic

smear.
b. The membranous slough of pseudomembranous candidosis can often times be wiped off with
gauze to reveal an erythematous surface underneath.
c. The clinical appearance of pseudomembranous candidosis alone is sufficient for the diagnosis
of candidosis in most cases.
d. Smears are collected by gentle scraping of the lesion with a spatula or tongue blade with the
resulting debris being directly applied to a glass slide for a cytopathological exam.
Which of the following is the MOST PROBABLE diagnosis for a 45-year old patient who
complains of a unilateral facial burning and aching pain, intermittent paresthesia and itching, and
small white scars in his pre-auricular area.

A. Bell's palsy
B. Burning mouth syndrome
C. Post-herpetic neuralgia
D. Psychoneurosis
E. Auriculo-temporal syndrome C. Post-herpetic neuralgia

1) Concept: The most probable diagnosis for these conditions is post-herpetic neuralgia
b. It is characterized by nerve pain due to the damage caused by Varicella Zoster virus.
c. It is commonly restricted to a dermatome of the skins and follows a Varicella Zoster infection
in the same dermatome.
d. Post-herpetic neuralgia presents with
1) Possible paresthesia and itching
2) Discomfort to severe pain which can be described as burning or stabbing
3) Persistence of pain for 3+ months
4) Cutaneous scarring may be present
Which of the following lesions is the LEAST likely to be visible radiographically?

A. Lateral periodontal cyst

B. Nasolabial cyst
C. Nasopalatine duct cyst
D. Traumatic bone cyst B. Nasolabial cyst

1) Concept: Nasolabial cysts are NOT always visible on radiographs because of their soft tissue
origin and extra osseous occurrence

2) Nasolabial cysts
a. rare, non-odontogenic, soft-tissue, developmental cysts that occur inferiorly to the nasal alar
region
b. they are also known as nasoalveolar cysts of Klestadt's cysts
A 35 year-old man presents with multiple macular pigmented spots on the skin and multiple soft
nodules. What is the most likely diagnosis?
A. Lipomatosis
B. Metastatic malignant melanoma
C. Nevoid basal cell carcinoma syndrome
D. Polyostotic fibrous dysplasia
E. Neurofibromatosis E. Neurofibromatosis

1) Concept: Neurofibromatosis
a. genetic condition that manifests as cafe au lair spots and multiple soft nodules which may
occur anywhere else in the body.
b. Neurofibromatosis occurs with many varieties with the most commonly occurring variety
being the NF1 or von Recklinghausens disease.
c. No cure currently exists for neurofibromatosis and is only managed by treating the symptoms
as they arise.
A 42-year old asthmatic patient who smokes and is HIV+ presents to your office for a routine
evaluation. Upon examination, you notice an asymptomatic red patch on the midline dorsum of
their tongue and a marked loss of lingual papillae. Which of the following is the most likely
diagnosis?

A. Geographic tongue
B. Median Rhomboid glossitis
C. Schwannoma
D. Ulcerative lichen planus
E. Carcinoma B. Median Rhomboid glossitis

1) Concept: Median Rhomboid Glossitis

a. is a condition characterized by a midline erythematous patch on the dorsum of the tongue
immediately in front of the circumvallate papillae combined with a loss of lingual papillae
b. Median rhomboid glossitis is though to be created by a chronic fungal infection, and usually is
a type of oral candidiasis.
c. Risk factors include:
1) Smoking
2) Denture wearing
3) Corticosteroid sprays or inhalers
4) Human immunodeficiency virus (HIV) infection
An oral cytology smear is MOST INDICATED for the diagnosis of which of the following
conditions?

A. Lichen planus
B. Mucous membrane pemphigoid
C. Papilloma
D. Pseudomembraneous candiodosis
E. Squamous cell carcinoma D. Pseudomembraneous candiodosis

1) Concept: Definitive diagnosis of candidosis requires specialized tests such as a cytologic

smear.
b. The membranous slough of pseudomembranous candidosis can often times be wiped off with
gauze to reveal an erythematous surface underneath.
c. The clinical appearance of pseudomembranous candidosis alone is sufficient for the diagnosis
of candidosis in most cases.
d. Smears are collected by gentle scraping of the lesion with a spatula or tongue blade with the
resulting debris being directly applied to a glass slide for a cytopathological exam.
Which of the following procedures describes the best method to treat a recurrent ranula?

A. Electrosurgery
b. Marsupialization
C. Parotid gland excision
D. Sublingual gland excision
E. Cryosurgery D. Sublingual gland excision

1) Concept: ranuls typically exhibit a recurrence rate of up to 25% after a complete excision of
the ranula and up to 2% in cases of complete excision of the ranula and sublingual gland

2) Ranulas
a. are mucoceles found on the floor of the mouth that present as soft tissue swellings of collected
mucin from a ruptured salivary gland duct
b. usually caused by local trauma, and are left alone if they are small and not problematic

3) The salivary level experiences by a patient following an ipsilateral sublingual gland excision
is usually not noticed by the patient, so if the first surgery is considered a failure, excision is
recommended.
Which of the following is the MOST COMMON location that Kaposi's sarcoma lesions occur in
AIDS patients?

A. Floor of the mouth

B. Lower Lip
C. Palate
D. Tongue
E. Buccal mucosa C. Palate

1) Concept: The hard palate is most frequently affected, followed by the gums.

2) Kaposi Sarcoma (KS)

a. tumor caused by the human herpesvirus 8 that often appears in patients suffering from AIDS
b. The mouth is involved in about 30% of cases, and is the initial state in 15% of AIDS-related
Kaposi Sarcoma.
c. Lesions in the mouth may be easily damaged by chewing and bleed or suffer secondary
infection, and even interfere with eating or speaking.
1) Lesions manifest as macular, patches, or plaques, that are nodular, and exophytic
2) The cutaneous lesions can be solitary, localized, or disseminated
3) Kaposi Sarcoma can involve the oral cavity, lymph nodes and viscera
4) Kaposi Sarcoma diagnoses can be made through tissue biopsy
For which of the following conditions is the mucosa of the hard palate the most common location
of occurrence?

A. Lichen planus
B. Mucocele
C. Necrotizing sialometaplasia
D. Sialothiasis
E. Apthous ulcer C. Necrotizing sialometaplasia

1) Concept: Necrotizing sialometaplasia

a. rapidly expanding ulcerative lesion that mostly occurs on the posterior area of the hard palate
b. usually benign and is often painless, and is usually self-limiting and resolves in about six to
ten weeks.
c. trauma to the minor salivary glands located in the hard palate causes this condition
All of the following are correct about mucous retention phenomena (pseudocysts) EXCEPT one.
Which of the following is the EXCEPTION?

A. Appears radio-opaque
B. Is dome shaped
C. Protrudes from the floor of the maxillary sinus
D. Require surgical removal
E. Lined with respiratory epithelium D. Require surgical removal

1) Concept: Mucous retention pseudocysts

a. are benign inflammatory reactions, there is no need for surgical treatment.
b. Mucous retention pseudocysts are dome-shaped radiopaque entities seen on the floor of the
maxillary sinus that represent focal accumulation of inflammatory exudate that lifts the epithelial
lining of the sinus and the periosteum away from the underlying bone.
c. Their histologic appearance is that of normal or inflamed maxillary sinus lining. Because
mucous retention pseudocysts are benign inflammatory reactions, there is no need for surgical
treatment.
d. Mucous retention pseudocysts appear radiopaque because the air surrounding the pseudocyst
is radiolucent, making the pseudocyst appear more radiopaque.
Which of the following lesions is known to possess the greatest malignant potential?

A. Actinic chelitis
B. Hyperkaratosis
C. Lichen planus
D. White sponge nevus A. Actinic chelitis

1) Concept: Actinic cheilitis

a. Actinic cheilitis is documented to possess the greatest malignant potential among the lesions
listed in the question presented. It is a counterpart of the actinic keratosis of the skin and is prone
to progress into squamous cell carcinoma. It is characterized by a thickening whitish
discoloration of the lips at the border of the lip and skin and loss of vermillion border.
2) Hyperkeratosis
a. associated with the thickening of the outermost layer of the epidermis and presence of an
abnormal quantity of keratin

3) Lichen Planus
a. autoimmune disease of skin and mucous membranes

4) White sponge nevus

a. involves a defect in the normal process of keratinization of the mucosa.
What location are mucous retention swellings and mucoceles most commonly found?

A. Gingiva
B. Lower lip
C. Tongue
D. Upper lip
E. Buccal mucosa B. Lower lip

1) Concept: Mucoceles (mucus extravasation phenomenon/retention cysts) are a swelling

consisting of collected mucous due to a ruptured salivary gland duct usually caused by local
trauma
b. Mucoceles present a bluish translucent color, and are more commonly found in children and
young adults
c. The most common mucocele locations are lower lip, the inner side of the cheek, on the
anterior ventral tongue, and the floor of the mouth.
d. A mucocele on the floor of the mouth is referred to as a ranula because it looks like a frog
belly.
A 19-year-old woman complains of a tingling in her lower lip. An examination reveals an
asymptomatic, indurated swelling of her mandibular premolar region that she has been aware of
for 3 weeks. Radiographs indicate a loss of cortex with diffuse trabeculation. What is the most
likely diagnosis?

A. Dentigerous cyst
B. Hyperparathyroidism
C. Leukemia
D. Osteosarcoma
E. Ossifying fibroma D. Osteosarcoma

1) Concept: Osteosarcomas are classified as a form of bone cancer that predominantly occurs in
children and teenagers.
2) Osteosarcomas
a. The reason for this occurrence of osteosarcoma is still unknown at present but some studies
suggest a genetic etiology.
b. Usually manifest as a solid, indurated swelling that can be distinguished in radiographs as
appearing moth-eaten, or having a sun-burst appearance. The sun-burst appearance is due to the
calcified tumor spicules that radiate outward of the bone.
Which of the following would a cross-sectional occlusal radiograph be useful in locating?
A. Sialoliths in Wharton's duct
B. The hyoid bone
C. The mandibular foramen
D. Maxillary sinus polyps A. Sialoliths in Wharton's duct

1) Concept: Occlusal radiographs are important when attempting to discern the location of
submandibular sialoliths.

2) Stones in the Wharton's duct are made visible in cross sectional occlusal radiographs.

3) Diagnosis is usually made by characteristic history and physical examination.

4) Sialoliths or salivary calculi confirmation requires occlusal x-rays.

a. 80% of salivary gland calculi are visible on x-rays.
Which of the following muscles is usually involved in myositis?

A. Digastric
B. Lateral pterygoid
C. Masseter
D. Mylohyoid C. Masseter

1) Concept: Mositis is a general term for the inflammation of the muscles

2) The masseter muscle is the most commonly inflamed facial uncle.

3) Myositis is also a documented side effect of lipid-lowering drugs like statins and vibrates.
Severe dysplasia or carinoma in situ is MOST OFTEN associated histologically with which of
the following clinical lesions?

A. Erythroplakia
B. Hairy leukoplakia
C. Leukoplakia
D. Lichen planus
E. White sponge nevus A. Erythroplakia

1) Concept: Erythroplakia:
a. red lesions that considered to be one of the most common premalignant lesions in the oral
cavity
b. Erythroplakias are MOST COMMONLY found:
1) Floor of the mouth
2) Tongue
3) Soft palate

2) Histopathological examination of erythroplakias exhibit severe dysplasias, carcinoma in situ

and invasive squamous cell carcinoma
3) Erythroplakia appears red due to the following premalignant changes:
a. absence of keratin production
b. reduce number of epithelial cells
c. increased vascularity due to inflammation
d. thin and neoplastic epithelium
Which of the following does squamous cell carcinoma of the tongue MOST COMMONLY
metastasize to?

A. Brain
B. Cervical nodes
C. Liver
D. Lungs
E. Bone B. Cervical nodes

1) Concept: Squamous cell carcinoma of the tongue most commonly metastasizes to the cervical
lymph nodes because the lingual lymph drainage occurs through the cervical lymph nodes.

2) The spread of carcinoma in the cervical lymph noes typically exults in its poor prognosis.

3) Surgical neck dissection is typically used to treat this type of cancer.

A patient presents to your office with an indurated submucosal tumor that when biopsied,
suggests a neoplasm of glandular and myoepithelial origin. Which of the following is the most
likely diagnosis?

A. Fibroma
B. Mucocele
C. Schwannoma
D. Pleomorphic adenoma D. Pleomorphic adenoma

1) Concept: Pleomorphic adenoma is a common benign salivary gland neoplasm of glandular

cells along with myoepithelial components, that can potentially become malignant.

2) Pleomorphic adenoma
a. most common variety of salivary gland tumor and also the most common tumor of the parotid
gland
b. Plemorphic adenoma derives its name from the architectural pleomorphism (variable
appearance) observed with light microscopy.
c. The tumor usually presents as a slowly proliferating, painless, indurated single nodular mass.

3) Schwannomas and mucoceles are not indurated or firm.

4) Fibromas, mucoceles, and Schwannomas do not present microscopically with glandular or

myoepithelial cells.
In the United State populace, which of the following describes the MOST COMMON location
premalignant lesions of squamous epithelium are observed?
A. Soft Palate
B. Buccal mucosa
C. Dorsum of the tongue
D. Floor of the mouth
E. Gingiva
F. Hard palate D. Floor of the mouth

1) Concept: The floor of the mouth and lateral border of the tongue are the most common
locations for the development of squamous cell carcinoma inside the mouth.

2) An explanation for the high potential for premalignant lesions in this area is due to its rich
blood supply because rapidly dividing malignant cells require more nutrition than normal cells.

3) If an ulcer or lesion develops on the floor of the mouth, healing is difficult because of the high
degree of mobility of the tongue and floor of the mouth.
A 41 year old female from your practice resorts, developing a symptomatic, rapidly expanding
ulcer on her right lateral hard palate that appears crater-like and measures 35mm in diameter.
What is the most likely diagnosis?

A. Actiomycycosis
B. Adenoid cystic carcinoma
C. Necrotizing sialometaplasia
D. Pleomorphic adenoma
E. Squamous cell carcinoma C. Necrotizing sialometaplasia

1) Concept: Necrotizing sialometaplasia is a rapidly expanding ulcerative lesion that mostly

occurs on the posterior area of the hard palate.

2) Necrotizing sialometaplasia
a. usually benign and is often painless, and is usually self-limiting an resolves in about six to ten
weeks.
b. trauma to the minor salivary glands located in the hard palate causes this condition
Which of the following changes in lingual papillae results in the manifestation of a black hairy
tongue?

A. Atrophy of the circumvallate papillae

B. Atrophy of the filiform papillae
C. Atrophy of the fungiform papillae
D. Hypertrophy of the circumvallate papillae
E. Hypertrophy of the filiform papillae
F. Hypertrophy of the fungiform papillae E. Hypertrophy of the filiform papillae

1) Concept: Black hairy tongue

a. Hypertrophy of the filiform papillae manifests itself as black hairy tongue after the bacteria or
yeast attach the papillae
b. Filiform papillae become elongated and give hair like presentation on the dorsum side of the
tongue.
c. Black hairy tongue is most commonly caused by too much bacteria or yeast growth on the
tongue
d. Black hairy tongue is more common in men, people who use intravenous drugs, and those who
are HIV-positive.
e. The dorsum of the tongue may become blackish in color due to the use of

1) poor oral hygiene

2) smoking tobacco
3) drinking a lot of coffee or tea
4) using antibiotics (which may disrupt the normal balance of bacteria in the mouth)
5) being dehydrated
6) taking medications that contain the chemical bismuth (such as Pepto-Bismol for upset
stomach)
7) xerostomia
8) regularly using mouthwash that contains peroxide, witch hazel, or menthol
9) getting radiation therapy to the head and neck
Carcinoma in situ displays each of the following characteristics EXCEPT one. Which
characteristic is the EXCEPTION?

A. Abnormal mitosis
B. Invasion
C. Loss of cellular polarity
D. Pleomorphism B. Invasion

1) Concept: Invasion is NOT a feature shown by carcinoma in situ. The basement membrane is
NOT breached in the case of carcinoma in situ.

2) Carcinoma in situ which is also known as an "in situ neoplasm" is an abnormal mass of cells

3) These abnormal cells grow in their initial location and do NOT invade the surrounding tissues.

4) Features include:
a. Abnormal mitosis
b. Loss of cellular polarity
c. Pleomorphism
Which of the following describes the MOST COMMON cause of intraoral verruca vulgaris?

A. Chronic alcoholism
B. Pipe smoking
C. Trauma
D. Autoinoculation D. Autoinoculation

1) Concept: Autoinoculation is the most common cause of intraoral warts causing verruca
vulgaris
2) The human papilloma virus (HPV) virus self implants inside the mucous epithelium, causing
infection.

3) The transmission or auto inoculation of the wart can occur by:

a. mechanical touching of one part of the organism to another
b. friction removing a part of the infected cells to another surface and then reintroducing these
cells upon contact with another body part
c. transportation though the blood stream
Which of the following sites is the prognosis LEAST favorable for oral squamous cell
carcinoma?

A. Floor of the mouth

B. Hard palate
C. Lower lip
D. Soft palate
E. Bucal mucosa A. Floor of the mouth

1) Concept: Squamous cell carcinomas occurring in the floor of the mouth demonstrate the
LEAST favorable prognosis

2) The squamous cell carcinoma occurs in the floor of the mouth because it contains such a rich
blood supply.

3) Cancer cells require an increased level of nutrition compared to normal cells, so a rich blood
supply aids in tumor growth.
A 24-year old female patient reports to your office with small red and white oral lesions that are
located on alveolar non-keratinized mucosa. The patient reports that the ulcerations are
intermittent and painful when present, but usually resolve in 7-10 days. What is the most likely
explanation for her symptoms?

A. Primary herpes
B. Recurrent aphthous stomatitis
C. Recurrent herpes
D. Squamous cell carcinoma
E. Acute necrotizing ulcerative gingivitis B. Recurrent aphthous stomatitis

1) Concept: Aphthous stomatitis (Canker sores) is a common cause of benign and noncontagious
mouth ulcers reported in roughly 20% of the population.

2) Recurrent pathos stomatitis

a. characterized by repeated formation of ulcers on the mucous membranes of the oral cavity that
usually take 1-2 weeks to typically heal.

3) There is no cure, and treatments are aimed at reducing pain and speeding the healing process.
4) The formation of apthae involves a T cell mediated immune response triggered by a variety of
a factors, including nutritional deficiencies, local trauma, stress, hormonal influences, allergies,
and a genetic predisposition.

5) Aphthous stomatitis occurs on non-keratinized mucosa

6) Recurrent herpes occurs on keratinized mucosa

Which of the following is LEAST PROBABLE for adolescents and pediatric patients to
develop?

A. Ameloblastic Fibro-odontoma
B. Calcifying epithelial odontogenic tumor
C. Compound odontoma
D. Adenomatoid odontogenic tumor B. Calcifying epithelial odontogenic tumor

1) Concept: Calcifying epithelial odontogenic tumor (Pindborg tumor) is a neoplasm that

commonly arises son the posterior aspect of the mandible during 4th and 5th decade life

2) It is a benign tumor that is thought to have originated from the epithelial remnants of the
stratum intermedium of the enamel organ.

3) It is a slowly progressing painless swelling that is often associated with impacted teeth and
occurs most frequently in the molar area but may also appear near premolars.

4) Presence of amyloid-like deposits appear microscopically and a "driven-snow" appearance is

observed radiographically.
Each of the following is characterized by BILATERAL enlargement of the parotid glands
EXCEPT ONE. Which is the EXCEPTION?

A. Benign lymphoepithelial lesion

B. Malnutrition
C. Sialolithiasis
D. Sjogren's syndrome
E. Acute epidemic parotitis C. Sialolithiasis

1) Concept: Sialolithiasis is a condition characterized by the formation of calcified mass within a

salivary duct and is most commonly associated with submandibular glands.

2) Sialolithiasis
a. unilateral enlargement and rarely is associated with parotid glands and is also known as
salivary calculi or salivary stones.
b. All other answer foils mostly describe conditions that are characterized by a bilateral
enlargement of parotid salivary glands
A 50 year-old man presents to your office for a periodic exam smelling of tobacco pipe smoke.
Upon examination, you notice a raised white lesion covering most of his hard palate and many
red papules within the white lesion. Which of the following is the most likely diagnosis?
A. Hairy Leukoplakia
B. Lichen planus
C. Nicotonic stomatitis
D. Papillary hyperplasia
E. Leukoplakia C. Nicotonic stomatitis

1) Concept: Nicotinic stomatitis

a. condition that manifests on the hard palate as a white surface lesion associated with pipe and
cigar smoking and is not considered to be premalignant
b. is induced by the palate being exposed to very hot conditions, so it is also associated with
chronic ingestion of hot beverages
c. found most commonly in men over 45 years old
d. should completely resolve on its own after 1-2 weeks upon smoking cessation. If the lesions
persists, a biopsy may be necessary to confirm the diagnosis.
e. Immediate cessation of smoking may be advised in order to monitor lesion and see if
differential diagnoses are required
f. there is usually no treatment necessary since cancer risk is not elevated

2) The palate may appear gray or white and contain many papules that are slightly elevated with
red in their center.
Upon routine examination, you notice a rubbery, firm, asymptomatic 2mm circumscribed
exophytic nodule within the main body of the parotid gland. The patients states that they have
noticed the nodule for about "a year or so". Which of the following is the MOST LIKELY
diagnosis?

A. Bengin mixed tumor

B. Encapsulated sialolith
C. Lymph node
D. Mucocele
E. Squamous cell carcinoma A. Bengin mixed tumor

1) Concept: Benign mixed tumor or pleiomorphic adenoma presents as a rubbery, firm,

asymptomatic nodule within the main body of the parotid land. It accounts for 90% of the benign
tumors occurring in the gland. It occurs as a preexisting lesion of long duration.

2) Encapsulated Sialolith
a. is a calcified mass with laminated layers of inorganic material
b. commonly occurs in the subandibular gland and presents with pain

3) Mucoceles
a. occur on the inside of lower lips, gums, roof of the mouth and under the tongue
b. they can cause more problems with speech, chewing, and swallowing

4) Squamous cell carcinoma

a. malignant condition
Where is the most common site of a intraoral malignant melanoma?

A. Buccal mucosa and vestibule

B. Floor of mouth and anterior lingual gingival
C. Hard palate and maxillary gingiva
D. Soft palate and tonsillar pillar complex
E. Lateral and ventral tongue C. Hard palate and maxillary gingiva

1) Concept: Malignant melanomas usually occur along the hard palate, maxillary gingiva,
tongue, mandible, and the buccal mucosa.

2) The incidence of melanomas within the oral mucosa is said to be rare with an occurrence of
less than 1%

3) The prognosis of treating malignant melanoma is said to be poor with a 5-year survival rate of
about 10-25% in the average.

4) Early signs of melanoma can be diagnosed by "ABCDE"

A: Asymmetry
B: Borders (irregular)
C: Color (multicolored)
D. Diameter (greater than 6mm, about the size of a pencil erase)
E: Evolving over time

5) The most dangerous form of melanoma, nodular melanoma can be diagnosed with "EFG"
E: Elevated above the skin surface
F: Firm to the touch
G: Growing
In the United State populace, which of the following describes the MOST COMMON location
premalignant lesions of squamous epithelium are observed?

A. Dorsum of the tongue

B. Floor of the mouth
C. Gingiva
D. Hard palate
E. Soft Palate
F. Buccal mucosa B. Floor of the mouth

1) Concept: The floor of the mouth and lateral border of the tongue are the most common
locations for the development of squamous cell carcinoma inside the mouth.

2) An explanation for the high potential for premalignant lesions in this area is due to its rich
blood supply because rapidly dividing malignant cells require more nutrition than normal cells.

3) If an ulcer or lesion develops on the floor of the mouth, healing is difficult because of the high
degree of mobility of the tongue and floor of the mouth.
Each of the following is characterized by BILATERAL enlargement of the parotid glands
EXCEPT ONE. Which is the EXCEPTION?

A. Sjogren's syndrome
B. Acute epidemic parotitis
C. Benign lymphoepithelial lesion
D. Malnutrition
E. Sialolithiasis C. Sialolithiasis

1) Concept: Sialolithiasis is a condition characterized by the formation of calcified mass within a

salivary duct and is most commonly associated with submandibular glands.

2) Sialolithiasis
a. unilateral enlargement and rarely is associated with parotid glands and is also known as
salivary calculi or salivary stones.
b. All other answer foils mostly describe conditions that are characterized by a bilateral
enlargement of parotid salivary glands
Which of the following locations is inflammatory papillary hyperplasia most commonly
observed?

A. Hard palate
B. Labial tissue
C. Posterior gingival tissue
D. Soft palate
E. Anterior gingival tissue A. Hard palate

1) Concept: Inflammatory Papillary Hyperplasia

a. appears as an overgrowth of tissue usually associated with poor denture hygiene, denture
overuse, and ill-fitting dentures
b. the exact cause of inflammatory papillary hyperplasia is unknown, around 20% of patients
who wear dentures 24 hours a day develop it.
c. It manifests as an asymptomatic erythematous area, on the hard palate, with a pebbly surface
in mouth breathing patients.
d. often associated with epulis fissuratum.
A pantomograph reveals a radiopaque lesion associated with a patient's maxillary sinus, that the
patient does not report as being symptomatic. Which of the following should NOT be included in
the differential diagnosis?

A. Antrolith
B. Odontoma
C. Osteoma
D. Periapical cyst
E. Mucus retention pseudocyst D. Periapical cyst

1) Concept: Periapical cysts are localized radiolucencies associated with the apex of a tooth that
previously suffered chronic pulpal or periodontal infection
2) Odontomas
a. radiopaque lesions that may occur along the anterior and posterior teeth

3) Osteoma
a. radiopaque benign lesions or bone growth within a membranous bone

4) Antroliths
a. calcified lesions or masses which are usually located along the maxillary sinus

5) Mucus retention pseudocysts

a. collection of mucous deposits within the paranasal sinuses. They appear radiopaque because
the air that surrounds the pseudocyst is radiolucent, making the mucous more radiopaque.
The most serious effects of repeated exposure to X-radiation in low doses is characterized by
which of the following?

A. Alteration of oral microflora

B. Carcinogenesis
C. Diarrhea
D. Pupura
E. Radionecrosis B. Carcinogenesis

1) Concept: Carcinogenesis
a. Repeated low doses of ionizing radiate may induce irreparable DNA damage which leads to
errors in replication and transcription that result in carcinogenesis
b. Persistent low dose radiation can induce a type of genomic instability in cells that may trigger
viral interactions leading to pre-mature aging and carcinogenesis
c. Ionizing radiation results in the enhancing of the frequency of mutation and other genetic
changes in the descendants of the irradiated cell after many generations of replication.
d. Gap junction mediated cell-cell communication and activation of the p53 damaged response
pathway may result in carcinogenesis.
A 32-year old patient presents to your office with a tender swelling in the submandibular
triangle. The most likely etiology is...

A. Infected thyroglossal duct cyst

B. Lymphadenopathy
C. Sialolith obstructing salivary flow
D. A mucocele B. Lymphadenopathy

1) Concept: Tender swelling localized within the submandibular triangle is indicative of

lymphadenopathy.

2) Lymphadenopathy
a. condition where the lymph nodes become swollen, tender and enlarged.
b. could be an indication of infection, malignancy, or an auto-immune disease.
c. enlarged lymph nodes within the submandibular triangle are palpable during bi-digital jaw
palpation
Hard Tissue Hard Tissue
Ameloblastoma in the mandible are similar to which of the following conditions
radiographically?

A. Central giant cell granuloma

B. Osteosarcoma
C. Squamous cell carcinoma
D. Ameloblastic fibro-odonoma A. Central giant cell granuloma

1) Central giant cell granuloma

a. benign neoplasm that usually occur in the mandible and occur in women twice as often
b. characterized by a large radiolucent multilocular lesion that expands the cortical plate and can
reabsorb roots and move teeth
c. aggressive form of this condition exhibits rapid growth and is much more likely to absorb
roots and perforate the cortical plate and has a high rate of recurrence and can be painful or cause
paresthesia

2) Ameloblastomas and Central giant cell granulomas

a. radiolucent multilocular lesions
b. most likely to occur in the mandible of women age 20-40 years old and often cross the midline
A pantomograph of an asymptomatic adult shows a well-defined 35mm radiolucency inferior to
the mandibular canal. The lesion is not palpable. Which is the most likely diagnosis?

A. Ameloblastoma
B. Salivary gland inclusion defect (Stafne defect)
C. Traumatic bone cyst
D. Focal osteoporotic bone marrow defect
E. Odontogenic keratocyst B. Salivary gland inclusion defect (Stafne defect)

1) Stafne defect
a. depression along the lingual surface of the mandible that is near the tongue and submandibular
salivary gland
b. well demarcated radiolucency that is approximately about 10-35mm in diameter
c. made by ectopically formed salivary gland tissue which is near the submandibular gland
d. not pathologic and is considered a pseudocyst since it doesn't have fluid and epithelial lining
Which of the following conditions exhibit globular dentin, early pulpal obliteration, defective
root formation, periodical granuloma/cysts, premature exfoliation, and appear to be normally
clinically?

A. Amelogenesis imperfecta
B. Dentin Dysplasia
C. Dentinogenesis imperfecta
D. Regional Dontodysplasi
E. Shell teeth B. Dentin Dysplasia
1) Dentin Dysplasia
a. disturbance in normal dentin formation causing
b. pulpal chamber obliteration
c. alteration or absence of root formation
d. premature tooth exfoliation

2) Amelogenesis Imperfecta
a. affects ONLY the formation of enamel and NOT dentin

3) Dentinogenesis Imperfecta
a. form of dentin dysplasia which causes discoloration or some sort of translucency to affected
teeth
Which of the following has the LOWEST probability of being a sign or symptom of a metastatic
jaw lesion?

A. A symptomless radiolucency
B. A tooth that has not erupted
C. A tooth with no mobility of unknown origin
D. Unilateral paresthesia of the patient's lower lip B. A tooth that has not erupted

1) Non-Metastasis
a. un-erupted tooth has the lowest probability of being associated with a metastatic jaw lesion
b. to be in conjunction with an odontogenic cyst such as dentigerous cyst

2) Metastasis
a. unilateral paresthesia of the lower lips
b. symptomless radiolucency
c. tooth having mobility of unknown origin
Radiographs of a 22-year old man disclose a sharply outlined radiolucent lesion in the
mandibular 1st molar area. This 35 mm lesion scallops between the roots of vital teeth. What is
the most likely diagnosis?

A. Odontoma
B. Radicular cyst
C. Traumatic bone cyst
D. Dentigerous cyst C. Traumatic bone cyst

1) Traumatic bone cyst

a. well circumscribed radiolucency that usually scallops in between the roots of teeth
b. usually occur during the 2nd or 3rd decay of life of active people due to being more prone to
trauma from accidental heavy blows to the bone
c. affects the jaws of males more than females
Tooth fusion or gemination occurs during which of the following stages of tooth development?

A. Calcification
B. Eruption
C. Initiation/Proliferation
D. Maturation
E. Apposition C. Initiation/Proliferation

1) Fusion
a. a dental abnormality that occurs during the initiation stage of tooth development where two
different tooth buds unite to form one tooth
b. involves the mandibular anterior teeth, particularly the lateral incisors and canines
Radiographs reveal a radiolucency where the right 3rd molar usually resides. The mandibular
right 3rd molar is not present. Which of the following should NOT be included in a differential
diagnosis?

A. Ameloblastoma
B. Dentigerous cyst
C. Odontogenic keratocyst
D. Odontogenic myxoma
E. Residual cyst B. Dentigerous cyst

1) Dentigerous cyst
a. also known as follicular cysts and occur along the crown area of a partially erupted or
unerupted tooth
b. lining of the dentigerous cyst originates from the epithelial cells of the reduced enamel
epithelium of the tooth

2) Cyst present along the area of 3rd molar

a. 3rd molar was already extracted may be due to the
b. formation of a residual cyst
c. ameloblstoma
d. odontogenic myxoma
e. keratocyst
Neoplasia of both epithelial and connective tissue components is exhibited by which of the
following?

A. Ameloblastic fibroma
B. Cementoblastoma
C. Odontogenic adenomatoid tumor
D. Ameloblastoma A. Ameloblastic fibroma

1) Ameloblastic fibroma
a. benign odontogenic tumor arising from epithelial and ectomesenchymal tissues and produces
no mineralized product
b. appears radiographically as sharply demarcated radiolucent lesion

2) Ameloblastoma
a. benign tumor derived from strictly odontogenic epithelium and not ectomesenchyme tissue.
Amelogensis imperfecta and dentinogenesis imperfecta are MOST STRONGLY differentiated
by which of the following features?

A. Blue sclera
B. Hair loss
C. Hereditary background
D. Radiographic appearance
E. Color of the hair D. Radiographic appearance

1) Amelogenesis Imperfecta
a. teeth are covered with thin, abnormally formed enamel
b. enamel is avascular and high calcified and does not contain the proteins ameloblastin,
enameling, tuftelin, and amelogenin
c. teeth are often brown, gray, or yellow
d. crowns of these teeth are often subject to rampant caries and excessive attrition
A clinical examination discloses a soft, fluctuant, tender swelling in the midline of the hard
palate. All maxillary teeth test vital. Radiographs shows a radiolucency between the roots of the
maxillary central incisors, which of the following cysts is the most likely diagnosis?

A. Incisive papilla
B. Median palatal
C. Nasopalatine duct
D. Periapical
E. Nasolabial C. Nasopalatine duct

1) Nasopalatine duct cyst

a. hard shaped radiolucency often found in the median aspect of the hard palate anterior to the 1st
molars
b. palatal swellings that are asymptomatic
c. considered the most prominent nonodontogenic cyst within the oral cavity
Which of the following diagnoses CANNOT be ruled out for a lesion posterior to mandibular 3rd
molars?

A. Cementoblastomas
B. Fibroma
C. Salivary gland inclusion defect (Stafne defect)
D. Osteoma *B. Fibroma

1) Fibroma
a. tumors that are composed of fibrous tissues that are usually benign
b. grow anywhere in the body, but usually grow in tissues that arise from the mesenchymal
tissues

2) Stafne defects
a. occur in the mandible along the lingual area near the submandibular salivary gland
3) Cementoblastomas
a. occur within the cementum of affected tooth

4) Osteomas
a. usually occur in the paranasal sinus and nose
Which of the following cysts is an ameloblastoma most likely to develop from?

A. Nasopalatine duct
B. Radicular
C. Traumatic bone cyst
D. Dentigerous D. Dentigerous

1) Ameloblastoma
a. rare benign odontogenic tumor derived from epithelium that occurs more commonly in the
mandible than the maxilla
b. often associated with unerupted teeth
c. rarely malignant or metastatic
d. expand the bony cortices at a slow growth rate that allows time for the periosteum to develop a
thin shell of bone that cracks when palpated.
e. appear multiloculated with "soap bubble" appearance
f. resorption of root of involved teeth can be seen
g. Symptoms include:
1) painless swelling
2) facial deformity
3) loose teeth
4) ulceration
5) periodontal disease
A 33-year-old woman of African American descent is asymptomatic, but presents to your office
for a routine check-up. No evidence of decay is noted, but examination of her radiographs reveal
periodical radiolucencies associated with the apices of her mandibular central incisors. Pulp
testing reveals all teeth respond similarly. What treatment is indicated?

A. Initiate root canal treatment on the two mandibular central incisors

B. No treatment is necessary at this time
C. Perform test cavities on the mandibular central incisors
D. Refer for evaluation to rule out possible malignancy
E. Identify the dark, potentially necrotic pulp chambers by transillumination B. No
treatment is necessary at this time

1) Periapical cemental dysplasia

a. periapical radiolucency found along the apices of mandibular central incisors and is
predominantly discovered in African-American females
b. teeth show no signs of decay and are symptomatic, indicating that the periodical radiolucency
seen under the apices of the mandibular central incisor is not cause by bacterial infection
involving the pulp
c. no treatment should be performed since all teeth are vital and non carious based on the oral
examination
A 21-year-old male patient complains of a dull pain in their posterior left mandibular region with
a radiograph that reveals not only a radiolucency around the 1st molar roots, but also a
radiopacity of bone peripheral to this radiolucency. Which of the following is the best diagnosis?

A. a manifestations of systemic bone disease

B. a reaction to an apical inflammatory disease
C. An error in radiographic technique (artifact)
D. Normal for this patient
E. A developmental abnormality B. a reaction to an apical inflammatory disease

1) Radiolucency is from the tissue destruction that occurred within the periodical area and the
radiopacity that denotes the boundary set by the inflammatory cells as they try to confine the
infection.

2) Once the infection is completely confined by the inflammatory cells, a periodical cyst or a
granulation tissue may form and the damaged bone begins to remodel.

3) The continuous remodeling of the bone creates the solid, well-defined and radiopaque border
around the periphery of the periodical cyst or of the granulation tissue.
A patient exhibiting a "cotton wool" appearance of the bone in their x-rays and an elevated level
of alkaline phosphatase and normal calcium, phosphate, and aminotransferase concentrations in
their blood is most probably suffering from which of the following diseases?

A. Fibrous dysplasia
B. Hyperthyroidism
C. Multiple myeloma
D. Paget's disease of bone
E. Ewing's sarcoma D. Paget's disease of bone

1) Paget's disease of bone

a. chronic disorder that can result in enlarged and misshapen bones, pain, fractures, and arthritis
b. diagnosed by the presence of elevated level of alkaline phosphatase and normal calcium,
phosphate, and aminotransferase levels in the blood

c. "cotton wool" appearance of the bone on x-ray

d. Signs
1) enlarged skull and facial bones
2) enlarged maxilla and alveolar ridges
3) displaced teeth
4) hypercementosis
Immune System Immune System Answers
Which of the following can be diagnosed by the presence of "sulfur granules"?

A. Actinomycosis
B. Candidiasis
C. Histoplasmosis
D. Sarcoidosis
E Tinea versicolor A. Actinomycosis

1) Actinomycosis
a. Actionmycosis Isreali is the etiologic bacteria behind actinomycosis infection
b. presence of yellow sulfur granules confirms the presence of actinomycosis colonies
c. characteristics
1) non-painful hard lump in the jaw
2) painful skin abscesses which initiates a red bruise
3) muscle spasms in the jaw leading to locked jaw
Which of the following is the MOST probable diagnosis for a patient that presents with painful
lesions on their buccal mucosa and whose biopsy revealed a suprabasilar vesicle and
acantholysis?

A. Bullous lichen planus

B. Erythema multiforme
C. Necrotizing sialometaplasia
D. Pemphigus
E. Systemic lupus erythematosus D. Pemphigus

1) Pemphigus Vulgaris
a. autoimmune disorder characterized by the production of antibodies against specific proteins in
the skin and mucous membranes resulting in formation of skin blisters
b. MOST commonly associated with painful lesions on the buccal mucosa.
c. Biopsy reveals a suprabasilar vesicle and acantholysis

2) Necrotizing sialometaplasia
a. infection condition of salivary glands

3) Erythema multiform
a. hypersensitivity reaction occuring in response to medicine, infections, or illness

4) Systemic lupus erythematosus (SLE)

a. hypersensitivity reactoin
Each of the following aids in the diagnosis of evaluation of Sjogren's syndrome EXCEPT ONE.
Which is the EXCEPTION?

A. Exfoliative cytology
B. Labial salivary gland biopsy
C. Salivary flow rate
D. Serology
E. Sialograms A. Exfoliative cytology

1) Exfoliative cytology
a. uses the scraped off or exfoliated tissues to evaluate and examine lesions through
cytopathology analysis and CANNOT be used to diagnose Sjugren's syndrome

2) Labial salivary gland biopsy

a. important diagnostic tool identifying affected salivary glands and is performed by taking a
small sample of the salivary gland for analysis

3) Sialograms
a. used to determine any blockage or clogged structure at the salivary ducts and glands.
b. helpful tool to diagnose or rule out Sjogrens syndrome
Sjogren's Syndrome is associated with each of the following conditions EXCEPT ONE. Which
condition is the EXCEPTION?

A. Arthritis
B. Cervical caries
C. Warthin's tumor
D. Xeropthalmia
E. Xerostomia C. Warthin's tumor

1) Warthin's tumor
a. also known as papillary cyst adenoma lymphomatous is a benign tumor with unknown
etiology that is strongly associated with cigarette smoking and is NOT directly associated with
Sjogren's syndrome

2) Sjogren's Syndrome
a. systemic autoimmune condition in which the autoimmune system attacks the exocrine glands
like the salivary gland and lacrimal gland
b. signs and symptoms
1) arthritis
2) Xeropthalmia
3) Xerostomia

c. most commonly affects women after menopause

Acute abscesses induce...

A. Leukocytosis
B. Leukopenia
C. Lymphocytosis
D. Neutropenia
E. Leukemia A. Leukocytosis

1) Leukocytosis
a. patient's white blood cell count is above the normal range
b. indicates an inflammatory response where infection may be present
c. common in patient's suffering from
1) acute illness such as fungal, viral, or parasitic infection, cancer, hemorrhage, and exposure to
substances that include steroids

d. may manifest after

1) tiring exercise
2) emotional stress
3) pregnancy and labor
4) epileptic convulsions
5) anesthesia
6) epinephrine administration

2) Types of leukocytosis:
a. Neutrophilia (most common)
b. Monocytosis
c. Eosinophilia
d. Lymphocytosis
e. Basophilia
TMJ TMJ Answers
The MOST COMMON cause of intracapsular restraint of mandibular movement is described by
which of the following?

A. Disc interference disorders

B. Infection
C. Myofacial pain disorders
D. Akylosis A. Disc interference disorders

1) Disc interference disorders

a. most commonly cause intracapcular restraint of mandibular movement in adults
b. associated with dysfunctional condyle disc complex and are also termed as internal
derangement disorders
c. anterior and medial displacement or dislocation of the articular disc
d. Signs and symptoms
1) clicking sounds
2) catching or locking during jaw movements
3) may or may NOT be associated with pain
Which of the following jaw relations is a pure hinging movement possible?

A. Postural position of the mandible (vertical dimension of rest)

B. Retruded contact position
C. Transverse horizontal axis (Terminal hinge position)
D. Centric occlusion C. Transverse horizontal axis (Terminal hinge position)

1) Transverse horizontal axis

a. purely hinging movements of the mandible are possible when the jaws are in transverse
horizontal axis or in the terminal hinge position
b. once the mandible moves beyond the hinge position, translational movement occurs
c. An imaginary line through both temporomandibular joints about which the mandible rotates in
the sagittal plane during opening and closing of the mouth.

2) Terminal hinge position

a. mandibular hinge position from which further opening of the mandible would produce forward
translator movement rather than hinge movement
Which of the following is the least effective method of addressing and diagnosing TMJ
disorders?

A. Arthrography
B. Arthroscopy
C. Magnetic resonance Imaging
D. Pantomograph
E. Cone-beam computed tomographyA. Arthrography

1) Arthography
a. considered the least effective tool in the assessment and diagnosis of a temporomandibular
joint (TMJ) dysfunctions
b. involves multiple radiographic images with contrast medium in order to assess different
aspects and angles of the TMJ and are difficult to place and interpret

2) Pantomographs
a. Radiographic images used in orthography are 2-dimensional representations of a 3-
dimensional object, so accurate diagnoses are difficult to make at best
b.

3) Arthroscopy
a. less invasive surgical procedure wherein an arthroscope is inserted into a small incision
approximating the TMJ to directly examine or treat inferior portion of the joint

4) Cone-Beam Computed Tomography (CBCT)

a. provides clear and accurate images of different orientations of the condylar head and the
glenoid fossa through their para-sagittal, axial and coronal image reconstruction views

5) Magnetic Resonance Imaging (MRI)

a. currently the modality of choice in assessment and diagnosis of TMJ because it can provide
direct visualization of the articular disk and intra-articular abnormalities within the TMJ
Pain and tenderness upon palpation of the temporomandibular joint are usually associated with...
A. Deviation of the jaw to the painful side upon opening of the mouth
B. Flaccid paralysis of the non painful side of the face
C. Flaccid paralysis of the painful side of the face
D. Impacted mandibular third molars
E. Excitability of the second division of the Trigeminal Nerve (V2) A. Deviation of the jaw to the
painful side upon opening of the mouth
1) Jaw of the patient deviates to the painful side during mouth opening because the jaw is
limiting itself from excessive movements that may cause further pain and damage to the joint

2) In order to lessen the movements within the painful side of the jaw during jaw opening, the
side of the jaw that experiences pain limits its movements.

3) The condyle on the non-painful side maintains its function and therefore appears to move
toward the painful side of the jaw.
Which of the following MOST ACCURATELY describes trigeminal neuralgia (tic douloreux)?

A. Brief periods of sharp excruciating pain

B. Dull pain with pressure applied to the affected area
C. Unilateral episodes of prolonged facial pain
D. Unilateral paralysis of the face
E. Unilateral uncontrolled twitching A. Brief periods of sharp excruciating pain

1) Tic douloureux

a. Characteristics
1) having brief episodes of sharp/excruciating pain
2) experience paroxysmal attacks of pain lasting from a fraction of second to 2 minutes
3) Affecting one of more divisions of the trigeminal nerve
4) Pain may or may not be persistent between paroxysms
5) Pain is usually a sudden and sharp/stabbing feeling after stimulating a trigger zone

2) Trigger zones
a. Trigger zones are affected areas within the branches of the trigeminal nerve
b. Trigger zones in one branch, and may spread to other branches over time. The most commonly
affected branches are V2 and V3, but pain can be in just about any location on the head, and
even the index finger.
Which of the following is the most likely diagnosis for a patient presenting to you with a
unilateral, slowly progressing elongation of their face causing malocclusion and deviation of
their chin away from the affect side?

A. Condylar Hyperplasia
B. Myofascial pain disorder
C. Osteoarthritis
D. Rheumatoid arthritis
E. Tooth ankylosis A. Condylar Hyperplasia

1) Condylar Hyperplasia
a. idiopathic, slowly progressive unilateral enlargement of the head and neck of the condyle
b. typically results in crossbite malocclusion, facial asymmetry, and shifting of the midpoint of
chin to the unaffected side
c. treatment is condylectomy if it occurs during the active growth period
d. orthodontics or surgical mandibular repositioning is performed following growth cessation
What is the classic clinical sign or symptom of an anteriorly displaced disc with reduction (ADD
with Reduction)?

A. Decreased range of opening

B. Pain
C. Reciprocal click
D. Closed lockC. Reciprocal click

1) Anterior Disc Displacement with Reduction

a. is when the articular disc, attached anteriorly to the superior head of the lateral pterygoid
muscle and posterior to the retrodiscal tissue, moves anteriorly out from between the condyle and
the fossa, so that the mandible and temporal bone contact is made on something other than the
articular disc and the disc slides back into place.
b. sliding of the disc back into place creates the characteristic popping or clicking noise

2) Anterior Disc Displacement without Reduction

a. the disc stays anterior so the condylar head upon opening so mouth opening is limited and
there is no "pop" or "click" sound on opening.
Anterior Disc Displacement with Reduction Anterior Disc Displacement with Reduction

(http://bodymechanics.com.au/jaw-tmj-clicking-popping-part1.html)
Anterior Disc Displacement without Reduction Anterior disc displacement (without
reduction)

(http://bodymechanics.com.au/jaw-tmj-clicking-popping-part1.html)
True/False:
Polymorphonuclear neutrophils (PMN) cause tissue damage while protecting host tissues.
Overall, the role of PMNs is described as mostly destructive. The first statement is true and
the second is false

1) Polymorphonuclear leukocytes or PMNs

a. white blood cells of the immune system that actively engulf foreign bodies that enter the body
b. first defense cells to migrate to the site of injury and fight against pathogens during an acute
inflammatory reaction
c. engulf and eliminate most of the pathogen are able to evade phagocytosis, causing an
accumulation of PMNs in the affected area
d. excess PMN's that are unable to engulf the pathogens die and degranulate which results in the
release of host proteases which also may damage the hosts' cell matrix
e. uncontrolled and destructive potential of host proteases release by the PMNs can kill
pathogens and at the same time damage the host's tissue
f. severe uncontrolled PMN functions may lead to endotoxic shock and disorders mediated by
the immune complex .
Which of the following is most frequently noted in patient populations suffering from chronic
temporomandibular joint disorder?

A. Depression psychosis
B. Passive-aggresive behavior
C. Schizotypical behavior
D. Sociopathy
E. Borderline personality disorder A. Depression psychosis

1) Depression psychosis
a. condition which may worsen with the presence of TMJ dysfunction
b. presence of depression is a common condition among people experiencing chronic pain,
especially TMD
c. most pone to TMJ possess a malocclusion
d. factors that cause TMJ disease
1) grinding teeth during sleep (bruxism)
2) overbite
3) rheumatoid arthritis
Most patients suffering from TMJ pain/dysfunction typically exhibit...

A. Evidence of destruction of cortical bone of the condylar head on the affected side
B. Normal dentitions
C. Physical findings of rheumatoid arthritis in other joints
D. No obvious TMJ pathology on pantomographs D. No obvious TMJ pathology on
pantomographs

1) Pantomographs are not useful when diagnosing TMJ pain/dysfunction disorders because only
hard tissues are visible.

2) Relation of the condylar head to the mandibular fossa and articular tubercle are also often
distorted

3) MRI is the preferred method for visualizing the TMJ followed by Cone-beam Computed
Tomography.
Which direction is the articular disc of the TMJ moved if the lateral pterygoid muscle is
contracted?

A. Anterio-laterally
B. Anterio-medially
C. Posterio-medialy
D. Posterio-laterally B. Anterio-medially

1) Lateral Pterygoid Muscle

a. depresses and protrudes the mandible during its contraction
b. articular disc will be directed antero-medially as the TMJ move downward and forward
c. main muscle that pulls the condyle head out of the glenoid fossa
A patient presents to your office with pain associated with the right pre-auricular region of the
face. The patient has a maximum opening of 45mm, and presents with a "joint click" associated
with the right mandibular condyle. What is the most likely diagnosis?
A. Coronoid hyperplasia
B. Internal derangement with reduction
C. Myofascial pain dysfunction syndrome
D. Auriculotemporal syndrome B. Internal derangement with reduction

1) Internal Derangement with reduction

a. condition within the temporomandibular joint that involves displacement or slipping of the
articular disc
b. internal derangement with reduction denotes tha the articular disc is moving and sliding in and
out of its normal limiting structure as the condyle head functions during the jaw opening and
closing movements
c. movement of the condyle against an articular disc that slides back and forth causes the clicking
sound which characterizes a temporomandibular joint disorder. In severe conditions, patients
may experience altered or limited mouth opening and locked jaw.
Each of the following aids in the diagnosis or evaluation of Sjogren's syndrome EXCEPT ONE.
Which is the EXCEPTION?

A. Labial salivary gland biopsy

B. Salivary flow rate
C. Serology
D. Sialograms
E. Exfoliative cytology E. Exfoliative cytology

1) Exfoliative cytology
a. uses the scraped off or exfoliated tissues to evaluate and examine lesions through
cytopathologic analysis and CANNOT be used to diagnose Sjogren's syndrome.

2) Labial salivary gland biopsy

a. important diagnostic tool in identifying affected salivary glands and is performed by taking a
small sample of the salivary gland for analysis

3) Salivary flow rate

a. any abnormality in saliva flow rate may hint for the presence of Sjogren's Syndrome

4) Sialograms
a. used to determine any blockage or clogged structure at the salivary ducts or glands. It is a
helpful tool to diagnose or rule out Sjogren's syndrome.
A patient reports moderate intermittent pain and popping/clicking associated with their right pre
auricular area. The patient has a 45mm maximum incisal opening. What is the most likely reason
for the patient's discomfort?

A. Anterior disc displacement without reduction

B. Coronoid hyperplasia
C. Myofascial pain disorder
D. Anterior disc displacement with reduction D. Anterior disc displacement with
reduction
1) Anterior disc displacement with reduction
a. articular disc is located anterior to the condyle head during opening of the jaw which results in
limited mouth opening without any clicking or popping sound

2) Anterior disc displacement without reduction

a. observed in patients who experience pain and a popping sound or clicking sound upon opening
and closing their mouth
b. popping sounds indicate that the condyle head is moving back against the disc, and as the
mouth closes, the condyle head slides off to the posterior aspect of the disc creating another
clocking sound

3) Myofascial pain syndrome

a. condition where the pain is felt along the TMJ area associated with the muscles of mastication
Which of the following is the MOST LIKELY explanation for an audible "click" being heard
when a patient opens their mouth?

A. A flattened articular eminence

B. A lack of coordination between the articular disc and condyle
C. A spasm of the lateral pterygoid muscle
D. A thickened joint capsule B. A lack of coordination between the articular disc and condyle

1) "click" being heard when a patient opens their mouth

a. anterior disc displacement with reduction
b. audible click during mouth opening is a sign of a disc displacement disorder within the
temporomandibular joint
c. popping or clicking sounds in the TMJ indicate that the articular disc is displaced by the
condyle during a normal jaw opening
d. as the condyle moves back and forth, the articular disc is drawn away or displaced from its
normal position and lack of synchronized condylar movement against the articular disc causes
the clicking or popping sound

2) Disc displacement with reduction

a. usually the type of TMJ disorder that elicits a "click" or "pop" during mouth opening when the
disc moves back into place
Which of the following is the MOST COMMON cause if intracapsular restraint of mandibular
movement?

A. Ankylosis
B. Disc interference disorders
C. Infection
D. Myofacial pain disorders B. Disc interference disorders

1) Disc interference disorders

a. most commonly cause intracapsular restraint of mandibular movement in adults
b. associated with dysfunctional condyle disc complex and are also termed as internal
derangement disorders
c. commonly associated with the anterior and medial displacement or dislocation of the articular
disc
d. Signs and Symptoms
1) clicking sounds
2) catching or locking during jaw movements
3) may or may NOT be associated with pain
Which of the following types of TMJ disorders would a clinician expect to respond best to
treatment with an occlusal separator?

A. Arthrosis
B. Chronic dislocation
C. Muscle spasm
D. Unilateral condylar hyperplasia
E. Capsular Fibrosis C. Muscle spasm

1) Occlusal Separators
a. help the TMJ recover from heavy bite forces following muscle spasms
b. separate upper and lower teeth from each other and allow the TMJ to rest and recover
c. they also serve to help the muscles of mastication relax
Which of the following diagnoses is the MOST PROBABLE for a patient with spontaneous
necrotizing ulcers of the oral cavity and a CBC with differential that reveals 68% lymphocytes,
28% monocytes, 2% polymorphonuclear neutrophils, 1% eosinophils, and 1% basophils and
WBC count of 1,986?

A. Infectious mononucleosis
B. Leukemia
C. Primary Herpes
D. Recurrent apthae
E. Systemic Lupus Erythematosis
F. Agranulocytosis F. Agranulocytosis

1) Agranulocytosis
a. health condition manifested with spontaneous mucous membrane ulcerations in the mouth,
vagina or rectum
b. occurs when the body fails to create mature and normal white blood cells making the body
more susceptible to bacterial infection

c. other manifestations
1) sore throat
2) rigor
3) chills
4) fever
Cast gold vs. amalgam 1) Cast gold material provides superior marginal sealing and
physical properties which makes it an ideal material for recreating anatomic contours.
2) Cast gold material can be re-adapted and burnished at the finish lines of the cavity preparation
to ensure a tiger fit and lesser marginal leakage.
Which of the following factors is MOST important when choosing the optimal restorative
martial for a Class V restoration on the buccal surface of a mandibular 2nd premolar?

B. Esthetics
C. Reaction of gingival tissues C. Reaction of gingival tissues

1) Esthetics is not a factor because the Class V restoration is placed at the cervical area of a
mandibular premolar and is not within the esthetic zone.

2) Restorative materials that do not induce gingival tissue reaction should be considered when
selecting the proper restorative material for Class V restorations.
The dentist should mentally plan the outline from before beginning tooth preparation to:

A. Aid in the finish of a enamel walls and margins

B. Establish the convenience form
C. Establish the resistance and retention form
D. Prevent over cutting and overextension D. Prevent over cutting and overextension

1) Over cutting and over extension compromises the remaining tooth structure and the success of
the restorative procedure. Excess removal of tooth structure may extend close to the pulp,
causing accidental pulp exposure or irritation.

2) Outline Form: shape of the boundaries of the completed cavity; cavity is removed

3) Resistance Form: design feature in the cavity preparation which allows tooth and restoration
to resist the masticatory stresses without fracture

4) Retention Form: design features in the cavity preparation which allows it to retain restoration
securely during function

5) Convenience Form: features in the prepared cavity which improve visibility and accessibility
during preparation and restoration
According to G.V. Black classification, the outline from of a cavity preparation is in the shape of
the cavity preparation

B. Along the cavosurface margin

C. After caries removal B. Along the cavosurface margin

1) Outline Form: describes the outline of the tooth surface to be included in the preparation.
24 hours after the placement of a routine Class V composite, the patient reports discomfort with
the tooth. Which of the following is most likely etiology of the complaint?
A. No liner or base placed under the restoration
B. Root dentin was exposed during the finishing of the restoration B. Root dentin was exposed
during the finishing of the restoration

1) The tooth maybe sensitive after the restoration of #31 caused by inadequate or inaccurate
filling of the cavity preparation resulting to root dentin exposure.

2) The exposed root dentin is more sensitive since the cavity is open and prone to acid attacks.
Anterior maxillary incisors in a middle-aged patients can be given a younger appearance by
performing an enameloplasty that:

A. moves the facial height of curvature gingival

B. move the facial line angles proximally
C. rounds the incisal point angles C. rounds the incisal point angles

1) Rounding the incisal point angles of maxillary incisors removes the sharp angles that make the
teeth appear worn down and abraded.

2) Rounded incisal edges and pointed cusp tips = younger looking smile

3) Round incisal edges = more feminine

4) Square incisal edges = masculinity

The dentist should do which of the following when finishing the occlusal portion of a posterior
composite restoration?

A. avoid altering the centric contact on enamel

B. eliminate contacts in the fossae
C. make sure to include protrusive contacts into the restoration
D. develop centric contacts on cavosurface margins A. avoid altering the centric contact on
enamel

1) The centric contact in enamel should be preserved since it established the original and proper
occlusal contact between maxillary and mandibular teeth.

2) Decreasing of removing the centric contact in enamel may cause occlusal disharmony and
unsta
Dental Caries Dental Caries Answers
Which of the following describes a case where compound caries may be found?

A. 2 surfaces of the same tooth

B. 2+ surfaces of the same tooth
D. The distal, occlusal, and facial surfaces of a maxillary molar A. 2 surfaces of the same
tooth

1. Compound lesion = lesions that covers 2 surfaces of a tooth

2. Complex lesion = lesion that covers 3 surfaces of a tooth
3. Simple lesion = lesion that covers 1 surface of a tooth
4. Secondary lesion = recurrent lesion; lesion created from a previous lesion that has been
restored and is also known as recurrent caries
The cariostatic effect of fluoride is manifested during which of the following stages of tooth
development?

A. Calcification
B. Histodifferentiation
C. Proliferation
D. Apposition A. Calcification
Patients who chose not to treat tooth decay may experience...

A. All answers are correct

B. Dietary deficiency
C. Gingivitis
D. No answers are correct A. All answers are correct

1) Untreated caries --> affect the pulp --> irreversible pulp damage --> tooth loss

2) Progression of tooth decay

a. loss of esthetic
b. change in eating habits
c. occlusion issues
Xerostomia (drymouth) is LEAST LIKELY to be induced with the administration of which of
the following agents?

D. Benzodiazepines
E. Opioids E. Opioids
Which of the following patient situations is associated with the highest caries risk?

A. All answers are correct

B. Arthritic
C. Lactating
D. Pregnant
E. Xerostomic E. Xerostomic
Which of the following concentrations describes the range of lethal dose of fluoride?

A. 0.5-1.0 mg/kg
B. 100-200 mg/kg
C. 20-50 mg/kg
D. 300-500 mg/kg
E. 500-800 mg/kg C. 20-50 mg/kg

1) 20-50 mg/kg body weight is the lethal dose of fluoride. Above this range, fluoride starts
showing its toxic effects in the body.
Which of the following is NOT a reason why fluoride prevents tooth decay?

A. Interference of bacterial metabolic activity

B. Prevention of bacterial aggregation B. Prevention of bacterial aggregation

1) Fluoride replaces the hydroxyl groups of the hydroxyapatite crystals of enamel. It then forms
fluoroapatite crystals that are significantly more resistant than acid.
Which of the following portion of primary teeth is staining MOST evident?

A. Cervical
B. Distal
C. Facial/Buccal
D. Incisal/Occlusal
E. Lingual
F. Mesial A. Cervical

1) Cervical bulbs can trap debris underneath

2) Cervical portions are more constricted in primary teeth making plaque, caries, and stain
formation easier
G.V. Black Class IV lesions typically occur on which of the following surfaces?

B. In proximal surfaces of anteriors including incisal edges

D. incisal edges of cusp tips B. In proximal surfaces of anteriors including incisal edges

1) Class III: proximal surfaces of anterior teeth not including incisal edges
2) Class IV: proximal surfaces of anterior teeth including the incisal edges
3) Class V: smooth facial and lingual surfaces in the gingival 1/3
4) Class VI: occur on the incisal edges or cusp tips
Incipient interproximal caries are typically found...

A. Facial to the contact

B. Gingival to the contact
C. Incisal to the contact
D. Lingual to the contact
E. At the contact B. Gingival to the contact

1) Incipient interproximal caries

a. found gingival to the contact area
b. extend up to half of the thickness of enamel and do not extend beyond the enamel
Which of the following is the BEST reason a dentist may choose to use a resin-based composite
to restore posterior teeth?

A. bad oral hygiene

B. esthetics
C. frequent clinching or grinding
D. patient demonstrates trismus
E. unable to isolate tooth with rubber dam B. esthetics

1) Some patient do NOT like amalgam fillings in molars as these fillings sometimes show during
speech.

2) With para functional habits such as frequent clenching or grinding of teeth indicate that
amalgams or metal crowns are placed.
Which carbohydrate found in human dies is most responsible for caries?

B. Glucose
E. Sucrose E. Sucrose

1) Sucrose (glucose + fructose) is used as a sweetener and is fermented by bacteria into acid,
which helps form caries.

2) Glucose is cariogenic, but is less cariogenic than fructose since it is a monosaccharide not a
disaccharide
Which of the following are considered to be organic components of oral bacterial plaque?

B. Polysaccharides and protein

C. Potassium and phosphorus
D. Calcium and sodium B. Polysaccharides and protein

1) Plaque is made up of organic components and non-organic components (minerals)

2) Organic components include:

a. polysaccharides
b. glycoproteins
c. proteins
d. lipids
Root surface caries is MOST COMMONLY associated with which of the following microbial
species?

A. Porphromonas gingivalis
B. Streptococcus mutans
C. Streptococcus salivarius
E. Actionmyces viscosus E. Actionmyces viscosus

1) Actinomyces viscosus = commonly associated with acid production and root caries
2) Porphyromonas gingivalis = pathogen of periodontitis
3) Streptococcus gordinii = early colonizers involved in plaque formation
4) Streptococcus mutans = coronal caries
5) Streptococcus salivarius = common oral bacterium and resides on the tongue
Each of the following is suggested to cause the deposition of sclerotic dentin EXCEPT one.
Which one is the EXCEPTION?
A. Abrasion
B. Age
C. Caries
D. Nutrition
E. Occlusal stress D. Nutrition

1) Sclerotic dentin
a. results from aging or mild irritation such as
b. abrasion
c. attrition
d. occlusal stress
e. is harder, denser, less sensitive and more protective of the dental pulp
f. characterized by hyper mineralization or blockage of tubules by the deposition of whitlockite
crystals and be denatured collagen

2) Physiologic dentinal sclerosis

a. sclerosis occurring with aging is termed physiologic dentinal sclerosis due to mild irritation
Which of the following bacterial species is considered an early colonizer of supra gingival
plaque?

B. Lacrobacillus casei
C. Porphyromonas gingivalis
D. Streptococcus salivarious
E. Streptococcus sanguinis E. Streptococcus sanguinis

1) Plaque formation Stages

a. formation of pellicle on the tooth surface
b. initial colonization by bacteria
c. secondary colonization with plaque maturation

2) Supragingival plaque consists of gram positive facultative microorganisms

a. Actionmyces viscosus
b. Streptococcus sanguinis
Which of the following describes the putative explanation for why dental plaque adheres to tooth
surfaces?

A. Dextrans are insoluble and sticky

B. Levans are insoluble and sticky A. Dextrans are insoluble and sticky

1) After dental plaque is formed, it adheres to the surface of tooth through dextrans.
2) Dextrans are insoluble and sticky and serve to increase the tenacity of the attachment of dental
plaque to the surface of the tooth
3)
The letter "D" in DMFS stands for...

A. Decayed
D. Demineralized A. Decayed

1) DMFS
D: decayed or carious tooth surfaces of all teeth present within the oral cavity
M: missing tooth surfaces of all teeth present within the oral cavity
F: filled surfaces of all teeth present within the oral cavity
S: surfaces
T: teeth
Which of the following is the primary factor in determining the optimal fluoride concentration
for community water?

A. air temperature
B. DMFT score of the community
C. Weight of the average community member
D. Adult to child ration of the community A. air temperature

1) high temperatures --> lower fluoride levels since most people will drink copious amounts of
water
2) low temperatures --> higher fluoride levels since most people will drink less water in this type
of weather
Which of the following factors is MOST related to caries initiation in elderly patients?

A. Bruxism
B. Erosion
C. Gingival recession
D. Attrition C. Gingival recession

1) Gingival recession results in exposure of the root surfaces

2) Passive movement of gingival tissue occurs apically with the aging process
Each of the following characteristics describe acute (active) caries EXCEPT one. Which is the
EXCEPTION?

A. Dentinal pulp is at risk of irreversible damage

B. Rapid rate of progression
C. The cavity floor is rough and leathery
D. There is little color changeC. The cavity floor is rough and leathery

1) Acute Caries
a. really soft to touch and caseous (cheesy) in consistency
b. rapid process involving a large number of teeth
c. dental pulp is at risk of irreversible damage
d. lesions are lighter in door mostly light brown and gray
Each of the following accounts for the increased risk of caries risk of elderly people EXCEPT
one. Which is the exception?

A. changes in the oral microflora

B. decreased salivary flow
C. medication side effects
D. poor oral hygiene A. changes in the oral microflora

1) Oral microflora is relatively constant after initial colonization in childhood. Oral microflora
may be modified with changes in diet, salivary flow, oral hygiene, and etc.

2) Age (increased)
a. increased number of medications used to treat various disease
b. as person ages, acidic are replaced by fibrous and fatty tissue leading to decreased salivary
flow

3) Oral hygiene (decreased)

a. due to hand dexterity due to increased likelihood of stroke and arthritis
Caries can be diagnosed accurately without radiographs when...

A. All answers are correct

B. No answers are correct
C. When all posterior teeth have proximal restoration
D. When the patient is pregnant
E. Only primary teeth are present B. No answers are correct

Caries can be diagnosed accurately without radiographs

a. visual/tactile sense
b. transillumination
c. caries detector dyes
d. laser fluorescent light
Which of the following describes the pH threshold at which enamel begins to demineralize?

A. 4.5
B. 5.5
C. 6.5
D. 6.9
E. 1.5 B. 5.5

1) When the pH at the surface of a tooth drops below 5.5, demineralization proceeds faster than
remineralization (there is a net loss of tooth structure on the tooth's surface)

2) Caries process occurs when bacterial acid demineralization excess the remineralization by
salivary components.
The earliest manifestation of a carious lesion is...

A. Cavitation of enamel
B. Change in enamel opacity
C. Radiolucency
D. Rough surface texture
E. Sensitivity B. Change in enamel opacity

1) change in the opacity of enamel becomes more evident along the areas of active caries
progression
2) Caries process demonstrates area of demineralization that are suggested by a chalky white
appearance in the enamel.
3) Change in enamel opacity will eventually leda to further tooth surface destruction and
formation of tooth decay/cavitation is not addressed immediately.
Which of the following treatments is best when superficial decalcification and staining are
evident in the buccal groove of a mandibular molar?

B. Full removal of the affected area with good retention and resistance form and restoration
D. Enameloplasty limited to the superficial depth of the decalcified enamel D.
Enameloplasty limited to the superficial depth of the decalcified enamel

1) Localized and decalcified superficial stains within the limits of the enamel layer can be
addressed by enameloplasty procedures.
Which of the following is the MOST LIKELY diagnosis for a tooth with a cavity floor that is
hard and leathery with a very dark appearance?

A. acute caries
B. aggressive caries
C. chronic caries
D. localized caries
E. severe chronic periodontitis C. chronic caries

1) Chronic caries
a. lesions that are hard, leathery cavity floors
b. dark appearance
c. affect fewer number of teeth and are smaller in size
Which describes the correct order for the progression of carious lesions?

i. Subsurface enamel lesions

ii. Cavitation
iii. Infection of demineralized dentin
iv. Dentin demineralization
v. Dentin-matri dissolution
vi. Pulpal necrosis The correct order of progression of a carious lesion is

1) Subsurface enamel lesions

2) Cavitation
3) Dentin demineralization
4) Infection of demineralized dentin
5) Dentin-matrix dissolution
6) Pulpal necrosis
When prescribing fluoride supplements, the most important factor(s) for the dentist to consider
is/are...

A. Amount of fluoride consumed already in drinking water

B. The age of the patient and concentration of fluoride in the water.B. The age of the patient and
concentration of fluoride in the water.

1) Essential to know the fluoride content of the tap water to recognize if supplementary fluoride
sources should be used.
Which of the following anatomical features of a tooth is mistaken MOST OFTEN for a carious
lesion in radiographs?

A. Cingulum
B. Cusp
C. Marginal ridge
D. Pulp Horn
E. Cemento-enamel junction E. Cemento-enamel junction

1) Apparent radiolucency is often found just below the cemento-enamel junction on the root
surface called "cervical burn out" and is often misdiagnosed as root caries in many cases.

2) Cervical burn-out is due to

a. gap between the enamel and cementum or bone covering the root anteriorly
b. concave root formation posteriorly
The leading reason for the extraction of a primary tooth is...

A. Accidental trauma
B. Periodontal disease
C. Untreated caries
D. Treated caries C. Untreated caries

1) Untreated caries is the leading reason for the extraction of primary teeth
2) Primary teeth have thinner enamel which makes it easier and faster for bacteria to generate
cavities
Which of the following factors of caries susceptibility is modified most by fluoride therapy and
occlusal sealants?

A. Microflora
B. Substrate
C. Time
D. Host D. Host

1) Hydroxyapatite crystals are the building blocks of tooth enamel.

2) Fluoride replaces the hydroxyl ions with fluoride ions, resulting in the formation of
fluorapatite instead of hydroxyapatite.
An increase in which salivary properties would increase a patient's caries risk?
A. mineral content
B. protein content
C. viscosity
D. pH
E. Flow C. viscosity

1) If the saliva becomes more viscous, its ability to flow is altered resulting in diminished
function in the oral cavity.

2) Saliva fucntions
a. dilute the bacterial acid metabolites that hart teeth
b. buffer acid from cardiogenic bacteria
c. remove food debris on tooth surface
d. remineralized damaged tooth structure
Which of the following should a dentist consider primarily when restoring the incisal edge or
enameloplasty for a patient with slight chipping of the incisal edge of teeth #8 and #9?

A. Height of the smile line

B. Location of proximal contacts
C. Shape of incisal embrasures
D. Amount of translucent enamel present D. Amount of translucent enamel present

1) Very important to consider morphology and translucency when restoring incisal edges of
maxillary incisors
2) Thickness of enamel in the incisal surface area is greater than that of the facial and incisal
surfaces
3) Difference in the thickness of enamel in this area make it appear more radiolucent.
What would happen to the caries risk of a mouse that was fed by a gut tube so that no
carbohydrates would be allowed in the oral cavity?

A. The caries risk of the mouse would decrease

B. The caries risk of the mouse would increase
C. The caries rate would stay the same as if the mouse was fed directly A. The caries risk of
the mouse would decrease

1) Caries risk
a. amount
b. frequency
c. duration of carbohydrate ingestion
d. presence of fermentable food substrate like carbohydrates in the mouth is necessary for caries
generation

2) Cariogenic bacteria like Streptococcus mutans and Lactobacillus case:

a. ferment carbohydrates into acid
b. demineralization occurs with a pH<5
c. secrete collagenase that break down demineralized tooth structure
Examination, Diagnosis, & Treatment Planning Examination, Diagnosis, & Treatment
Planning Answers
A patient calls your office complaining of thermal and masticatory sensitivity following
placement of a large MOD restoration yesterday on #20. What most likely explains the etiology
of your patient's symptoms?

A. Gingival recession
B. Microleakage
C. Premature occlusion
D. Recurrent caries C. Premature occlusion

1) Masticatory sensitivity
a. apical portion of the periodontal ligament experiences excessive pressure or apical periodontal
tissue destruction
b. vital tooth that recently experienced an excessively high occlusal restoration will exhibit
masticatory sensitivity due to being the first tooth to receive the heavy occlusal force during
mastication
c. premature contact is an area of stress concentration that is transmitted to the periodontal
ligament which can cause dental trauma and masticatory sensitivity.
Which composite resin constituent provides the most radiopacity?

A. Barium
B. Fumed Silica
C. Silicate
D. Quartz A. Barium

1) Composite Fillers
a. like quartz, silica, barium, strontium, aluminjm, and zirconium are incorporated in the
composite resin for strength, translucency, and radiopacity

2) Barium
a. metal particle that is a well-known replacement filler for quartz because of its ability to
improve the radiopacity of composites
A very deep MO cavity was restored with an amalgam restoration one month ago with deep
retentive grooves placed into the dentinal line angles of the gingival box. The patient reports pain
in the general area of the tooth, what is the most probable reason for this discomfort?

A. A pulp exposure that was not detected

B. Moisture contamination of the amalgam only after condensation
C. The amalgam was over-triturated and therefore, not enough amalgam was expressed during
the condensation
D. Moisture condensation of the amalgam before condensation A. A pulp exposure that was
not detected
1) Rentetion grooves placed into a deep cavity may potentiate an accidental and undetected
pulpal exposure.
Using a high speed hand piece with the water spray turned off, but still cooling the tooth with air
can cause... Select all that apply.

A. Hypersensitivity in the prepared tooth

B. Irritation of the pulp from being too cold
C. Irritation of the pulp from being too dry
D. Too much tooth structure can be removed
E. The odontoblasts to be forced into the dentinal tubules causing damage A. Hypersensitivity in
the prepared tooth
C. Irritation of the pulp from being too dry
E. The odontoblasts to be forced into the dentinal tubules causing damage

1) High speed hand pieces

a. produce heat that cause damage to odontoblasts and tooth sensitivity
b. heat produced by using high speed hand pieces without water makes the odontoblastic process
to dry up and damage the odontoblasts
c. movement of dentinal fluid causes irritation and pain stimuli to the pulp
d. Heat from the handpiece might cause pulpal hypersensitivity/hyperemia and may progress
further to irreversible pulpits.
Which of the following characteristics is generally the LEAST favorable in a sealant material?

A. Filled
B. Fluoride release
C. Light cured
D. Opaque/tinted
E. Self-cured E. Self-cured

1) Self-curing nature of a resin

a. least favorable characteristic in a sealant
b. DO NOT provide sufficient working time to the operator

2) Favorable properties
a. light cured polymerization
b. fluoride release
c. opaque/tinted composites resins in order to differentiate from tooth structure
d. filled composite resin
Which of the following describe the advantages of resin based composite (RBC) as a posterior
restorative material?

A. Elimination of galvanic currents

B. High fracture toughness
C. Increased wear resistance
D. Low degree of elastic deformation
E. No secondary caries A. Elimination of galvanic currents
1) Resin Based Composites (RBC)
a. elimination of galvanic currents is an advantage of posterior (RBC) restorations compared to
posterior amalgam restorations
b. insulators of electric currents and do NOT transmit electric impulses which can endanger the
pulp tissues
c. lower wear resistance
d. low fracture toughness
e. high degree of elastic deformation than amalgam fillings
Which of the following describes the purpose of silane when it is used as a structural component
in resin composite?

A. A photoinitiator to activate the polymerization of the resin composite

B. As a coupling agent to coat filler particles to promote adhesion
C. As a matrix, to which other ingredients are added to create the resin composite
D. Silane is NOT a structural component in resin compositeB. As a coupling agent to coat filler
particles to promote adhesion

1) Silane
a. structural component in resin composite to act as a coupling agent to coat filler particles to
promote adhesion
b. helps to make a bond between the resin composite on one end and the tooth substrate on the
other acting as a bi-functional coupling agent. This process is termed as hybridization and the
structure formed is called hybrid layer.
Which of the following does the bonding of composite material to dentin depend on?

A. Dehydration of dentin
B. Difunctional coupling agents
C. Etching with dilute phosphoric acid
D. Covalent bonding C. Etching with dilute phosphoric acid

1) Bonding
a. dentin bonding mechanisms rely on difunctional coupling agents like silane, which penetrate
into the inherently moist dentin surfaces and are able to copolymerize with composite resins
b. bond strength is obtained from the penetration and adaptation of the bonding agent to the
demineralized inter tubular dentin and exposed collagen fibers
c. interdiffusion zone formed by the bonding agent and the dentin is called hybrid layer
A 35 year old patient presents to your office with unrestored teeth #1-#32 with staining of the
occlusal pits and grooves without a detectable catch with the explorer. What is the best treatment
option...

A. Bis-GMA sealant
B. Conservative class I amalgam fillings
C. No treatment
D. Preventive resin restoration
E. Topical fluoride placement
F. Cyanoacrylate sealant C. No treatment

1) Presence of stains within the occlusal pits and grooves of a sound tooth

2) Arrested Caries
a. dark stains observed in pits and fissures of teeth without any detectable catch is arrested caries,
which occur when a formerly caries affected area of tooth remineralized, stopping the caries
process.

3) Incipient Caries
a. is distinguished by a chalky white appearance on the smooth surfaces of teeth

4) Active Caries
a. distinguished during an oral examination as an explorer catch with soft, easy to flake off tooth
structure
Which of the following describes the primary advantage of placing a microfilmed resin
composite?

A. Microfilled resin composites are highly polishable

C. Microfilled resin composites are stronger than most resin based composite materials A.
Microfilled resin composites are highly polishable

1) Microfill resin composites

a. highly polishable because they contain colloidal silica particles having an average diameter of
0.01-0.04 micrometer
b. small particle size of micro-filled composite resins results in a smooth, polished surface after
finishing
c. highly polished restoration surface is less receptive to plaque or extrinsic staining
Which of the following describes the non-carious level loss of cervical tooth structure that occurs
due to cyclic loading of teeth by occlusal forces?

A. Abfraction A. Abfraction

1) Abfraction
a. loss of tooth structure caused by flexural forces applied by cyclic loading of the enamel that
usually occurs at the cementoenamel junction (CEJ).

2) Attrition
a. loss of tooth structure by contact with another tooth

3) Abrasion
a. describes the loss of tooth structure by an external force like dentifrice

4) Erosion
a. describes the loss of tooth structure through chemical dissolution by acids NOT of bacterial
origin
A patient of record calls your office complaining of discomfort after a routine class V restoration
was placed yesterday on tooth #31. Which of the following is the likely etiology of the patient'
discomfort?

A. No liner or base placed under the restoration

B. Root dentin was exposed during the finishing of the restoration
C. The axial depth of the preparation was too aggressive compared to the actual depth of caries
D. The tooth was over-etched with phosphoric acid B. Root dentin was exposed during the
finishing of the restoration

1) Tooth may be sensitive after the restoration of #31 is probably caused by inadequate or
inaccurate filling of the cavity preparation resulting to root dentin exposure.

2) Exposed root dentin is more sensitive since the cavity is open and prone to acid attacks
Rubber dam clamps must contact the anchor tooth apical to the height of contour and which of
the following to be stable?

A. All 4 tips must be in contact with the tooth

C. The bow must be pointed toward the distal of the tooth A. All 4 tips must be in contact with
the tooth

1) All 4 tips of the rubber dam clamp should be in contact with the surface of the tooth to provide
maximum stability.

2) Rubber dam clamps should be placed apical to the height of contour

How far light is able to travel into tooth structure before being reflected back outward is
termed...

A. Degree of translucency
B. Hue
C. Metamerism
D. Value
E. Penetrance A. Degree of translucency

1) Translucency
a. distance travelled by light into tooth structure before it is reflected back outward is known as
its degree of translucency

2) Metamerism
a. when the angle of lighting of type of light source make colors appear as the same or different

3) Value
a. refers to the lightness or darkness of a certain area or color

4) Hue
a. is the color itself and its distinctive shades
5) Penetrance
a. degree of the ability of light to pass through
During operative procedures, which of the following is the best method for prevention pulpal
damage?

A. Keep the dentinal surface without frequent cleaning

B. Prepare dentin structure with slow-speed hand piece
C. Use anesthetics without vasoconstrictors
D. Use light, short duration bursts of tooth-bur contact using air cooling
E. Minimize dehydration of the dentinal surface E. Minmize dehydration of the dentinal
surface

1) Pulpal damage
a. when too much heat is transmitted to dentin causing dentin dehydration
b. dry cutting of the tooth structure causes heat build-up along the tooth surface, eliciting pain
and causes damaged due to trauma to the pulp
c. use of water spray during tooth preparation decreases heat build-up and minimizes dehydration
of dentin
When restoring MO or DO decay, an only is indicated...

A. if cuspal integrity is in question

B. If the opposing tooth structure has an all porcelain occlusal surface
C. When there is a need for extra retention
D. If the patient has a high caries riskA. if cuspal integrity is in question

1) Onlays
a. reinforce fractured, weakened, or unsupported tooth structure
b. weakened cusps are reinforced by reducing unsupported structure and replacing it with a
durable material capable of bearing heavy occlusal forces
c. restore a cusp of cusps

2) Inlays
a. do not restore cusps
Which of the following is caused by gastric regurgitation?

A. Attrition
B. Erosion
E. Abrasion B. Erosion

1) Erosion
a. caused by gastric regurgitation or reflux, which is characterized by the back flow of gastric
juices in the oral cavity
b. contain HCl, which damages the tooth structure because it has a pH<5.5
c. loss of tooth structure through chemical dissolution by acids NOT created by bacteria
d. by ingestion of acidic beverages in males
e. by bulimia in adolescents or females
f. occurs when oral pH drops below 5.5
The preferable treatment option for a fractured incisal of a mandibular central incisor that is not
pulpally involved in a 10 year old is...

A. A porcelain fused to metal crown

B. Composite resin placement
C. Glass ionomer placement
D. An amalgam buildup with pins for retention B. Composite resin placement

1) Composite resin placement

a. ideal treatment option for an incisal fracture
b. 10 years old have large pulps, so a crown preparation is not indicated because it might cause
harm to the recovering pulp

2) Glass Ionomer
a. have short longevity because cannot withstand high occlusal stress load
Which of the following tooth conditions presents the most favorable outcome for tooth
whitening?

A. Aged-yellow teeth
B. Blue-gray teeth
C. Patients with amelogenesis imperfect
D. Patients with old composite-resin restorations A. Aged-yellow teeth

1) Teeth Whitening
a. yellowing of teeth due to age, coffee, and tea staining will demonstrate the most favorable
tooth whitening results due to the stains being extrinsic in nature.
b.
Which dental procedure is a rubber dam most indicated...

B. Indirect pulp capping

D. Direct pulp capping D. Direct pulp capping

1) Direct pulp capping

a. essential to have adequate access, visibility, and isolation of the operating field
b. is indicated if a pin-point exposure is made during a cavity preparation
c. teeth should be isolated to avoid saliva and bacterial contamination during direct pulp caps
The restorative material with the highest potential for marginal leakage due to high thermal
elasticity properties is...

A. Composite resin
B. Silicate cement
C. Unfilled resin
D. Amalgam C. Unfilled resin
1) Unfilled resin
a. exhibit higher coefficient of thermal expansion than tooth structure, leading to increased
marginal leakage
b. high CTE means that the resin expands and contracts faster than the tooth, resulting in gaps
that
c. make teeth sensitive to changes in temperature
d. increase marginal leakage
A mature pulp does all of the following EXCEPT one. What is the EXCEPTION?...

A. Forms dentin
B. Forms enamel
C. Provides the nerve blood supply to the tooth
D. Forms cementum B. Forms enamel

1) Mature pulp
a. lay down tertiary dentin throughout life for protection from physical or chemical insult
b. contain capillaries that approximate the dentin just below the layers of odontoblasts, and
nourish the entire tooth
c. innervated by autonomic nerve fibers that control smooth muscles of arterioles and the afferent
sensory fibers coming from the trigeminal nerve
For an Ideal Class V restoration on a mandibular premolar, which of the following is the MOST
IMPORTANT factor when choosing a restorative material?

A. Ease of manipulation of material

B. Esthetics
C. Reaction of gingival tissue
D. Compressive strength C. Reaction of gingival tissue

1) Restorative materials
a. do not induce gingival tissue should be considered when selecting the proper restorative
material for Class V restorations
b. esthetics are not a factor since the Class V restoration is placed at the cervical area of a
mandibular premolar and not in the esthetic zone
c.
A 43 year old male fractures at the distoincisal point angle of #9. The facial of the tooth has
previously been restored with composite resin, from the site of the fracture, you can see that the
layer of composite is very thin and you assume that the remaining strength is questionable. The
patient presents a restoration that would provide the best longevity.

B. MID composite resin with composipin retention

C. PFM crownC. PFM crown

1) Porcelain fused to metal (PFM) crowns

a. are indicated for teeth where the remaining tooth structure is compromised in strength

2) Pin-retained amalgam
a. not a good option since it is anesthetically pleasing and pin placement may harm the pulp

3) 3/4 cast gold crown

a. good treatment for damaged tooth structure but technique sensitive, and too anesthetic for this
case

4) Composite resin restoration with a composipin

a. would have good retention
b. strength of remaining structure makes this option contraindicated
Replacement of defective amalgam with a cast gold restoration might be indicated to achieve...

C. More ideal contours

D. Better marginal seal C. More ideal contours

1) Cast gold material provides superior marginal sealing and physical properties which makes it
an ideal material for recreating anatomic contours.

2) Cast gold material can be re-adapted and burnished at the finish lines of the cavity preparation
to ensure a tiger fit and lesser marginal leakage.
Each of the following is an advantage of a resin composite for posterior restorations EXCEPT
one. Which is the EXCEPTION?

A. Conserves tooth structure

B. Low fracture toughness
C. Low thermal conductivity
D. Resin composite is radiopaque B. Low fracture toughness

1) Low Fracture toughness

a. is NOT an advantage of using composite resins in posterior tooth restorations
b. posterior restorations are prone to undergo heavy occlusal forces and para-functional habits

2) Occlusal evaluation
a. amalgam or gold restorations are recommended in such conditions

3) Advantages
a. low thermal conductivity
b. radiopacity of composite resins
Which of the following materials demonstrates the highest rate of fluoride release, but also the
least resistant to wear?

A. Compomer
B. Glass Ionomer
C. Resin Composite
D. Resin-Modified Glass Ionomer
E. Silica Cement B. Glass Ionomer
1) Glass Ionomer
a. glass ionomer cements have the highest rate of fluoride release and recharge yet possess poor
wear resistance
b. low wear resistance
c. NOT recommended as restorative materials in high stress bearing areas
d. mostly indicated as liners under more strong restorative materials such as composites and
composers
e. can be used in Class III and Class IV cavities where low stresses are encountered

2) Fluoride release order (Most --> Least)

Glass Ionomer > Resin-Modified Glass Ionomer > Compomer > Resin Composite
Why would it be a good clinical decision to replace a silicate cement restoration on the distal of
tooth #11?

A. Silicate cement restorations on proximal surfaces cause gingival irritation

B. Silicate cement restorations will not maintain the mesio-distal width of #6
C. Silicate cement restorations will result in open contacts
D. Silicate cements stain easily are considered anesthetic B. Silicate cement restorations will
not maintain the mesio-distal width of #6

1) Silicate cements
a. not good for restoring teeth with proximal contacts
b. glass particles in silicate cements are easily dislodged from the restorative filling
c. is brittle and prone to surface crazing and chipping on the margins
d. unsuitable for restoring:
1) proximal contacts
2) stress bearing areas
Which of the following would most likely be the result of inadvertently sealing a small occlusal
carious lesion on a maxillary 1st premolar?

C. Progression of the carious lesion

D. Arrested caries D. Arrested caries

1) Sealing a carious lesion

a. deprives the bacteria of resources, resulting in arrested dental caries
b. sealing occlusal pits and fissures terminates the progression of caries, but also help the tooth
remineralize and recover

2) Arrested caries
a. may appear darker due to staining from recent dimeralization, and does not necessary require
restoration
b. teeth arrested occlusal caries should be sealed to protect the tooth from further damage.
Which of the following is the correct order for listing the occlusal forces applied to the tooth
from greatest to least?

1. Molars
2. Premolars
3. Canines
4. Incisors

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

1) Occlusal force order (greatest --> least)

a. Molars > Canines > Premolars > Incisors

b. Molars can tolerate maximum amount of masticatory loads while incisors can bear minimal
forces of chewing and mastication
c. excessive forces can cause wear or fracture of teeth and their cusps. The normal physiologic
contact wear of teeth is 20 micrometers/year.
d. molars and premolars are important in maintaining the vertical dimensions of face
Each of the following is consider a disadvantage of Microfilled Resin Based Composite
compared to Hybrid-filled Composite EXCEPT one. Which is the EXCEPTION?

A. Decreased tensile strength

B. Increased polymerization shrinkage
C. Increased stiffness
D. Increased thermal expansion
E. Increased water absorption C. Increased stiffness

1) MicroFilled Composites Disadvantages

a. Increased thermal expansion
b. Decreased tensile strength
c. Increased water absorption
d. Increased polymerization shrinkage

e. allow the restoration to bend with tooth flexure, better protecting the bonding interface
f. has greater flexibility and low modulus of elasticity may perform better in certain Class V
restorations than a more rigid hybrid composite
Each of the following is a recognized disadvantage of amalgam restorations EXCEPT one.
Which is the EXCEPTION?

A. Brittleness
B. Does notnd to tooth structure on its own
C. Esthetics
D. Short lifespan D. Short lifespan

1) Amalgam restorations
a. short lifespan is NOT recognized as a disadvantage of amalgam restoration
b. have documented long life in all areas of the oral cavity
c. does NOT bond to tooth structures on its own and require certain retention features like
converging walls and adequate cavity depth
d. disadvantages
1) poor esthetic
2) brittleness
Which of the following describes the BEST clinical reason to place a restoration>

A. Aid plaque control

B. Esthetic contouring
C. No answers apply
D. Staining is evident on occlusal
E. Tooth is sensitive to cold & sweet A. Aid plaque control

1) The MOST IMPORTANT reason to place a restoration is to aid in plaque control.

2) Restorations
a. intended to be preventive in regards to future carious activity and has a primary emphasis on
restoring a smooth surface which will NOT allow plaque accumulation
b. restore structure, function, and esthetics are also of prime importance
Which of the following site is the LEAST likely for Class I carious lesions to occur?

A. Lingual surfaces of mandibular incisors

B. Lingual surfaces of maxillary incisors
C. Lingual surfaces of maxillary molars
D. Buccal surfaces of mandibular molars A. Lingual surfaces of mandibular incisors

1) Class I carious lesions

a. lingual surfaces of mandibular incisors are the LEAST common sites for the occurrence of
Class I carious lesions
b. mandibular incisors are typically morphologically stable and do not demonstrate lingual pits or
fissures

2) G.V. Black Classification

Class I: occlusal areas and buccal or lingual pits

Class II: Posterior Interproximal
Class III: Anterior Interproximal
Class IV: Anterior Interproximal including the incisal corner
Class V: Gingival at facial or lingual
Class VI: Cusp tip
Which of the following substances can be used to sedate the pulp of a tooth?

A. Calcium Hydroxide
B. Fluoride Varnish
C. Zinc Oxide Eugenol
D. Sodium Hypochorite C. Zinc Oxide Eugenol
1) Zinc Oxide Eugenol
a. type of intermediate restorative material made by mixing zinc oxide powder and eugenol (oil
of cloves)
b. its anesthetic and antibacterial properties make it an ideal material for sedating pulp and
temporarily restoring teeth
c. good interim restoration between endodontic treatments and is also use as sealing material in
obturation of root canals
Which of the following materials are contraindicated as a sealant?

A. Amalgam
B. Glass Ionomer
C. Nanohybrid resin
D. Unfilled resin
E. Microhybrid resin A. Amalgam

1) Sealant
a. biocompatible with the oral tissues
b. resistant to dissolution by oral fluids
c. lasts for a long time in the oral cavity
d. application is not technique sensitive

2) Amalgam
a. contraindicated for small restoration since it is brittle
b. needs a minimum of 1.5mm thickness to obtain flexural resistance

3) Glass Ionomer
a. being used as a sealant because of its ability to release fluoride
Which of the following variables accounts for the primary retention of fissure sealants

A. Chemical bonding of the sealant to enamel

B. Mechanical microretention
C. Surface tension
D. Adhesion of the sealant to enamel B. Mechanical microretention

1) Micro-mechanical retention
a. primary means of retention for pit and fissure sealants
b. shape and depth of pits and fissure provide mechanical retention for sealants
c. deep pits and fissures are more retentive than shallow pits and fissures
Which of the following materials demonstrates the greatest coefficient of thermal expansion?

A. Compomers
B. Glass ionomers
C. Resin composites
D. Resin-modified glass ionomers C. Resin composites
1) Resin composites
a. greatest value of coefficient of thermal expansion (CTE) among the materials listed
b. rate of dimensional change of a material per unit change in temperature
c. CTE is approximately 3 times that of the tooth structure
d. etching reduces the potential negative effects as well the difference between the CTE of tooth
structure and that of the material
As an amalgam preparation becomes wider buccolingually?

A. The integrity of the tooth and restoration is more likely to be maintained

B. The occluso-gingival depth should be increased to enhance the resistance of the planned
restoration
C. The tooth is more subject to fracture C. The tooth is more subject to fracture

1) Amalgam Restoration
a. becomes wider faciolingually, the following drawbacks can result:
1) tooth is more subject to fracture
2) integrity of the restoration is less likely to be maintained

2) Ideal Dimensions
a. facilingual width of NO more than 1-1.5mm and a depth of 1.5-2mm are considered ideal
taking into consideration the extent of caries progression
The filler particles within resin composites are coated with which of the following substances to
promote adhesion to the matrix?

A. Bis-EMA
B. Big-GMA
C. Comphorquinone
D. Polymethylmethacrylate
E. Silane E. Silane

1) Silane
a. filler particles of the resin composites are coated with silane coupling agents to promote
adhesion to the matrix
b. coupling agent that enhances the bonding between the filler particles and resin matrix
c. synthetic hybrid inorganic-organic compounds which are also used to promote adhesion
between dissimilar materials. Good in promoting adhesion in silica based materials such as
porcelain.
d.
What is the primary reason for administration of prednisolone during an operative procedure?

A. All answers are correct

B. It decreases the likelihood of pulpal inflammation
C. It reverses an already inflamed pulp
D. It serves as a hemostatic agent B. It decreases the likelihood of pulpal inflammation

1) Prednisolone
a. decrease pain stimuli by reducing the production of prostaglandins responsible for the
mediation of pain and inflammation
b. anti-inflammatory steroid drug that functions as an effective inhibitor of phospholipase A2
that is responsible for promoting inflammation
c. down-regulate some pro-inflammatory cytokines and reduce the pulpal inflammation during
operative procedures
Each of the following about spherical alloys compared to admixed alloys is true EXCEPT one.
Which is the EXCEPTION?

A. Spherical alloys are less sensitive to variations in condensation pressure

B. Spherical alloys demonstrate a lower mercury: alloy ratio
C. Spherical alloys demonstrate a shorter working time and faster set comparatively
D. Spherical alloys demonstrate poorer adaptation to cavity walls
E. Spherical alloys typically create a better inter proximal contact in Class II restorations E.
Spherical alloys typically create a better inter proximal contact in Class II restorations

1) Admixed alloys
a. yield better inter proximal contacts for Class II restorations
b. tends to resist condensation better than sperical alloys

2) Spherical
a. very plastic and cannot rely on pressure of condensation to establish proximal contour
b. require lower mercury:alloy ratio due to decreased surface area per unit volume
c. have shorter working time, faster setting reaction and poorer adaptation to the cavity walls
Which of the following describes the loss of tooth structure through dissolution by acid NOT
created by bacteria?

A. Abfraction
B. Attrition
C. Erosion
D. No answers apply
E. Abrasion C. Erosion

1) Erosion
a. loss of tooth structure through chemical dissolution by acids NOT created by bacteria
b. most commonly caused by ingestion of acidic beverages in males
c. most commonly caused by bulimia in adolescent females
d. when oral pH drops below 5.5
e.
The most significant factor in IATROGENIC pulpal damage is...

A. Bacterial invasion
B. Heat
C. Proximity of preparation to the pulp
D. DesiccationC. Proximity of preparation to the pulp
1) Pulpal damage
a. avoided by maintaining dentin thickness is 2mm or more
b. number and diameter of dentinal tubules increases with closer proximity toward the pulp, so
the dentin becomes more permeable and easily damaged.
c. dentin has average thickness of 3mm
d. a minimum remaining dentin thickness of 2mm can help prevent pulpal damage
e. dentin thickness of 0.75mm, pulpal reaction to increased bacterial load is observed
f. dentin thickness of 0.25mm, loss of the odontoblasts is observed

g. Other sources of pulpal injury

1) bacteria
2) heat
3) chemical irritants
Each of the following is a characteristics of conventional glass ionomer EXCEPT one. Which is
the EXCEPTION?

A. Low viscosity
B. Lowest fluoride release
C. Sealants on partially erupted molars
D. Used as liner, base, or restorative materials B. Lowest fluoride release

1) Glass Ionomer
a. highest degree of fluoride release
b. used as liners, bases, and restorative materials
c. used as sealant on partially erupted teeth and as caries control restorations in deep cavities
Leakage of the margins of an amalgam restoration...

A. is high compared to silica cements

B. is least at the time of restoration placement
C. is related to the ratio of gamma versus beta phases of amalgam
D. decreases as the restoration gets older D. decreases as the restoration gets older

1) Amalgam restorations
a. release corrosion products that fill in and seal the micro-gap in between the tooth and
restorative material with age
b. improves the seal within the margins, decreasing marginal leakage and percolation of fluids in
the micro-gap
c. considered to be the only dental restorative material that improves its marginal sealing with
age
A patient reports to your clinic in pain for the last two weeks after a well condensed Class V
restoration was placed in tooth #20 4 months previous. The patient reports no discomfort up until
these last two weeks. What is the most likely cause of the discomfort experience by the patient?

A. A fracture in the restoration

B. Cervical abrasion caused by factorial in jury during brushing
C. Marginal leakage
D. Pulpal damage from the preparation leading to irreversible pulpitis D. Pulpal damage
from the preparation leading to irreversible pulpits

1) Cervical region of the tooth has thinner enamel, so caries located there progresses faster if not
immediately restored.
2) Restorative treatment procedures performed on the tooth could have caused trauma to the pul
pouring caries removal which manifested laster due to the inflammation process.
3) Cervical abrasion would take longer than 4 months to manifest
4) Class V fracture would NOT allow the tooth to flex more causing pain.
The tooth most commonly involved in the dental anomaly "dens in dente" or is the permanent:

A. Maxillary lateral incisor A. Maxillary lateral incisor

1) Dens in dente
a. infolding of the outer surface of the tooth and must be diagnosed radiographically
b. "tooth within a tooth" and is also known as Dens invaginatus
c. most often in maxillary lateral incisors and bilateral occurrence is not uncommon
Which of the following esthetic properties dose dentin provide?

A. All answers apply

B. Chroma
C. Fluorescence
D. No answers apply
E. OpaquenessA. All answers apply

1) Dentin provides
a. Chroma: intensity of any particular hue or color.
b. Fluorescence: emission of light by a substance that has absorbed light or other electromagnetic
radiation
c. Opaqueness: absorption and scattering of radiation in a medium. It is neither transparent allow
all light to pass through nor translucent allowing some light to pass through.
Which of the following is the MOST significant disadvantage of glass ionomer cements?

A. Difficult preparation
B. Low bond strength to dentin
C. Moisture sensitivity during initial curing
D. Pulpal irritation C. Moisture sensitivity during initial curing

1) Glass-ionomer cements
a. set through acid-base reaction
b. water loss and moisture contamination must be prevented in order to obtain satisfactory
physical properties
c. desiccation prevents formation of the polycarboxylate matrix, resulting in a rough chalky
surface and decreased surface hardness
d. during the latter part of the reaction, water is essential in hydrating the cross link of the
polymer matrix to strengthen the cement
The American Dental Association (ADA) Statement on posterior resin based composite
restorations suggest their use for which of the following?

A. All answers are correct

B. Areas where esthetic is important
C. Conservative tooth preparation
D. Small and moderately sized restorations A. All answers are correct

1) ADA endorses the use of posterior composites in the following conditions:

a. small and moderately sized restorations
b. conservative tooth preparations
c. areas where esthetics is important
Which of the following BEST describes the smear layer? It is...

A. Another name for the pellicle

B. Produced when phosphoric acid is used when acid etching
C. The layer of debris from grinding on the surface of a cavity prep
D. The layer of plaque closest to the tooth structure C. The layer of debris from grinding on the
surface of a cavity prep

1) Smear layer
a. layer of debris produced from grinding on the surface of a cavity preparation
b. tooth surface is altered by rotary and manual instrumentation during cavity preparation,
cutting debris is smeared over the enamel and dentin surfaces, forming the smear layer
c. contains
1) Calcified debris
2) Shattered and crushed hydroxyapatite
3) Fragmented and denatured collagen
4) Bacteria
5) Saliva
6) Dentinal chips
Each of the following statements regarding mercury is true EXCEPT one. Which is the
EXCEPTION?

A. All answers are TRUE answers of mercury

B. Hg is the only metal that remains the liquid state at room temperature
C. Hg cannot combine under ordinary conditions with nickel, chromium, molybdenum, cobalt,
and iron, to form amalgam
D. Hg demonstrates a higher surface tension than water A. All answers are TRUE answers of
mercury

1) Mercury (Hg)
a. only metal that remains in the liquid sate at room temperature
b. combines with silver-copper-tin alloy to form dental amalgam.
c. can't combine with nickel, chromium, molybdenum, cobalt, and iron under ordinary conditions
to form dental amalgam
d. surface tension of Hg is higher than water
e. in low copper amalgam, Hg is liberated as a result of corrosion to react with an unreacted
gamma phase to produce gamma-1 and gamma phases.
In relation to resin composites, which mechanical property measure the material's ability to resist
the propagation of a crack?

A. Elasticity
B. Flexural strength
C. Fracture toughness
D. Hardness C. Fracture toughness

1) Fracture toughness
a. measures the material's ability to resist the propagation of a crack
b. quantitative way of expressing a material's resistance to brittle fracture when a crack is present
c. brittle fracture = characteristic of materials with low fracture toughness

2) Elasticity
a. tendency of a solid material to return to their original shaped after being deformed.
Which of the following is dentin primarily composed of?
i. Apatite crystal flakes
ii. Elastic fibers
iii. Collagen
iv. Fibroblasts

A. i and ii
B. i and iii
C. i, ii, and iii
D. i, ii, and iv B. i and iii

1) Dentin
a. composed of apatite crystal flakes and collagen fibers
b. 45-50% inorganic component in the form of hydroxyapatite
c. 30% organic mainly collagen
d. 25% water

2) Odontoblasts
a. generate an extracellular collagen matrix as they being to move away from the adjacent
ameloblasts

3) Dentin formation
a. begins immediately before the enamel formation
Which of the following most accurately describes the difference in the thickness of coronal
dentin in primary teeth compared with their corresponding permanent tooth?

A. 33%
B. 50%
C. 66%
D. 75%
E. 25%B. 50%

1) Coronal dentin of primary teeth is typically 50% of the quantity of the coronal dentin found in
permanent teeth because:
2) Primary teeth have pronounced pulp horns which causing less dentin coverage.
3) Permanent teeth are large in size and have smaller pulp spaces in relation to their crown size.
4) Dentin formation occurs throughout life thus increasing the bulk of dentin in permanent teeth
The primary concern in planning a patient's treatment is...

A. All answers are correct

B. Arresting of all carious activity
C. Establishment of good home care and dental home
D. No answers are correct
E. The general comfort and overall health of the patient E. The general comfort and overall
health of the patient

1) Beneficence
a. dentist has a duty to promote your patient's comfort and welfare
b. primary objective of the clinician is to respect the patient's right to be treated in a way that puts
their rights to autonomy, beneficence, justice, nonmaleficence, and veracity above all else
Ramifications due to a lack of inter proximal contacts between amalgam restorations usually
include which of the following?

A. Poor marginal adaptation

B. Sensitivity to cold
C. Less interproximal debris
D. Fremitis
E. Gingival inflammation E. Gingival inflammation

1) Lack of inter proximal contacts

a. causes food debris to be trapped in the inter proximal space
b. presence of food debris within the interproximal space promotes caries formation and gingival
inflammation
Each of the following statements about restorative dentistry is TRUE EXCEPT one. Which is the
EXCEPTION?

A. Attrition wear occurs in occlusal contact areas

B. Polymerization shrinkage occurs toward the walls of cavity preparations to which it is bonded
most strongly
C. The release of unbound monomers and/or additives is hypothesized to be the cause of the
cytotoxicity observed in in-vitro studies of resin-based composites
D. Water absorption is greater in composites with smaller particles than in composites than with
larger particlesD. Water absorption is greater in composites with smaller particles than in
composites than with larger particles
1) Water absorption is NOT greater in composites with micro fine particles than in composites
with fine particles

2) Materials with HIGHER filler contents exhibit LOWER water absorption than materials with
lower filler content

3) Polymerization shrinkage occurs toward the walls of cavity preparations to which it is bonded
most strongly.

4) Attrition wear occurs in occlusal contact areas.

5) Release of unbound monomers and/or additives is hypothesized to be the cause of the

cytotoxicity observed in in-vitro studies of resin-based composites.
Each of the following is a consequence (positive or negative) of dentinal smear layer removal
EXCEPT one. Which is the EXCEPTION?

A. All answer choices are consequences of dentinal smear layer removal

B. Increased bond strength
C. Increased dentin wetness
D. Makes micro leakage more significant because barrier of bacteria to pulp is removed A. All
answer choices are consequences of dentinal smear layer removal

1) Smear Layer
a. defined as debris, calcific in nature which is produced by reduction or instrumentation of
enamel, dentin, and cementum
b. interfere with any adhesive bond formed between the tooth strutter and the restorative material
c. 2 strategies used to overcome the low attachment strengths of smear layer
1) removal of the smear layer prior to bonding by acid etching
2) use of bonding agents that can penetrate the smear layer and incorporate it into the bonding
layer

2) Smear Layer Removal

a. increase wetness of dentin
b. increase bond strength
c. makes micro league more significant because barrier of bacteria to pulp is removed
d. an increase of the fluid flow onto the exposed dentin surface
After having a filing placed a week ago that was found to be about 1.5mm from the pulp. The
patient returns to your office with acute pain with thermal stimulus. What is the most likely
cause of the patient's pain?

A. Hyperemic pulp
B. Irreversible pulpitis
C. Necrotic pulp
D. Reversible pulpitis
E. Chronic pulpal inflammation D. Reversible pulpitis
1) Acute Reversible Pulpitis
a. transient condition of the pulp where in it experiences unusual sensitivity due to the following
causes:
b. Thermal Shock
1) pulp is damaged by heat generally created by friction during the preparation process or
polishing the restoration

c. Trauma
1) induced by a blow to the tooth or improper occlusal relationship

d. Desiccation
1) tooth is prepared without the utilization of a high-speed hand piece without a water jet

e. Amalgam restoration in contact with gold restoration

1) situation causes reversible pulpits and sensitivity because the tooth will experience galvanic
shock having two different metallic restorations in contact with the oral cavity

f. Chemical stimulus
1) sweets are easily fermented and bacteria easily forms acid by products that triggers the
sensitivity
2) sour foods on their own are acidic by nature and could demineralize the tooth surface and
cause sensitivity

g. Caries extension
1) continuous bacterial attack on the tooth surface causes pain and sensitivity to tooth
2) pain is lost after stimulus is removed
Resin Modified Glass Ionomers are _____ compared to Resin Composite materials.

A. Better with fluoride recharging

B. More color stable
C. More wear resistant
D. Stronger A. Better with fluoride recharging

1) Resin modified glass ionomer (RMGI)

a. have better fluoride recharging as compared to composites

2) Compared to RMGIC
a. stronger
b. more color stable
c. more wear resistant
What is the most accepted treatment for mottled enamel (Colorado brown
stains/Hyperfluorosis/Chalky enamel white enamel with brown spots)

A. Microabrasoin with HCl/pumice

B. Vital tooth bleaching at home
C. Walking bleach after root canal treatment
D. In-office bleaching with 35% hydrogen peroxide A. Microabrasoin with HCl/pumice

1) Mottled enamel
a. combination of small white, brown and yellow spots are seen all over the suffices of the teeth

2) Microabrasion
a. fast, pain-free treatment that is effective in lightening or completely removing the yellow,
white and brown stains seen on mottled enamel
b. removes a thin layer of stained enamel with the use of pumice and hydrochloric acid.
c. Hydrochloric acid whitens the stains in the tooth surface and has an effect that lasts for a few
days after its application.
Which of the following describes the 1st step in cavity preparation according to G.V. Black?

A. Convenience form
B. Outline form
C. Resistance form
D. Retention form B. Outline form

1) Outline form
a. initial extension or the outline form of the tooth preparation should be visualized
preoperatively by estimating the extent of the defect, the preparation form requirements of the
amalgam, and the need for the adequate access to place amalgam into the tooth

2) G.V. Black's various steps of cavity preparation

1) Establish outline form
2) Obtain retention form
3) Obtain resistance form
4) Obtain convenience form
If you place a direct pulp cap that remains asymptomatic after 6 months, what is the most likely
understanding of the pulp status?

A. The calcium hydroxide has induced reparative dentin formation to completely heal the
exposure
B. The lack of symptoms may be temporary, and the tooth may become symptomatic later
C. The pulp cap was a success
D. Tertiary dentin has been laid down to heal the exposure site permanently B. The lack of
symptoms may be temporary, and the tooth may become symptomatic later

1) Histological analysis and not with clinical signs and symptoms that the tooth elicit, so it is
impossible to truly know the pulp status with out extracting the tooth or waiting for symptoms to
arise

2) Asymptomatic condition of the pulp at present could never determine the status of the pulp
Which of the following is the mechanism by which mercury enters the body that is considered to
induce the highest toxicity?
A. Absorbed through the skin
B. All mechanisms of absorption are equally toxic
C. Ingestion
D. Inhalation D. Inhalation

1) Most toxic form of mercury to enter the body is through inhalation of mercury vapors
2) 80% of elemental and inorganic mercury is absorbed in the lungs.
In patients with cusps undermined, by decay and heavy occlusal forces, the restorative material
of choice is...

A. Amalgam
B. Cast gold
C. Glass Ionomer
D. Composite resin B. Cast gold

1) Cast Gold
a. Patient with undermined cusps and heavy occlusal forces, cast gold is the restorative material
of choice
b. Gold is the most durable restorative material
c. can be easily finished, polished, burnished and adapted to tooth structure to decrease recurrent
caries risk
d. highest corrosion resistance of any restorative material
Which of the following describes the loss of tooth structure through contact with another tooth?

B. Attrition B. Attrition

1) Attrition
a. loss of tooth structure by contact with another tooth
b. occurs most frequently in patients who suffer from bruxism or who habitually intake
stimulants both prescribed and illegal

2) Abrasion
a. describes the loss of tooth structure by an external force like dentifrice

3) Erosion
a. loss of tooth structure through chemical dissolution by acids NOT of bacterial origin
The properties of zinc-oxide eugenol can be describe by the each of the following EXCEPT one.
Which is the EXCEPTION?

A. It can be easily removed from cavity preparations

B. It can insulate the pulp better than dentin
C. It has a soothing effect on dental pulp
D. It provides an excellent marginal seal B. It can insulate the pulp better than dentin

1) Zinc-oxide eugenol
a. pulpal sedaton
b. cavity base
c.interim dental restoration
d. can be easily adapted into the walls of cavity preparation and will stay intact when properly
condensed into the cavity
e. zinc-oxide eugenol cement as temporary restorations is specifically indicated when tooth has a
very deep cavities eliciting pulp sensitivity and requires further observation prior to placement of
final restoration
The term for when different types of light sources makes color appear different is...

A. Metamerism
B. Opalescence
C. Translucency
D. Fluoroscence A. Metamerism

1) Metamerism
a. where colors which appeared similar in a particular light source appear different when
observed with another light sources

2) Fluorescence
a. light absorbed by a substance is emitted back in a longer wavelength

3) Opalescence
a. appears yellowish-red when light is transmitted through it
b. material appears blue in the scattered light that is perpendicular to the transmitted light

4) Translucency
a. when light is permitted to pass through a material but is diffused within the material, making
the image on the opposite side not clearly visible
General Operative Procedures General Operative Procedures Answers
Which of the following compounds is responsible for the photoinitiaion step of light-cured
sealants?

A. Benzoyl peroxide
B. Bisphenol A
C. Camphoroquionone
D. Fluoride
E. Fumed Silica C. Camphoroquionone

1) Camphoroquionone
a. used as a photo initiator and visible light or argon laser is used as the activator in light cure
sealants

2) Benzoyl Peroxide
a. incorporated as a component in auto-curing/self-curing sealants
3) Sealants
a. most important requirements of a pits and fissure sealant is that it should prevent leakage at its
periphery and gives an adequate working time
b. adherence of pits and fissure sealants and working time is significantly better in light cured
sealants as compared to chemical cure sealants
Which of the following statements it CORRECT?

A. All answers are correct

B. Finishing diamond burs impart less surface damage than carbide burs
C. Metamerism aides the dentist while selecting a shade
D. Rebonding decreases both marginal integrity and color stability
E. Retentive pins should be used in Class IV restorations B. Finish diamond burs impart less
surface damage than carbide burs

1) Finishing Diamond Burs

a. impart less surface damage as compared to carbide burs

2) Retentive pins
a. in Class IV restorations are CONTRAINDICATED because they can show through the tin
enamel and give an unaethetic appearance to the solution

3) Rebonding
a. completed at the end of restorative procedures is does NOT decrease marginal integrity and
color stability

4) Metamerism
a. complication in color perception as various light sources produce different perceptions of
color. It will create problems in shade selection.
Name the technique where deep caries are excavated from a tooth, and a small amount of
affected dentin is left provided that caries-free DEJ is present, and a base is placed along with a
permanent restoration?

A. Indirect pulp cap

B. Semi-permanent caries excavation
C. Step-wise caries removal
D. Direct pulp cap A. Indirect pulp cap

1) Indirect Pulp Cap

a. avoids the risk of accidental pulp exposure during excavation of a deep cavity
b. affected dentin is usually only a few millimeters from the pulp and is relatively unharmed by
indirect pulp capping
c. affected dentin is covered using a cavity liner like calcium hydroxide or glass ionomer and is
then restored
d. indicated for teeth with deep caries with minimal pulpal inflammation

e. Steps
1) Infected dentin is completely removed
2) Affected dentin close the pulp is left due to the possibility of pulp exposure
3) Calcium hydroxide, then glass ionomer is placed over the affected dentin
4) Final restoration is placed

f. Calcium hydroxide
1) placed on the affected dentin to induce its remineralization and promote the reparative dentin
formation
Each of the following is an indication for the placement of placing a base EXCEPT one. Which
is the EXCEPTION?

A. All answers apply

B. Prevent or decrease marginal leakage
C. Prevent other dental materials from irritating the pulp
D. Replace missing tooth structure
E. Thermal protection for the pulp B. Prevent or decrease marginal leakage

1) Bases
a. replace missing tooth structure and support the final restoration
b. insulate the pulp from drastic temperature changes experiences by the restoration
c. provide structure to condense against when placing amalgam
d. protect the pulp from agents which may irritate it
Which of the following describes Metamerism?

A. A complication observed when the perceived color of objects is different in differing light
sources
B. A disease associated with high soda consumption
C. A problem caused by over etching
D. The closing of dentin tubules
E. When color changes due to wetness A. A complication observed when the perceived
color of objects is different in differing light sources

1) Metamerism
a. complication observed when the perceived color of object is different in differing light sources
b. various light sources produce different perceptions of color
c. color of the surrounding environment influences what is in the patient's mouth
d. complicates the selection of the appropriate shade of the restorative material
Each of the following statements is TRUE concerning resin based composite restorations
EXCEPT one. Which is the EXCEPTION?

A. Obtaining an adequate contact in the final restoration starts with pre-wedging

B. Placing composite ring and matrix band is helpful in avoiding damage to adjacent teeth
C. Single wedging is alway more effective than multiple wedging
D. You should check the occlusion before restoring if possible C. Single wedging is alway
more effective than multiple wedging
1) Wedging
a. Multiple wedging is typically more effective than single wedging concerning resin based
composite restorations

2) Occlusion
a. It is necessary to carry out occlusal evaluation before restoring if possible

3) Pre wedging
a. helps in obtaining an adequate contact in the final restorations

4) Placement of composite ring and matrix band

a. damage to inter proximal surfaces of adjacent teeth can be prevented through the placement of
composite ring and matrix band
* Each of the following is indicated by a high C-factor EXCEPT one. Which is the
EXCEPTION?

A. A higher Calset temperature

B. A higher potential for bond disruption
C. More bonded to unbonded restoration surface areas
D. More stress on the walls of the preparation * A. A higher Calset temperature

1) C-factor
a. ratio of bonded to unbounded or free surfaces in a tooth preparation
b. the greater the C-factor, the greater the potential for bond disruption from polymerization
shrinkage.
c. Class IV restoration has the lowest c-factor
d. Class I restoration has the highest c-factor

2) Calset composite temperatures

a. warmer temperature of 130oF of 155oF causes the composite to flow and adapt to the internal
morphology of the cavity preparation resulting in decreased micro leakage and compensates the
effects of polymerization shrinkage

3) Composites
a. polymerization shrinkage is one of the biggest concerns regarding the composite resins
Each of the following is a reason adjacent Class I I or Class III cavities should be prepared and
restored using a composite resin during a single appointment EXCEPT one. Which is the
EXCEPTION?

A. Matching the color is easier

B. The contact area will be better
C. Time is conserved for the clinician and patient
D. Access to the cavities is simplified B. The contact area will be better

Adjacent proximal cavities are best restored in one appointment because

a. time is conserved for the clinician and patient
b. colors will match and age similarly since they are likely to be from the same batch.
c. there will be adequate access and visibility, enabling the dentist to work more efficiently and
effectively.
d. restorations can be placed easier due to adequate space to finish the proximal margins of the
restorations properly.

e. the fact that the caries to be restored are adjacent does not improve the contact of the
restoration
Which of the following materials possess the strongest ability to recharge its fluoride?

A. Compomer
B. Glass Ionomer
C. Resin based glass ionomer
D. Resin composite B. Glass Ionomer

1) Glass Ionomers and Resin Modified Glass Ionomers

a. demonstrates the ability to recharge its fluoride capacity
b. conventional glass ionomers are regarded as having a better ability to recharge its fluoride
capacity
c. recharge capability may be due to the porosities present in glass ionomers and resin modified
glass ionomers
The perceived form of a restoration is affected by its surface characteristics in which of the
following ways?

A. Surfaces smoother than usual will give the impression of a larger size
B. Teeth appear smaller when the value is increased
C. The illusion of increased length can be achieved with horizontal highlights
D. The illusion of increased width can be achieved with vertical highlights A. Surfaces smoother
than usual will give the impression of a larger size

1) Smooth Surfaces
a. give the impression of larger size and vice versa

2) Increased value
a. teeth appear larger than their actual size when the value is increased

3) Illusion
a. art of changing the perception of an object to appear different from what it is
b. illusion of size, shape, length, and color are created to solve or hide an esthetically difficult
situation
c. increased length: achieved with vertical highlights
d. increased width: achieved with horizontal highlights
When utilizing four-handed dentistry, the assistant should be positioned...

A. Different positions depending on where the dentist is working

B. Higher than the dentist to facilitate visibility
C. Lower than the dentist for ergonomic posturing
D. At the same height because they are a team B. Higher than the dentist to facilitate
visibility

1) Four-handed dentistry
a. assistant should sit close to the back of the patient's chair higher than the dentist to facilitate
visibility
b. position is suitable for better view of the site, instruments and materials from the mobile cart
or instrument tray
c. allows you access to these materials without leaning or overextending your arms
d. assistant stools should be placed in a position so that their eye level is 4 to 6 inches higher than
the dentist's
For a class V restoration where should in the rubber dam be punched?

A. 3mm facial to the designate tooth

B. 3mm lingual to the designated tooth
C. 1mm facial to the designated tooth
D. 1mm lingual to the designated tooth
E. Rubber dams should never be used in Class V restorations C. 1mm facial to the
designated tooth

1) Rubber dam placement

a. rubber dam should be placed 1mm facial to the designated tooth for Class V restorations,
enabling the rubber dam to completely cover the area to be isolated and making subgingival
placement easier if needed

b. Class V restorations require planned measure for maintenance of isolation as it is extremely

difficult to place rubber dam in these areas

c. Location of Class V preparations makes it very difficult to prevent moisture contamination.

Hand instruments classified as "angle formers" are most common used for...

A. Anterior Class III composite resin preparations

B. Anterior Class III direct filling gold preparations
C. Cast onlays
D. Class II amalgam preparations D. Class II amalgam preparations

1) Angle formers
a. hand instruments with their cutting edge sharpened at an angle to the axis of the handle
b. used to create bevels, refine pulpo-axial line angles, and smooth margins
c. also called "marginal trimmers"
Each of the following is a criteria when determining the effectiveness of a visible light-curing
unit EXCEPT one. Which is the EXCEPTION?

A. Fluoride releasing ability of the composite being cured

B. Light exposure time
C. Shade of composite
D. Wavelength A. Fluoride releasing ability of the composite being cured

1) Composite resins
a. do not typically release and therefore is NOT a factor in determining the effectiveness of a
visible light-curing unit

2) Criteria
a. wavelength of the curing light is an important consideration
b. normal range of composite curing light units is approximately 470 nm.
c. shade of the composite resins also affects the penetration of light required for curing.
d. exposure time should neither be overextended nor kept short
Which of the following describes the blade length on a cutting instrument with a four number
formula of : 10 95 7 14

A. 1 mm
B. 10 mm
C. 14 mm
D. 7 mm
E. 9.5 mm D. 7 mm

G.V. Black's four number formula for instruments

(that have a primary cutting edge or working end that is NOT at right angle to the long axis of
the blade).
a. First number: width of the blade in tenths of a millimeter
b. Second number: cutting edge angle in centigrades
c. Third number: length of the blade in millimeter
d. Fourth number: blade angle in centigrades
The _____ of the gingival marginal trimmer corresponds to the nib of the _____?

A. Blade, Condenser
B. Blade, Hatchet
C. Blade, Periodontal Probe
D. Shaft, Forceps
E. Shank, Explorer A. Blade, Condenser

1) The blade of the gingival marginal trimmer corresponds to the nib of the condenser.

2) Gingival margin trimmers are cutting instruments while condensers are non cutting
instruments.

3) In non-cutting instruments, the blade is replaced by a nib or point

4) Nibs
a. working ends or nibs of the condenser may be of any shape but they are usually round with flat
ends. Triangular, rectangular or diamond shaped nibs are also used.
Which of the following statements is TRUE?

A. 2-step etch-and-rinse adhesives save time and improve bond performance

B. Acid-etching should be done on enamel, not on dentin
C. Adhesive resin removes the smear layer and creates a microporous layer
D. Enamel has a variable structure with a higher percentage of organic material compared to
dentin
E. Formation of resin tags in enamel is important for bond strength E. Formation of resin tags in
enamel is important for bond strength

1) Bond Strength
a. relies upon the formation of resin tags in enamel

2) Acid Etching
a. thought to remove the smear layer and creates a micro porous enamel layer on which resin tags
are formed by adhesive resins
b. 2 step etch and rinse adhesives consume longer time periods as compared to the self-etch
adhesives
c. can be done on both enamel as well as dentin
After recurrent Class V caries were found on a molar that extends subgingivally, crown
lengthening surgery was performed to expose 3+mm of root structure. The best design features
would include:

A. The cervical line must be re-established in the restoration

B. The gingival margin of the restoration must be placed at the new gingival level
C. The gingival restorative margin should be moved apically until it is in sound tooth structure
D. The restoration should be over contoured to maintain the protection the gingiva provided by
the buccal bulge of the crown. C. The gingival restorative margin should be moved
apically until it is in sound tooth structure

1) Margins Concept
a. margins of cavity preparation should always be placed in sound tooth structure

2) Prepared teeth should always have supported tooth structure surrounding the restorative
material to decrease the chances of tooth fracture from occlusal stresses

3) Preparation margins should ideally be placed supra or equigingivally for ease of

instrumentation and ease of cleaning

4) Margins of tooth preparation must not violate the biologic width.

Visible light curing units present the MOST danger to which of the following?

A. Cornea
B. Iris
C. Lens
D. Retina
E. Cilliary muscle D. Retina

1) Continuous exposure to visible light used for curing the composite can cause serious damage
to the RETINA.

2) Care should be taken to look directly at the visible light cure sources.

3) Use a light curing machine with a protective barrier covering the light source.

4) Prolonged visible light exposure can lead to photoreceptor cell damage.

The most likely cause of interdental papillae bulging out from underneath a rubber dam is...

A. Each tooth is not ligated with floss

B. Inflamed gingival tissues
C. The rubber dam is too thin of material
D. The rubber dam holes were punched too close together
E. The rubber dam holes were punched too far apart
F. Thick periodontal biotype D. The rubber dam holes were punched too far apart

1) The most likely cause of the interdental papillae bulging out from underneath of a rubber dam
is when the rubber dam holes are punched too close together.

2) Holes punching too close together cause the material to stretch too much and prevent the
rubber dam from adapting properly.

3) Lack of adaptation creates space of fluid seepage and contamination and rubber dam tearing
may occur more easily
Which of the following locations is ideal for the placement of a microfilm composite?

A. Class I
B. Class III
C. Class IV
D. Class V D. Class V

1) Microfill composites are considered an appropriate choice for restoring Class V cervical
lesions or defects in which cervical flexures can be significant.

2) This is true for cases of bruxism, clenching and stressful occlusion. Their low modulus of
elasticity allows them to flex during tooth flexure, better protecting the bonding interface.

3) Microfilled composites also provide a smooth and polished surface in the finished restoration
that is less receptive to plaque.
If a rubber dam is abnormally wrinkled between teeth, the probable reason is...

A. Overlapping and/or crowding of the teeth involved

B. Teeth with abnormally broad contacts
C. The holes were punched too closely
D. The holes were punched too far apart
E. The holes were not punched large enough D. The holes were punched too far apart

1) Large areas between holes in the rubber dam sheet cause wrinkling due to excess material
between teeth.

2) Excess material between the holes became evident with the folding of the rubber dam septum
in-between the holes.

3) Excess material increase the difficulty of passing the rubber dam through the contact area.

4) Prevent incorrect punching of holes

a. Assess the distance between each tooth
b. Assess the position of teeth in the arch
c. Rubber dam holes should be approximately 3-4mm apart from each other on average
Which of the following statements is TRUE regarding Class IV composite restorations?

A. A final veneer layer of microfilled resin will help create a smooth, glossy surface.
B. It is recommended to use retentive pins for support on Class IV restorations.
C. No answers apply
D. Tooth fragments should never be reattached to the remaining tooth structure A. A final
veneer layer of microfilled resin will help create a smooth, glossy surface.

1) A final veneer layer of micro filled resin will help create a smooth and glossy surface due to
its small sized particles.

2) Polished surfaces are less receptive to plaque accumulation and extrinsic staining

3) Retentive pins are never recommended for support and retention in Class IV restorations.
Which of the following is the instrument grasp MOST commonly used in operative dentistry?

A. 2-handed grasp
B. Palm grasp
C. Palm-thumb grasp
D. Pen grasp D. Pen grasp

1) Pen grasp is the MOST frequently used instrument grasp in operative dentistry procedures.

2) Modified pen grasp

a. is similar to the pen grape expect the operator uses the pad of the middle finger o nthe handle
of the instrument. It provides more strength and stability in some procedures.

3) Palm grasp
a. used for bulky instruments
b. commonly used for surgical forceps, rubber damp clamp forceps, straight chisels, and the
air/water syringe.

4) Palm-thum grasp
a. used by the assistant for holding the oral evacuator.
b. operator may use this with instruments that require a more vertical movement
Dental burs are MOST COMMONLY made from which material?

A. Galvanized iron
B. Iron
C. Steel carbide
D. Tungsten carbide D. Tungsten carbide

1) Most dental burs are made up of tungsten carbide material.

2) Tungsten carbide burs

a. most efficient in the removal of soft carious lesions by using them with a touching action
b. these are less efficient in cutting hard tooth enamel

c. Different Types
1) Cutting burs
2) Excavation burs
3) Finishing and polishing burs

d. Finishing and polishing tungsten carbide burs have more flutes compared to cutting burs. The
number of flutes range commonly ranges from 12-30.
To extend the life of a tungsten carbide bur, the bur should...

A. Be moving fast before contacting tooth structure

B. Be moving slow before contacting tooth structure
C Contact tooth structure before rotating
D. Be sterilized with heat sterilization A. Be moving fast before contacting tooth structure

1) The lifespan of a tungsten carbide bur can be extended by bringing the bur up to speed before
contacting tooth structure, because it decreases the friction between the bur and the tooth
structure thereby decreasing damage to the bur and the pulp.

2) Sufficient rotating speed makes the cutting edge of the bur more efficient even with using
light pressure.

3) Heat sterilization corrodes the carbon steel and anneals the cutting edge of the bur.
The maxillary incisors of a middle-aged patient can be made to appear younger through
enameloplasty that includes

A. Flattening the incisal edges

B. Moving the facial height of curvature gingivally
C. Moving the facial line angles proximally
D. Rounding the incisal point angles
E. Shortening the incisal edges D. Rounding the incisal point angles

1) Rounding the incisal point angles of maxillary incisors removes the sharp angles that make the
teeth appear worn down and abraded.

2) Rounded incisal angles and pointed cusp tips create the illusion of a younger looking smile.
Rounded incisal angles also make a person appear more feminine, while square looking incisal
angles suggest masculinity.

3) Shortening and flattening of incisal edges makes a person appear older since it insinuates
abrasion of teeth due to old age.
Each of the following can be achieved with a properly trimmed wooden wedge EXCEPT ONE.
Which is the EXCEPTION?

A. Protect the gingiva

B. Provide space for the matrix band
C. Reduce leakage of moisture into the cavity preparation
D. Prevent overcontouring of the contact D. Prevent overcontouring of the contact

1) A well-fitted and properly tightened matrix band placed between the filling surface and
adjacent proximal tooth surface to prevent over contouring of the contact point.

2) A proper contact point is important for the life of the restoration and gingival health.

3) Food impaction and gingival disease may occur if a contact point is NOT properly established.

4) A properly trimmed wooden wedge placed in the interdental space below the matrix band can
help to,
a. protect the gingiva
b. provide space for the matrix band placement
c. reduce leakage of moisture ion the cavity preparation
d. prevent material from leaking out during condensation
When placing a light cure resin composite in a deep cavity preparation, the composite should be
placed in increments of no greater than...

A. 0.5mm
B. 1 mm
C. 1.5 mm
D. 2 mm
E. 2.5 mm D. 2 mm

1) When placing a light cured resin composite in a deep cavity preparation, the composite should
be placed in increments of no greater than 2mm.
2) Composite should be placed incrementally to facilitate proper light activation, combat
polymerization shrinkage stresses, and the development of correct anatomy. The deepest portions
of the tooth preparation are restored first incrementally.

3) An anatomic layering technique is preferred. The operator places and light-activates one
increment per cusp at a time and continues to place subsequent increments until the preparation
is filled with development of anatomic contours.
Which of the following is the reason trituration is completed?

A. Activate the copper in the alloy

B. All answers are correct
C. Remove the oxide coating and wet each particle of alloy with mercury
D. Remove the oxide coating and wet each particle of alloy with zinc. C. Remove the oxide
coating and wet each particle of alloy with mercury

1) The primary objective of the process of trituration of amalgam is to remove the oxide coating
and wet each particle of alloy with mercury.

2) Properly triturated amalgam is a homogenous mass with slightly reflective surface. It flattens
slightly if dropped on a tabletop.

3) A correctly mixed amalgam should have sufficient wetness to aid in achieving a well-adapted
restoration and NOT be dry or crumbly.
Which of the following does not damage soft tissue?

A. Home bleaching treatment

B. Placement of a matrix band in a Tofflemire retainer
C. Placement of gingival retraction cord
D. Use of an inter proximal carver
E. Topical fluoride treatment E. Topical fluoride treatment

1) Fluoride
a. in small controlled doses helps to strengthen teeth nd does not cause harm to the gums

2) Home bleaching treatment

a. has high percentage of peroxide components which may cause harm or damage to gingiva and
soft tissues

3) Gingival retractors
a. placement of gingival retractors into the sulcus also causes certain damage to the marginal
gingiva as the retraction cord displaces them from their original location.

4) Placement of matrix band in a Tofflemire retainer

a. damages the gums surrounding the tooth because it keeps on sliding down into the gingival
sulcus as the retainer is tightened
5) Interproximal carvers
a. damage the gums while carving the restoration that approximates or extends into the marginal
gingiva
b. sometime such gingival injury is inevitable and is sacrificed for the sake of attaining proper
anatomic contours and preventing overhangs in the restorations.
Which of the following is the reason zinc is a constituent of amalgam?

A. All answers are correct

B. To enhance its mechanical properties
C. To prolong the service of the restoration
D. To reduce marginal fracture A. All answers are correct

1) Zinc
a. is added to amalgam to prevent the oxidation of other metals in the alloy during the
manufacturing process, which keeps the alloy from turning dark.
b. accomplishes this by combining readily with oxygen to form zinc oxide

2) Zinc Benefits
a. enhances the mechanical properties of amalgam
b. reduces marginal fracture rate
c. prolongs the service of the restoration
Name the technique where a deep caries are excavated from a tooth, and a small amount of
affected dentin is left provided that a caries-free DEJ is present, and a temporary restoration is
placed then replaced with a permanent restoration following analysis 6 months later?

A. Indirect pulp cap

B. Semi-permanent caries excavation
C. Step-wise caries removal
D. Direct pulp cap C. Step-wise caries removal

1) Step-wise caries removal

a. when decay is excavated around the margins of a preparation and the tooth structure is
remineralized until the permanent restoration is placed later.

2) Step-wise caries removal steps

a. Totally remove caries from the margins of the preparation, spring the pulpal affected dentin
but not the infected dentin
b. Place a CaOH liner and restore with glass ionomer.
c. 6-12 months later remove glass ionomer and test tooth vitality then placed definitive
restoration

3) Indirect Pulp Capping

a. different because a permanent restoration is placed at the first appointment and is more
aggressive with caries excavation
When sharpening instruments, the _____ of the blade should be placed at a _____ angle to the
sharpening stone.
A. Bevel, 45o
B. Bevel, 90o
C. Working end, 45o
D. Working end, 90o A. Bevel, 45o

1) When sharpening an instrument, the bevel of the blade is placed at an angle of 45o to the
sharpening stone. This ensure maximum efficiency of the blade to sharpen the instrument.

2) Instrument sharpening is an important aspect of operative dentistry. Dull instruments are not
recommended for carrying out procedures in the oral cavity.

3) Dull instruments
a. produce more heat
b. less efficient and can damage tooth structure
c. recommended to discard those instruments which cannot be sharpened.
Light-cured composite resin is most affected by which of the following variables?

A. Opacity of enamel
B. Shade of material
C. Thickness of increment
D. Length of exposure C. Thickness of increment

1) Polymerization of light cure composites is dependent upon the penetration of light through the
composite resin

2) As the material thickness increases, the penetration of light decreases, which may lead some
composite unpolymerized, resulting in the failure of restoration.

3) Place composite resin in small increments is advised because it allows for complete
penetration of curing light and complete polymerization.

4) Incremental Placement minimizes shrinkage which

a. increases bond strength
b. decrease cuspal fractures
c. deceases marginal leakage
Each of the following statements regarding sealants is TRUE EXCEPT one. Which is the
EXCEPTION?

A. They are considered a non-invasive procedure

B. They perform as a physical barrier
C. They prevent biofilm from collecting within a pit or fissure
D. They should be used on all patient's teeth D. They should be used on all patient's teeth

1) Sealants
a. should NOT be used on all patient's teeth
b. indicated for either preventive or therapeutic uses, depending upon patient's caries risk, tooth
morphology or presence of incipient enamel caries
c. only caries-free pits and fissures or incipient lesions in enamel no extending to the DEJ are
recommended for treatment with pits and fissure sealants

d. Advantages
a. Perform as a physical barrier
b. Prevent bio film from collecting within a pit or fissure
c. Sealant placement is considered as non-invasive procedures
Each of the following describes an ideal ergonomic position for dental work EXCEPT one.
Which is the EXCEPTION?

A. Back and neck upright

B. Elbows bent at 90o or greater
C. Elbows kept close to the body
D. No more than 10 inches between operator's nose and patient's oral cavity
E. Use entire seat/stool surface to support operator's weight D. No more than 10 inches between
operator's nose and patient's oral cavity

1) Ergonomic position
a. at least 10 inches or more space between his/her nose and patient's oral cavity in order to
achieve better visualization, controlled instrumentation and convenient working environment.
b. elbows at 90o or greater
c. operator's weight should be supported using the entire seat/stool surface to maintain balance
Each of the following are TRUE regarding self-curing sealants EXCEPT ONE. Which is the
EXCEPTION?

A. Benzoyl peroxides or aromatic tertiary amines are components

B. Late manipulation may disrupt polymerization
C. They cure by an endothermic reaction
D. They have 2 components C. They cure by an endothermic reaction

1) The setting reaction of self cure or chemical cure or auto-curing sealants is exothermic in
nature.
2) Significant amount of heat energy is liberated. It is advised to use light curing sealants for
safety, good manipulation and ease of handling.
3) Auto curing sealants are composed of benzoyl peroxide or tertiary amines.
4) Late manipulation can disrupt polymerization.
A carious lesion is detected clinically and is confirmed radiographically extending from the
distal pit to the central fossa along the central groove of #19. The planned amalgam preparation
and restoration should

A. Extend from the distal pit to the central fossa along the central groove. It should also include
any enamel undermined by the removal of carious tooth structure
B. Extend from the distal pit to the medial pit, along the central groove
C. Extend from the distal pit to the medial pit, along the central groove. Buccal and lingual
extension should be prepared as well, from the central fossa along the buccal and lingual grooves
D. Span the entire occlusal surface, along the central groove, including both the medial and distal
marginal ridges A. Extend from the distal pit to the central fossa along the central groove.
It should also include any enamel undermined by the removal of carious tooth structure

1) The depth of the preparation should be at least 1.5-2mm in order to provide strength to the
restoration.

2) The pulpal floor depending upon the enamel thickness is almost always in dentin.
Which of the following tooth structures is (are) affected by tooth bleaching?

A. All of the enamel only

B. Dentin only
C. Surface of enamel only
D. Both dentin and enamel A. All of the enamel only

1) Bleaching agents like hydrogen peroxide and carbide peroxide act on the tooth enamel only
unless root dentin is exposed during bleaching.

2) Oxidation of enamel surface stains and impurities is carried out by these bleaching agents.

3) Dentin and pulp are typically NOT affected by bleaching procedures.

4) Discoloration of tooth enamel caused by extrinsic stains can be corrected with the help of
tooth bleaching or tooth whitening procedures.
The remaining cusps should be evaluated if the faciolingual width of a Class I preparation
exceeds a distance of _____ the facial and lingual cusp tips?

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

1) If the faciolingual width of a Class I preparation exceeds 1/3 of the distance between facial
and lingual cusp tips, the remaining cusps should be evaluated.

2) If extension from a primary groove toward the cusp tip is no more than half the distance, no
cusp capping needs to be done.

3) If this extension is 1/2-2/3 of the distance, consider cusp cupping. If the extension is more
than 2/3 of the distance, cusp capping is usually recommended.
A patient presents with a carious lesion that my result in a pulp exposure upon preparation for an
MOD amalgam restoration on a vital and asymptomatic tooth. Which of the following should the
clinician do?
A. Leave the infected dentin in the deeper areas, temporize the tooth and observe it for 2 weeks
then restore or initiate root canal treatment.
B. Remove the carious dentin completely then initiate root canal treatment
C. Remove the infected dentin laterally first before removing it completely from the deeper parts
of the carious lesion
D. Leave the affected dentin in the deeper areas, apply a base material, then restore. D.
Leave the affected dentin in the deeper areas, apply a base material, then restore.

1) Indirect Pulp capping

a. conservative treatment of choice for teeth presenting with deep carious lesions in close
proximity to the dental pulp
b. enhances the formation of reparative dentin
c. if indirect pulp capping fails, root canal treatment should be performed
d. involves the removal of soft carious dentin (infected dentin) without exposing the pulp tissue.
Hard dentin (affected dentin) is NOT removed completely. Following excavation, a sedative base
is placed and the restoration is completed.
e. it is CRITICAL that the margins of the preparation are in CLEAN TOOTH STRUCTURE
WITH NO CARIOUS ACTIVITY PRESENT, otherwise the procedure has a significantly higher
failure rate.
Which of the following is the minimum number of flutes needed on a carbide bur for it to be
considered a "finishing bur"

A. 12
B. 18
C. 24
D. 6
E. Finishing carbide burs do not have flutes A. 12

1) The minimum number of flutes needed on a carbide bur to be considered as a finishing bur is
12.

2) Carbide burs
a. used most commonly for excavating and preparing cavities, finishing cavity walls, finishing
restoration surfaces, drilling old fillings, finishing crown preparations, contouring bone,
removing impacted teeth, and separating crowns and bridges.

b. made of tungsten carbide, a metal that is extremely hard and can withstand high temperatures
c. carbide has high hardness and can maintain a sharp cutting edge and be used many time
without becoming dull
d. carbide burs are brittle and have a tendency to fracture under pressure. Because of their
brittleness, they are best operated at high speeds with light pressure.

3) Trimming and finishing burs

a. have more blades than operative burs and the blades are closer together and shallower, making
them ideal for the fine finishing and polishing
Which of the following necessitates an increase from the typical amount of curing time when
using a tungsten halogen curing light?
1. Microfilled resin
2. Translucent, incisal shade resin
3. Dentin shade resin
4. A larger diameter curing light tip
5. Cold (refrigerated) resin

A. 1, 2, and 5
B. 1, 3, 4, and 5
C. 1, 3, and 4
D. 2 and 4
E. 3 and 5 B. 1, 3, 4, and 5

1) Longer light exposures usually are required for the polymerization of dark and opaque shades.

2) An increase from the typical amount of curing light (e.g. 30-40 seconds), when using a
tungsten halogen light is necessary in microfilmed resins, dentin shade resin, cold or refrigerated
resin and with a larger diameter tip

3) In addition to classic tungsten halogen light, plasma arc curing systems and blue light-emitting
diodes (LEDs) are available which are more efficient, more portable, and more durable.
Which of the following creates the phenomena of dentinal plugs?

A. Adhesive
B. Debris from the smear layer
C. Oxalic acid
D. Primer (from micro/macrotags)
E. Sclerotic dentin B. Debris from the smear layer

1) Dentinal or smear plugs are composed of debris from the smear layer

2) Smear layer is documented to be about 0.5-2.0mm thick layer of debris with a mainly granular
substructure that entirely covers the dentin. The surface of the smear layer appears quite
irregular.

3) The orifices of dentinal tubules are obstructed by debris tags known as smear plugs or dentinal
plugs. These dentinal plugs extend into the tubules to a depth of 1-10 micrometers.

4) Smear layer is reported to reduce dentinal permeability by about 86% due to dentinal
plugging.

5) Dentinal plugs are removed by acid etching the tooth surface with phosphoric acid.
Each of the following is an advantage of using the acid-etch technique for composite resin
restorations with minimally cavity preparations EXCEPT one. Which is the EXCEPTION?
A. Improved esthetic outcomes
B. Improve retention of the restoration
C. Maximum conservation of tooth structure
D. Improved access for finishing of the restoration D. Improved access for finishing of the
restoration

1) Acid etching
a. creates microporosities that adhesive can infiltrate to create retention for composite resin
bonding
b. roughens the enamel rods and dentin thus creating micro mechanical abrasions that allows the
bonding agent to flow and adhere to the tooth surface
c. removes surface debris, allowing for a clean bonding site for improved esthetics
d. creates higher bond strength between composite restorations and tooth structure and decreases
micro leakage

e. DOES NOT IMPROVE ACCESS to the restoration

Which of the following describes the radiant exposure for a curing light producing 1000 mW of
power with a focal spot size of 2cm2 and an exposure time of 40 seconds?

A. 20,000 mJ/cm2
B. 200,000 mJ/cm2
C. 2000 mJ/cm
D. 500 mJ/cm2 A. 20,000 mJ/cm2

1) The radiant exposure for a curing light producing 1000 mW of power with a spot size of 2
cm2 and an exposure time of 40 seconds is 20,000 mJ/cm2.

2) Dental curing light is a piece of dental equipment that is used for polymerization of light cure
resin based composites

3) It can be used on several different dental materials that are curable by light.

4) Camphorquinone is the typical agent used as a photo initiator in composite resins.

Preparation of Cavities Preparation of Cavities Answers
When preparing for a tooth for a Class I amalgam, the medial and distal walls are supposed to
diverge occlusally to...

A. Extend the preparation for ease of cleans ability

B. Prevent the undermining of the tooth structure of the marginal ridge
C. Resist forces of occlusal loading
D. Create a convenience formB. Prevent the undermining of the tooth structure of the marginal
ridge

1) Concept: Marginal ridges should be supported by dentin to avoid fracture under heavy
occlusal forces and should NOT be undermined
2) Undermined marginal ridges are easily fracture because the enamel in these areas is
unsupported

3) Dentin supported marginal ridges provide the best fracture resistance against heavy occlusal
forces.
A cast gold restoration is retained primarily by...

A. All answers are correct

B. Cement seal
C. Retention and resistance form
D. Sharp cavosurface angles C. Retention and resistance form

1) Concept: Cast gold restoration is retained primarily by retention and resistance form of the
cavity preparation.

2) Retention
a. form prevents the removal of the restoration along its path of placement by the occlusal forces
b. achieved with parallel walls with minimal taper to facilitate a single pathos placement of the
restoration

3) Resistance
a. resistance form resists the dislodgment and movement of restoration under directed apical,
oblique, or occlucsal forces.
b. achieved with the use of fish tail and dovetail preparations, presence of grooves, slots and
pins.
Which of the following is the MOST IMPORTANT reason a dentist should visualize the outline
form before they begin to prepare a tooth?

A. To establish the convenience form

B. To establish the resistance and retention form
C. To prevent over cutting and overextension
D. To make finishing the enamel walls and margins easier C. To prevent over cutting and
overextension

1) Concept: Overcutting and over extension compromises the remaining tooth structure and the
success of the restorative procedure

2) Cutting extensively without a thorough knowledge of dental anatomy could result in excessive
removal of tooth structure that may extend too close to the pulp, causing accidental pulp
exposure or irritation.

3) Undermining cusps and overextending the cavity outline weakens the remaining tooth
structure. Large cavities are too difficult to restore and normally result in a greater chance of
post-operative sensitivity.
Which of the following should be the proximal cavosurface angle be on for a MO preparation?
A. 120o
B. 30o
C. 45o
D. 60o
E. 90o E. 90o

1) Concept: The proximal cavo-surface angle for a MO preparation should be approximately

90o. Enamel cavosurface angles of 90-100o are considered ideal.

2) It helps to conserve the dentinal support and the strength of the restoration and enables the
restoration to withstand the forces of mastication adequately without undergoing fracture.
Which of the following describes how the surface of the enamel should appear after acid etching
of the enamel is complete?

A. Blue and opaque

B. Brown and opaque
C. Brown and shiny
D. White and opaque
E. White and shiny D. White and opaque

1) Concept: After acid etching of the enamel tooth surface, it appears white and opaque in
appearance commonly described as possessing a frosty appearance.

2) The frosty appearance is due to the action of acids causing selective demineralization of the
area, creating porosities in the superficial enamel surface.

3) Resin tags are formed in the porosities following application of adhesive and resin composite
materials, creating micro mechanical interlocking and a strong resin bond is formed.
Which of the following permanent tooth pulp horns is at the most risk for a potential accidental
exposure during a preparation for a Class II amalgam?

A. Distofacial of a mandibular 1st molar

B. Distofacial of a maxillary 1st molar
C. Lingual of a mandibular 1st premolar
D. Buccal of a mandibular 1st premolar D. Buccal of a mandibular 1st premolar

1) When making a Class II cavity preparation, the pulpal floor along the buccal cusp of the
mandibular 1st premolar should be higher than the lingual to avoid encroaching on its prominent
buccal pulp horn.

2) Mandibular premolars have a more prominent buccal cusp and consequently, a prominent
buccal pulp horn.

3) The position of the pulp follows the external anatomy of the tooth which must always be
considered during preparation of cavities
Which of the following is/are considered reason(s) to place bevels into enamel?
A. All answers apply
B. To enhance esthetics if the margin is in a visible location
C. To remove fragile enamel
D. To smooth the cavorestorative margins A. All answers apply

1) Concept: Enamel bevels are generally placed to minimize the line of demarcation at the tooth-
restoration interface. The bevel is commonly placed at a 45-60 degree angle.

2) Advantages of enamel bevels are:

a. Removal of fragile enamel and strengthening the restoration
b. To aid in making margins smooth
c. Enhancement of esthetics if the margin is in a visible location
Which of the following would create the MOST esthetically pleasing Class IV resin-based
composite restoration?

A. A 1.0mm facial bevel should be placed

B. A 2.0mm lingual bevel should be placed
C. A facial bevel of ~2.0mm should be placed
D. No bevel placed, facially or lingually C. A facial bevel of ~2.0mm should be placed

1) Concept: A facial bevel of approximately 2mm should be placed in order to achieve the most
esthetically pleasing Class IV resin-based composite restorations. Bevel is placed at an angle of
45-60 degrees.

2) Advantages of bevel placement are:

a. No line of demarcation between the tooth and restorative material interface (enhancing
esthetics)
b. Conservative tooth preparation
c. 2x high bond strength is achieved
d. an adherence with acid etched ends of rods crystals is possible
e. better resistance to fracture
Which of the following describes the BEST method to remove carious dentin near pulp in a
Class II preparation?

A. A bur with high speed hand piece

B. A very slowly rotating large bur
C. An explorer tip
D. Use a spoon excavator by hand B. A very slowly rotating large bur

1) Concept: It is recommended to remove the carious dentin near the pulp in a Class II
preparation with a large very slowly rotating bur. This precaution is necessary to prevent
accidental pulp exposures during caries excavation.

2) Spoon excavators are used to remove very soft various dentin.

3) High speed burs are used to prepare cavity walls, remove hard enamel, and carious dentin
away from he pulp.

4) Sharp explorer tips are contraindicated to use near the pulp because they might pierce the
dentin and create a small pulp exposure.
Which of the following terms describe the line, or angle formed by the junction of a cavity all
with unprepared surface of the tooth?

A. Cavosurface angles
B. Dimensional angles
C. Line angles
D. Point angles
E. wall A. Cavosurface angles

1) Concept: The line or angle formed by the junction of a cavity wall with the unprepared surface
of the tooth, that is a continuous entity enclosing the entire external outline of the prepared
cavity, is termed as the cavo-surface angle.

2) Point angle
a. angle formed between 2 cavity walls and a floor or between 3 walls

3) Line angle
a. is formed between 2 walls or a wall and floor of a cavity
Which of the following describes a major difference between a Class V preparation form
amalgam versus a composite restoration

A. Convenience form
B. Depth of the preparation
C. Outline form
D. Angulation of the enamel cavosurface margins D. Angulation of the enamel cavosurface
margins

1) Concept: Amalgam restorations always require 90 degree cavosurface margins because

amalgam has weak edge strength

2) Enamel cavosurface margins for an amalgam restoration should have no bevel to avoid
amalgam fracture due to lack of minimum thickness of material for strength

3) The cavosurface margin preparation for Class V composite restorations require a 45 degree
bevel to provide additional surface for adhesion as well as to create an esthetically blended
junction between the tooth and the composite material.
What design features of a DO alloy preparation would proven the restoration from falling out
into an edentulous space? Select all that apply.

A. Amalgapin in the proximal box

B. Bevel of pulp axial line angle
C. Convergent axial walls
D. Occlusal dovetailes A. Amalgapin in the proximal box
C. Convergent axial walls
D. Occlusal dovetailes

1) Concept: Placing occlusal dovetails provide resistance to dislodging forces for the restoration

2) Convergent axial walls keep the restoration in placed by providing retention and resistance to
dislodgment to perpendicular and shear stress

3) An amalgapin in the proximal box provides added resistance and prevents displacement into
adjacent edentulous space.
How do preparations for proximal amalgam and cast gold inlay differ?

A. All answers are correct

B. Cast inlay preparations require a bevel
C. No answers are correct
D. Resistance form design principles
E. Use of instruments
F. Amalgam preparations require a bevel B. Cast inlay preparations require a bevel

1) Concept: Cast gold inlay preparations require a bevel to remove unsupported enamel rods and
render a smooth flowing form of cavity preparation

2) The bevel on the margin allows for better marginal adaptation through burnishing.

3) Amalgam has a weak edge strength, requires a 90o cavosurface margin and an adequate
thickness for strength and durability.
Class II amalgam cavity preparations in primary molars DO NOT require a gingival bevel
because the enamel rods in that area are tilted which direction?

A. Gingivally
B. Horizontally
C. Lingualy
D. Occlusally
E. Facially D. Occlusally

1) Concept: The enamel rods of primary teeth are occlusally directed which makes the gingival
bevel unnecessary.

2) Beveling of gingival margins in a Class II amalgam preparation of a permanent molar is

performed to remove unsupported enamel rods

3) The enamel rods of permanent molars become apically directed as they approach the cervical
aspect of tooth.
Tooth #19 is being prepared for an occlusal amalgam restoration. Caries remains in the facial,
pulpal, and lingual walls after the ideal outline form and depth were established. Which of the
following is the next step in the treatment of this tooth?

A. Remove caries and prepare the tooth for a crown

B. Remove the caries with a larger round bur
C. Remove the caries with a spoon excavator
D. Extend the outline form D. Extend the outline form

1) Concept: The outline form should be extended to completely remove all the infected dentin
and enamel.

2) Amalgam restorations require solid parallel walls with no unsupported enamel to avoid failure
of the restoration or tooth fracture under function.

3) Proper extension of the outline form when removing carious tooth structure should be done to
prevent leakage and recurrence of caries.
Each of the following is a rationale for placing a bevel on preparations for composite resin
restorations EXCEPT one. Which of the following is the EXCEPTION?

A. To expose the ends of enamel rods instead of the sides

B. To improve the seal of the enamo-resin margin
C. To increase the surface area of enamel for etching
D. To expose more inorganic tooth structure D. To expose more inorganic tooth structure

1) Concept: Exposing organic layers of enamel is insignificant for bonding composite and tooth
structure and is NOT a reason to place a bevel into the cavosurface margin.

2) Beveling is performed to
a. Expose ends of the enamel rods
b. Improve the marginal seal of composite restoration with tooth structure
c. Increase the surface area of enamel for etching
d. Eliminate the ling between filling and tooth
Which of the following describes Low viscosity resins?

A. Condensable
B. Flowable
C. No answers apply
D. Packable B. Flowable

1) Concept: Flowable composites

a. are low viscosity resins
b. are low viscosity based materials that differ in filler load and resin content. Their filler content
is 20 to 25% lower than conventional composites and the increase in resin component
particularly diluent monomers such as TEDGDMA which gives the material its flow properties.
2) The greater the filler content in resin, the greater the viscosity of resin and more difficult its
adaptation to cavity walls and areas resulting in voids and gap formation is.
The angles in the preparation for an amalgam restoration should be...

A. Acute angles
B. Obtuse angles
C. Rounded
D. Right angles D. Right angles

1) Concept: The angles in the preparation for an amalgam restoration should be right angles.

2) Right angles preparation

a. Right angles in a preparation direct occlusal forces toward the long axis of the tooth, making
the restoration more resistant to occlusal load
b. Right angles also help to improve retentive properties of the restoration
c. Composite resin retained by adhesives flowing into microporosities exposed during etching.
Which of the following describes why the matrix is burnished against the adjacent tooth when
placing Class II restorations?

A. It helps to establish an inter proximal contact

B. It helps to prevent overhanging restorative margins
C. It holds the ring in the embrasures
D. It prevents the wedge from being displaced during the restoration placement A. It helps to
establish an inter proximal contact

1) Concept: Burnishing of the side of the matrix band against the adjacent tooth during the
placement of Class II restorations helps to obtain an accurate inter proximal contact.

2) Establishment of proximal contact is very important for the longevity of the restoration and
gingival health around the tooth being restored.

3) Failing to achieve an optimum proximal contact can lead to pocket formation and overhanging
restorations which result in the failure of restorations.

4) Matrices also serve to:

a. confine the restorative materials for application of adequate condensation forces
b. re-establish the contact with adjacent tooth
c. restrict formation of an overhang in the proximal gingival margin
d. provision of adequate proximal contour
Beveling the enamel on resin restorations does which of the following?

A. All answers apply

B. Improves esthetics
C. Improves retention
D. Reduces microleakage A. All answers apply
1) Concept: An enamel bevel in the facial area is intended to improve esthetics, retention of the
restorative material, and minimize micro leakage.

2) An enamel bevel helps in diminishing the line of demarcation at the interface between the
restorative material and tooth surface.

3) Bevels increase the resin bond strength and decreases the chance of fracture and dislodgment
of the restoration.
Retention grooves MUST be deep enough to resist explorer tip displacement an thus should be
how many mm deep?

A. 0.5mm
B. 1.5mm
C. 1mm
D. 2mm
D. 3mm A. 0.5mm

1) Concept: Retention grooves are the secondary retention features of a preparation and must be
deep enough to resist explorer tip displacement. Ideally grooves are 0.5mm deep.

2) The use of retention grooves is recommended in tooth preparations with extensive proximal
boxes in order to enhance retention form and counter proximal displacement.

3) The four main characteristics or determinants of proximal grooves are:

a. Position
b. Translation
c. Depth
d. Occluso gingival orientation

4) Depth refers to the extent of translation i.e. direction of the movement of axis of the bur. It is
about 0.5mm at the gingival floor level.

5) The retention grooves are positioned 0.2mm inside the DEJ maintaining the enamel support.
Radiographs reveal that a 16 year old patient with excellent oral hygiene and no missing teeth
presents with distal decay on #12. A distal slot preparation can be performed if...

A. All answers are correct

B. No answers are correct
C. The caries has not violated the DEJ
D. When the adjacent tooth is missing
E. Proximal caries on a tooth with severe attrition A. All answers are correct

1) Concept: Distal Slot Preparations

a. proximal root caries in patients with gingival recession
b. teeth with distal decay and no adjacent tooth positioned distally
c. teeth with distal decay extending up to the DEJ
d. small proximal caries that does not include or undermine the occlusal surface
e. proximal caries in tooth with attrition
An anterior interproximal composite (Class III) restoration prep on an anterior tooth...

A. Has cavosurface margins with supported enamel rods

B. Should always include the contact area
C. Should extend subgingivally
D. Should have margins on the facial and lingual surfaces to facilitate cleaning
E. Should have 60 degree bevel on the lingual and facial walls A. Has cavosurface margins
with supported enamel rods

1) Concept: Cavosurface margins should be free of unsupported enamel rods because they
normally fracture under occlusal stress

2) A 45o cavo-surface bevel exposes more surface area of enamel rods that can be etched and
bonded to retain and seal composite restorations,
a. NO bevels should be placed on occlusal surfaces
The most retentive pin design is...?

A. Friction-lock system
B. No answers are correct
C. Threaded
D. Cemented C. Threaded

1) Concept: Threaded pins

a. approximately 0.0015 and 0.002 inch bigger than the prepared channels where they would be
placed
b. considered the provide the most retention. However, their placement also creates stresses and
cracks in the dentin.

2) Friction locked pins and threaded pins are both retained by the elasticity of the dentin walls

3) Cemented pins
a. least retentive among pin designs used in restorative dentistry but also creates the least stress
on dentin
Retention features for Class V restorations are typically placed on...

A. Every wall but the pulpal

B. Incisal/Occlusal and gingival walls
C. Mesial and distal walls
D. The pulpal wall B. Incisal/Occlusal and gingival walls

1) Concept: Retentive undercuts are prepared within the Incisal/Occlusal and Gingival walls of
cervical cavities (Class V preparations).
2) Placement of undercuts should be confined within the dentin layer to prevent the undermining
of enamel.

3) Added restorative features like points and grooves within the dentin walls allow more
retention for the restoration.

4) Retention for Class V restorations can be improved by lengthening the walls and making
parallel opposing walls
According to Black's steps in cavity preparation, which step occurs first?

A. Clean preparation area in attempts to remove any superficial debris and to ensure a clear
working field
B. Establish outline form based on location and extent of carious lesion
C. Establish outline form by removing deepest portion of carious lesions first
D. Obtain convenience form by removing carious lesion and tooth structure adjacent to it to
allow adequate observation, accessibility and ease of operation B. Establish outline form
based on location and extent of carious lesion

1) Concept: G.V. Black Summary

a. Establish outline form based on location and extent of carious lesion
b. Establishment of resistance form
c. Establishment of retention form
d. Establishment of convenience form
e. Removal of any remaining residual caries, enamel pits and fissures, infected dentin or old
restorative material if indicated
f. pulp protection if indicated
g. toilet of the cavity
h. procedures for finishing and polishing of the restoration
An amalgam preparation outline for a primar mandibular 2nd molar is MOST similar to which of
the following permanent teeth?

A. Mandibular 1st premolar

B. Maxillary 2nd molar
C. Mandibular 1st molar
D. Mandibular 2nd premolar C. Mandibular 1st molar

1) Concept: The outline for an amalgam preparation for a primary mandibular 2nd molar will be
almost identical to the permanent mandibular 1st molar tooth except slightly smaller.
2) The primary 2nd molar and permanent 1st molar are nearly identical in tooth morphology.
3) The primary 2nd molar typically demonstrates 5 cusps like the permanent 1st molar.

2) Mandibular Molars:
Primary 2nd = Permanent 1st
Design principles for Class II amalgams include which of the following? Select all that apply.

A. Extension of the prep to line facial and lingual line angles for better cleansibility
B. Facial/Lingual extension of the gingival box to the point where contact is totally removed
C. Removal of unsupported enamel and loose enamel rods
D. A rounded pulpo-axial line angle B. Facial/Lingual extension of the gingival box to the point
where contact is totally removed
C. Removal of unsupported enamel and loose enamel rods
D. A rounded pulpo-axial line angle

1) Concept: Rounded pulpo-axial line angle provides resistance to fracture for the amalgam
restoration by lessening the occlusal stress concentration.

2) Loose enamel rods and unsupported enamel has to be removed because they are weak areas of
tooth that may fracture against occlusal load.

3) The extension of the facial and lingual preparation within the gingival box should be out of
contact to its adjacent tooth to provide room for access, instrumentation and proper restoration of
contacts.
According to G.V. Black, the outline form of cavity preparation is the shape of the cavity
preparation...

A. After retention forms

B. Along the cavosurface margin
C. Along the pulpal floor
D. After caries removal B. Along the cavosurface margin

1) Concept: Outline form

a. describes the outline of the tooth surface to be included in the preparation

2) Internal Finish Line

a. dictates the inner perimeter of the cavity floor

3) External Finish Line

a. dictates the external perimeter of the outline form
b. is defined by

1) Extent of the carious lesion

2) Restorative margins should be extended into cleanable areas
3) Depth of the cavity preparation should provide sufficient bulk for restorative material (2mm
for amalgam)
Which of the following terms describes where 2 walls of a prepared cavity meet?

A. Cavosurface angle
B. Line angle
C. Point angle
D. Wall junction B. Line angle

1) Concept: Line angle

a. Line angle is the junction formed between the two walls of a cavity preparation

2) Point angle
a. junction formed between 3 walls or 2 walls and 1 floor or 2 floors and 1 wall of a cavity
preparation is known as a point angle.

3) Wall Junction
a. point where 2 walls or the floor and walls meet.
DO amalgam restorations are less likely to fracture between the occlusal and distal portion if...

A. A bevels is placed on the pulpoaxial line angle

B. All answers are correct
C. All unsupported enamel is removed
D. No answers are correct
E. The preparation includes a dovetail feature A. A bevels is placed on the pulpoaxial line
angle

1) Concept: Pulpo-axial line angle

a. The pulpo-axial line angle of a proximal box restoration is an area of stress concentration as
occlusal forces interact with the restoration. Placement of a bevel on internal line angle decreases
the concentration of forces along the pulpo-axial line angle.
b. Rounding of point angles will also help lessen the concentration of forces along the sharp
corners/angles of the cavity preparation
c. Sufficient depth of the pulpal and cervical floor must be achieved to provide enough bulk of
material to resist fracture
d. Sufficient width of the isthmus connecting the proximal box to set of the cavity preparation
must be achieved to provide enough bulk for the restorative material to resist fracture.
Which of the following BEST describes the smear layer? It is...

A. Another name for the pellicle

B. Produced when phosphoric acid is used when acid etching
C. The layer of debris from grinding on the surface of a cavity prep
D. The layer of plaque closest to the tooth structure C. The layer of debris from grinding on the
surface of a cavity prep

1) Concept: The smear layer is the layer of debris produced from grinding on the surface of a
cavity preparation.

2) When the tooth surface is altered by rotary and manual instrumentation during cavity
preparation, the cutting debris is smeared over the enamel and dentin surfaces, forming the smear
layer.

3) Smear layer contains

a. Calcified debris
b. Shattered and crushed hydroxyapatite
c. Fragmented and denatured collagen
d. Bacteria
e. Saliva and
f. Dentinal chips
Which of the following is the term to describe the enamel bevel placed on the facial side of a
Class IV preparation?

A. A conventional bevel
B. A retentive bevel
C. An esthetic bevel
D. No answers apply C. An esthetic bevel

1) Concept: Esthetic Bevel

a. The enamel bevel placed on the facial side or surface of a Class IV preparation is an esthetic
bevel (Infinity bevel)...
b. Esthetic bevels are typically placed at 60o
c. This bevel is placed to remove or mask the line of demarcation between the restorative
material and the tooth structure.
d. If NO bevel is placed, a visible line can be seen at the restorative-tooth interface making the
restoration unaesthetic for the patient.
e. Placement of this esthetic bevel also makes the restoration conservative, increases the resin
bond strength and decreases the chances of fracture.

2) Retentive Bevel
a. typically found around the margins of a Class V restoration
When prepping a tooth for a cast gold restoration, the tooth structure that is weakened by the
preparation and subjected to masticatory forces must be

A. Etched
B. Reduced and protected by the restoration
C. Reinforced by a core buildup and cement
D Safeguarded by a full coverage restorationB. Reduced and protected by the restoration

1) Concept: Weak tooth structure must be removed or reduced to provide a strong foundation for
the restoration

2) Undermined cusps and unsupported tooth structure are prone to fracture, so capping of cusps
may be necessary to protect the tooth and provide strength.

3) The tooth preparation must conserve sound tooth structure and have adequate retention and
resistance form.
Which of the following is the reason why satisfactory gingival seats are NOT POSSIBLE for the
proximal box of a deep Class II cavity preparation in PRIMARY teeth?

A. The buccal and lingual surfaces converge occlusally for primary molars
B. The enamel rods of the gingival 1/3 of primary molars extend occlusally
C. The proximal contact of primary molars is flat and broad
D. Primary teeth possess a marked cervical constriction D. Primary teeth possess a marked
cervical constriction

1) Concept: Primary teeth possess prominent cervical ridges and are more slender mesiodistally
at their cervical portions and narrower at their necks.

2) These features make it extremely difficult to achieve satisfactory gingival seats for proximal
boxes of deep class II cavity preparations

3) The enamel rods in the gingival 1/3 of the crown also extend in an occlusal direction
compared to permanent dentition that run cervically.
Restoration of Prepared Cavities Restoration of Prepared Cavities Answers
Over-mixing an admix (dispersalloy) amalgam capsule can result in each of the following
outcomes EXCEPT one. Which is the EXCEPTION?

A. Decrease in strength of admix alloys

B. Decreased working time
C. Increase in creep
D. Increased contraction A. Decrease in strength of admix alloys

1) Concept: Over mixing admix amalgam alloy capsule does NOT result in a decrease in overall
strength

2) The triturated amalgam should be bright and have a plastic consistency.

a. Amalgam that appears excessively splashy and wet looking indicates that the trituration time
or amalgamator speed should be increased because it is undermined.
b. Amalgam that appears excessively dry indicates trituration time or amalgamator sped should
be decreased because it is over mixed.

3) When performing adjustments, it is recommended to adjust trituration time in 2 second

increments, until optimum mix is obtained. Over mixing admixed alloy decreases the working
time, increases contraction, and creep values.

4) Dispersalloy is designed for use in stress bearing restorations e.g. Class 1 and 2 preparations,
when other restorative materials or restoration techniques are NOT indicated.
Which of the following phases of amalgam is considered the weakest?

A. Beta
B. Gamma
C. Gamma-1
D. Gamma-2
E. Alpha D. Gamma-2

1) Concept: Gamma-2 phase is the weakest and has the least resistance to corrosion

2) Gamma-1: has the highest strength and corrosion resistance

3) Gamma: is the amalgam phase which is considered unreacted during the chemical reaction
between amalgam alloy and mercury.
Which of the following types of excursive movements would be interfered with if a mesial
marginal ridge of a maxillary left 2nd molar was built up too high during a restoration
placement?

A. Non-working
B. Protrusive
C. Retrusive
D. Working B. Protrusive

1) Concept: An overbuilt mesial marginal ridge of a maxillary 2nd molar tooth will interfere with
protrusive movement.

2) High spot will hinder the forward movement as it will come in contact with the opposing tooth
earlier.

3) It is ESSENTIAL to remove all the high spots after restoring the tooth so that occlusal trauma
is not incurred by the tooth and its antagonist.

4) Articulating paper can be used to identify the high spots in order to carry out their removal.

5) High spots in a restoration will affect the normal functioning as well as cause pain in the long
run.
Which of the following should be performed in regards to calcium hydroxide (Ca(OH)2)
placement during indirect or direct pulp capping procedures to ensure optimal thermal and
protective insulation of the pulp?

A. Ca(OH)2 should be covered by a stronger base before the restoration is completed

B. Cavity varnish should be placed before Ca(OH)2 is placed
C. ZnPO4 should be placed before Ca(OH)2
D. Ca(OH)2 should be placed at least 2.5mm thickness around the pulp A. Ca(OH)2 should
be covered by a stronger base before the restoration is completed

1) Concept: A stronger base will ensure that the calcium hydroxide and pulp are well protected
and sealed against irritants that may cause further harm to the pulp.

2) Calcium hydroxide dissolves easily and exhibits weak mechanical properties as a base.

3) Calcium hydroxide bases should stay undisturbed when approximating the pulp in order to
induce dentin bridge formation within the dentin pulp complex.
Which of the following is the primary photo initiator used to initiate curing in resin composites?

A. Benzoyl Peroxide
B. Bezoyl methyl ether
C. Bis-phenol A
D. Camphoroquinone D. Camphoroquinone

1) Most composite resins currently used employ camphoroquinone as the primary photo initiator.

2) Camphoroquinone
a. absorbs photons of light energy (predominantly at about 470 nm).

3) Curing lights
a. The manufacturer of light curing lights attempt to maximize the light in the absorption range
of the photo initiator within the composite being cured.

4) Benzoyl peroxide
a. is used as an initiator along with tertiary amine activator in chemical or self cure composites
Cast gold restorations are indicated to replacing aging amalgams to...

A. Achieve better margins

B. Remove less tooth structure
C. Traumatice the pulp less during preparation
D. Achieve more ideal anatomy D. Achieve more ideal anatomy

1) Concept: Cast gold restorations can achieve more ideal anatomic contours because they are
made outside the mouth and under controlled conditions.

2) During the process of carving cast gold restorations, the master cast can be articulated
properly and the contours can be corrected immediately prior to its placement in the mouth.

3) Carving and shaping of anatomical contours is done more accurately and efficiently outside
the mouth.

4) Since cast restoration are fabricated on the master cast, the margins and the cavity prep will be
clearly seen and proper extension of the restoration to the finish lines can be achieved.
Which of the following is the most probable explanation for a freshly condensed amalgam
restoration that begins to chip away when it is carved?

A. The alloy was improperly mixed and was not fully wetted with mercury
B. The amalgam was condensed after its working time had elapsed
C. The amalgam was contaminated by moisture
D. A low-copper alloy was used B. The amalgam was condensed after its working time had
elapsed

1) Concept: Over condensation of amalgam alloy will result in chipping away of the filling
material during carving.

2) Prolonged condensation pressure will result in a decrease in strength of the amalgam

restoration.
3) Amalgam alloys typically take roughly 24 hours to set completely, so undue pressure or
disturbance during this time will result in the breakage of restoration.
Each of the following statements about posterior Class II resin composite restoration are correct
EXCEPT one. Which is the EXCEPTION?

A. Superseal needs to be used to seal the dentinal tubules to prevent sensitivity

B. The preparation has more round internal line angles
C. The preparation tends to be shallower than for a Class II amalgam restoration
D. The preparation tends to have a narrower outline form than for a Class II amalgam restoration.
A. Superseal needs to be used to seal the dentinal tubules to prevent sensitivity

1) Concept: Superseal and dentinal sealers are typically used in amalgam preps only.

2) The preparation should have rounded line angles to conserve tooth structure in posterior Class
II resin composite restorations. Sharp angles will eventually lead to breakage or fracture of
restoration in these areas.

3) The preparation tends to be shallower than for an amalgam restoration.

4) The preparation tends to have a narrower outline form than for an amalgam restoration.

5) Preparation outline should follow the extent of carious lesion only. There is no extension for
prevention.
Which of the following describes why it is recommended that a matrix for a proximal restoration
(Class II or III) be taller than the adjacent marginal ridge being restored?

A. It allows the wedge to adapt more to the proximal area

B. It prevents escape of the amalgam during condensation
C. It serves as a template to determine the complete restoration height
D. It allows for overfilling of the amalgam so it can be properly condensed and shaped to the
proper conformation D. It allows for overfilling of the amalgam so it can be properly condensed
and shaped to the proper conformation

1) Concept: The matrix band should be placed slightly higher than the adjacent marginal ridge
during the placement of proximal restorations which allows the clinician to achieve overfilling of
the cavity preparation.

2) Overfilling the amalgam in proximal restoration is necessary because it allows for the:
a. proper carving of the amalgam restoration
b. burnishing and achieving the contact point
c. ease in the restoration of tooth morphology
Which of the following describes the function of silanes in resin composites?

A. To bind fluoride and enhance remineralization

B. To bind inorganic and organic materials with hydrogen and covalent bonds
C. To make the composite polish smoothly
D. To make the dentin rough B. To bind inorganic and organic materials with hydrogen and
covalent bonds

1) Concept: The function of silanes from resin composites is to bind the inorganic and organic
materials with hydrogen and covalent bonds.

2) The bi-functional silane coupling agents are incorporated in composites resins to make a
strong bond between the resin composite material and the tooth surface.

3) These attach to the dentinal substrate on one side and the composite resins on the other side
forming a hybrid layer.
Which of the following properties are improved by adding filler particles added to the matrix of
resin composites?

A. All answers apply

B. Make the material harder, denser, and more resistant to wear
C. Reduction of the coefficient of thermal expansion
D. Reduction polymerization shrinkage of the composite A. All answers apply

1) Concept: Filler particles provide strength to the composite resins and help to improve the
following physical properties:
a. Reduces the coefficient of thermal expansion
b. Reduces polymerization shrinkage of the composite
c. Make the material harder, denser, and more resistant to wear
d. Cause reinforcement of the resin matrix
e. Decrease polymerization shrinkage
f. Improves workability
g. Decrease water sorption
h. Increases radiopacity
Admixed amalgam alloy consists of which of the following?

A. Copper silver and mercury only

B. Lathe-cut particles
C. Silver and tin and mercury only
D. Spherical and Lathe-cut particles
E. Spherical particles D. Spherical and Lathe-cut particles

1) Concept: Admixed amalgam alloy consists of a mixture of lathe-cut particles and spherical
particles

2) Admixed alloys
a. have the "body" of lathe-cut alloys when condensing; are easily condensed with goo
adaptation but are more easily worked with like the spherical alloys
b. can withstand forces of condensation better than the spherical alloys which is why these alloys
are preferred for proximal amalgam restorations.
c. demonstrate higher levels of creep and corrosion compared to spherical alloys.
Which of the following methods should be employed if the tip of the curing light is narrower
than the composite restoration being cured?

A. Move the curing tip over the surface for the recommended time
B. Place the tip stepwise over each area and expose each area for the recommended time
C. Position the tip far away enough from the tooth to illuminate the entire restoration
D. Center the tip on the surface and cure the entire composite from that spot. B. Place the
tip stepwise over each area and expose each area for the recommended time

1) Concept: Proper exposure time for every portion of a composite resin will ensure that the
entire restoration is completely polymerized.

2) Placing the small tip from one area to another while following the recommended curing time
will ensure that no unpolymerized composite will be left behind.

3) Adequate curing of composite restoration is important to ensure the restoration has no weak
areas, is properly sealed and can perform at its best during mastication.
Each of the following is a component of the chemical reaction for light initiated composite resin
polymerization EXCEPT one. Which is the EXCEPTION?

A. Benzoyl peroxide
B. Camphoroquinone
C. Tertiary amine
D. ~468 nm blue light A. Benzoyl peroxide

1) Concept: Benzoyl peroxide is used as an initiator in self cure or auto-curing composite resins

2) Camphorquinone is an initiator and tertiary amines are activators for light activated composite
resins.

3) VLC composites need a light of wavelength approximately 468 nm to initiate (start) the
polymerization reaction.
Which of the following describes the primary method for retention to enamel by adhesives?

A. Dentin tubules
B. Macrotags
C. Microtags
D. Primer application
E. Smear layerC. Microtags

1) Concept: Microtags are believed to be the major contributors to retention to enamel with
regards to adhesives.
2) The acid treated enamel surface has a high surface energy allowing the flow, intimate
adherence and polymerization of the resin monomer within the pores, creating retentive resin
micro tags up to 20 micrometers deep.

3) At the same time, the individual cores of all the exposed individual crystals are solubilized to
form a multitude of micro porosities.

4) These countless numbers of mini tags or micro tags formed within the individual crystal cores
are major contributors to enamel bond strength.
After etching a Class III preparation for a composite restoration, the preparation is contaminated
with saliva. Which of the following actions are indicated are indicated next?

A. Rinse away the saliva with water, dry the preparation, then repeat the etching procedure and
restore
B. Rinse away the saliva with water, then dry the preparation, then proceed
C. Wipe away all saliva with cotton pellet, rinse away the saliva with water, dry, and proceed
D. Blow dry the saliva with the air/water syringe then proceed A. Rinse away the saliva with
water, dry the preparation, then repeat the etching procedure and restore

1) Concept: Saliva contains minerals that can immediately remineralize the etched tooth and
weaken the bonding of the composite to tooth surface.

2) By drying and re-etching the surface to be restored, the primer and bonding agent can
establish better adhesive interface between composite and the tooth structure.

3) Re-etching the tooth will ensure roughening of the tooth surface is achieved and will ensure
better adhesion of the bonding agent to the etched tooth structure through increased mechanical
retention through increased microtention.

4) Salivary contamination also inhibits the proper setting of composite resins.

The formation of which of the following induces sealants to polymerize?

A. Bis-GMA
B. Camphorquinone
C. Filler particles
D. Free radicals
E. Polymethymethacrylate D. Free radicals

1) Concept: The formation of free radicals induces the polymerization of pits and fissure
sealants.

2) Sealants
a. are the most effective clinical technique to proven tpit and fissure caries
b. the cost effectiveness of sealants is based upon sealant retention
c. classified as self-cure or auto-cure sealants and visible light cure sealants
d. Camphorquinone is the most common photo initiator found in resins and is used because its
decomposition creates free radicals
Which of the following factors demonstrate an effect on photo polymerization?

A. All answers apply

B. Distance of the curing light from the restoration
C. Irradiance
D. Time light is applied to restoration A. All answers apply

1) Concepts: Photo-polymerization in visible light cure composite resins can be affected by the
following factors:
a. Time of application of curing light is an important factor. It depends upon the type of resin
used, amount of tints or opacifiers incorporated, wavelength of light and its intensity
b. Distance of light curing tip from the surface of restorative resin can affect the amount of
polymerization
c. Irradiance and wavelength of the photo-polmerizing sources should be considered
Which of the following describes the maximum amount of resin composite that can be properly
cured per layer of restoration?

A. 0.5mm
B. 1mm
C. 2mm
D. 4mm
E. Depth does not matter C. 2mm

1) Concept: The maximum depth of resin that can be properly cured per layer is approximately
2mm.

2) Light cured composites are currently among the most popular restorative materials due to their
ease of handling.

3) The success of composite resin restorations depends upon the access of high intensity curing
light to the material.

4) If the composite thickness exceeds 2mm, inadequate curing occurs. This phenomenon is
specially seen with darker shade composites. Filler particles and coloring agents tend to scatter
or absorb the curing light within 1-2mm of the material.
How does etching tooth structure with acid improve retention of composite restorations? Select
all that apply.

A. It displaces the water in dentinal tubules and allows composite to flow deeper into dentin
B. It increases the chemical bonding strength
C. It increases the mechanic retention
D. It removes the surface debris from the cavity preparation. C. It increases the mechanic
retention
D. It removes the surface debris from the cavity preparation.
1) Concept: Acid etching removes debris and other impurities from the cavity that may affect the
overall result of the restorative procedure.

2) Acid etching
a. provides surface roughness to provide mechanical retention without too much loss of healthy
tooth structure during cavity preparation
b. microporosities created by acid etching allows even small cavity preparations to have
rendition despite insufficient retention form
c. Acid etching improves MECHANICAL retention NOT CHEMICAL bonding.
Which of the following statements regarding the creep of amalgam is CORRECT?

A. Alloys with higher copper content demonstrate lower creep values

B. Alloys with lower copper content demonstrate lower creep values
C. Creep value is NOT a property of amalgam restorations, only noble ones
D. The lower the creep value, the worse the marginal integrity of the restoration A. Alloys with
higher copper content demonstrate lower creep values

1) Concept: Alloys with higher copper content demonstrate lower creep values because they
exhibit little of no gamma 2 phase.

2) Creep
a. defined as the time dependent plastic permanent deformation of amalgam under static or
dynamic loading.
b. causes protrusion of amalgam out of the cavity. The protruded edges are unsupported and
weak and are further weakened by corrosion leading to fracture, ditching, and micro leakage of
the restoration.
c. the gamma 2 phase is primarily responsible of higher creep values
True/False:

Spherical alloys contain more mercury than admixed alloys. The higher mercury content is why
it is easier to achieve a contact with spherical alloy. Both statements are false

1) Concept: Spherical amalgam alloys do NOT contain more mercury than the admixed alloys.

2) Spherical alloys
a. are easier to condense into areas of difficult access such as around pins because they provide
less resistance to condensation pressures. They harden rapidly, are smoother for carving,
burnishing and polishing.
b. are difficult to achieve tight interproximal contacts with because of their pliable nature and
admixed alloys are recommended for areas requiring development of proximal contacts.
Each of the following is an indication for using resin composite materials EXCEPT one. Which
is the EXCEPTION?

A. Areas where esthetic is important

B. Conservative tooth preparations
C. Gingival margin is not on intact enamel
D. Small and moderately sized restorations C. Gingival margin is not on intact enamel

1) Concept: Composite resin restorations are contraindicated when gingival margins are NOT
intact typically due to concerns regarding fluid contamination

2) It is very difficult to maintain isolation and make a satisfactory bond with etched dentin.

3) It is advised to placed an (Resin Modified Glass Ionomer Cement) RMGIC liner before
placement of resin material if it necessary to fill it with composite (like in anterior esthetic
cases).

4) Indications of composite restorations are

a. small and moderately sized restorations
b. conservative tooth preparations
c. areas where esthetics is important
Which of the following describes how thick the first increment should be for a Class II
restoration to ensure proper curing of composite and lowest strain of the tooth structure to a
polymerization shrinkage? (Not counting snowplow or sandwich techniques?

A. 0.5mm
B. 1.0mm
C. 2.0mm
D. 2.5mm
E. <0.5mm B. 1.0mm

1) The first increment in a Class II restoration must be 1mm thick if snowplow technique is not
used. The first increment is placed on the gingival floor of the restoration.

2) The snowplow technique

a. employs the use of flowable composites in conjunction with the posterior composite
restorations
b. an initial thin layer of flowable composite is placed on the gingival or pulpal floor and left
uncured at this stage.
c. an initial increment of heavily filled composite resin is placed or pushed over the unset
flowable composite displacing most of it into the areas where heavily filled composite cannot
penetrate. Its advantages are:
1) Decreased voids in the restoration
2) Decreased gingival marginal leakage
Which of the following is the most likely cause of an open gingival margin of a proximal
restoration?

A. Clinician forgot to burnish the matrix band against the adjacent tooth
B. Loading too much amalgam into the prep before properly condensing it into the proximal box
C. Over-tightening of the matrix band
D. Clinician forgot to place a wedge B. Loading too much amalgam into the prep before
properly condensing it into the proximal box

1) Concept: Inadequate condensation of amalgam into a proximal box before it sets will result in
an open gingival margin.

2) Placement of excessive amalgam into the cavity prep often allows the amalgam to set before it
is adapted and properly condensed into the floor and walls of the cavity resulting in voids in the
restoration and an open gingival margin
a. Small condensers should be used initially for proximal boxes
b. Larger condensers should be used after the adaptation to the margins and cavity floor are
deemed adequate.

3) Incremental filling ensures that amalgam is condensed and adapted to the cavity completely
and also reduces incidence of voids and open margins in the restoration

4) Well condensed amalgam restorations demonstrate increased compressive strength,

dimensional stability, and corrosion resistance because excess mercury moves to the surface and
is removed from the amalgam restoration with proper condensation.
Precarve burnishing after condensation amalgam is important because which of the following
reasons?

A. It eliminates the need for retentive grooves

B. It enhances the final shine of the restorations
C. It ensures that any residual mercury is incorporated into the restoration
D. it produces denser amalgam at the margin of restorationsD. it produces denser amalgam at the
margin of restorations

1) Concept: Precarve burnishing should take place soon after condensation of the amalgam is
completed in order to produce denser amalgam at the margin of restorations.

2) When the amalgam is placed or inserted to slight excess with condensers, it should be pre
carved burnished with a burnisher.

3) It is done to achieve:
a. Finalization of condensation
b. Removal of excess mercury rich amalgam
c. Initiation of carving process
Which of the following are recognized methods to cure resin sealants? Select all that apply.

A. Autocuring
B. Chemical polymerization
C. Photopolymerization A. Autocuring
B. Chemical polymerization
C. Photopolymerization
1) Concept: Pits and sealants are most efficient in sealing the caries susceptible in a tooth

2) Pits and fissure sealants are placed after minimal and no preparation of the tooth surfaces and
then cure to make a hermetic seal.

3) The curing of sealants can occur through chemical or auto-curing as is the case in self cure
pits and fissure sealants.

4) VLC sealants are cured through the mechanism of photo-polymerization with the help of
visible light curing units.
Each of the following is an advantage indirect composite restorations over direct placement
composite restorations EXCEPT one. Which is the EXCEPTION?

A. Decreased marginal leakage

B. Decreased postoperative sensitivity
C. Improved proximal contacts
D. Increased polymerization shrinkage
E. Increased strength D. Increased polymerization shrinkage

1) Concept: The primary advantage of indirect resin restorations over direct resin restorations
are:
a. Improved proximal contacts
b. Decreased marginal leakage
c. Increased strength
d. Decreased postoperative sensitivity

2) The primary disadvantage of indirect resin restorations are:

a. time
b. patient doesn't leave the office with the definitive restoration
The most significant advantages of acid-etching for composite placement is represented by
which of the following?

A. Curing shrinkage
B. Microleakage
C. Pulpal irritation
D. Coefficient of thermal expansion B. Microleakage

1) Concept: Microleakage can be reduced by acid etching the tooth when placing composite
restorations.

2) Conventional acid etching techniques demonstrate less micro leakage than the newer self-
etched primers.

3) Liquid or gel etchant is placed for about 15-30 seconds.

4) Acid etching results in the formation of microscopic retentive areas about 25 microns in depth.
Which of the following instruments is MOST useful when polishing an amalgam restoration?

A. Abrasive-impregnated rubber points

B. All answers apply
C. Prophylaxis cup with tin oxide
D. Sof-Lex disks B. All answers apply

1) Concept: Various polishing instruments such as sod-lex disks, abrasive-impregnated rubber

points and prophlyaxis cup with tin oxide are used when polishing amalgam restorations.

2) it is advised to carry out finishing and polishing of am algae restorations at least 24 hours
AFTER the placement of the amalgam so that complete setting of the amalgam can occur.
Which of the following acts as the BEST conditioner to clean the tooth's surface when applying
glass ionomer adhesives?

A. Acetone
B. Ethanol
C. Isopropyl alcohol
D. No answers apply
E. Phosphoric Acid
F. Polyalkenoic Acid F. Polyalkenoic Acid

1) Concept: Polyalkenoic Acid is used for glass ionomers because it is a weaker acid that does
NOT penetrate into the dentin as much as phosphoric acid.

2) This is because the glass ionomers have a much higher molecular weight polymer that cannot
penetrate into the smaller tubules created further gingival by the phosphoric acid.

3) Ethanol is a solvent primer used to remove excess water after rinsing acid.
Each of the following statements about resin based composites (RBCs) as a posterior restorative
material are correct EXCEPT one. Which is the EXCEPTION?

A. RBC preps conserve more tooth structure than amalgam preps

B. RBCs adhere to tooth structure
C. RBCs demonstrate low thermal conductivity
D. RBCs provide superior esthetics
E. RBCs should always be used instead of amalgam E. RBCs should always be used instead of
amalgam

1) Concept: Amalgam has been demonstrated to be a better restoration for rests of removable
partial dentures than that of resin based composites.

2) Amalgam core buildups have also demonstrates better longevity than that of composites.
3) It is preferable to use amalgam in areas experiencing high masticatory and functional loads,
areas where isolation cannot be maintained and patients with parafunctional habits like bruxism
and clenching.

4) Posterior composite restorations are recommended in the given conditions:

a. Where esthetics is the primary concern
b. In cases requiring conservation of tooth structure
c. Where low thermal conductivity is required
d. Where bonded restorations are feasible and isolation can be obtained
Which of the following materials is used as the base material for the bonded-base (open
sandwich technique)?

A. Bonding adhesive
B. Glass Ionomer
C. Hybrid fill
D. Micro fill
E. Nanofill B. Glass Ionomer

1) Concept: The bonded base or open sandwich technique liner is made up of glass ionomer
cement or resin modified glass ionomer cement.

2) In an open sandwich technique, a restorative glass ionomer cement or resin modified glass
ionomer cement is used in the portion of the restoration near the gingival margin.

3) Open sandwich or bonded base technique is recommended in composite restorations with

margins in thin enamel near the CEJ or on cementum or dentin.

4) Composite resins are placed over the glass ionomer cement without impending the contact of
glass ionomer cement with oral cavity.
Which of the following is the MOST important variable for the clinical success of posterior resin
based composite (RBC)?

A. Choosing the best manufacturer of RBC

B. The placement technique
C. The proper amount of Bis-GMA in the resin
D. The shade of RBC selected B. The placement technique

1) Concept: The most important variable in clinical success of posterior RBC is the placement
technique used to carry out restoration.

2) Posterior composites should be placed incrementally in order to facilitate proper light

activation and restore correct anatomic contours. The enamel layer of the restoration which is
occlusal 1.5-3mm is placed using an anatomic layering technique.

3) An important step to restore Class II preparations with direct composite restorations is the
selection and proper placement of matrix band.
4) Class II composites are totally dependent upon the contour and position of matrix and wedge
for establishing appropriate proximal contacts.
Each of the following statements about polishing amalgam are all correct EXCEPT one. Which
is the EXCEPTION?

A. Can cause an unanesthetic appearance if amalgam becomes too shiny

B. Polishing creates a comfortable surface for the patient's tongue
C. Polishing should be performed AT LEAST 24 hrs after placement
D. Polishing significantly increases the longevity of the restoration D. Polishing significantly
increases the longevity of the restoration

1) Concept: Polishing amalgam restorations has NOT shown any significant increase in the life
of restorations.

2) It is advised to polish amalgam restorations AT LEAST 24 hours after the restorative

procedure in order to allow complete setting of the alloy.

3) Finishing can create a more comfortable surface for patient's tongue, however, it can produce
an unaesthetic and shiny surface in some cases.
Which of the following materials will provide the MOST ESTHETIC restoration for a Class V
preparation on an anterior tooth?

A. Glass ionomer
B. Hybrid resin composite
C. Microfilled resin composite
D. Resin based glass ionomer C. Microfilled resin composite

1) A Class V preparation should be restored with micro filled resin composite material whenever
esthetics is the main concern.

2) Due to their small particle size, microfilmed resin composites have a smooth, highly
polishable surface which requires minimal finishing.

3) The low elastic modulus of these materials allows them to flex during tooth flexure, better
protecting the bonding interface in Class V restorations.

4) Microfilled resins are NOT typically used for restorations that are going to be in contact with
other teeth because they have a low resistance to wear.
Which of the following statements is TRUE concerning the carving of amalgam?

A. Carving strokes should always start on amalgam and proceed to enamel

B. It is best to use dull instruments when carving amalgam
C. Marginal angles should be made acute to help in resisting fracture of occlusal amalgams
D. While the matrix is in place, the marginal ridge should be carved very nearly to the height of
the adjacent marginal ridge D. While the matrix is in place, the marginal ridge should be
carved very nearly to the height of the adjacent marginal ridge

1) Concept: While the matrix is in place, the marginal ridge should be carved very nearly to the
height of the adjacent marginal ridge.

2) Initial carving of the occlusal surface should be rapid, concentrating primarily on the marginal
ridge height and occlusal embrasure areas.

3) The explorer tip is pulled along the inside of the matrix band mimicking the adjacent tooth,
creating the occlusal embrasure form.
The indicated method for trimming the margins of an amalgam restoration is by...

A. Carving a circumferential trough around the margins of the restoration so that amalgam can
be burnished into it for a tight seal
B. Carving circumferentially with a sharp instrument resting mostly on the restoration
C. Carving circumferentially with a sharp instrument that rests mostly on the tooth surface
D. Burnishing from the tooth to the restoration C. Carving circumferentially with a sharp
instrument that rests mostly on the tooth surface

1) Concept: A sharp carver should be placed on the tooth surface at the tooth and restoration
surface.

2) Carver instrument is moved circumferentially for trimming the margins of the restoration

3) Instrument should be moved in order to restore the normal morphology of the tooth.
Glass ionomers use an acid/base reaction to chemically bond to the tooth surface. What are the
acid and bases used to create this reaction?

A. Acid-polyalkenoic acid and Base-Alumino-silicate glass

B. Acid-Phosphoric acid and Base-Alumino-silicate glass
C. Acid-Phosphoric acid and Base-Sodium hypochlorite
D. Acid-Polyalenoic acid and Base-Sodium hypochlorite A. Acid-polyalkenoic acid and Base-
Alumino-silicate glass

1) Concept: The setting reaction of glass ionomer cement is an acid-based reaction between the
polyalkenoic acid and fluoroaluminosilicate glass powder resulting in a chemical bonding to the
tooth surface.

2) When the powder and liquid are mixed, the fluoroaluminosilicate glass powder is attacked by
hydrogen ions from the polyalkenoic acid liberating Al+3, Ca+2, Na+1, and Fl-1 ions.

3) After saturation the free calcium and aluminum ions diffuse into the liquid and cross link with
2 or 3 ionized carboxyl groups of the polyacid to form a gel.
Zinc is added to lower-copper amalgam for each of the following reasons EXCEPT one. Which
is the EXCEPTION?

A. Decreases the restoration longevity

B. Enhance its mechanical properties
C. Produced delayed expansion when contaminated with moisture
D. Reduce marginal fracture rates A. Decreases the restoration longevity

1) Concept: Zinc in low-copper amalgams do NOT decrease the restoration longevity.

2) If a low-copper, zinc-containing alloy is moisture contaminated, it will result in surface

blistering, internal corrosion, and a delayed expansion of up to 4% by volume beginning 3 to 5
days after the contamination and continuing for up to six months, which can lead to a reduction
in strength of up to 24%.

3) Delayed expansion and corrosion products result in sealing the restoration which reduces
marginal voids and chances of fractures.
Each of the following statements regarding flowable resin composite as the first increment in a
Class II prep are true EXCEPT one. Which statement is the EXCEPTION?

A. Flowable demonstrates 3X greater polymerization shrinkage than hybrid composite

B. Flowable has NOT demonstrated any difference in post-op sensitivity
C. Flowable has superior mechanical properties compared to conventional composite
D. Most flowables are NOT as radiopaque as enamel C. Flowable has superior mechanical
properties compared to conventional composite

1) Concept: Flowable resin composites demonstrate inferior mechanical properties compared to

tradiational resin composites. Flowable resin composites demonstrate low strength, wear
resistance, and all other mechanical properties.

2) Lower viscosity composite resins exhibit high flow rates and penetrate deeper portions of the
preparation to fill the voids and irregularities.

3) Flowable composites exhibit 3x greater values of polymerization shrinkage stresses compared

to conventional RBC.

4) The flowable composites are commonly used as the first small increment in snowplow
technique in proximal preparations.

5) A small uncured increment of flowable composite is placed on the gingival portion, and then a
conventional composite is placed over it. The conventional composite is condensed ti displace
most of the flowable composite out of the cavity preparation and rest of it flows into deeper
portions where conventional composite cannot reach.
Why is calcium hydroxide the suggested material for vital pulp capping procedures?

A. It induces dentin bridge formation

B. It seals the cavity best
C. It stimulates primary dentin formation
D. It is least irritating to the pulp A. It induces dentin bridge formation

1) Concept: Calcium hydroxide is the most biocompatible material that has been proved to help
induce dentin bridge formation.

2) Calcium hydroxide has been used for a long time and is the gold standard for direct and
indirect pulp capping.

3) Calcium hydroxide induces the formation of reparative dentin to wall off and protect the pulp
against bacterial attacks.
Larger sized condensers and lateral force application are techniques used to properly condense
which type of amalgam?

A. Admix
B. Low copper
C. Spherical
D. Lathe-cut C. Spherical

1) Concept: Spherical amalgam alloy has high compressive strength requiring strong
condensation forces to ensure proper adaptation to the cavity preparation.

2) Use of strong lateral forces and large condensers should deb used to properly condense
spherical amalgam alloy.

3) Spherical alloys have large particle composition necessitating good condensation to minimize
the gap between the cavity prep and the amalgam.
Which of the following is/are true of convention Glass Ionomers? Select all that apply.

A. Contain basic ion-leachable glass

B. Contain water soluble polyacids
C. Contain water soluble polymerizable resin
D. Use free radical polymerization to cure A. Contain basic ion-leachable glass
B. Contain water soluble polyacids

1) Concept: Conventional glass ionomer contain water soluble polyacids and basic ion leachable
glass in their composition.

2) Convetional glass ionomer cements

a. undergo a chemical self-setting acid base reaction created by mixing an ion leachable
fluoroaluminosilicate glass power with an aqueous polyacrylic or polycarboxylic acid.

3) Resin modified glass ionomers

a. were formulated by adding a water soluble polymerizable resin such as 2-HEMA in the acidic
cement liquid
Which of the following properties indicates that amalgam was properly triturated?

A. Dry and coherent

B. Dry and crumbly
C. Shiny and coherent
D. Sticks to the capsule C. Shiny and coherent

1) Concept: The shiny and coherent mass of amalgam produced after the process of trituration
(mixing) indicates that the material is mixed homogeneously.

2) The purpose of trituration is to remove oxide layers from the alloy particles, to coat each alloy
particle with mercury, and to provide a homogenous mass for condensation.

3) The amalgam should NOT be dry and crumbly.

4) No adherence or stickiness to the capsule walls should occur.

Which of the following is regarded as the most toxic form of mercury?

A. Each form is considered equally as toxic

B. Elemental
C. Inorganic
D. Organic D. Organic

1) Concept: Organic mercury is considered to be the most toxic form of mercury. Mercury can
form organic compounds such as methyl mercury.

2) Organic mercury compounds can be readily absorbed by many organisms and concentrated as
they pass up the food chain. Organically bound mercury in food is the primary source of mercury
exposure in most people.

3) Excretion of mercury is less effective from the human body compared to its absorption.
Organic mercury has a tendency to concentrate in liver, kidney, and brain after being absorbed.

4) Higher concentration of mercury in the human body is harmful. Mercury toxicity can result in
bronchitis, pneumonia, kidney disease, allergic reactions. When inhaled in toxic quantities, it can
cause damaged to the central nervous system.

5) Dentists are at an increased risk of mercury toxicity due to the excessive use of amalgam
fillings in the operator. The maximum safe dose ingested in a 40 hour work week is 50
microgram per cubic meter.

6) The dental operator should be well-ventilated with seamless floor tiles in order to prevent
mercury retention in higher concentrations and decreased mercury inhalation. Use of personal
protective equipment is mandatory.
Which of the following should be performed to test the occlusion of an amalgam restoration?
A. Instruct the patient to bite down and report how it feels
B. Instruct the patient to bite on articulating paper
C. Perform the tap test with articulating paper by manually moving the patient's jaw
D. The restoration will be correct if it was carved to typical occlusal anatomy C. Perform the
tap test with articulating paper by manually moving the patient's jaw

1) Concept: The tap test is usually performed to test the occlusion of an amalgam restoration. It
is performed with the articulating paper by moving the patient's jaw side to side and up and
down.

2) It is advised that the occlusion of the restoration should be evaluated. A piece of articulating
paper is placed over the restoration and the patient is instructed to close gently into occlusion and
manual movement of jaws is carried out.

3) Any high area of contact can be evaluated by the depth of color imparted by the pear and
especially if it has a silvery centre. These deep colored or shiny centered areas are reduced and
adjusted.

4) Instructing the patient to bite hard on the paper can cause fracture of the restoration.
Cavity liner placement should be limited to which of the following? Select all that apply.

A. Areas of prep where there is a possibility of a minute pulpal exposure

B. Areas where carious tissue is left in the prep
C. The entire axial wall of prep
D. Used in conservative sized preps instead of an adhesive agent A. Areas of prep where there
is a possibility of a minute pulpal exposure
B. Areas where carious tissue is left in the prep

1) Concept: The use of cavity liners should be limited to those areas of the preparation where
there is a possibility of a minute pulpal exposure.

2) The placement of cavity liners protects the endangered pulp from thermal, chemical,
electrical, and mechanical trauma.

3) The choice of cavity liner material depends upon the remaining dentin thickness. If the
remaining dentin thickness is greater than 1.5mm, glass ionomer cement can be used as cavity
liner but for a remaining thickness of 0.5mm or less, calcium hydroxide should be used, then
glass ionomer should be placed.

4) Application of cavity liners along the entire wall will reduce the retention or bonding of
restorative material.
The first step in the delivery of a cast gold inlay is...

A. Adjust contacts
B. Adjust occlusion
C. Burnish, adapt margins
D. Cement the restoration
E. Seat the restoration with a mallet A. Adjust contacts

1) Proximal contacts must first be assessed and adjusted to properly placed gold inlays.

2) Contacts if an inlay must always be checked because dimensional change might have occurred
during casting.

3) After evaluating the contacts, seat the restoration to check the marginal fit and its occlusal
relationship.

4) Gold can be burnished against the margins of the preparation to make it more adapted and
tightly fit for a good marginal seal.
Composite is bonded to adhesive by which of the following means.

A. Both mechanically and chemically

B. Chemically
C. Mechanically
D. No answers apply B. Chemically

1) Concept: Composite resin restorative materials is chemically bonded to adhesive resin through
polymerization through MMA bonds.

2) Mechanical bonding occurs between the adhesive and tooth substrate such as dentin/enamel.

3) The zone in which low viscosity resin of the bonding resin or adhesive system micro
mechanically interlocks with dentinal collagen is termed as hybrid layer or hybrid zone.
Composite resin restorations...

A. Can be placed and finished at the same appointment

B. Chemically bond to dentin
C. Have a thermal coefficient of expansion similar to amalgam
D. Release fluoride A. Can be placed and finished at the same appointment

1) Concept: Composite restorations are restorative materials popularly used because of its:
a. High esthetic value
b. Ease of manipulation
c. Durability

2) Glass Ionomer cement is a restorative material that

a. releases fluoride into surrounding tooth structure
b. chemically bonds to tooth structure
c. is less resistant to wear than composite
Which of the following is NOT an advantage of amalgam when compared to other restorative
materials?
A. Amalgam bonds directly to tooth structure
B. Clinicians are less likely to remove additional tooth structure when removing an amalgam
restoration due to its color
C. Less-time consuming to place
D. Lower cost A. Amalgam bonds directly to tooth structure

1) Concept: Amalgam does NOT bond directly to the tooth structure

2) Mechanical features like convergence of cavity walls, adequate preparation depth, grooves
and slots are incorporated in cavity preparations to retain amalgam fillings.

3) The advantages of amalgam restorations as compared to other materials are:

a. Less time consuming to place
b. Lower cost
c. Less technique sensitive
d. Less likely to remove additional tooth structure when removing an amalgam restoration due to
its color
Adjusting the shade of restorations using complementary colors will result in which of the
following?

A. Decreased value
B. Increased translucency
C. Increased value
D. Decreased hue A. Decreased value

1) Concept: Decrease in value occurs when complimentary colors are used to adjust the shade of
a restoration.

2) This becomes a compromising situation when relative brightness is sacrificed for the sake of
shade matching.

3) Value describes the relative lightness or darkness of a material.

4) Variations in value are used to create a focal point for the design of a restoration.

5) Gradations of value are also used to create the illusion of depth in a restoration.

Value can be remembered by thinking that patients VALUE WHITE teeth:

1) Lighter colors are of increased value

2) Darker colors are of decreased value
A periapical radiograph shows a deep carious lesion and the patient is in intermittent acute pain.
Caries removal dose not extend to the pulp? What is the best treatment?

A. Direct pulp cap

B. Indirect pulp cap
C. Zinc-oxide eugenol then placement of a permanent composite restoration
D. Root canal therapy B. Indirect pulp cap

1) Concept: Indirect pulp caps are indicated for teeth with deep caries with minimal pulpal
inflammation

2) Steps of an indirect pulp cap:

a. Infected dentin is completely removed
b. Affected dentin close the pulp is left due to the possibility of pulp exposure
c. Calcium hydroxide, then glass ionomer is placed over the affected dentin
d. Final restoration is placed.

3) Calcium hydroxide base is placed on the affected dentin to induce its remineralization and
promote the reparative dentin formation.
Which of the following techniques should be implemented for a patient presenting with rampant
caries in an area where esthetics are NOT considered important to the patient?

A. Glass ionomer without a bevel

B. Resin composite with a bevel
C. Resin composite without a bevel
D. Resin modified glass ionomer with a bevel A. Glass ionomer without a bevel

1) Concept: Glass ionomer without placement of a bevel should be used in a case of rampant
caries in an area where esthetics is NOT a concern.

2) Glass ionomer composite imparts an acceptable esthetics to the restorations. In a case of

rampant caries, fluoride release and fluoride uptake qualities of glass ionomer composite have
higher significance than esthetic concerns.

3) Beveling of enamel margins is NOT beneficial in this case because there is no need to blend
the color of the restoration to the tooth and does not provide a better seal.
Acid etching teeth for resin composites will accomplish which of the following. Select all that
apply.

A. Create a clean surface to bond to

B. Decrease thermal conductivity
C. Increase retention of the restoration
D. Prevent staining/color change
E. Prevent microleakage A. Create a clean surface to bond to
C. Increase retention of the restoration
E. Prevent microleakage

1) Concept: Acid etching teeth creates microporosities that adhesives can infiltrate to create
retention for composite resin bonding.
2) Acid etching roughens the exposed enamel rods and dentin, thus creating micro mechanical
abrasions that allows the bonding agent to flow and adhere to the tooth surface.

3) Etching also removes surface debris, allowing for a clean bonding site.

4) Acid etching creates higher bond strength between composite restoration and tooth structure
while also decreasing micro leakage.
In the bonding process, which of the following describes what primer BEST?

1. Remove smear layer and mineral from tooth surface

2. Infiltrate and remove water from enamel prisms, dentin tubules, and exposed collagen network
3. Couple tooth surface to restorative material
4. Made of hydrophobic nonsolvented monomers
5. Made of solvents and bi-functional/amphiphilic penetrating monomers

A. 1
B. 1 and 5
C. 2 and 4
D. 2 and 5
E. 3 and 4 D. 2 and 5

1) Concept: Primer use is intended to provide 2 main functions in dentin bonding:

a. infiltrate and remove water from enamel prisms, dentin tubules, and exposed collagen network
b. form hybrid layer because it is made of solvents and bi-functional/amphiphilic penetrating
monomers

2) Hybrid is formed in the following manner:

a. etching removes the smear layer and hydroxyapatite within the inter tubular dentin in addition
to exposing the collagen fibers
b. primers penetrate the collagen network and allow the adhesive resins to form micro tags
within the inter tubular dentin.
Which of the following is the average wavelength range that should be emitted by a light curing
unit to cure composite resin?

A. 400-499nm
B. 500-599nm
C. 600-699nm
D. 700-799nm
E. 300-399nm A. 400-499nm

1) Concept: A wavelength range of 400-499nm provide sufficient energy to activate the

camphorquinone molecules and initiate polymerization of composites.

2) The opimum absorption of energy of camphorquinone is at 465nm which is why a narrow

spectrum of wavelength is required in the polymerization of composites.
3) When camphorquinone and its amine co-initiator reacts with the blue light spectrum, they
create radicals which initiates polymerization.

4) LED curing lights have made composite curing easier and faster because they emit a beam of
light up to 1000mW/cm2.
Although the ADA standards for shrinkage is 20 microns/cm, NO detrimental effects are
associated with shrinkage less than which of the following amounts?

A. 20 microns/cm
B. 30 microns/cm
C. 40 microns/cm
D. 50 microns/cm D. 50 microns/cm

1) Concept: The ADA standard for the polymerization shrinkage of composite resins is 20
microns/cm. However, values of polymerization shrinkage less than 50 microns/cm are
acceptable haven NO detrimental effects.

2) The presence of inorganic filler particles throughout the composite structure reduces shrinkage
of the restorative. Higher the volume of the inorganic fillers, the lower the shrinkage of
composites.

3) Microhybrids and nano-hybrids demonstrate the highest percentage of inorganic filler

particles and thus, the lowest percentage of polymerization shrinkage.
Each of the following is an indication for resin composite in posterior teeth EXCEPT one. Which
is the EXCEPTION?

A. Buccal-lingual width of preparation is less than 1/3 intercuspal distance

B. Esthetics are important
C. Gingival margin of preparation is on intact enamel
D. Large preparations D. Large preparations

1) Concept: Large cavity preparations are NOT an indication for composite in posterior teeth.

2) Small to moderate sized cavities in posterior teeth should be restored with RBC.

3) Composites in posterior teeth are indicated if:

a. Buccal-lingual width of preparation is <1/3 inter-cuspal distance
b. Gingival margin of preparation is on intact enamel
c. Esthetics are important
Which of the following lists the restorative materials in the order of greatest to least fluoride
release?

I. Compomer
II. Resin-Modified Glass-Ionomer
III. Glass-Ionomer
IV. Resin Composite
A. I, II, III, and IV
B. III, I, II, IV
C. III, II, IV, I
D. IV, III, II, I
E. No Answers apply E. No Answers apply

1) Concept: The fluoride releasing ability of various dental restorative material decreases in the
order of:

glass ionomer cements > resin modified glass ionomers > compomers > composites

2) This order is the same for fluoride recharging ability of materials from outside sources.

3) The greatest release occurs on the 1st day and subsequently decreases as the time passes.

4) Fluoride releasing materials can be recharged with external fluoride sources in order to
increase their fluoride release and re-mineralizing potential.
How is a cast gold onlay superior to a cuspal coverage amalgam? Select all that apply.

A. Decreased levels thermal conductivity

B. Higher compressive strength
C. More precise inter proximal contacts
D. Decreased elastic modulus B. Higher compressive strength
C. More precise inter proximal contacts

1) Concept: Cast gold inlays are fabricated more precisely because they are outside of the mouth
a. It is easier to manipulate material when there is better access.
b. There is no interaction with oral fluids to contaminate the materials.

2) Cast gold inlays have better compressive strength and are less likely to fracture.
Adjacent proximal cavities can be restored with composite resin at the same appointment
because...Select all that apply.

A. All answers are correct

B. Restoration and finishing can be completed in the same appointment
C. The possibility of having proximal contacts is increased.
D. They can be restored with one carpule of composite, so materials can be conserved
E. It conserves operating time. B. Restoration and finishing can be completed in the same
appointment

1) Concept: Adjacent proximal cavities are best restored in one appointment because

2) The cavity preparations can be made more conservatively, preserving more healthy tooth
structure.
3) There will be adequate access and visibility, enabling the dentist to work more efficiently and
effectively.

4) The restorations can be placed easier due to adequate space to finish the proximal margins of
the restorations properly.

5) Placing the restorations at the same time will decrease the wasted materials like adhesives etc.
that must be dispensed.

6) Placing the restorations at the same time DOES NOT increase the chance of having proximal
contacts.
When using matrix bands for posterior proximal amalgam restorations, the band should be
trimmed to which dimension?

A. 0.5mm below marginal ridge height

B. At least 1mm higher than the adjacent marginal ridge
C. To be equal with the adjacent marginal ridge
D. The band should not be trimmed B. At least 1mm higher than the adjacent marginal ridge

1) Concept: The coronal portion of the matrix band should be located approximately 1mm higher
than the adjacent marginal ridge to facilitate proper contouring and adaptation of the restorative
material along the proximal wall and marginal ridge of the restoration.

2) Placing the matrix band too high will cause

a. Access and visibility problems
b. Difficult instrumentation
c. Difficult placement of materials

3) Matrix bands should also be placed tightly hugging the tooth to ensure proper marginal
adaptation and anatomical form.
When finishing the occlusal surface on a posterior composite, the dentist should...

A. Develop centric contacts on cavosurface margins

B. Eliminate contacts in the fossae
C. Make sure to include protrusive contacts into the restoration
D. Avoid altering the centric contact on enamel D. Avoid altering the centric contact on
enamel

1) Concept: The centric contact in enamel should be preserved since it establishes the original
and proper occlusal contact between maxillary and mandibular teeth.

2) Increasing the intensity of centric contacts during restorative treatments may cause premature
contact, occlusal disharmony and eventually dental trauma.

3) Decreasing of removing the centric contact in enamel may cause occlusal disharmony and
unstable centric occlusion.
Incremental placement for a Class II prep leads to all of the following EXCEPT one. Which is
the EXCEPTION?

A. Decreased marginal deterioration

B. Enhanced marginal adaptation
C. Increased post-op sensitivity
D. Reduced marginal leakage C. Increased post-op sensitivity

1) Concept: Increased post-operative sensitivity is NOT among the recognized effects following
incremental placement for a Class II preparation because incremental placement of composite
resins decrease the polymerization shrinkage of composites and increases the percentage of
curing resulting in decreased postoperative sensitivity.

2) Incremental placement also enhances marginal adaptation, decreased marginal deterioration,

and reduces marginal leakage of the restoration.
Which of the following structure(s) must be annihilated for a periodical radiolucency to be
visualized?

A. the facial or lingual periosteum

B. the junction of the cortical and cancellous bone
C. the junction of the facial and cortical plates
D. both the facial and lingual cortical plates B. the junction of the cortical and cancellous bone

1) Periapical radiolucencies can only be visualized after the cortical bone surrounding the root
apex is destroyed and the infection extends into the cancellous bone of periosteum.

2) Lamina dura is considered cortical bone, and as long as the cortical bone is intact, periodical
radiolucency will not be evident radiographically.
Odontoblasts vs. Odontoclasts Calcific metamorphosis is carried out by odontoBLASTS
not odontoCLASTS.

Calcific metamorphosis occurs when trauma induces odontoblasts to rapidly form extensive
amount of repartee dentin, causing the pulp to appear smaller and at some point obliterated
almost entirely.
Loss of the apical seat that is incurred through over-instrumentation is best clinically managed
by:

A. Filling with a gutta-percha cone that is larger than the apical perforation
B. Increasing the file size and decreasing the length of the file
C. Prescribing analgesics and antibiotics
D. Using a chelating agent and placing Ca(OH)2
E. Filling with a warm gutta percha technique B. Increasing the file size and decreasing the
length of the file

1) A shorter length of file should be used to establish a correct working length.

2) The correction of working length will eventually help re-establish apical seat, then adequate
flaring of the apical portion of the canal can be done with the use or larger size of hand files.
Ankylosis Replacement resorption = ankylosis

1) splinting should last for about 2 weeks. Freedom for slight movement lessens the pressure on
bone and allows better healing along the periodical aspect of bone.
Which of the following characteristics provide the least reliable finding from a clinical
examination of teeth subjected to traumatic injury?

A. Loss of tooth structure

B. Mobility of teeth
C. Vitality of teeth
D. Displacement of teeth C. Vitality of teeth

1) Tooth that experienced trauma may or may not elicit a response to tooth vitality test, since the
nerves of the tooth could be damaged.

2) Traumatic tooth takes about 8 week minimum before it can display a normal pulp response.
Which of the following choices describes the access cavity preparation on a mandibular molar
with 3 canals best?

A. Pentagonal
B. Trapezoidal
C. Triangular
D. Oval B. Trapezoidal

1) Access preparation for the mandibular 1st molar is trapezoidal in shape since it follows the
position of the cusp tips.
Clinical Diagnosis, Case Selection, Treatment Planning, and Patient Management Clinical
Diagnosis, Case Selection, Treatment Planning, and Patient Management Answers
Which of the following treatment is indicated for a patient with irreversible pulpits on tooth #8
with an open apex?

A. Calcium hydroxide pulpotomy

B. Conventional root canal treatment
C. Direct pulp cap
D. Indirect pulp
E. Apexification E. Apexification

1) Apexification
a. procedure where calcium hydroxide or MTA is placed in the apical end of a tooth to close the
apex of teeth with a necrotic pulp so that the tooth can be filled with a biocompatible material
such as gutta percha so the tooth will be restored permanently

2) Direct pulp capping

a. procedure where vital pulp that is mechanically exposed is capped with calcium hydroxide and
a base to promote secondary dentin formation

3) Indirect pulp capping

a. procedure where a pulp capping material is placed over an area of in which the clinician left
affected dentin during caries excavation that is approaching the pulp so that it can be
reminderalized so that a root canal can be possibly avoided

4) Pulpotomy
a. procedure commonly performed on carious primary tooth where the pulpal inflammation
extends only in the crown
Referred periauricular pain is most common with...

A. Mandibular molars
B. Mandibular premolars
C. Maxillary premolars
D. Maxillary molars A. Mandibular molars

1) The pain that originates from mandibular molars is sometimes referred toward the ear because
both are innervated from one source - the mandibular nerve (V3).

2) The nerves from the mandibular molars transmit pain stimuli to the mandibular nerve which
also provide sensory innervation to some parts of the external ear.

3) The same origin of innervation and the proximity of the external ear to mandibular molars, the
pain perceived within the molar area easily travels and radiates into the external ear.
True/False:

The dental community believes that rubber dams must be used to complete all root canal
treatments.

In certain cases, a clinician can choose not to use a rubber dam with proper informed consent to
complete endodontic procedures. Statement I is true and Statement II is false.

1) Rubber Dams
a. using rubber dams during root canal procedures is a standard operating procedure and is
accepted and practiced worldwide

b. root canal treatment requires an operating field free of contamination to prevent saliva and
bacteria from entering the canal orifice

c. Proper isolation techniques decrease the changes of canal infection

Periapical radiolucencies only are able to be visualized after which of the following is (are)
annihilated?

A. The facial or lingual periosteum

B. The junction of the cortical and cancellous bone
C. The junction of the facial and cortical plates
D. Both the facial and lingual cortical plates B. The junction of the cortical and cancellous bone

1) Periapical radiolucencies
a. can only be visualized after the cortical bone surrounding the root apex is destroyed ad the
infection extends into the cancellous bone of periosteum

b. lamina dura surrounding the periodical aspect of tooth is considered cortical bone, and as long
as the cortical bone is intact, periodical radiolucency will not be evident radiographically

c. evidence of bone destruction that extends into the cortical bone and cancellous bone
supporting the tooth.
Pulpotomy procedures on primary molars depend on primarily on which of the following factors
for success?

A. Absence of root resorption

B. GV black classification of coronal caries
C. The age of the patient
D. Vitality of tooth pulp D. Vitality of tooth pulp

1) Pulpotomy
a. Success of a pulpotomy procedure lies on the ability of the remaining healthy pulp to remain
vital and not irreversibly inflamed after the procedure

b. procedure that removes only the portion of he coronal pulp that is infected and inflamed,
which keeps the radicular portion vital

c. cover the pulptomized tooth with an SSC crown may increase the chance for success of
treatment
Which of the following terms can be used to describe replacement resorption?

A. Ankylosis
B. Apical pathosis
C. Painful
D. Rapidly progressing
E. Acute apical abscesA. Ankylosis

1) Replacement Resorption
a. process wherein the tooth firmly attached to the bone, leading to ankylosis
b. possible outcome observed in a replanted avulsed tooth
c. inflammatory response initiated by the damaged PDL results in its replacement with alveolar
bone

2) Ankylosis
a. describes a tooth wherein an area of root is devoid of an attachment apparatus
Which of the following treatments is indicated for a patient with a 1mm pulp exposure created
when their cusp fracture off 30 minutes ago above the gumline?

A. Pulpectomy with apexification when necessary

B. Pulpotomy with calcium hydroxide
C. Pulpotomy with formocresol
D. Direct pulp cap with calcium hydroxide D. Direct pulp cap with calcium hydroxide

1) Direct pulp cap

a. calcium hydroxide should be placed above the exposure site and it should be sealed with
immediate restorative material (IRM)
b. patient needs to be evaluated clinically and radiographically after 4-6 weeks
c. direct placement of calcium hydroxide over the exposure site will stimulate reparative dentin
formation in a few weeks and is known as direct pulp capping
d. Micro exposures of the pulp during cavity preparation or trauma DO NOT ALWAYS
necessitate root canal treatment
A21-year-old hemophiliac male presents to your office with a necrotic pulp and periodical
radiolucency associated with tooth #14. Which of the following is the best treatment for this
patient?

A. Debride the canals and place calcium hydroxide in the canals and place a permanent
restoration.
B. Instrument and obturate the canals to mid root level in order to avoid vascular trauma
C. Perform a non-surgical root canal treatment
D. Perform a non-surgical root canal treatment with systemic vitamin K administration
E. Extract #14 C. Perform a non-surgical root canal treatment

1) Hemophiliac Patient need Endodontic Procedure

a. root canal treatment is documented to have a low risk intervention for hemophiliac patients.
b. completely safe to carry out non-surgical endodontic treatment in this patient, which is
indicated for treatment of necrotic pulp with apical periodontitis
c. Vitamin K does not affect hemophilia A and B.
d. can be treated by addition of the missing clotting factors
Which of the following factors account for the most common etiology of dental trauma for
children 1-3 years of age?

A. Athletic
B. Lack fo supervision by parents
C. Physical abuse
D. Underdeveloped motor coordination skills
E. Alcohol related falls D. Underdeveloped motor coordination skills

1) Dental Trauma for 1-3 year old

a. Children under the age of 1-3 year old have very limited and underdeveloped motor
coordination which often causes accidents including dental trauma
b. Children have prominent anterior teeth and lack of coordination.
Trauma to a tooth can cause the pulp chamber to undergo calcific metamorphosis.

Calcific metamorphosis occurs because trauma can induce odontoblasts to activate. Both
the statement and the reason are correct and related

1) Calcific Metamorphosis
a. common condition observed in teeth that have experienced trauma and is characterized by an
abnormal hard tissue formation and deposition in the pulp space that either partially or
completely fills it
b. trauma induces odontoblasts to rapidly form extensive amount of reparative dentin, causing
the pulp to appear smaller and at some point obliterated entirely
c. may occur when the fragments of fracture roots are in tight contact with one another if the
apical portion of the tooth is still vital. The calcification will close the fracture line and stabilize
the connection of the two fragments of the root.
Which of the following is the most likely complication of bleaching a tooth that was not
adequately obturated?

A. Asymptomatic apical periodontitis

B. Discoloration
C. External cervical root resorption
D. Fracture
E. Symptomatic apical periodontitis E. Symptomatic apical periodontitis

1) Bleaching a non-obturated tooth

a. Bleaching agents may leach ion the root canal treated tooth and beyond, into the apical portion
causing periodical swelling or apical pain
b. goal of canal obturation is to produce a hermetic seal of the apical terminus and prevent re-
infection of the periodical structures
c. without adequate seal at the apex of the root canal treated tooth, infection and chemicals may
penetrate the apical tissues and cause the failure of the root canal treatment
Which tooth is known for having the most consistent root canal morphology out of the following
choices?

C. Maxillary canines
E. Maxillary incisors C. Maxillary canines

1) Maxillary canine
a. longest root in the oral cavity
b. root is relatively straight with only some slight palatal or labial tipping along its apex.
c. presents with only one root canal most of the time
d. diameter is relatively large and oval in shape when viewed in cross-section
An increase in which of the following is evidence of an aging pulp?

A. fibrous elements
B. number of odontoblasts
C. pulp stones
D. size of the pulp chamber
E. vascularity
F. cellular elements A. fibrous elements

1) Pulp Chamber
a. fibroblasts in the pulp chamber continue to produce fibrous connective tissue and ground
substance, increase its amount compared to the other substances within the pulp
b. size of the pulp decreases as we age due to the continuous formation of secondary dentin and
the formation of reactionary dentin related to cares and other dental trauma
c. decrease in pulp size also decreases the vascular supply, nerve fibers and the overall cellularity
of the pulp.
Which of the following best describe replacement root resorption?

A. Ankylosis
B. Apical pathosis
C. Chronic pain
D. Rapid progression
E. Acute inflammation A. Ankylosis

1) Root Replacement
a. occurs in response to dental trauma or severe damage to the periodontium
b. bone grows and attaches to the root causing ankylosis
c. happens more commonly among patients who suffered severe cases of avulsion and luxation
A 6 year-old boy presents with a carious lesion on tooth T and no mobility, a small draining
sinus tract is found adjacent to tooth T. Radiographs indicate no furcal bone loss. Which of the
following is the suggested treatment?

A. Extraction
C. PulpectomyC. Pulpectomy

1) Pulpectomy
a. indicated for cases where there is no tooth mobility but the infection might already have
reached the pulp

2) Pulpotomy
a. indicated for primary teeth having accidental pulp exposure or a bacterial attack that only
affects the coronal portion of the pulp
The apical foramen is most commonly...

A. 0.5-1.mm from the anatomic apex

B. less than 0.5mm from the anatomic apex
C. more than 1mm from the anatomic apex
D. at the anatomic apex A. 0.5-1.mm from the anatomic apex

1) The apical foramen is usually situated approximately 0.5-1.0mm short of the root apex.
2) Apical constrition
a. narrowest portion of the canal located a few mm from the anatomical apex.
b. junction between the first layer of dentin and the first cementum layer that covers the exiting
portion of the tooth apex.
A 22-year old patient presents your office complaining of mild-to-moderate pain associated with
tooth #30 that had an amalgam restoration recently placed. The pain occurs for roughly 2
seconds and is provoked by cold, heat, and sweet foods. Which of the following is the most
probable diagnosis?

A. Internal resorption
B. Irreversible pulpitis
C. Pulp necrosis
D. Reversible pulpitis
E. Externa resorption D. Reversible pulpitis

1) Reversible Pulpitis
a. pain that is provoked by various stimuli including cold, heat, sweet foods, touch, and etc.
b. pain that only lasts for just a few seconds after the stimulus is removed

2) Irreversible Pulpitis
a. condition of the pulp where it cannot return to a healthy state

3) Internal and External Resorption

a. pathoses that are commonly asymptomatic and are usually discovered through routine
radiographs

4) Necrotic Pulp
a. usually asymptomatic
b. characterized by non-vital pulp
c. pain associated with a necrotic pulp can be attributed to a periodical infection associated with
the necrotic pulp
Following trauma to primary maxillary incisors, which of the following would MOST LIKELY
cause yellowish discoloration>

A. Calcific metamorphosis
B. Internal resorption
C. Pulp hyperemia
D. Pulp necrosis
E. Blood pigments A. Calcific metamorphosis

1) Calcific metamorphosis
a. is a common reason that teeth appear yellow after trauma occurs and is recognized clinically
as early as 3 months following injury.
b. characterized by hard tissue within the root canal space of a tooth causing yellow discoloration
of the clinical crown
Internal resorption that has not totally perforated the root surface is BEST managed by which of
the following?

A. Incision and drainage

B. Periodic recall and evaluation
C. Root canal treatment
D. Surgical curettage
E. Cvek pulpotomy C. Root canal treatment

1) Internal root resorption

a. root canal therapy is indicated for cases involving internal resorption where the root surface is
not perforated by the defect
b. most commonly caused by trauma and infection
c. infection of trauma results in an inflammatory response within the pulp resulting in abnormal
vascularization and production of multinuclear odontoclasts, which initiate the process of
resorption
d. radiographs are made after 1 year to determine if healing has occurred and the resorptive
process is halted.
Which of the following pulpal conditions are suggested when a patient experiences prolonged,
unstimulated pain while trying to sleep?

A. Necrosis
B. No specific condition
C. Normal pulp
D. Reversible pulpitis
E. Mild irritation A. Necrosis

1) Necrosis
a. prolonged unstimulated pain is associated with cases involving pulpal necrosis or irreversible
pulpits
b. describes the death of pulpal cells
c. pain associated with pulpal necrosis is often periodically derived

2) Reversible Pulpitis
a. pain subsided after the removal of the stimulation in cases of reversible pulpits
Periapical cemental dysplasia in its early stages is best differentiated clinically from apical
abscess by which of the following methods>

A. Palpation
B. Patient symptoms
C. Percussion
D. Periodontal examination
E. Radiographic appearance
F. Pulp Testing F. Pulp Testing

1) Pulp Testing
a. tooth should be tested for vitality to rule-out apical abscess
b. a vital pulp designation suggest that the radiolucency is probably due to other causes

2) Periapical cemental dysplasia

a. during the first phase of periodical cemental dysplasia or the osteopathic phase, there is
usually bone loss predominantly along the apices of the mandibular central incisors. This abscess
is usually mistaken as an apical abscess.

b. presence of an intact lamina dura along the apical portion of the involved tooth also shows that
the radiolucency did not come from an infected tooth.
A patient presents to your office with a tooth #19 that tests indicate pulp necrosis, pain on
percussion; and no periodical lesion present. Which of the following should the emergency
treatment consist of?

A. Open the tooth to achieve drainage and leave the tooth open to drain
B. Open the tooth, perform apical trephination, temporize, and check occlusion
C. Perform a pulpotomy, temporize, and check the occlusion
D. Prescribe antibiotics and analgesics and reschedule the patient for later
E. Debride the canals, temporize, and check the occlusion E. Debride the canals, temporize, and
check the occlusion

1) Emergency endodontic treatment

a. removal of necrotic pulp through debridement of the root canals
b. placement of temporary dressing material within the root canals
c. affected tooth needs to be evaluated for high occlusal spots
d. occlusion of the affected tooth should be thoroughly checked and sometimes needs to be
removed from occlusion as a preventive measure to relieve pain on occlusion
If a patient presents to your office with a periodical radiolucency associated with a tooth
demonstrating a midroot fracture, where the lower portion of the tooth is nonnegotiable with
files, the indicated treatment is...

A. Apical surgery with removal of the apical segment root canal treatment of the coronal
segment
B. Apical surgery with reverse filling
C. Calcium hydroxide treatment of the coronal segment only
D. Extraction with removal of the apical segment and replantation of the coronal segment
E. Extraction of both tooth segments D. Extraction with removal of the apical segment and
replantation of the coronal segment

1) Treatment with mid-root fracture

a. to counter-act the possibilities of having failed treatment for teeth with mid root fractures,
intentional replantation is conducted

2) Intentional replantation
a. indicated when the apical half of the root of the tooth cannot be engaged, cleaned, and shaped
b. extract the apical segment and replant the coronal segment that recently received a root end
filling
Which of the following actions is indicated if an accessory canal in the middle 1/3 of a tooth with
a necrotic pulp and an adjacent radiolucent lesion is noted? A radiograph made after obturation
suggest that no material entered the accessory canal?

A. Observe the patient with a 6 month recall and radiograph schedule for the next year
B. Perform an apicoectomy
C. Re-obturate the canal using the continuous wave warm lateral to force material into the
accessory canal
D. Expose the root surgically then curette the lesoin A. Observe the patient with a 6 month recall
and radiograph schedule for the next year

1) Treatment
a. best to observe and evaluate the root canal treated tooth prior to re-obturating the canal even if
the accessory canal was not included during obturation
b. observation is best because the complete sealing of the main root canal might be sufficient to
prevent bacterial re-infection.
c. only way to know if the treatment was successful is by having recall and radiographic
evaluation to assess bone healing and absence of active infection
A patient presents with continuous and spontaneous pain associated with the maxillae left central
incisor. Tooth #9 has a large Class V composite restoration placed many years ago. Cold testing
elicits a lingering pain. There is no sensitivity to percussion or palpation. What is the most
probable diagnosis?

A. Irreversible pulpits with symptomatic apical periodontitis

B. Necrotic pulp with asymptomatic apical periodontitis
C. Reversible pulpits with a normal periapex
D. Irreversible pulpits with normal periapex D. Irreversible pulpits with normal periapex

Diagnosis
1) Irreversible pulpits
a. condition known to elicit spontaneous lingering, and throbbing pain sometimes without a
stimulus

2) Continuous pain
a. experienced by the patient is an indication that the pulp is already inflamed and irritated even
without external stimulus
b. large and old Class V restoration could have lost its seal and served as an opening for bacterial
invasion.
Which of the following pulpal changes is MOST PROBABLE to occur if a permanent tooth with
a mature apex is intruded due to trauma?

A. Internal resorptin
B. Necrosis
C. Transient inflammation
D. Calcific metamorphosis B. Necrosis

1) Necrosis
a. When a permanent tooth is intruded, the most probable result is pulpal necrosis because the
blood vessels supplying the pulp are impeded
b. intrusion of primary teeth does not typically result in necrotic pulp because the bloodflow is
better because of the open apex
c. 90% of intruded primary teeth will re-erupt after 2-6 months
Pulpotomies are CONTRAINDICATED in primary molars with which of the following?

A. Radiographic evidence of deep caries approximating the pulp chamber

B. Radiographic evidence of internal resorption
C. Sensitivity to sweet
D. Exposure of the pulp during caries excavation B. Radiographic evidence of internal
resorption

1) Internal resorption
Root canal therapy is indicated to treat cases involving internal resorption.

2) Treatment Options
a. When a carious lesion approximates or extends into the pulp chamber of a deciduous tooth,
removal of coronal pulp is performed to prevent the spread of the infection into the radicular
pulp

3) Pulpotomies
a. performed on deciduous teeth to prevent premature tooth loss and potential loss of space
b. Contraindications
1) internal root resorption (root canal therapy indicated)
2) perforation of pulp chamber floor
3) over 1/2 root resorption
4) cellulitis
5) localized abscess
6) draining sinus
7) inability to isolate the tooth
8) inability to properly restore tooth after the procedure
During an automobile accident, a patient experiences a blow to the face and mouth. Radiographs
suggest a horizontal mid-root fracture of maxillary central incisor. The tooth presents with NO
mobility and NO symptoms. The tooth does not response to pulp testing. No radiographic lesion
is present. The best course of action is...

A. Initiate root canal treatment to include both segments of the tooth

B. Render no treatment at this time and periodically check clinically and radiographically
C. Surgically remove the apical segment and reverse fill the coronal segment
D. Extract the coronal segment and surgically remove both segments B. Render no
treatment at this time and periodically check clinically and radiographically
1) Tooth with no pulpal symptoms and mobility
a. must be reevaluated after 8 weeks to ensure that the tooth is vital and requires no other
treatment
b. if the tooth tests non-vital due to the horizontal midroot fracture, the prognosis of restoring
tooth decreases significantly
c. if the tooth remains vital, calcific healing might have occurred at the site of feature. It is a type
of healing wherein calcific callus develops along the fracture site.
The most important factor influencing the solubility of zinc phosphate cement is...

A. All answers are correct

B. The age of the patient
C. The liquid/power ratio
D. The brand of the material since phosphate levels vary widely C. The liquid/power ratio

1) Solubility
a. increasing the power to liquid ratio makes the mixture more viscous, stronger, and less soluble
b. presence of moisture on a mixing slab also affects the quality of the polyacrylic acid liquid and
increases the solubility of the zinc phosphate cement mix
c. proper mixing techniques also affects the quality of the mixture
d. the zinc phosphate must be uniformly mixed through flat sweeping motion of the spatula while
powder is added in increments
Which of the following does a negative response of a tooth to electronic pulp testing (EPT) an
hour after a severe lunation indicate?

A. The EPT gave a false negative reading

B. The negative response may be temporary because the blood supply was interrupted
C. The negative response may be temporary because the neural transmission was interrupted
D. The pulp is necrotic and should undergo a root canal procedure
E. The pulp is inflamed C. The negative response may be temporary because the neural
transmission was interrupted

1) Electric pulp testing

a. gives the status of the pulpal nerve fibers not the blood supply of the tooth
b. pulpal response to electric current only suggests that some viable nerve fibers are capable of
responding to electric current are present

2) Electric pulp testing within a hour of a lunation injury

a. is contraindicated because of inconsistent findings
b. Positive response from electric pulp testing of retained vitality and DOES NOT differentiate
between:
1) Normal pulps
2) Reversible pulp inflammation
3) Irreversible inflammation

2) Negative response
a. may not always indicate pulpal necrosis because many teeth take about 2 months to respond to
electric pulp testing again
Sudden relief of severe pain associated with a dentoalveolar abscess can be explained by which
of the following?

A. Neutralizing effect of tissue enzymes

B. Rupture of the abscess from the periosteum into the soft tissue
C. Walling-off the infection by the body
D. Neurotoxic effects of bacterial toxins anesthetize the nocioceptors B. Rupture of the
abscess from the periosteum into the soft tissue

1) Dentoalveolar abscesses
a. accumulation of pus within the teeth, gums, and supporting alveolar bone
b. accumulation of pus within the dentoalveolar abscess creates hydrostatic pressure, resulting in
the sensation of severe pain
c. treated through root canal treatment and possibly incision and drainage depending upon case
severity
d. drainage of the lesion releases the pressure caused by the suppuration and results in sudden
relief of pain that is experiences by the patient.
e. severe, intense, and throbbing pain which worsens with the passage of time
f. can be partially diagnosed by noting the presence of periodical radiolucency
Which of the following describes the most common sequences of treatment for replanting
permanent teeth with closed apices?

A. Canal debridement, calcium hydroxide therapy, repositioning, splinting, and gutta-percha fill
B. Root canal therapy, Respositioning, and splinting
C. Repositioning, splinting, and root canal therapy
D. Repositioning, splinting, canal debridement, calcium hydroxide therapy, and gutta-percha fill
D. Repositioning, splinting, canal debridement, calcium hydroxide therapy, and gutta-
percha fill

1) Replanted Tooth Procedures

a. splined with adjacent teeth to ensure table in positioning for about 2 weeks, also serving to
keep the tooth properly aligned with the other teeth in the arch.
b. once the tooth is stabilized in its socket for about 1-2 weeks, canal debridement is performed
to remove necrotic pulp and traces of bacteria that might re-infect the root canal
c. After proper canal debridement, calcium hydroxide paste is used as a medicament to fill up the
root canal. Gutta percha point is then used with a sealer to fill the canal up to create a hermetic
seal.
Which of the following would be the diagnosis for a patient with a tooth that demonstrates
spontaneous pain, is not sensitive to hot or cod, but is sensitive to percussion and does NOT have
a periodical radiolucency?

A. Asymptomatic Apical Periodontitis

B. Chronic Apical Periodontitis
C. Reversible Pulpitis
D. Symptomatic Apical Periodontitis
E. Irreversible Pulpitis D. Symptomatic Apical Periodontitis

1) Symptomatic Apical Periodontitis

a. sensitive to percussion and occlusal forces and do NOT necessarily demonstrate periodical
radiolucency

2) Asymptomatic Apical Periodontitis

a. not sensitive to percussion/palpation and may or may not demonstrate a periodical
radiolucency

3) Irreversible Pulpitis
a. lingering sensitivity after the cold stimulus is removed.
b. may or may not elicit spontaneous pain

4) Reversible Pulpitis
a. characterized by a patient that may be sensitive to cold or sweet but the pain quickly
diminished once the cold stimulus is removed
Each of the following would be visible on a periodical radiograph EXCEPT one. Which is the
EXCEPTION?

A. Calcification of a canal
B. Canals of a maxillary 1st premolar
C. Lingual curvature of the palatal root
D. Open apex of a tooth
E. Perforation of the furcation C. Lingual curvature of the palatal root

1) Root Radiographs
a. illustrate a 2-dimensional mesiodistal view of the tooth and surrounding structures, therefore
the buccolingual aspects are not able to be portrayed
b. canal that suddenly disappears midroot, or appears off center is often the result of the tooth
possessing 2 canals
c. open apices and furcation perforations can also be seen radiographically
Which of the following histologic features are least likely to be found in normal dental pulp?

A. Lymphocytes and plasma cells

B. Palisade odontoblastic layer
C. Undifferentiated mesenchymal cells
D. Cell-free zone of Weil A. Lymphocytes and plasma cells

1) Lymphocytes and plasma cells

a. presence of lymphocytes and plasma cells denote that an infection is present

2) Cell free zone

a. located within the pulp complex and is located beneath odontoblasts
3) Undifferentiated mesenchymal cells
a. normally present within the pulp
b. reserved cells that differentiated into another type of cell when it is needed by the pulp
Which of the following is considered the best method of determining if a tooth has irreversible
pulpits?

A. cold/thermal testing
B. palpation
C. percussion
D. Test cavity
E. Electric pulp test A. cold/thermal testing

1) Irreversible Pulpitis
a. pain perceived by a tooth with irreversible pulpits during a cold test or a heat test is more
intense and lingers even after the stimulus is removed

2) Healthy vital pulp

a. pain perceived with healthy pulp during a cold test or heat test is usually short in duration, and
it does not linger
All 4 mandibular incisors were damaged in an automobile accident 5 years ago. Radiolucencies
were noted apically to these 4 incisors. Which of the following is the best treatment for this
patient?

A. No treatment necessary, evaluate the status of the patient periodically

B. Perform root canal therapy on the incisors, raise a flap, and cure out the involved bone
C. Test the vitality of the pulps of all 4 incisors and perform root canal therapy in teeth that do
not respond
D. Extract all 4 mandibular incisors and fabricate a fixed partial denture C. Test the vitality of
the pulps of all 4 incisors and perform root canal therapy in teeth that do not respond

1) Treatment
a. root canal therapy is the treatment of choice for teeth with non-vital pulps resulting from
trauma
b. necrotic tissues (pulp and infected dentin) are removed, canals are cleansed with an irrigating
solution like sodium hypochlorite, then filled with an inert material and a coronal restoration is
placed to seal the canals from the oral environment and restore masticatory function.

2) Vitality tests
a. performed in order to assess the status of the pulpal tissue, especially after a tooth has
undergone trauma
b. teeth which do not respond to vitality tests are considered non-vital and possess a necrotic
pulp
Which of the following is the MOST LIKELY adverse effect of internally bleaching an
endodontically treated tooth with superoxide?

A. Demineralization of tooth structure

B. External cervical root resorption
C. Reinfection of the canal
D. Weakening of the remaining tooth structure B. External cervical root resorption

1) Concept: The most common side effect of internally bleaching a tooth with superoxide is
external cervical root resorption.

2) The presence of a glass ionomer barrier over the root filling material may help to reduce the
instances of external cervical root resorption if it is at least 4mm in thickness.

3) The walking bleach technique using sodium perborate is NOT associated with external
cervical root resorption.

4) Bleaching dentin dose NOT weaken the tooth structure.

Each of the following is present in a healthy pulp EXCEPT one. Which is the EXCEPTION?

A. Cell-free zone
B. Odontoblastic layer
C. Plasma cells
D. Undifferentiated mesenchymal cells C. Plasma cells

1) Concept: A healthy pulp does NOT contain plasma cells because they are stimulated to
migrate to the pulp with inflammation and infection.

2) The main components of the pulp are

a. Neurovasculature cells
b. Undifferentiated mesenchymal cells
c. Odontoblastic layer
d. Cell free zone
Which of the following is the MOST COMMON etiology of severe pain upon percussion of a
tooth?

A. Chronic apical abscess

B. Irreversible pulpitis
C. Reversible pulpitis
D. Symptomatic apical periodontitis D. Symptomatic apical periodontitis

1) Concept: Symptomatic apical periodontitis (SAP) presents with pain upon masticatory forces
or percussion.

2) Symptomatic Apical Periodontitis

a. a periapical diagnosis whereas Irreversible is a pulpal diagnosis
b. indicative of inflamed periodical tissues and may present with or without a radiolucency
associated with the root apices of the tooth.

3) Chronic Apical Abscess (CAA)

a. typically regarded to be NOT AS painful to percussive forces because the sinus tract
associated with it is able to relieve some of the built up percussive forces
Each of the following are parts of informed consent EXCEPT one. Which is the EXCEPTION?

A. Alternative to treatment
B. Benefits of treatment
C. Cost of treatment
D. Risks of treatment C. Cost of treatment

1) Informed consent requires that the patient has the capacity to act autonomously with
understanding, and without outside controlling influences.

2) Informed consent requires that the patient have the knowledge and understanding of the risks
and benefits of the proposed treatments.
Basic Endodontic Treatment Procedures Basic Endodontic Treatment Procedures Answers
Which of the following pairs of intracanal instruments and its action is INCORRECT?

A. Intracanal instruments are more susceptible to breaking if they are rotated after becoming
locked into dentin
B. K-files can be used to file and ream, while a reamer can only be used to ream
C. Reaming action will enlarge a root canal and make it more round in shape
D. Rotating instruments in a clockwise direction forces debris apically, while counterclockwise
rotation forces debris coronally D. Rotating instruments in a clockwise direction forces
debris apically, while counterclockwise rotation forces debris coronally

1) Directions
a. debris is forced in a coronal direction when rotating instruments are used in a clockwise
direction and vice versa

2) K files
a. have both reaming and filing actions when used during root canal preparation

3) Reamers
a. cause enlargement of root canals producing a round shape
b. cannot be used in a filing motion

4) Separated instruments
a. to prevent broken or separated instruments, never fro to rotate an instrument that is locked into
dentin.
Which of the following describes which cell layer the nerve plexus of raschkow resides in?

A. Cell-free layer
B. Cell-rich layer
C. Central core of the pulp
D. Odontoblastic layer
E. Only in the apical 1/3 of the tooth A. Cell-free layer
1) Cells found in the dental pulp
a. fibroblasts (principal cell)
b. odontoblasts
c. defense cells like
1) histiocytes
2) macrophages
3) granulocytes
4) mast cells
5) plasma cells

2) Nerve Plexus of Raschkow

a. located central to the cell-free zone
b. monitors painful sensations as well as mediation as inflammatory events and subsequent tissue
repair

3) A-fibers
a. myelinated nerve that conduct rapid and sharp pain sensations
b. close association with the odontoblasts and extend fibers to many but not all dentinal tubules

4) C-fibers
a. thinner, non-myelinated nerved involved in dull aching pain
b. terminate in the pulp tissue proper, either as free nerve endings or as branches around blood
vessels
Proper irrigation helps decrease the likelihood of incomplete removal of bacteria, pulp tissue,
and dentinal shavings. Which of the following is the best method to ensure complete cleaning of
the root canal?

A. Obtaining straight line access

B. Use of Gates-Gliden burs
C. Use of a canal lubricant
D. Use of broaches
E. Use of a chelating agent A. Obtaining straight line access

1) Straight line access

a. enables the dentist to adequately clean the shape the root canal
b. having adequate acces and visibility of the root canal allows the dentist to freely perform
proper instrumentation, irrigation, and debridement of the root canal
Which of the following describes the placement of the orifice of the 4th canal in permanent
maxillary 1st molars?

A. Distal to the palatal canal in patients from the pacific islands

B. On a line on the pulpal floor from the distobuccal orifice to the mesiobuccal orifice
C. On a line on the pulpal floor from the palatal orifice to the distobuccal orifice
D. Palatal to the orifice of the mesiobuccal canal D. Palatal to the orifice of the mesiobuccal
canal
1) MB2 canal
a. located lingual to the orifice of the mesiobuccal canal (MB1) and is observed in 68-98% of
permanent maxillary 1st molars.
b. MB2 canal often times joins with the MB1 canal before the apex is reached.
Which of the following shapes best describes the outline of an access preparation of a
mandibular 1st molar with 3 canals?

A. Oval
B. Pentagonal
C. Triangular
D. TrapezoidalD. Trapezoidal

1) Access Preparation
a. design for the mandibular 1st molar is trapezoidal in shape, since it follows the position of the
cusp tips

2) Mandibular 1st molar

a. has 5 cusp with pulp horns underneath each cusp
b. access preparation must expose the whole pulp chamber, so the position of cusps is used as a
guide for the access prep outline
c. have two roots, a medial and distal root
d. mesial root has a mesiobuccal and mesiolingual canals which are both located under the cusp
tips that bear the same name.
e. distal root has one very large canal or two root canals
Which of the following does a 0.02 taper indicate for a K-file?

A. 0.02mm increase in diameter per 1mm of file length

B. 0.02mm increase in diameter per 2mm of file length
C. 0.2mm increase in diameter per 1mm of file length
D. 0.2mm increase in diameter per 2mm of file length A. 0.02mm increase in diameter per
1mm of file length

1) Taper
a. 0.02mm taper indicates an increase of 0.02mm in diameter per 1mm of file length.
b. describes the amount of file diameter increases with each millimeter from tip of the file toward
the handle.
The pulpal anatomy of which of the following teeth means that the endodontic access should be
triangular in shape?

A. Mandibular 2nd premolar

B. Maxillary canine
C. Maxillary central incisor
D. Mandibular canine C. Maxillary central incisor

1) Maxillary Central Incisor Access

a. access preparation is triangular, following the shape of its pulp chamber
b. sides of the inverted triangle are guided by the presence of a marginal ridge that border the
access opening
c. access preparation is designed to provide a straight line view of the canal up to the apex if
possible
Establishing drainage is an important aspect of emergency treatment for an acute periradicular
abscess. An equally important aspect is...

A. Adjusting occlusion
B. Debriding the canal system of necrotic tissues
C. Introducing antimicrobial medicaments into the pulp space
D. Prescribing analgesics B. Debriding the canal system of necrotic tissues

1) Debriding the canal of necrotic tissue

a. will decrease the amount of bacteria that form abscesses
b. bacterial niche will be removed and the root canal system will be cleared of bacterial infection
with good debridement
c. after debridement in an acute periradicular abscess, it is also a good practice to place an
antimicrobial medicament like Ca(OH)2
Which of the following is a reason recapitulation is indicated between file sizes during stepback
enlargement?

A. to create a coronal funnel to make filling easier

B. to maintain the apical stop
C. to remove the dentin fillings from the apical segments that are not removed by irrigation
D. to maintain curvature of the canal C. to remove the dentin fillings from the apical segments
that are not removed by irrigation

1) Recapitulation
a. serves to maintain canal latency
b. it also prevents deposition of dentin chips and fillings that may cause blockage of the canal
during step back canal preparation
c. performing recapitulation on after each file is used prevents canal preparation errors like apical
transportation, incomplete instrumentation, and under-filling during obturation
When instrumenting the medial root of a mandibular 1st molar, which of the following canal
surfaces is the most likely to become stripping-perforated?

A. Buccal
B. Distal
C. Lingual
D. Mesial B. Distal

1) Mesial root of mandibular 1st molar

a. distal surface of the medial root of the mandibular 1st molar is most likely to undergo strip
perforation during root canal instrumentation
b. mesial surface of the distal root and the distal surface of the mesial root in the mandibular 1st
molar have a root concavity making the dentin walls very thin
c. overenthusiastic root canal instrumentation (overcutting) can lead to strip perforations in these
areas and should be avoided
Which of the following is predominantly the basic component of most root canal sealers?

A. Polyvinyl resin
B. Zinc oxide
C. Zinc Oxyphosphate
D. Zinc stearate
E. Polycarboxylate B. Zinc oxide

1) Zinc oxide
a. antibiotic properties
b. serves to prevent reinfection of the root canal

2) Eugenol
a. sometime used in conjunction and serves to sedate and sooth periradicular nerve tissues to
decrease post obturation sensitivity
The root canal anatomy of a maxillary 1st molar with 4 canals requires which shape of access
preparation?

A. Ovoid
B. Quadrilateral
C. Square
D. Triangular
E. Round B. Quadrilateral

1) Maxillary permanent 1st molar with 4 canal orifices

a. quadrilateral-shaped access preparation
b. provides the most ideal preparation since the pulp chamber of this tooth is also of the same
shape
c. mesiobuccal and distobuccal orifice of this tooth are most commonly locoed near each other
Which of the following describes the proper length at which the tooth should be filed and gutta
percha be placed?

A. Filing 0.5-1.0mm beyond the radiographic index and obturating to the radiographic index
B. Filing 0.5-1.0mm short of the radiographic index and obturating to 0.5-1.0mm short of the
radiographic apex
C. Filing to the radiographic index and obturating 0.5-1.0mm short of the radiographic index
D. Filing to the radiographic apex and obturating to the radiographic apex B. Filing 0.5-1.0mm
short of the radiographic index and obturating to 0.5-1.0mm short of the radiographic apex

1) Filing procedures
a. recommended to keep the preparation length 0.5-1.0mm short of the radiographic apex during
root canal treatment.
b. leaves a pulp stump (apical constriction), which prevents extrusion of irritating filling
materials into the periradicular tissues.
c. Filing should be carried out followed by gutta percha filling placement 0.5-1.0mm short of the
radiographic apex to provide a hermetic apical seal.
Procedural Complications Procedural Complications Answers
Which of the following is the suggested protocol if the pulpal floor is perforated during access
preparation?

A. Perform no treatment at this time and schedule the patient for an extraction
B. Repair the perforation and continue the root canal treatment at a subsequent appointment
C. Repair the perforation at a subsequent appointment only if symptoms occur
D. Repair the perforation immediately with mineral trioxide aggregate (MTA/Portland Cement),
inform the patient, and reassess the tooth at the recall appointment
E. Continue the root canal treatment as normally planned because tertiary dentin will fill in
D. Repair the perforation immediately with mineral trioxide aggregate (MTA/Portland

1) Root Perforations
a. should be addressed immediately through the use of MTA to help stimulate healing of
periradicular tissues and to promote cementum deposition
b. MTA is ideal material since it create a seal when moisture is present
c. MTA is biocompatible and is capable of inducing periradicular tissue repair and cementum
deposition
If a permanent maxillary central incisor was avulsed and rigidly splinted, what is the most likely
outcome?

A. Internal resorption
B. Normal healing process
C. Replacement resorption
D. Root fracture
E. Calcific metamorphosis C. Replacement resorption

1) Avulsed tooth should be splinted with a flexible splint to avoid extensive healing
complications like replacement resorption
2) Avulsed teeth should have some degree of freedom to lessen pressure on the bone and allows
better healing along the periodical aspect of bone surrounding the traumatized tooth.
Two weeks following the obturation of a maxillary central incisor due to trauma, a radio-opaque
horizontal line was noted in the midroot area, extending both medially and distally and into the
periodontal ligament (PDL) space. This finding is most likely indicative of...

A. Accessory canals
E. A midroot fracture E. A midroot fracture

1) Midroot fracture
a. become more visible after root canal treatment as the sealer flows out of the space in between
the fractures
b. prognosis of a midroot fracture is relatively poor
c.
Which of the following is the most UNDESIRABLE property of sodium hypochlorite?

A. Corrosiveness to endodontic files

B. Reaction with chelating agents
C. Tendency to bleach tooth structure
D. Toxicity to vital tissues
E. Smell D. Toxicity to vital tissues

1) Sodium Hypochlorite
a. undiluted or excessive amounts is toxic to vital tissues and can cause periodical tissue damage
and pain
b. good disinfectant that is used in dentistry as an endodontic canal irritant at a diluted
concentration
c. disinfect gutta percha points prior to placement and obturatoin of the canal
Which method is the best to manage loss of apical seat due to over-instrumentation?

A. Filling with gutta-percha cone that is larger

B. Increasing the file size and decreasing the file length
C. Prescribing analgesics and antibiotics
D. Using a chelating agent and packing with calcium hydroxide
E. Filling with a warm gutta-percha technique B. Increasing the file size and decreasing the
file length

1) Apical seat
a. use a shorter length of file to establish a correct working length
b. correction of working length will eventually hep re-establish apical seat, then adequate flaring
of the apical portion of the canal can be done with the use of larger sized hand files
You break a size of 35 K-file 1mm short of the apex in the MB1 canal of tooth #15 that was
diagnosed with irreversible pulpits. The remaining file can neither be retrieved nor by-passed. It
is indicated that the dentist finishes the root canal treatment and does which of the following?

A. Extract the tooth

B. Perform an apicoectomy of the mesiobuccal root
C. Place the patient on a recall schedule for further evaluation
D. Amputate the mesiobuccal root C. Place the patient on a recall schedule for further
evaluation

1) Broken file
a. broken file inside poses some risks of reinfection due to the incomplete sealing of the canal
b. process of instrumentation, cleaning and shaping is compromised because of the broken file,
which may result in a failure of the root canal treatment later.
c. unretrieved broken file may stay inside the mouth if the tooth is asymptomatic and if a
radiographic lesion shows evidence of healing
Which of the following locations would a perforation demonstrate the BEST prognosis?
A. Apical 1/3 of root
B. Coronal 1/3 of root
C. Floor of pulp chamber
D. Middle 1/3 of root A. Apical 1/3 of root

1) Apical Perforations
a. occur through the apical foramen or the body of the root to form a new canal
b. the more apical the perforation the more favorable the prognosis for the tooth (except for
coronal perforations)
Which of the following locations would a perforation present the HIGHEST failure risk?

A. Apex
B. Apical 1/3 of the root
C. Crown
D. Furcation
E. Middle 1/3 of the root D. Furcation

Perforations
a. HIGHEST risk for endodontic failure is the perforation through the furcation because it is
more difficult to seal
b. Perforations near the root apex can be sealed during obturation.
c. Teeth with endodontic perforations may still be successful.
d. NOT a guarantee of endodontic failure
Traumatic Injuries Traumatic Injuries Answers
A 42 year old patient reports to your office after a car accident where their maxillary central
incisor is traumatized, and is slightly tender to percussion, is in good alignment, and responds
normally to pulp vitality tests. Radiographic examination reveals a horizontal fracture of the
apical 1/3 of the root. Which of the following is the treatment of choice?

A. Apexification and subsequent root canal therapy

B. Apicoectomy to remove the fracture apical section of the root followed by root canal
treatment
C. Splint and re-evaluate the tooth for pulp vitality at later time
D. Root canal treatment C. Splint and re-evaluate the tooth for pulp vitality at later time

1) Pulp vitality tests on traumatized teeth are usually inaccurate, necessitating a few weeks later.
2) A tooth that has fracture roots in close proximity with one another have a greater chance of
developing calcific metamorphosis, therefore splinting for the immobilization of the traumatized
tooth is necessary.
An 8 year old boy presents to your office with a traumatized #8 that no longer responds to
electric and thermal vitality tests. Which of the following is the suggested treatment?

A. Apexification
B. Calcium Hydroxide pulpotomy
C. Pulpectomy
D. Re-evaluate after 2 weeks
E. Svek pulpotomy D. Re-evaluate after 2 weeks

1) Traumatized immature teeth may give a false reading with thermal and electric vitality tests
because their blood supply may still be intact, but their nerve may not respond.

2) As the circulation is restored to the tooth, the responsiveness to pulp testing may return after 2
weeks.

3) Apexification or pulpectomy is NOT indicated at this time because the pulp may still be vital.
Which of the following treatments is indicated for a 5-year-old patient with a sinus tract and a
dark brown discoloration associated with their maxillary central incisor that appeared following
trauma.

A. Direct pulp cap

B. Extraction
C. Indirect pulp cap
D. Pulpectomy
E. Pulpotomy B. Extraction

1) Extraction
a. of the primary maxillary central incisor is induced for a 5 year old child when the tooth is
associated with a sinus tract and discoloration
b. NOT advisable to retain this tooth considering the proximity of the permanent successor and
age of the patient. Retention of this diseased tooth can lead to abnormal function of permanent
tooth.

2) Turner's Tooth
a. describes when the permanent tooth bud is affected via infection or trauma of a primary tooth

3) Infection
a. most commonly affects the canine
b. trauma most commonly affects the maxillary central incisor
An 11-year-old girl presents to your office 4 hours after a fall that fractured her maxillary central
incisor to the point that the remaining tooth structure is supra gingival. The exposed pulp is
diagnosed as vital. Which of the following is considered the treatment of choice?

A. Apexogenesis procedure then root canal treatment

B. Non-surgical root canal treatment
C. Pulpectromy and placement of calcium hydroxide
D. Pulpotomy
E. Pulp cap B. Non-surgical root canal treatment

1) Proper restoration of the fracture maxillary central incisor can only be done if the tooth
undergoes root canal treatment

2) Tooth can be restored after root canal treatment and exposure of adequate tooth length.
Which of the following is the correct sequence for the INITIAL TREATMENT in which mature
avulsed teeth are replanted?

A. Performing root canal debridement, calcium hydroxide therapy, repositioning, splinting, and
filling with gutta-percha
B. Repositioning and splinting only
C. Respositioning, splinting, and performing root canal therapy
D. Performing root-canal therapy, repositioning, and splinting B. Repositioning and
splinting only

1) During an initial treatment, the avulsed tooth is gently repositioned into its socket and then
splinted to the adjacent teeth to ensure that the arch form is preserved

2) Maintaining the tooth's proper position within the socket is important for the success of the
replantation procedure. Tooth should be splinted until it is stable enough until the necessary
treatments can be done.
In a clinical exam following a traumatic injury, which of the following is the LEAST reliable
finding?

A. Displacement of teeth
B. Loss of tooth structure
C. Tooth vitality
D. Tooth mobility C. Tooth vitality

1) Tooth that recently experience trauma may or may not elicit a response to tooth vitality test
because the nerves of the tooth could be damaged

2) Inability of the traumatized tooth to elicit pulpal response during a vitality test can be
attributed to the injury within the nerve fibers of the tooth.

3) Tooth with trauma may takes approximately 8 weeks at a minimum before it can display
normal pulp response.
Adjunctive Endodontic Therapy Adjunctive Endodontic Therapy Answers
When restoring an endodontically treated tooth with amalgam, what depth into each root canal
should be achieved to obtain satisfactory retention?

A. 2mm
B. 3mm
C. 4mm
D. 5mm
E. 1mm B. 3mm

1) Amalgam
a. A depth of at least 3mm into the root canals is essential for the retention of an amalgam
restoration in an endodontically treated tooth
b. depends upon mechanical retention because it does not demonstrate chemical bonding with the
tooth structure
c. after completing root canal treatment, roughly 3mm of gutta percha should be removed from
the root canals using a heated instrument
d. space created int he root canal should be filled and condensed with amalgam before carrying
out coronal filling (nayyar core technique)
Each of the following are true regarding the treatment tooth with a sinus tract EXCEPT one.
Which is the EXCEPTION?

A. Antibiotics are indicated

B. Root-end surgery should be performed if the tract persists after the root-canal
C. The sinus tract should heal within a month of the root canal
D. The tooth should be treated with a root canal A. Antibiotics are indicated

a. Chronic Apical Abscesses present with sinus tracts that eventually drain into the oral cavity
although they may drain into the gingival sulcus (which may imitate a periodontal abscess)
b. Teeth with sinus tract do NOT require antibiotics because the infection drains
c. Apical periodontitis (acute or chronic) should be treated with root canal therapy.
d. If the tract does not heal within a month or so, root-end surgery should be performed
e. Teeth with chronic apical periodontitis may develop an epithelial lining and form a true
periodontal pocket if they are left untreated.
Which of the following material is typically used for the walking bleach technique?

A. 10% Phosphoric acid

B. 14% Carbamide peroxide
C. 2.6% Sodium Hypochlorite
D. 30% Carbamide peroxide
E. 30% Hydrogen peroxide
F. Sodium Perborate F. Sodium Perborate

1) Walking bleach technique

a. intracoronal bleaching technique which utilizes a mix of sodium perborate and anesthetic or
sterile water to create a paste to be sealed into the pulp chamber for 14-21 days
b. should be repeated as necessary until the desired tooth color is attained
c. used on teeth that have already undergone endodontic therapy and dose not lighten staining
due to previous amalgam placement
d. external root resorption may occur if the canal is NO obturated properly or if 30% hydrogen
peroxide (superoxol) is used.

2) Superoxol (30% hydrogen peroxide)

a. used for many years for internal bleaching
b. discontinued due to high incidence of external root resorption

3) Carbamide peroxide
a. used for vital tooth bleaching (external bleaching)
The prognosis for internal bleaching is best if the etiology of the stain is...
A. Necrotic pulp tissue
B. Precipitation of metallic salts
C. Silver-containing root canal sealers
D. Amalgam restorations A. Necrotic pulp tissue

1) Internal bleaching treatment

a. most effective among root canal treated tooth which have internal stains due to blood, necrotic
tissue, and fluids that could have leaked in prior to root canal therapy
b. placing peroxide directly into the pulp chamber of a root canal treated tooth
c. peroxide wil then directly work on the stains within the tooth structure

2) Staining from silver containing root canal sealers and from mercury of amalgam restorations
a. appear dark
b. seldom treated by bleaching
c. restorative treatments provide the most esthetic result because they remove or cover up these
stains
Each of the following statements about post preparations is CORRECT EXCEPT one. Which is
the EXCEPTION?

A. It is recommended that at least 5mm of gutta percha should remain in the root canal after the
post space is prepared
B. Posts are indicated when there is inadequate coronal tooth structure for fixed restorations
C. Posts reinforce the tooth structure and prevent vertical root fractures
D. Posts retain the core for teeth with extensive coronal tooth structure loss C. Posts
reinforce the tooth structure and prevent vertical root fractures

1) Posts
a. function of posts are to retain the core, they DO NOT reinforce the tooth
b. typically weaken the tooth because the removal of dentin causes stress and further thins the
walls of the root, predisposing the root to fracture
c. Rule of thumb for post preparation is that you prepared the canals so that 1/2 of the root has
gutta percha remaining (or about 5mm+)
Which of the following is the usual sequence for the amputation (resection) or a root for
periodontal reasons?

A. Periodontal therapy followed by observation

B. Root canal therapy followed by observation
C. Root canal therapy followed by periodontal therapy
D. Periodontal therapy followed by root canal therapy C. Root canal therapy followed by
periodontal therapy

1) Amputation (resection)
a. root canal system is exposed during root amputation and therefore must immediately undergo
root canal therapy to ensure that no bacteria will enter the canal system
b. resection of a root with a hopeless or questionable prognosis in its periodontal condition will
save the whole tooth from being extracted
c. periodontal therapy should follow immediately after root canal treatment is accomplished in
order to stop or prevent further periodontal damage
d. root amputation typically prolongs the life of the tooth by about 5 years on average
Each of the following is a reason for placing a post in the restoration of an endodontically treated
posterior tooth EXCEPT one. Which is the EXCEPTION?

A. To enhance the resistance of the restoration to lateral forces

B. To strengthen the root
C. To enhance the retention of the core B. To strengthen the root

1) Post
a. primary purpose or using a post in an endodontically treated tooth is to retain the core if there
is extensive loss of coronal tooth structure
b. enhance the resistance of the restoration to lateral forces depending on the amount of
remaining tooth structure, the length and rigidity of the post, presence of ferrule and the presence
of anti-rotation features
c. placement of posts inside the root canal does NOT strengthen the root tooth.
Post Treatment Evaluation Post Treatment Evaluation Answers
Most vertical root fractures of endodontically treated teeth result from which of the following?

A. Cementation of a cast post and core

B. Permanent cementing of crowns after treatment
C. Removal of temporary restorations on prepared teeth
D. Traumatic occlusion
E. Condensation forces during gutta percha filling E. Condensation forces during gutta percha
filling

1) Concept: Endodontically treated test are weaker and more prone to fracture when excessive
condensation forces is used during obturation.

2) The width of the prepared root canal compared to the remaining tooth structure also affects the
ability of the endodontically treated to withstand condensation forces.

3) During the condensation of the gutta percha, the force exerted during the compaction of the
gutta percha is transmitted back to the walls of the tooth.
A marked reduction in the size of a periodical radiolucency can be expected approximately how
long after a root canal procedure is completed?

A. 1 Month
B. 1 Year
C. 2 Weeks
D. 2 Years
E. 3 Months
F. 1 Week B. 1 Year
1) Concept: The continuous bone deposition increases the bone density along the periodical area
resulting in a diminished periodical lesion size after about a year.

2) The periodical bone regeneration usually occurs at a rate of about 1.2mm2 per month,
gradually reducing the size of the periodical lesion.

3) Bone deposition in the periodical area is not very evident radiographically until sufficient
thickness of bone is present.
An endodontically treated tooth was restored using a cast post-and-core with a porcelain fused to
metal crown. The patient complains of pain on biting 3 months after the restoration was
completed. Radiographs and mobility are normal. Which of the following is the most probable
reason the patient is feeling pain?

A. Loose crown
B. Open crown margin
C. Psychosomatic
D. Vertical root fracture
E. Premature contact D. Vertical root fracture

1) Concept: Endodontically treated teeth with cast post and core restorations that occlude under
heavy occlusal stress may end up with a vertical root fracture.

2) Cast post and core restorations are solid restorations that completely adapt into the canal
system.

3) Occlusal and shear forces encountered by the cast post-and-core is immediately transmitted to
the weakened endodontic tooth, resulting in a vertical root fracture.
True/False:

One objective of root-canal obturation is to create a fluid tight seal. Another objective is to create
an environment of healing to occur. Both statements are True

1) Concept: Obturation
a. is the step in root canal treatment that involves filling the root canal with a biocompatible
material to create a hermetic seal to prevent contamination caused by leakage either from the oral
cavity or periradicular tissues into the root canal.
b. seals the remaining irritants in the root canal system after proper cleaning and shaping of the
canal creates a conducive environment for the periodical healing to occur.
The treatment with the most favorable post treatment prognosis is a tooth with...

A. A history of avulsion that was replanted within one hour of avulsion

B. An area of limited internal resorption
C. External apical root resorption
D. External lateral root resorption
E. A vertical fracture that extends through the floor of the pulp chamber B. An area of limited
internal resorption

1) Concept: An area with limited internal root resorption provides a more favorable prognosis
because there is less irritation incurred to the pulp.

2) Vertical fractures are best manage with tooth extraction since the tooth will always have a
fracture line which weakens the tooth and exposes it to the harmful bacteria inside the mouth.

3) External lateral root resorption entails destruction of root surface of the tooth that my weaken
the root itself. Treatment external root resorption is also difficult to perform.
Which of the following describes when a clinician can reasonable expect a reduction in the size
of a periodical lesion to be radiographically evident following endodontic therapy?

A. 1-2 weeks
B. 1-2 months
C. 2-3 weeks
D. 6-12 months
E. > 1 year D. 6-12 months

1) Concepts: A clinician can expect bone to be redeposited in the apical area following the
removal of the infected tissues and obturation/swelling of the root canals.

2) When the lesion is healed, osteoblasts form a collagen matrix which is then calcified.

3) Calcification of the collagen matrix typically occurs within 6-12 months.

Each of the following is a possible result of a successful root canal treatment EXCEPT one.
Which is the EXCEPTION?

A. Formation of reparative dentin

B. Regeneration of alveolar bone
C. Regeneration of periodontal ligament
D. Apical seal A. Formation of reparative dentin

1) Concept: Formation of reparative dentin only occurs when the odontoblasts in the pulp are
still vital.

2) Reparative dentin is laid down by the odontoblasts in the pulp to protect the pulp and keep it
away from the harmful stimuli

3) Apical seal is the main objective of the root canal treatment in order to prevent bacterial
invasion of pulp canal and periodical tissues.
The duration of activity of diazepam depends chiefly on

A. Competitive inhibition from metabolites

B. Elimination of active drug
C. Tolerance to the drug
D. Systemic distribution of the drug B. Elimination of active drug

1) Duration of action for diazepam is due to the long half life of desmethyldiazepam, which may
last from 3 to 7 days.

2) Diazepam
a. fast acting agent with a long duration of action
b. lipid solutble
c. binds to proteins
c. widely distributed throughout the body
The clinical definition of alcohol abuse is when someone...

A. Drinks enough that it puts their relationships, job, or health in jeopardy

B. Experiences withdrawal symptoms when not drinking
C. get seriously intoxicated on a regular basis
D. Drinks more than the legal limit of alcohol A. Drinks enough that it puts their
relationships, job, or health in jeopardy

1) Alcohol Abuse
a. when your alcohol intake causes harm to yourself, to your social and interpersonal
relationships, and to your capability to perform your duties at work

b. Symptoms
1) Poor judgment
2) tipsiness
3) irritability
4) sleeping difficulties

c. Alcohol abuse if not prevented could lead to alcohol dependence

Supplementation of which of the following may be necessary when a patient is prescribed a
thiazide diuretic like hydrocholorothiazide (HCTZ)?

A. C-1
B. K+
C. Mg+2
D. Na+1
E. Ca+2 B. K+

1) Potassium (K) and hydrocholorothiazide are used in combination in order to reduce the
patient's blood pressure and prevent the occurrence of hypokalemia.

2) Hydrochlorothiazide administration causes the body to lose potassium, so hypokalemia often

occurs without supplementation.

3) Potassium
a. regulate intracellular osmoregulation
b. helps in reducing unneeded water and salt inside the body
Excretion of an acidic drug will be increased if which of the following is administered to the
patient?

A. Ammonium chloride
B. Mannitol
C. Sodium Chloride
D. Sodium bicarbonate
E. Aldosterone D. Sodium bicarbonate

1) Concept: Alkalinization of urine through the use of sodium bicarbonate decreases acid drug
reabsorption and increases renal excretion of the drug.

2) Concept: Acidic urine allows weak acids to be easily reabsorbed

3) If the drug is a weak base, making the urine more alkaline, it will help the drug be reabsorbed.

4) Excretion of drugs can be greatly affected by urinary pH.

Which of the following agents is prescribed to be administered orally to treat vaginal
candidiasis?

A. Fluconazole (Diflucan)
B. Griseofulvin (Grifulvin)
C. Miconazole (Monistat)
D. Nystatin (Mycostatin)
E. Clotrimazole Troche (Mycelex) A. Fluconazole (Diflucan)

1) Fluconazole
a. oral triazole used to treat and prevent superficial and systemic fungal infections by inhibiting
the fungal cytochrome P450 enzyme.
b. inhibition of P450 prevents the conversion of lanosterol to ergosterol, and essential component
of the fungal cytoplasmic membrane

2) Clotrimazole and miconazole

a. topical drugs

3) Griseofulvin
a. primarily used to treat hair and nail fungal infections
The most ideal class of drugs for oral sedation in the dental setting are:

A. Antihistamines
B. Benzodiazepines
C. Muscle relaxants
D. Opioids
E. Barbiturates B. Benzodiazepines
1) Benzodiazepines
a. popular anti anxiety drugs
b. produce anterograde amnesia so that patients does not remember any unpleasant feeling after
the surgical procedure is completed
The ration of an agents LD50 to ED50 provides information as to the drug's

A. Efficacy
B. Potency
C. Safety
D. Therapeutic application
E. Allergenicity C. Safety

1) Therapeutic Index = LD50/ED50

a. ratio of the dose of drug that causes lethal effect per the minimum dose of the drug that can
elicit a therapeutic effect
b. is important to check the margin of safety of using a certain drug
c. high therapeutic index value states that the drug is effective at a minimum dose and its lethal
effect at higher doses
d. low therapeutic index suggests that the drug has a narrow margin of safety
The early recovery of a patient from an ultra-short-acting barbiturate is primarily related to

A. Breakdown in the blood

B. Breakdown in the liver
C. Excretion in the urine
D. Redistribution
E. Binding to proteins in plasma D. Redistribution

1) Concept: Redistribution of ultra-short acting barbiturates into all body tissues explains the
rapid recovery time.

2) Barbiturates
a. eliminated from the bloodstream as they redistribute into body tissues
b. excess drug may also be stored within body fat
c. if the fat becomes saturated with too much barbiturate, the only way to eliminate this excess is
through drug metabolism
d. with slow metabolisms, barbiturates may stay longer in the body causing prolonged effects,
delayed anesthetic recovery, and a possibility of overdose
A 53-year-old male presents for multiple extractions and has been taking 10mg of prednisone
daily for colitis for the last 10 years. After consulting with the patient's physician, you should:

A. Change the patient to another steroid for the week before the surgery
B. Decrease the patient's dose of prednisone by half to 5 mg on the day of surgery
C. Discontinue the patient's steroid therapy preoperatively
D. Send the patient for serum prednisone levels
E. Ask the patient to continue taking the prednisone and consider temporarily increasing the dose
E. Ask the patient to continue taking the prednisone and consider temporarily increasing
the dose

1) Concept: If a patient taking steroids is going to have a surgery, go ahead and increase the dose

2) Intake of corticosteroid drugs like prednisone should not be terminated immediately.

a. patient should be advised by the physician to temporarily increase the doses he takes to help
him cope with the stress of surgery.
b. Sudden reaction of total absence of prednisone may induce a fatal crisis among patients who
take it regularly.
Which of the following local anesthetic functions as the MOST effective topical anesthetic?

A. Prilocaine
B. Bupivacaine
C. Lidocaine
D. Procaine
E. Articaine C. Lidocaine

1) Lidocaine
a. an effective topical anesthetic drug that can effectively numb the mucosal surfaces of the oral
cavity
b. lidocaine topical anesthetic can penetrate approximately 2-3mm deep into the mucosal layer
when applied properly.
General Principles General Principles Answers
Which of the following is NOT a biologic change that occurs with advancing age that affects the
pharcodyanmics and pharmacokinetic of pharmaceuticals?

A. Altered volume of distribution and sequestration of drug in body fat

B. Decreased rate of biotransformation
C. Decreased renal excretion
D. Increased half lives of some drugs
E. Increased plasma protein binding E. Increased plasma protein binding

1) As people age
a. decreased renal excretion occurs as people age, causing increased longevity inside the body for
agents that are renal excreted
b. some drugs may have increased half lives due to reduced functionality of organs metabolizing
the drug such as the liver as we age
c. a decreasing rate of biotransformation also occurs as we get older because if inadequate
production of enzymes that activate the drug.
Which of the following cannot be used to accurately calculate pediatric drug dosages?

A. Body weight (mg/kg)

B. Clark's rule
C. Vital signs
D. Body surface area C. Vital signs

1) Inaccurate pediatric dosage has been found to be the leading cause of medical problems in
children.

2) Calculation of pediatric dosage is often based on

a. age
b. body weight
c. body surface area
d. stage of development of the child

3) Two of the methods used in calculating the pediatric dosage are

Clark's Rule = Adult Dose * (weight in LBS/150) = Child's Dose

Young's Rule = Adult Dose * (Age / (Age +12)) = Child's Dose

The onset of action of a drug administered orally is principally determined by the rate of which
of the following?

A. Absorption
B. Biotransformation
C. Distribution
D. Excretion
E. Temperature A. Absorption

1) Concept: Absorption
a. major factor determining the onset of action of orally administered drugs.
b. intravenous drugs demonstrate rapid onset of action due to high absorption while oral drugs
have delayed onset of action due to their first pass metabolism.
c. Different routs of administration provide different absorption rates.

2) Onset of action
a. The onset of action of a drug varies depending upon the routs of administration in the body.
How many milliliters are in a tablespoon?

A. 10 mL
B. 15 mL
C. 20 mL
D. 25 mL
E. 5 mL B. 15 mL

1) Tablespoon
a. There are 15mL in a tablespoon
b. a tablespoon is the largest type of spoon in USA and some part of Canada
c. MOST COMMON function of a tablespoon is its use as a measure of volume in cooking and
dispensing of cough syrup to children
2) Teaspoon
a. 1 tablespoon is equal to 3 teaspoons
Which of the following rationales most accurately describes why high polarized pharmaceuticals
work more rapidly?

A. They are bound to albumin more extensively

B. They are less lipid soluble
C. They are less water soluble
D. They are metabolized more rapidly B. They are less lipid soluble

1) Low lipid solubility of highly polar medication makes them less permeable to cell membranes
and increase their absorption in the blood stream.

2) High absorption in the bloodstream increases their bioavailability and efficacy as well.
Which of the following is another term for the maximal or "ceiling" effect of drug?

A. Agonism
B. Duration
C. Efficacy
D. Potency
E. Specificity C. Efficacy

1) Concept: Efficacy
a. Efficacy is another ten used for the maximal or ceiling effect of a drug
b. Efficacy is the capacity of a drug to produce its pharmacology effect in the body
c. In other words, it is the maximum achievable result from a drug
What drug characteristic does the ration of the LD50 vs. ED50 indicate to someone?

A. Efficacy
B. Potency
C. Safety
D. Therapeutic application
E. Allergenicity C. Safety

1) Therapeutic Index
a. Therapeutic index is a ratio of the dose of a drug that causes lethal effect over the minimum
dose of the drug that can elicit a therapeutic effect or LD50/ED50
b. Therapeutic index is important to check the margin of safety of using a certain drug
c. High therapeutic index value states that the drug is effective at a minimum dose and its lethal
effect occurs at higher doses
d. Low therapeutic index suggests that the drug has a narrow margin of safety
The primary reason to use antibiotic disk sensitivity assay use is...

A. It allows for the prescriber to test common antibiotics to see which are effective against the
infection in question.
B. It allows the prescriber to know which meds will cause more GI upset by destroying normal
gut flora
C. The results can be determined within minutes
D. It can distinguish between bacteriostatic and bactericidal effects on the bacteria in question
A. It allows for the prescriber to test common antibiotics to see which are effective
against the infection in question.

1) Concept: Antibiotic disc sensitivity assay

a. The antibiotic disc sensitivity assay helps in guiding the physician in choosing the appropriate
antibiotic for a certain bacterial infection.
b. type of test conducted in a laboratory that examines the effect of several types of antibiotics
against bacterial strains. The effects are evaluated until the most effective antibiotic for a specific
bacteria is determined.
c. Having antibiotic disc sensitivity assay reduces the chance of prescribing the inappropriate
antibiotic and reduce the risk of prolonged untreated bacterial disease.
Penicillin Vk is eliminated the body...

A. excreted unchanged in urine

B. metabolized by liver and excreted in urine
C. metabolized in liver and secreted into fecal flow
D. Secreted unchanged into fecal flows B. metabolized by liver and excreted in urine

1) Concept: Penicillin Vk is an antibiotic metabolized in the liver to be excreted by the kidneys

into urine.

2) Penicillin Vk
a. Penicillin Vk is a chemically augmented form of penicillin that combines acid stability with an
immediate solubility and faster rate of absorption
b. highly effective against pneumococci, staphylococci except for strains producing penicilinase
and streptococci (groups A, C, G, H, L, and M)
c. Half-life is approximately 30-60 minutes and takes about 5 hours to clear the body entirely.
The endplate potential of neuromuscular junctions is established through...

A. An increase in the conductance of sodium, chloride, and potassium ions through the
postsynaptic membrane
B. Hydrolysis of acetylcholine
C. Increased movement of potassium ions in the postsynaptic membrane
D. Reduction of the resting potential at the postsynaptic area by acetylcholine D. Reduction
of the resting potential at the postsynaptic area by acetylcholine

1) Concept: End plate potentials (EPPS)

a. are the depolarizations of skeletal muscle fibers caused by neurotransmitters binding to the
postsynaptic membrane in the neuromuscular junction
b. when an action potential reaches the axon terminal of a motor neuron, vesicles carrying
neurotransmitters (mostly acetylcholine) are exocytosed and the contents are released into the
neuromuscular junction.
c. these neurotransmitters bind to receptors on the postsynaptic membrane and leads to its
depolarization
The substance ethanol...

A. It is partially absorbed in the stomach and part in the intestine

B. It stimulates the CNS
C. Is possesses anticholinergic effects
D. Is metabolized predominantly by the kidney A. It is partially absorbed in the stomach and
part in the intestine

1) Concept: Roughly 20% of ethanol absorption occurs in the stomach and 80% takes place in
the jejunum and ileum of the small intestine.

2) < 1% of ethanol is absorbed in the mouth.

3) Alcohol absorption occurs quicker with an empty stomach because the pyloric sphincter has
no food to hold inside the stomach allows the alcohol to pass through, absorbing in the small
intestines.
When ethanol is consumed while a patient is taking barbiturates, the resulting reaction is
considered...

A. Competitive inhibition
B. Non-competitive inhibition
C. Potentiation
D. Uncompetitive inhibition
E. Negative synergism C. Potentiation

1) Concept: Potentiation occurs when one drug administered simultaneously with another drug
interacts to produce a synergistic effect.

2) Barbiturates are drugs known to cause depression of the central nervous system (CNS). Due to
their ability to make people calm, relaxed, and sleepy, they are also termed as sedative-
hypnotics.

3) Alcohol, like the barbiturates also depress the central nervous system. When alcohol is given
in combination with barbiturates, further depression of CNS can occur which might lead to
unconsciousness or death.
Which property of Erythromycin (macrolide) explains its propensity for interaction with other
drugs?

A. It decreases metabolism of drugs that interact with cytochrome P-450

B. It decreases the intestinal absorption of many pharmaceuticals, causing toxic megacolon
C. It increases renal re-absorption of drugs
D. It increases the intestinal absorption of many pharmaceuticals
E. It decreases body-wide distribution of other pharmaceuticals A. It decreases metabolism of
drugs that interact with cytochrome P-450
1) Concept: Erythromycin tends to inhibit metabolism of drugs within the liver through
cytochrome P450 inactivation

2) Erythromycin
a. stops the enzymatic reaction for other drugs, making their metabolism in the liver slower,
leading to possible increased toxicity of other drugs.

3) Toxic megacolon
a. is a side effect of inflammatory bowel diseases like Crohn's disease and ulcerative colitis,
which prevents pharmaceutical absorption.
The euphoria experience from ethanol absorption into the bloodstream is caused by...

A. Decreased activity in the medullary synapses

B. Decreased inhibitory activity of the frontal cortex
C. Increased activity of the synapses in the hypothalamic nuclei
D. Increased activity of the synapses in the limbic system
E. Increased activity of the synapses in the thalamic nuclei B. Decreased inhibitory activity of
the frontal cortex

1) Concept: Decreased inhibitory activity of the frontal cortex

a. GABA and dopamine levels in the frontal cortex are affected when ethanol is found in the
bloodstream
b. The frontal cortex is primarily responsible for impulse control and inhibition.
c. Ethanol alters the response of both GABA and the dopamine receptors
d. Ethanol binds to the GABA increasing the receptor response, leading to a reduction in the
inhibition of socially unacceptable behaviors.
e. Ethanol increases the level of dopamine found near the dopamine receptor. Enhanced activity
of dopamine induces an intense feeling of pleasure, happiness, and self-confidence.
A state central nervous depression where a person may be aroused from sled[ may be produced
by which of the following drug types?

A. A hypnotic
B. A sedative
C. An anesthetic
D. An opiate A. A hypnotic

1) Concept: Hypnotic
a. Hypnotic drugs are psychoactive medications that are mainly used to induce sleep and are
often used to treat sleep disorders like insomnia as well as surgical anesthesia.
b. prolonged used of hypnotic drugs can cause some form of dependence or habit and therefore
their use met be limited for a very short period of time.
c. Benzodiazepines and non-benzodiazepine drugs are the most common hypnotic drugs present
in the market today.
Which of the following demonstrates an enteral means of administration?
A. Inhalation
B. Intramuscular (IM)
C. Oral
D. Subcutaneous
E. Submucosal C. Oral

1) Concept: Enteral administration of medication is performed through the oral route where the
medicine is expected to be absorbed in the stomach and intestine

2) Intramuscular
a. Intramuscular drug administration is performed by injecting the drug into the big muscles of
the body

3) Inhalation
a. Inhalation route of drug administration is performed through the inspiration of medication in
the form of gas.

4) Subcutaneous
a. Subcutaneous drug administration is achieved through injecting the drug along the fatty
subcutaneous layer under the skin

5) Submucosal
a. Submucosal route of drug administration is achieved by placing the drug under the tongue.
Metabolism of drugs will usually leads to a(an)...

A. less active compound

B. less ionized compound
C. More active compound
D. Totally inactive compound
E. Increased hydrophilicity of compound B. less ionized compound

1) Concept: During metabolism, drugs undergo several phases of biotransformation which could
lead them into becoming a less ionized compound.
a. The liver is the primary organ responsible for the biotransformation of drugs.
b. A drug is biotransform in the liver to make it water-soluble, making it easier to be excreted out
of the body.
c. Metabolism can make a drug less ionized, prolonging its effect in the body. A drug can
activate or inactivate drugs.
After a threshold stimulus, the cell membrane permeability becomes altered due to the release of
which of the following transmitter substances?

A. Acetylsalicylic acid
B. Cholinesterase
C. Hydroxycholine
D. Acetylcholine D. Acetylcholine
1) Concept: The cell membrane becomes more permeable with the release of acetylcholine

2) Acetylcholine
a. a chemical neurotransmitter that works both for the central nervous system and peripheral
nervous system of the human body
b. Acetylcholine attaches to the acetylcholine receptors and initiates the opening of the Na
channels within the cell membrane.
A physician may enhance the renal excretion of an acidic drug by administering...

A. Ammonium chloride
B. Mannitol
C. Sodium Chloride
D. Sodium bicarbonate
E. Aldosterone D. Sodium bicarbonate

1) Concept: Alkalinization of urine through the use of sodium bicarbonate decreases acid drug
reabsorption and increases renal excretion of the drug.

2) Acidic urine allows weak acid drugs to be easily reabsorbed

3) If the drug is a weak base, making the urine more alkaline will help the drug be reabsorbed.

4) Excretion of drugs can be greatly affected by urinary pH.

Which of the following characterizes the therapeutic index (T.I.) of pharmaceutical agents?

A. ED1/LD99
B. ED50/LD50
C. LD50/ED50
D. LD99/ED1
E. LD99/LD50 C. LD50/ED50

1) Concept: Therapeutic Indexis a numerical comparison of a drug's therapeutic effect over its
toxic or lethal side effect

2) Therapeutic Index
a. measured by dividing the drug's lethal dose or the dose in which it produces toxic effects over
its minimum effective dose.
b. drugs having a low therapeutic index provides a narrow margin of safety which means, the
drug may pose a great risk as compared to its medical value.
When ingested, isopropyl alcohol is metabolized mostly into...

A. Acetaldehyde
B. Ethanol
C. Formaldehyde
D. Methanol
E. Acetone E. Acetone
1) Concept: Isopropyl alcohol is oxidized in the liver by the alcohol dehydrogenase into acetone
--> acetate --> formate --> C02

2) Formation of acetone contributes the CNS depression experience in isopropyl alcohol

poisoning

3) 20-50% of absorbed isopropyl alcohol is excreted/unchanged

When writing a prescription, which of the following do you NOT include?

A. Inscription
B. Subscription
C. Superscription
D. Transcription
E. Conscription E. Conscription

1) Concept: A typical prescription includes prescriber information, patient information,

superscription, inscription, subscription, transcription, renewal, and signature.

2) Superscription
a. includes the Rx symbol

3) Inscription
a. contains the name of the drug, quantity, and dosage form

4) Subscription
a. includes the guidelines to be followed by the pharmacist regarding the preparation and
distribution of the medication

5) Transcription
a. is the information regarding the intake of the medication (i.e. how, how much, when, and how
often).
Which blood alcohol content is closest to the LD50 (dosage at which 50% of the population
experiences death) of ethanol?

A. 0.1%
B. 0.2%
C. 0.3%
D. 0.5%
E. 0.08% D. 0.5%

1) Lethal dose fifty (LD50) is the concentration of a substance where half of the experimental
population will die if the substance is consumed.

2) LD50
a. is reached when the alcohol concentration in the bloodstream reach 0.4 to 0.5%
b. LD50 is often used to measure the level of toxicity
c. Variation in LD50 maybe influenced by genetic factors, environmental factors, and mode of
administration
The most medically accepted definition of alcohol abuse is when someone...

A. Becomes intoxicated on a regular basis

B. Consumes alcohol enough that it puts their relationships, job, or health in jeopardy
C. Experiences symptoms of withdrawal when alcohol is not ingested
D. Ingest enough alcohol to raise their blood alcohol content (BAC) over the legal limit B.
Consumes alcohol enough that it puts their relationships, job, or health in jeopardy

1) Concept: Alcohol Abuse

a. Alcohol abuse is defined as when your alcohol intake causes harm to yourself, to your social
and interpersonal relationships, and to your capability to perform your duties at work.
b. Alcohol abuse manifests differently as both acute and chronic effects on the central nervous
system which includes poor judgement, tipsiness, irritability, and sleeping difficulties.
c. Alcohol abuse if not prevented could lead to alcohol dependence.
Which of the following molecules is derived from the unsaturated fatty acids in cell membranes?

A. Endorphins
B. Histamine
C. Prostaglandins
D. Serotonin
E. Bradykinin C. Prostaglandins

1) Concept: Prostaglandins
a. Prostaglandins are lipid molecules that are enzymatically derived from arachadonic acid

2) Endorphins
a. are neurotransmitters that are endogenously formed morphine from the opioid peptides in the
body

3) Bradykinin
a. protein peptide that belongs with the kinin group

4) Enterochromaffin cells are the ones that secrete Serotonin

5) Histamine
a. produced by mast cells and basophils as an immunologic response to a foreign body that enters
our body
The drug administration method that is characterized by slowed absorption is...

A. Intramuscular (IM)
B. Intravenous (IV)
C. Subcutaneous
D. Sublingual
E. Oral E. Oral

1) Concept: Oral administration has the slowest absorption rate because it follows a long
digestive path prior to being absorbed into the body

2) Intravenous
a. drugs are immediately distributed when they are administered intravenously
b. effect is rapid since the drug is placed directly into the bloodstream

3) Intramuscular
a. administered into the voluntary muscle which provides faster absorption than oral and
subcutaneous routes

4) Subcutaneous
a. performed by inserting the drug under the skin where it will be absorb in a slow manner, thus,
prolonging its action in the body

Order (fastest to slowest)

Intravenous > Intramuscular > Subcutaneous > Oral
Ethanol ingestion results in all of the following EXCEPT one. Which is the EXCEPTION?

A. Decreased gastric acid secretion

B. Diuresis
C. Enzyme induction
D. Pupil dilation
E. CNS depression D. Pupil dilation

1) Concept: Ethanol ingestion causes pupil constriction NOT pupil dilation

2) Pupil constriction
a. occurs when the sphincter pupillage muscles elicit a delayed reaction to stimuli due to the
depression of the sympathetic nervous system brought about by excessive consumption of
ethanol
b. Ethanol consumption makes a person less responsive to its surroundings as it alters the senses.
A person under the influence of ethanol experiences CNS depression and diuresis.
Cephalosporins are MOST CONTRAINDICATED for patient that exhibit which of the
following reaction to penicillin antibiotics?

A. Delayed-type hypersensitivity reactions

B. Immediate-type hypersensitivity reactions
C. Nausea and vomiting
D. Any reactions to penicillins B. Immediate-type hypersensitivity reactions

1) Concept: Patients experiencing penicillin allergy also have a tendency to elicit a cross allergic
reactions with cephalosporin drugs.
2) Immediate hypersensitivity (Type I hypersensitivity reaction):
a. is a type of rapidly acting allergic response of the body over a certain kind of allergen
b. may result to severe systemic reactions like anaphylaxis which can cause difficulty of
breathing and death
c. administration of epinephrine and antihistamines may help slow down and present this allergic
reaction
Each of the following statements regarding biotransformation of drugs is true EXCEPT for one.
Which is the EXCEPTION?

A. It generally involves modifications of the chemical structure of the drug

B. It principally occurs in the microsomal enzyme system of the liver
C. It usually converts a drug into its lipid-soluble, non-ionized form
D. The rate may vary significantly between species C. It usually converts a drug into its lipid-
soluble, non-ionized form

1) Concept: Biotransformation
a. Biotransformation involves the conversion of a lipid soluble non-ionized form of a drug into
its more water soluble metabolites
b. Biotransformation increases the absorption of drug into the blood stream, making the
bioavailability of drug is enhanced. Water soluble drugs are also easily excreted in urine.
Which of the following describes the chemical bond type that is LEAST PROBABLE to be
involved in drug-receptor interactions?

A. Covalent
B. Dipole-dipole
C. Electrostatic
D. Hydrogen
E. Van der Waal's forces A. Covalent

1) Concept: Covalent bonds

a. Covalent bonds are NOT commonly used in drug-receptor interactions due to their almost
irreversible nature of bonding.
b. Covalent bonds are very tight and practically irreversible.
c. Covalent bond formation is a rare occurrence in drug-receptor interactions.

2) Drug-receptor interactions
a. are normally considered reversible in nature
Central Nervous System Central Nervous System Answers
Which of the following drugs is most likely to induce convulsions if a physically dependent
patient discontinue their use?

A. Meperidine
B. Pentobarbital
C. Phenytoin
D. Diazepam B. Pentobarbital
1) Concept: The sudden withdrawal of pentobarbital use may cause convulsions in patients who
are physically dependent.

2) Pentobarbital
a. is a short acting barbiturate, or CNS depressant.
b. withdrawal symptoms may be treated by administering another type of drug with a similar
effect as pentobarbital

3) Medical detoxification
a. when the substitute drug to treat the withdrawal symptoms does not have addictive properties
like pentobarbital
Antipsychotic drugs can induce extrapyramidal syndrome because of their effect on the...

A. Basal ganglia
B. Cerebellum
C. Cerebral Cortex
D. Hypothalamus
E. Lateral gyrus A. Basal ganglia

1) Concept: Antipsychotic drugs are known to cause side effects like extrapyramidal syndrome
as they affect the basal ganglia of the brain.

2) The basal ganglia functions during normal voluntary movement. Damage of the basal ganglia
can cause either excessive movement or slowly diminished movement

3) Extrapyramidal syndrome is suggested by the occurrence of involuntary muscle movement

that usually occurs when there is incorrect regulation of dopamine release and reuptake in the
brain.
Which of the following describes the central mechanism of action in a patient being treated for
Parkinson's disease with levodopa?

A. It acts through a direct serotonergic activity

B. It increases concentrations of norepinephrine
C. It replenishes insufficient dopamine levels
D. It stimulates specific L-dopa receptors C. It replenishes insufficient dopamine levels

1) Concept: Levodopa
a. Levodopa is an agent administered to patients to be converted by the body into dopamine to
maintain dopamine levels in the brain.
b. Levodopa has no ability to cure Parkinson's, but functions to delay it's effects and enable the
patient to live and function normally for a period of time
c. Levodopa is the most popular and effective drug for alleviating the symptoms elicited by
patients with Parkinson's disease
d. It improves the patient's control of muscle and balance while also reducing the quantity of
tremors experienced by the patient
Administration of which of the following drugs will result in the LEAST psychomotor
impairment and central nervous system depression?

A. Alprazolam
B. Buspirone
C. Chloral hydrate*
D. Diazepam*
E. Propofol B. Buspirone

1) Concept: Buspirone apart from other sedative hypnotic drugs is used to alleviate anxiety does
NOT cause depression of the central nervous system.

2) Buspirone
a. does NOT impair cognitive and motor coordination as observed from other anxiolytic drugs
b. It also does NOT cause physical dependence and any form of withdrawal syndrome
c. is an anti anxiety drug that is used primarily in generalized anxiety disorder. However this
drug is NOT known to be effective in controlling panic disorders.
What factor it the most likely cause for an early recovery from an ultra-short acting barbiturate in
a patient undergoing surgery?

A. Breakdown in the blood

B. Breakdown in the liver
C. Excretion in the urine
D. Redistribution
E. Binding to proteins in plasma D. Redistribution

1) Concept: The redistribution of ultra-short acting barbiturates into all body tissues explains the
rapid recovery time.

2) Barbiturates
a. are eliminated from the bloodstream as they redistribute into body tissues. The excess drug
may also be stored within body fat.
b. If the fat becomes saturated with too much barbiturate, the only way to eliminate this excess is
through drug metabolism.
c. With slow metabolisms, barbiturates may stay longer in the body causing prolonged effects,
delayed anesthetic recovery, and a possibility for overdose
Phenytoin is indicated for treatment of epilepsy and...

A. Antisocial personality disorder

B. Cardiac arrythmia
C. Dissociative identity disorder
D. Schizophrenia
E. Narcolepsy B. Cardiac arrythmia

1) Concept: Phenytoin is commonly prescribed as anticonvulsant and has an antiarrythmic effect

2) Phenytoin
a. decreases the activity of the motor cortex thereby controlling seizures
b. can treat cardiac arrythmias secondary to digitalis intoxication but can't treat arrhythmias
related with cardiac diseases.
Which of the following drug classes is known to produce a neurological side effect known as tar
dive dyskinesia?

A. Barbiturates
B. Monoamine oxidase inhibitors
C. Phenothiazine antipsychotics
D. Tricyclic antidepressants
E. Macrolides C. Phenothiazine antipsychotics

1) Concept: Tardive dyskinesia is a condition were the patient exhibits slow involuntary and
repetitive muscle movements.

2) Tardive dyskinesia is a condition were the patient exhibits slow involuntary and repetitive
muscle movements.
a. results from neuroleptic-induced dopamine super sensitivity in the nigrostriatal pathway, with
the D2 dopamine receptor being most affected.

3) Neuroleptics
a. act primarily on this dopamine system, and older generations of neuroleptics like
phenothiazine antipsychotics have greater affinity for the D2 binding site, and are associated
with a high risk for developing tardive dyskinesia
Administration of which of the following drugs is indicated to treat a grand map seizure.

A. Chlorpromazine (Thorazine)
B. Ethosuximide (Zarontin)
C. Phenytoin (Dilantin)
D. Thioridazine (Mellaril)
E. Trimethadione (Tridione) C. Phenytoin (Dilantin)

1) Concept: Phenytoin is the drug most indicated in managing grand mal seizures

2) Phenytoin
a. reduces the brain stem's unusual activity involved in causing the tonic stage of a tonic-clonic
or gran map seizure
b. stabilizes the brain activity and prevent hyper excitability that occurs due to over stimulation
and environmental stimuli that reduces the membrane sodium gradient
Which opioid analgesic can create a serious life threatening adverse drug reaction when given to
a patient on monamine oxidase inhibitors (MAOI)?

A. Fentanyl
B. Meperidine
C. Morphine
D. Propoxyphene
E. Codeine B. Meperidine

1) Concept: Meperidine when combined with a MAO inhibitor drug can cause life threatening
effects
a. These effects are hyperpyrexia, too much sweating, excitement, and respiratory depression
which can lead to unconsciousness
b. Meperidine is a drug that helps to control the amount of serotonin and dopamine in the blood.
Excessive amounts of these substances may cause hypertensive crisis.

c. Administration of substances that increase serotonin, norepinephrine, or dopamine activity can

result in severe acute consequences, including serotonin syndrome, hypertensive crisis, and
psychosis, respectively.
Which of the following is NOT produced by the administration of phenothiazines?

A. Alpha-adrenergic blockade
B. Anticonvulsant effect
C. Antiemetic effect
D. Potentiation of the action of narcotics
E. Sedation B. Anticonvulsant effect

1) Concept: Phenothiazine
a. as a drug DOES NOT function as an anticonvulsant.
b. it is present in several antihistamine and antipsychotic medications
c. is an antipsychotic that also has demonstrates antiemetic and sedation properties
d. known to have sedative effects like prochlorperazine and chlorpromazine, are used in treating
migraines and headaches in emergency rooms.
Which opioid analgesic can create a serious life threatening adverse drug reaction when given to
a patient on a monamine oxidase inhibitor (MAOI)?

A. Fentanyl
B. Meperidine
C. Morphine
D. Propoxyphene
E. Codeine B. Meperidine

1) Concept: Meperidine
a. when combined with a MAOI can cause life threatening effects
b. Among these effects are fever, too much sweating, nervous system excitability, and
respiratory depression, which can lead to unconsciousness
c. Meperidine is a drug that helps to control the amount of serotonin and dopamine in the blood.
Excessive amounts of these substances may cause hypertensive crisis.

c. Substances that increase serotonin, norepinephrine, or dopamine activity can result in severe
acute consequences, including serotonin syndrome, hypertensive crisis, and psychosis.
Which of the following drug class is the currently the first line treatment of depression?
A. Amphetamines
B. Monamineoxidease Inhibitors (MAOIs)
C. Phenothiazines
D. Selective Serotonin Reuptake Inhibitors (SSRIs) *
E. Tricyclic anti-depressants (TCAs) * D. Selective Serotonin Reuptake Inhibitors (SSRIs)

1) Concept: Serotonin is a neurotransmitter that intensifies or reduces the degree of happiness or

well being of a person

2) SSRI or Selective Serotonin Reuptake Inhibitors increase the serotonin levels extracellularly
by not allowing its reuptake on the presynaptic cleft.

3) Through the increased amount of serotonin level in the synaptic cleft, more serotonin are able
to bind with the postsynaptic end thereby prolonging its effect.

4) The changes in serotonin level thus affect the degree of depression.

For a pediatric patient being treated for seizures, discontinued used of which of the following
drugs may induce spontaneous gingival hemorrhage and/or acute stomatitis?

A. Carbamazipine
B. Hydrochlorothiazide
C. Phenytoin
D. Vanlafaxine
E. Valproic Acid E. Valproic Acid

1) Concept: Valproic acid is use to treat seizures and abruptly stopping its use will increase the
risk of bleeding, hemorrhage complicating hemostasis.

2) Thrombocytopenia
a. may develop in patients taking valproic acid because it inhibits the secondary phase of platelet
aggregation and causes abnormal coagulation.

3) Patients should be advised slowly and decrease their dose over 2 weeks and not to stop
valproic abruptly.

4) Platelet count should be monitored in patients taking valproic acid.

5) Presence of hemorrhage, bruising, hemostatic disorder are indications that valproic acid
should be withdrawn or the disease should be reduced.
Administration of which of the following drugs will result in LEAST psychomotor impairment
and central nervous depression?

A. Alprazolam
B. Buspirone
C. Chloral hydrate
D. Diazepam
E. Propofol B. Buspirone

1) Concept: Buspirone
a. a sedative hypnotic drugs use to alleviate anxiety that does NOT cause depression of the
central nervous system
b. does NOT impair cognitive and motor coordination as observed from other anxiolytic drugs
c. it also does NOT cause physical dependence and any form of withdrawal symptoms
d. is an anti anxiety drug that is used primarily in generalized anxiety disorder. However, this
drug is not known to be effective in controlling panic disorder.
The blood-brain barrier is most easily penetrated by which of the following barbiturates?

A. Barbital
B. Pentobarbital
C. Phenobarbital
D. Secobarbital
E. Thiopental E. Thiopental

1) Concept: Thiopental easily crosses the blood brain barrier because it is lipophilic.

2) Thiopental:
a. short acting drug that has a rapid onset of effect
b. it is a lipid soluble drug that is usually redistributed to muscles and fat as it moves away from
the central circulation
c. previously used for the general anesthesia induction phase but proposal is now used in its
place
d. known to induce medical comas and it was used as a drug for lethal injection along with other
medications
Why is phenytoin indicated over phenobarbital for grand mal seizures?

A. Phenytoin does not cause as much gastrointestinal upset

B. Phenytoin has a longer half life
C. Phenytoin has less of a sedative effect
D. Phenytoin is more effective for prevention seizures C. Phenytoin has less of a sedative
effect

1) Concept: Phenytoin has a less sedative effect as compared to phenobarbital.

2) Phenobarbital
a. an effective anticonvulsant but has a longer half-life is stored within body fat in an accidental
overdose
b. main side effect is drowsiness and is associated with over dosage. It also has a tendency to
cause medullary depression that could endanger the patient's life.
All of the following drugs achieve skeletal muscle relaxant through depressing he polysynaptic
reflex arc except...
A. D-tubocurarine (Tubarine)
B. Diazepam (Valium)
C. Lorazapam (Ativan)
D. Meprobomate (Equanil) A. D-tubocurarine (Tubarine)

1) Concept: D-Tubocurarine is an alkaloid used as an adjunctive drug in anesthesia by relaxing

skeletal muscles during surgery or during intubation.

2) D-Tubocurarine
a. used as an agent in diagnosing myasthenia gravis
b. its use harbors many disadvantages including a ver slow onset of action and an unnecessary
prolonged drug duration of about one to two hours
The drug-receptor activity of naloxone is BEST CHARACTERIZED by which of the following
pairs?

A. High affinity, High intrinsic activity

B. High affinity, No intrinsic activity
C. Low affinity, High intrinsic activity
D. Low affinity, High intrinsic activity
E. No affinity, High intrinsic activity
F. No affinity, Low intrinsic activity B. High affinity, No intrinsic activity

1) Concept: Naloxone exhibits an extremely high affinity for mu-opioid receptors present in the
central nervous system and negative intrinsic activity.

2) Naloxone
a. mu-opioid receptor competitive antagonist that causes rapid blockage of mu-opioid receptors,
producing rapid onset of withdrawal symptoms
Which of the following is NOT an advantage of midazolam (Versed) over diazepam (Valium)?

A. Decreased potential for respiratory depression

B. Decreased probability of thrombophlebitis
C. No significant active metabolites
D. Shorter elimination half-life
E. More rapid and predictable onset when administered intramuscularly E. More rapid and
predictable onset when administered intramuscularly

1) Concept: Midazolam (Versed)

a. short-acting benzodiazepine that is used to treat acute seizures, moderate to severe insomnia,
and for inducing sedation and amnesia before medical procedures
b. it possesses profoundly potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle
relaxant, and sedative properties
c. fast recovery time and is the most commonly used benzodidazepine for sedation and is used
less commonly for induction and maintenance of anesthesia
d. is superior to diazepam in impairing memory of surgical procedures, but proposal has a
quicker recovery time and a better memory-impairing effect
e. more predictable onset when administered intravenously

2) Flumazenil
a. benzodiazepine antagonist drug that can be used to treat an overdose of midazolam, as well as
to reverse sedation.
Pain experience from tic douloureux (trigeminal neuralgia) is best managed with which of the
following pharmaceutical agents?

A. Carbamazepine
B. Hydrocortisone
C. Ibuprofen
D. Oxycodone
E. Acetylsalicylic acid A. Carbamazepine

1) Concept: Trigeminal neuralgia (tic doloreux) is most commonly treated through the
prescription of anticonvulsant drugs like carbamazepine.

2) Carbamazepine
a. proven to be effective in reducing the pain caused by tic dolorous
b. dosage administered is usually very low but will gradually increase until the dosage becomes
sufficient to completely control the pain without causing side effects.
c. same effective dose is continued for the next two weeks until the drug dose is slowly reduced
back to minimal dose while providing the same effect.
Which of the following pharmaceuticals is known to reverse the effects of benzodiazepines?

A. Aminophylline
B. Flumazenil
C. Midazolam
D. Naloxone
E. Physostigmine B. Flumazenil

1) Concept: Flumazenil: benaodiazepine receptor antagonist available for injection exclusively

that reverses the effects of benzodiazepines by competitive inhibition of the benzodiazepine
binding site on the GABA receptor.

2) Aminophylline
a. is a bronchodilator that is a nonselective adenosine receptor antagonist and phosphodiesterase
inhibitor capable of reversing ischemia-induced bradyasystole.

3) Midazolam
a. short-acting benzodiazepine
b. used to treat seizures, moderate to severe insomnia, and for inducing sedation and amnesia
before medical procedures

4) Naloxone
a. opioid inverse agonist used to counter the effects of opiate overdose specifically used to
counteract life-threatening depression of the central nervous system and respiratory system

5) Physiostigmine
a. parasympathomimetic alkaloid that acts as a reversible cholinesterase inhibitor
For oral sedation by a dentist, the most favored class of drugs are...

A. Antihistamines
B. Benzodiazepines
C. Muscle relaxants
D. Opioids
E. Barbiturates B. Benzodiazepines

1) Concept: Benzodiazepines are a class of drugs that can help alleviate anxiety in patients
during dental surgery.

2) Benzodiazepines
a. popular anti-anxiety drugs used in the dental surgical field due to their effectiveness in
calming an anxious patient as well as its ability to produce anterograde amnesia so that patients
does not remember any unpleasant feeling after the surgical procedure is completed.
b. effectiveness of these drugs can be chased since it has short acting, intermediate acting and
long acting type that may suit the length of dental procedure
The duration of action for diazepam is directly related to...

A. Competitive inhibition from metabolites

B. Elimination of active drug
C. Tolerance to the drug
D. Systemic redistribution of the drug B. Elimination of active drug

1) Concept: Diazepam
a. duration of action of diazepam is due to the long half life of its main active metabolite known
as desmethyldiazepam, which may last from 3 to 7 days.
b. fast acting agent with a long duration of action. It is lipid-soluble, binds to protein, and is
widely distributed throughout the body after administration.
c. has a long duration of action, this drug is available in low doses to prevent drug accumulation
and an unnecessarily prolonged effect
Why does Levodopa (L-dopa) therapy diminish in effectiveness over time in the treatment of
patients suffering from Parkinsons' disease?

A. Cell loss in the Substantia nigra portion of the brain is continuous and progressive over time
B. Dopadecarboxylase activity increases with age.
C. Dopamine receptors are down-regulated over time with the presence of excess dopamine from
L-dopa
D. Patients develop a tolerance to L-dopa over time due to induction of metabolic enzymes in the
liver A. Cell loss in the Substantia nigra portion of the brain is continuous and progressive
over time
1) Concept: Parkinson's disease signs increase over time with Levodopa use because of an
increase in severity of the disease, not a decrease in effectiveness of the drug.

2) Levodopa
a. delayed the occurrence of the symptoms of Parinson's disease
b. provides patients with Parkinson's disease a longer moment of time to live a normal life
c. only has a certain degree in diminishing Parkinson's disease symptoms but it cannot cure the
disease nor stop its progression.
The muscle relaxation experienced by drugs under diazepam has a similar mechanism of action
to which other drug?

A. Gallimine
B. Ketamine
C. Meprobamate
D. Succinylcholine C. Meprobamate

1) Concept: Meprobamate and diazepam are both anxiolytic and hypnotic agents.

2) Meprobamate
a. barbiturate subgroup and is a non-selective central nervous system (CNS) depressant that can
induce surgical anesthesia

3) Diazepam
a. benzodiazepine and is a selective neuronal depressant
b. have replaced barbiturates due to their non-selective effect on CNS and high potential for
addiction

4) Benzodiazepines and Barbiturates

a. Both drugs potentiate gamma-aminobutyric acid (GABA), the neurotransmitter responsible for
inhibition
b. Barbiturates potentiate GABA by increasing chloride conductance
c. Benzodiazepines potentiate GABA by increasing the synaptic inhibition efficiency of GABA
Autonomic Autonomic Answers
Which of the following signs/symptoms is not associated with typical poisoning by
organophsophate pesticides?

A. Hyperlacrimation
B. Hypersalivation
C. Rash *
D. Skeletal muscle fasciculation *
E. Diarrhea C. Rash

1) Concept: Organophosphate poisoning causes several types of signs and symptoms which
occurred due to the excessive amount of acetylcholine along the different receptors and nerve
fibers within the body.
2) Excessive amounts of acetylcholine (ACh) is brought about by the blockage of
acetylcholinesterase.

3) The nicotinic expression becomes overstimulated due to the increased ACh along the motor
nerves causing muscle cramps, fatigue, fasciculation, muscle weakness and paralysis.

4) The muscarinic receptor are also affected by organophosphate poisoning.

5) Organophosphate Poisoning Effects by Muscarinic Receptors (MUDGELS)

M: Miosis
U: Urination
D: Defecation
G: Gastrointestinal Motility
E: Emesis
L: Lacrimation
S: Salivation
The first line treatment indicated to reverse tricyclic anti-depressant overdose is...

A. Amphetamine salts
B. Atropine
C. Carbemazipine *
D. Dopamine *
E. Physostigmine E. Physostigmine

1) Concept: Physostigmine is a reversible cholinesterase inhibitor able to reverse the effect of

tricyclic antidepressant overdose in 5-20 minutes.

2) Tricyclic anti-depressants (TCA) drugs enhance the anticholinergic activity of the body.

3) Physostigmine is also used to treat atropine overdose, myasthenia gravis, and glaucoma.
Coadministration of which of the following agents is necessary to block the cardiovascular
effects of accidental administration of a sympathomimetic drug?

A. Atropine and prazosin *

B. Atropine and propranolol
C. Phenobarbatal and succinylcholine
D. Propranolol and prazosin *
E. Amphetamine and propranolol D. Propranolol and prazosin

1) Concept: Sympathomimetic drugs

a. are vasoconstrictive in nature
b. increase the blood pressure
c. increase the heart rate
d. increase the force contraction of the heart
2) To manage the accidental administration of a sympathomimetic drug, a therapeutic
combination of systemic vasodilators and diuretics is considered ideal.

3) Propranolol (a beta blocker) and prazosin (alpha blocker) when administered together create
vasodilation and blocks the cardiovascular actions of the sympathomimetic drug.
Which of the following drug classes contains amphetamines, ephedrine, and tyramine?

A. Direct-acting parasympathomimetics *
B. Indirect sympathomimetics *
C. Irreversible anticholinesterases
D. Reversible anticholinesterases
E. Alpha-adrenergic blocking agents B. Indirect sympathomimetics

1) Concept: Sympathomimetic drugs like ephedrine, amphetamine, and cocaine work by

blocking the norepinephrine transporter, inhibiting the release of norepinephrine.

2) Indirect acting sympathomimetic drugs like the MAOIs, reuptake inhibitors, and released
stimulants can increase the amount of endogenous catecholamines in the body.

3) These drugs have been used to treat low blood pressure, cardiac arrest, and delaying
premature labor.
Atropine is able to

A. Decrease heart rate *

B. Relieve ptosis in myasthenia gravis patients *
C. Stimulate Mu receptors
D. Stimulate sweat and saliva secretion B. Relieve ptosis in myasthenia gravis patients

1) Concept = Atropine is a muscarinic blocker = so anti-cholinergic or anti-SLUDS or anti

parasympathetic = sympathetic

2) Atropine
a. competitive inhibitor of muscarinic receptors M1-M5.
b. causes

1) Pupil dilation by paralysis of the ciliary muscle, preventing lens accommodation

2) Prevents action of acetylcohline on muscarinic receptors M1-M5, causing an Increase in
sinoatrial (SA) node output and an increase in heart rate.

3) Myasthenia Gravis
a. autoimmune neuromuscular disease that leads to fluctuating muscle weakness and fatigability.
The symptoms are caused by circulating antibodies that block acetylcholine receptors at the
postsynaptic neuromuscular junction which inhibits of the excitatory effects of the
neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junction.
An overdose of cholinergic agents can create each of the following condition EXCEPT one.
Which condition is the EXCEPTION?
A. Bradycardia
B. Hypersalivation
C. Mydriasis *
D. Polydipsia
E. Diaphoresis C. Mydriasis

1) Concept: Cholinergic = SLUDS = Parsympathetic

2) Mydriasis is a sympathetic reaction of the pupil, causing it to dilate and allow more light to
pass through the eye.

3) In a cholinergic reaction, the parasympathetic nervous system is stimulated, causing increase

in the amount of normal secretions like saliva, tears and acids in the stomach.

4) Cholinergic effect can also cause a slow heart beat or low heart beat rate also known as
bradycardia.
DFP and organophosphate pesticide function through

A. Blocking nicotinic receptors

B. Blocking muscarinic receptors
C. Competitively inhibiting cholinesterases
D. Non-competitively inhibiting cholinesterases D. Non-competitively inhibiting
cholinesterases

1) Concept: DFP and organophosphate allow Cholinergic reactions to occur so must inhibit
cholinesterase

2) Cholinesterases are substances that allow for the breakdown of acetylcholine when in the
body, stopping the acetylcholine from sending electrical impulses and therefore regulates
movement of the body.

3) With the presence of a cholinesterase inhibitor such as DFP and organophosphate,

acetylcholine is not broken down resulting to acetylcholine build up.

4) This causes an uncontrollable and continuous firing of electrical impulses that results to
uncontrollable muscle twitching. Severe cases cold lead to inability to breathe due to muscle
paralysis and even death.
Sweat glands are innervated in which of the following innervation types?

A. Parasympathetic - adrenergic
B. Parasympathetic - cholinergic
C. Sympathetic - adrenergic
D. Sympathetic - cholinergic
E. Adrenergic - cholinergic D. Sympathetic - cholinergic
1) Sweat glands are classified as either eccrine and apocrine glands.

2) Eccrine sweat glands are coiled and unbranched glands that serve in thermoregulation and
function to cool down the body through the evaporation of sweat. They are innervated by the
cholinergic nerve fibers.

3) Apocrine glands secrete oily compounds that act as pheromones and also sweat when they are
stimulated by adrenaline.
Which of the following physiologic effects can occur after administration of a cholinomimetic
drug?

A. Decreased gastrointestinal peristalsis

B. Increased force of myocardial contraction
C. Increased salivation *
D. Peripheral vasoconstriction
E. Decreased gastric secretions C. Increased salivation

1) Cholinomimetic = Cholinergic = Parasympathetic = SLUDS

2) Stimulation of nicotinic and/or muscarinic receptors can initiate and increase salivation

3) Cholinomimetic drugs are designed to directly or indirectly inhibit acetylcholinesterase.

4) Cholinomimetic drugs are similar in action to acetylcholine an can cause stimulation of the
nicotinic acid and muscarinic receptors.
Succinylchline inhibits neuromuscular transmission through which of the following means?

A. Depolarizing the motor endplates of skeletal muscle

B. Inducing the release of cholinesterase at endplates
C. Inhibiting cholinesterase activity
D. Inhibiting release of acetylcholine at the endplates A. Depolarizing the motor endplates
of skeletal muscle

1) Concept: Succinylcholine is a depolarizing neuromuscular blocking drug that causes

depolarization along the motor endplate.

2) Phase I
a. Succinylcholine acts like acetylcholine because it binds to the ACh receptor and causes
muscular twitches or contractions during Phase I.

3) Phase II
a. In Phase II, due to the repetitive excitation and depolarization, the motor end plates become
resistant to acetylcholine activation

4) The resistance of motor end plates from acetylcholine activation prevents neuromuscular
transmission and thus, prevents muscle contraction.
Which of the following side effects might a patient experience if they are prescribed atropine to
reduce their salivary flow?

A. Bradycardia
B. Diarrhea
C. Gastrointestinal upset
D. Sedation
E. Blurred vision E. Blurred vision

1) Atropine = muscarinic blocker = Cholinergic blocker = anti-SLUDS = anti-parasympathetic =

sympathetic

2) Atropine
a. is an anticholinergic agent used to reduce salivary flow
b. Common side effects:
1) blurred vision
2) photophobia
3) tachycardia
4) anhidrosis = inability to sweat normally
The recommended pharcologic treatment for xerostomia is...

A. 1 mg Malathion
B. 10mg Dilantin
C. 5 mg Levonordefrin
D. 5 mg Pilocarpine
E. 1 mg Epinephrine D. 5 mg Pilocarpine

1) Concept: Pilocarpine
a. direct acting cholinergic agonist = SLUD
b. parasympathomimetic alkaloid that is considered a non-selective muscarinic receptor agonist
c. stimulates the secretion of large amounts of saliva and sweat through muscarinic receptor
stimulation
d. used in the treatment of chronic open-angle glaucoma

2) Muscarinic Receptor Effects: SLUG BAM

S: Salivation, Secretions, Sweating
L: Lacrimatin
U: Urination
G: Gastrointestinal Support
B: Bradycardia, Bronchoconstriction, and Bowel movement
A: Abdominal cramps / Anorexia
M: Miosis
The quaternary ammonium group in the structure of a cholinergic agent allow of it to act as a...

A. direct muscarinic agonist *

B. direct nicotinic agonist *
C. muscarinic anticholinesterase
D. nicotinic anticholinesterase B. direct nicotinic agonist *

1) Concept: Nicotinic antagonist are a type of anticholinergic agent that inhibit the action of
acetylcholine (ACh) at nicotinic ACh receptors and are used for peripheral muscle paralysis
during surgery.

2) Quarternary ammonium compounds can result in a range of health effects like mild skin and
respiratory irritation up to severe caustic burns on skin and gastrointestinal lining, hypotension
and death.

3) They are the chemical group thought to be responsible for anaphylactic reactions to occur with
use of neuromuscular blocking drugs during the use of general anesthesia in surgery.

4) Nicotinic Receptor Effects : MTWThF

M: Mydriasis / Muscle cramps
T: Tachycardia
W: Weakness
T: Twitching
H: Hypertension / Hyperglycemia
F: Fasiculation
The drug category contraindicated in glaucoma patients is...

A. Catecholamines
B. Epinephrine
C. Norepinephrine
D. Oxytocin
E. Belladonna alkeloids E. Belladonna alkeloids

1) Belladonna Alkaloids
a. like atropine are derived from the Atropa Belladonna or "deadly nightshade" plant and
function as anticholinergic drugs.
b. are contraindicated to patients predisposed to narrow-angle glaucoma because they:

1) prevent evacuation of aqueous humor through the canal of Schlemm

2) elevate intraocular pressure by increasing pupillary diameter

3) Atropine causea
a. Pupil dilation by paralysis of the ciliary muscle, preventing lens accommodation
b. Prevents action of acetylcholine on muscarinig receptors M1-M5, causing an increase in
sinoatrial (SA) node output

2) Glauacoma
a. pathology where an increase in fluid pressure in the aqueous humor of the eye causes pain
could result in blindness if not treated.
Which of the following doses of epinephrine is considered the maximum safe dose that could be
administered to a patient with a history of significant cardiovascular impairment?

A. 1cc, 1:100,000
B. 1cc, 1:50,000
C. 2cc, 1:100,000
D. 2cc. 1:50,000
E. 5cc, 1:1000 D. 2cc. 1:50,000

1) While administering epinephrine to patients who currently have or had cardiovascular

disorders like cardiac arrhythmias or coronary artery disease, extreme caution must be observed.

2) Administration of epinephrine carries the risk of precipitation of angina pectoris in patients of

ischemic heart disease or coronary insufficiency.

3) The dosage of epinephrine should not exceed the limit of 2cc or 2mL and the concentration
used should be 1:50,000.
Cyclopegia, or paralysis of the ciliary muscle of the eye can be caused by...

A. Acetylcholine
B. Amphetamine
C. Ephedrine
D. Homatropine bromide
E. Pilocarpine D. Homatropine bromide

1) Concept: Homatropine bromide

a. is a short-acting chemical drug utilized to cause mydriasis and cyclopegia
b. very useful as a pupil dilator during retinoscopy ad as a treatment for uveitis
c. also used to temporarily paralyze accommodate of the eyes. However, a complete cyclopegia
of the eye cannot be achieved by this drug.

1) Atropine = muscarinic blocker = anti-SLUD

2) Pilocarpine = cholinergic agonist = SLUD
Which of the following describe the likely mechanism of death from an irreversible anti
cholinesterase overdose?

A. Asphyxia resulting from airway restriction

B. Cardiac failure due to excessive stimulation
C. Respiratory failure due to diaphragmatic and intercostal muscle paralysis
D. CNS depression followed by prolonged excitation and laryngospasm C. Respiratory failure
due to diaphragmatic and intercostal muscle paralysis

1) Concept: Irreversible anticholinesterase overdose inflicts death when by causing the

diaphragm and other muscles needed during respiration fail to function.

2) Diaphragm and intercostal muscles expel air out of the lungs during expiration
3) The other effect of an anti cholinesterase overdose include
a. Bradycardia
b. Death due to bronchoconstriction
c. GI motility and secretion problems
d. Miosis

1) anti cholinesterase = cholinergic = SLUDS = Parasympathetic

Which substance is characterized as an irreversible cholinesterase inhibitor?

A. DFP (Disoofluorophate)
B. Neostigmine (Prostigmine)
C. Physostigmine (Antilirium)
D. Pilocarpine (Pilocar) A. DFP (Disoofluorophate)

1) Concept: Diisopropyl fluorophosphate is an organophosphate insecticide which can act as an

irreversible cholinesterase inhibitor.

2) Diisopropyl fluorophosphate (DFP) is substance that can elicit a parasympathomimetic action

and act as an irreversible anti-cholinesterase.

3) DPF became useful in ophthalmology for its ability to induce miosis (pupillary constriction)
for the treating of chronic glaucoma and in neurological experiments focusing on neuropathy.
Ephedrine, tyramine, and amphetamine are classified as which of the following pharmacological
classes?

A. Alpha-adrenergic receptor blocker

B. Beta-adrenergic receptor blocker
C. Direct-acting Sympathomimetics
D. Indirect-acting Sympathomimetics
E. AnticholinesterasesD. Indirect-acting Sympathomimetics

1) Concept: Ephedrine, amphetamines, and tyramine are indirect acting sympathomimetic

medications that function by preventing norepinephrine release.

2) Sympathomimetic drugs that act indirectly in the body and have the capability of increasing
catecholamine production endogenously

3) Indirect acting sympathomimetic

a. medications that are practically used in cases of cardiac arrest and stopping premature labor
When Chlorpromazine (CPZ/Thorazine) is administered to a patient and the patient stands up,
they may experience dizziness due to...

A. Anti-cholinergic activity
B. Bradycardia
C. Vagal stimulation
D. Alpha adrenergic inhibition D. Alpha adrenergic inhibition

1) Concept: Chlorpromazine effects various types of receptors along the central nervous system,
causing anti-dopaminergic, anti-cholinergic, anti-histaminic and some traces of anti-adrenergic
effect.

2) The alpha adrenergic inhibition of Chorpromazine may cause the lowering of the blood
pressure, which is later on accompanied by dizziness.

3) Chlorpromazine inhibits the alpha1 and alpha2 adrenergic receptors which results to
symptoms including reflex tachycardia, sedation, vertigo, hyper salivation, and a possibility of
causing sexual dysfunction.
Which statement is true about anti cholinesterase?

A. Agents may cause paroxysmal supraventricular tachycardia?

B. Agents such as DFP inhibit only plasma cholinesterase
C. Alkaloid physostigmine has the greatest number of side effects unrelated to ACHE inhibition
D. Reactivators such as 2-PAM reactivate ACHE which has undergone "aging"
E. Organophosphates are readily absorbed through the skin E. Organophosphates are readily
absorbed through the skin

1) Concepts: Organophosphates are included among the most toxic substances that can enter the
body easily.

2) Organophosphates
a. active substances in some pesticides that could enter a body by ingestion, skin absorption and
mostly through inhalation
b. capable of affecting cholinesterase activate within the blood

3) Cholinesterases
a. are substances that cause the breakdown of acetylcholine when in the body, stopping the
acetylcholine from sending electrical impulses and therefore regulates movement of the body
b. in the presence of cholinesterase inhibitor such as DPF and organophosphate, acetylcholine is
not broken down resulting to acetylcholine build up
c. this causes an uncontrolled and continuous firing of electrical impulses that results to
uncontrollable muscle twitching. Severe cases could lead to inability to breathe due to muscle
paralysis and even death.
Which statement is CORRECT concerning directly-acting cholinomimetics?

A. All of these
B. Bethanechol is predominantly selective for gastrointestinal and urinary bladder smooth
muscle
C. Methacholine has more prominent action on the cardiovascular system than carbachol
D. Bethanechol and Carbachol almost completely resist the action of ACHE A. All of these

1) Directly acting cholinomimetics perform well as receptor agonists.

2) They bind and activate the M2 and M3 muscarinic receptors.

3) Drugs like bethanechol acts in the management of urinary retention and pilocarpine is use in
treating glaucoma.

cholinomimetics = Cholinergic = SLUDS = Parasympathetic

Methacholine is related to acetycholine as a...

A. Antagonist
B. Congener
C. Isomer
D. Vehicle
E. Agonist B. Congener

1) Concept: Congeners are substances that are closely related in composition, function, or origin

2) Methacholine is a synthetically made choline ester that is more predisposed to function as a

muscarinic receptor agonist within the parasympathetic nervous system.

3) Methacholine and acetylcholine are both cholinergic agonists. However, the duration of action
of methacholine is longer than that of acetylcholine.
The most potent bronchodilator is which of the following sympathomimetics?

A. Isoproterenol
B. Methoxamine
C. Norepinephrine
D. Phenylephrine
E. Amphetamine A. Isoproterenol

1) Concept: Isoproterenol
a. a sympathomimetic that is similar to epinephrine in its action of cardiac excitatory but is
different from epinephrine in its property of vasodilation.
b. it is a potent bronchodilator when used in sulfate and hydrochloride forms

2) Methoxamine
a. a sympathomimetic used for the management of hypotension due to its vasopresive activity

3) Norepinephrine
a. a catecholamine that has vasopressive properties and is used to raise blood pressure to normal
levels in causes of acute hypotension

4) Phenylephrine
a. an adrenergic drug with strong vasoconstrictive properties
b. usually used as a nasal decongestant.
5) Amphetamines
a. psychostimulant drugs that stimulate the CNS. Their overuse can lead to addiction
Which of the following describes how neostigmine differs from physostigmine?

A. Neostigmine has an additional direct effect at the neuromuscular junction

B. Neostigmine has the specificity to selectively block cholinesterase at the neuromuscular
junction
C. Neostigmine is a reversible cholinesterase inhibitor while physostigmine acts irreversibly
D. Neostigmine is not a clinically useful drug
E. Neostigmine is well absorbed from the gastrointestinal tract A. Neostigmine has an
additional direct effect at the neuromuscular junction

1) Concept: Neostigmine
a. is a synthetic drug that is poorly absorbed when taking orally and is useful for managing
myasthenia gravis.
b. can also directly affect neuromuscular junctions

2) Physostigmine
a. unlike neostigmine is a naturally occurring lipid soluble drug hat is absorbed very when taking
orally

Physostigmine vs. Neostigmine LMNOP

Physostigmine
a. Lipid Soluble
b. Miotic
c. Natural
d. Orally absorbed well
e. Physostigmine

Neostigmine, on the contrary is:

a. water soluble
b. used in myasthenia gravis
c. synthetic
d. poor oral absorption
The drug category contraindicated in glaucoma patients is...

A. Cholinergic
B. Adrenergic blocking
C. Anticholinergic
D. Canabinoids
E. Adrenergic C. Anticholinergic

1) Concept: Anticholinergic agents like atropine are contraindicated to patients predisposed to

narrow-angle glaucoma because they:
a. prevent evacuation of aqueous humor through the canal of Schlemm
b. elevate intraocular pressure by increasing pupillary diameter

2) Atropine causes
a. pupil dilation by paralysis of the ciliary muscle, preventing lens accommodation
b. prevents action of acetylcholine on muscarinic receptors M1-M5, causing an increase in
sinoatrial (SA) node output

3) Glaucoma
a. pathology where an increased fluid pressure in the aqueous humor of he eye causes pain could
result in blindness if not treated
Cardiovascular Cardiovascular Answers
Cardiac glycosides are known to decrease the concentration of which ion in cardiac muscle?

A. Chloride (Cl-)
B. Potassium (K+)
C. Sodium (Na+)
D. Calcium (Ca+2) B. Potassium (K+)

1) Concept: Digitalis is a cardiac glycoside known to be potent inhibitors of Na+/K+ ATPase in

the cell.

2) Cardiac Glycosides
a. inhibit Na+/K+ ATPase, the transition state stabilizes and the sodium ions are not extruded
thereby increasing intracellular sodium concentration (assume Na+ is inside and K+ is outside)
b. By inhibiting the ion transportation, the concentration of potassium in the cell is decreased.
c. inhibit Na+/K+ ATPase causes an increase in the heart's contraction and consequently, cardiac
output.
Heparin functions by preventing the conversion of...

A. Factor IX to Factor X
B. PTA to PTC
C. Prothrombin to thrombin
D. Fibrinogen to fibrin D. Fibrinogen to fibrin

1) Concept: Heparin plays an important role in hemostasis by prevention coagulation...

a. prevents soluble fibrinogen conversion into soluble fibrin
b. fibrin is necessary to strengthen the clot
c. is secreted by basophilic and mast cells

d. Heparin activates and potentiates the activity of antithrombin, which inhibits the conversion of
fibrinogen into fibrin by thrombin
Digitalis should be prescribed to patients suffering from atrial fibrillation and already on
Quinidine to prevent...

A. Prolongation of the QRS complex of EKG reading

B. Pulmonary embolisms
C. Sino-atrial bradycardia
D. Ventricular tachyarrythmias
E. Hyperkalemia D. Ventricular tachyarrythmias

1) Concept: Digital and Quinidine are both used as anti-arrhythmic drugs.

2) Digitalis regulates the heart beat of patients with atrial fibrillation by slowing down the
ventricular contraction rate.

3) Digitalis is often prescribed for those patients suffering from congestive heart failure.
Administration of amyl nitrite for a prolonged period of time may result in...

A. Aplastic anemia
B. Thalassemia
C. Methemoglobinemia
D. Thrombocytopenia C. Methemoglobinemia

1) Concept: Methemoglobinemia is a blood disorder characterized level of methemoglbin

exceeding 1%. Common with nitrites.

2) Hemoglobin
a. Hemoglobin with the presence of a ferric heme group is called methemoglobin, which cannot
transport oxygen.
b. The blood has normally 1% methemoglobin
c. causes methemoglobinemia include exposure to benzocaine, benzene, and nitrites

3) Oxyhemoglobin
a. reduced form of iron, ferrous found in the heme group combines with oxygen to produce
oxyhemoglobin
b. oxyhemoglobin distributes oxygen to the different tissues in the body and is changed back to
hemoglobin after delivering the oxygen
Digitalis functions primarily on cardiac muscle by increasing which of the following?

A. Rate of conduction
B. Refractory period of the muscle of the atrium
C. Refractory period of the muscle of the ventricles
D. Force of contraction D. Force of contraction

1) Concept: Digitalis is a drug that is considered a cardiac glycoside. It increases the contractile
force of cardiac muscle.
A patient receiving Warfarin presents for an elective tooth extraction with a prolonged
prothrombin time (PT). Which of the following methods of reducing the PT to a level acceptable
for surgery is indicated?

A. Administering a Warfarin antagonist like heparin.

B. Administering a platelet transfusion
C. Asking the patient not to take their Warfarin for 2 days before the surgery
D. Asking the patient to take half of their normal dose of Warfarin for 2 days prior to surgery.
E. Administering Vitamin K C. Asking the patient not to take their Warfarin for 2 days before
the surgery

1) Concept: If a patient is on Warfarin and wants to go for tooth extraction, he will be asked by
the dentist to stop taking Warfarin 2 days prior the day of extraction.

2) The reason for this instruction is that once the tooth is pulled out, it will be difficult to bring
the bleeding under control due to the thinning of the blood by Warfarin.

3) Prothrombin time is the time required by your blood to form a clot and is measured in
seconds.
Which of the following describes the mechanism through which propranolol functions as an
antianginal?

A. Dilating coronary arteries

B. Dilating systemic blood vessels
C. Increasing cardiac contractility
D. Stimulating the parasympathetic nervous system to slow the heart rate
E. Blocking the beta-adrenergic receptors of cardiac muscleE. Blocking the beta-adrenergic
receptors of cardiac muscle

1) Concept: Propranolol is the first non-selective beta blocker developed and is used to treat
hypertension, anxiety, and panic attacks

2) Propranolol
a. blocks the action of epinephrine and norepinephrine on the beta-1 and beta-2 adrenergic
receptors and exhibits little intrinsic sympathomimetic activity.

3) Due to its high penetration across the blood brain barrier, lipophilic beta blockers such as
propranolol and metoprolol are more likely to cause sleep disturbances such as insomnia, vivid
dreams, and nightmares.
Propranolol functions as an antianginal through which of the following mechanisms?

A. Dilating coronary arteries

B. Dilating systemic blood vessels
C. Increasing cardiac contractility
D. Stimulating the parasympathetic nervous system to slow the heart rate
E. Blocking the beta-adrenergic receptors of cardiac muscleE. Blocking the beta-adrenergic
receptors of cardiac muscle

1) Concept: Propranolol is the first non-selective beta blocker developed and is used to treat
hypertension, anxiety, and panic attacks
2) Propranolol
a. blocks the action of epinephrine and norepinephrine on the beta-1 and beta-2 adrenergic
receptors and exhibits little intrinsic sympathomimetic activity.

3) Due to its high penetration across the blood brain barrier, lipophilic beta blockers such as
propranolol and metoprolol are more likely to cause sleep disturbances such as insomnia, vivid
dreams, and nightmares.
Which of the following drugs is indicated for use in patients suffering from congestive heart
failure?

A. Etotolac
B. Nitroglycerine
C. Procainamide
D. Digitalis D. Digitalis

1) Concept: Digitalis drugs are used to treat patients with congestive heart failure and cardiac
dysrhythmias

2) Digitalis
a. make the cardiac muscle to contract stronger and to pump more efficiently improving blood
circulation and reducing edema

3) Symptoms of Digitalis Intoxication

a. Nausea
b. Emesis
c. Diarrhea
d. Cardiac arrhythmia
e. Headache
Which of the following agents is the MOST commonly used treatment for bradycardia?

A. Epinephrine
B. Hydrochlorothiazide Diuretic
C. Vasodilators
D. Atropine D. Atropine

1) Atropine
a. is considered to be the first line drug to be used to treat bradycardia
b. increases the heart rate by blocking the action of vagus nerve and increasing the firing of SA
node.
c. intravenous injection of atropine is only a temporary solution for bradycardia.
d. Installation of a pacemaker is a better and more effective measure.

2) Atropine = muscarinic blocker = cholinergic blocker = anti-SLUDS = sympathetic

Essential hypertension can be treated with administration of a beta-adrenergic receptor blocking
drug. Which of the following agents is a "Beta blocker"?
A. Atenolol
B. Dilantin
C. Hydralazine
D. Valsartan
E. Verapamil A. Atenolol

1) Concept: Atenolol is a selective beta-1 receptor antagonist used to treat low grade essential
hypertension.
b. currently recommended only in special circumstances as complementary medication in
hypertension

2) ACE inhibitors and diuretics

a. more commonly used as first line therapy

3) Valsartan
a. is an angiontensin II receptor antagonist (ARB or angiotensin receptor blocker)

4) Verapamil
a. calcium channel blocker

5) Hydralazine
a. direct-acting smooth muscle relaxant
b. used to treat hypertension by relaxing vascular smooth muscle and dilating arteries and
arterioles decreasing peripheral resistance and lowering blood pressure and decreasing after load

6) Dilantin
a. antiepileptic drug
Which of the following does low-dose aspirin therapy preferentially inhibit to prevent the
formation of thromboemboli?

A. Phospholipase A2 in the walls of blood vessels

B. Prostacyclin synthetase in the walls of blood vessels
C. Thromboxane synthetase of platelets
D. Actions of Vitamin K C. Thromboxane synthetase of platelets

1) Concept: Aspirin causes the irreversible inactivation of the enzyme cyclogenase (COX) which
is responsible for the production of prostaglandin and thromboxane.

2) Thromboxane
a. a vasoconstrictor that is responsible for platelet aggregation and is responsible for
thromboemboli
b. Thromboxane synthetase is the enzyme that mediates the reaction of formation of
thromboxane
Which of the following is the most dangerous effect of Digoxin overdose?

A. Atrial fibrillation
B. Bradycardia
C. Tachycardia
D. Ventricular fibrillation
E. Renal toxicity/failure C. Thromboxane synthetase of platelets

1) Concept: Digotoxin toxicity can induce ventricular fibrillation leading to incoordination of

ventricular cardiac muscle contraction

2) A very narrow window between its therapeutic effect and toxic effect (Narrow therapeutic
Index) makes toxicity fairly common.

3) Toxicity reveals various electrolytes abnormalities and imbalances affect the normal rhythm
of the heart beat.

4) Toxicity leads to bradycardia, a prolonged PR interval, accelerated rhythm and possible

bidirectional ventricular tachycardia
The mechanism of action for which of the following antihypertensive drugs includes stimulating
arterial smooth muscle cells to vasodilator to decrease the overall blood pressure?

A. Hydrochlorothiazide (HCTZ)
B. Metoprolol
C. Valsartan
D. Hydralazine D. Hydralazine

1) Concept: Hydralazine acts to directly relax the vascular smooth muscles in the arteries and
arterioles causing vasodilation, which decreases blood pressure.

2) Hydralazine
a. not a primary drug in the management of hypertension since it also stimulates the baroreceptor
reflex, increasing the patient's heart rate and cardiac output
b. is contraindicated for patients with coronary artery disease because it could trigger angina
pectoris or possibly a myocardial infarction
Which of the following tests is the MOST VALUABLE for evaluating the surgical risk of a
patient on Warfarin that needs a tooth extracted?

A. Clotting time
B. Complete blood cell count with differential
C. Prothrombin time
D. Sedimentation rate
E. Bleeding time C. Prothrombin time

1) Concept: Prothrombin time (PT) is a good diagnostic tool to be used for a patient on Warfarin
before tooth extraction.
a. Prothrombin time (PT) measures the clotting tendency of blood. The normal range is 12-13
seconds.
2) International Normalized Ratio (INR) is also used in conjunction with PT. It should come with
a range of 0.8-1.2

3) Warfarin
a. is an anticoagulant and it prolongs PT and the INR comes in the range of 2-3
Which of the following physiologic changes does NOT occur due to amyl nitrite administration?

A. Coronary artery dilation

B. Decreased intraocular pressure
C. Peripheral arterial dilation
D. Tachycardia
E. Decreased in arterial blood pressure B. Decreased intraocular pressure

1) Concept: Amyl nitrite

a. short-acting vasodilator administered through inhalation to treat angina pectoris
b. takes effect within 30 seconds of inhalation and lasts about 5 minutes
c. can be used to treat angina pectoris and cyanide poisoning
d. Physiologic effects include
1) dizziness
2) headache
3) decrease in blood pressure
4) increased heart rate
5) relaxation of involuntary muscles

e. overdose leads to headache, emesis, nausea, dyspnea, syncope, and hypotension

Hydrochlorothiazide (HCTZ), a thiazide diuretic, may necessitate a supplementation which
which of the following?

A. Cl-
B. K+
C. Mg+2
D. Na+1
E. Ca+2 B. K+

1) Concept: Hydrochlorothiazide administration causes the body to lose potassium, so

hypokalemia often occurs with supplementation

2) Potassium (K) and hydrochlorothiazide are used in combination in order to reduce the
patient's blood pressure and prevent the occurrence of hypokalemia.

3) Potassium regulates intracellular osmoregulation and helps in reducing unneeded water and
salt inside the body.
Antihypertensive drugs often cause postural hypertension because they interfere with...

A. Epinephrine release from the adrenal medulla

B. Parasympathetic control of vascular resistance
C. Release of acetylcholine in the ganglia
D. Sympathetic control of vascular reflexes
E. Neuromuscular transmission in skeletal muscles D. Sympathetic control of vascular reflexes

1) Concept: Alpha-adrenergic (sympathetic) activity is the predominant pathophysiologic

mechanism of orthostatic hypertension in hypertensive patients, especially with patients taking
receptor blocking medications.

2) Orthostatic hypertension or postural hypertension is a medical condition consisting of a

sudden increase in blood pressure when a person stands up.

3) Baroreflex and autonomic pathways normally ensure that blood pressure is maintained despite
various stimuli including postural change.
Which of the following effects are produced by selective beta-1 adrenergic agonists?

A. Gluconeogenesis
B. Glycogenolysis
C. Increased cardiac output
D. Relaxation of bronchial smooth muscle
E. Decreased peripheral resistance C. Increased cardiac output

1) Concept: B1 adrenergic agonists cause an increase in heart rate and contractile force

2) B2 receptors are predominantly in vascular smooth muscle

3) The heart has both B1 and B2 adrenergic receptors, but B1 adrenergic receptors are the
predominant receptor present.
Local Anesthetics Local Anesthetic Answers
Cross-allergy is most likely to happen with which anesthetic agents?

A. Lidocaine and mepivacaine

B. Lidocaine and benzocaine
C. Prilocaine and tetracaine
D. Procaine and lidocaine
E. Procaine and mepivacaine A. Lidocaine and mepivacaine

1) Concept: IgE-mediated reactions with amide group local anesthetics are considered extremely
rare, but have been documented with lidocaine and mepivacaine.

2) Type IV hypersensivity reactions to local anesthetics have been well documented

predominantly to ester-type anesthetics

3) Ester Local Anesthetics

a. benzocaine
B. chloroprocaine
c. cocaine
d. piperocaine
e. procaine
f. tetracaine

4) Amide Local Anesthetics

a. lidocaine
b. mepivacaine
c. bupivacaine (most potent)
d. prilocaine (least potent)
e. articaine (least potent)
f. ropivacaine
5.4mL of 4% Articaine contains how many mg of Articaine?

A. 108 mg
B. 216 mg
C. 540 mg
D. 54 mg B. 216 mg

1) Concept: Multiplying the percentage of articaine against the total volume of anesthetic
solution in milligrams will determine the amount of articaine in the anesthetic solution.

5.4mL * 40mg/mL of articaine = 216 mg of Articaine

2) Articaine
a. well known dental anesthetic drug that contains an additional ester group that can be
metabolized with the esterase within the blood and tissues of the body
b. less toxicating than other anesthetic drugs because it is quickly hydrolyzed in the blood
Which of the following describes how salivary flow is decreased by the use of local anesthetics
during operative procedures?

A. Blockade of efferent parasympathetic nerves

B. Blockade of major salivary gland innervation
C. Blockade of cholinergic pathways
D. Reduction of sensitivity and anxiety during the procedure D. Reduction of sensitivity
and anxiety during the procedure

1) Concept: Before an operative procedure, patients experience anxiety, causing them to sweat
and increase salivary flow. As the patient feels more at ease, their emotion stabilizes and salivary
rate decreases.

2) Salivary flow increase as a consequence of the mouth's proprioception. Since treatment

procedures involve maneuvers inside the mouth, the mouth assumes food is in the oral cavity.

3) As the anesthesia numbs the area where treatments performed, pain and anxiety is reduced,
which also reduces perception of touch and sensation which also causes the decrease in salivary
flow later.
In inflamed tissues, local anesthetics are known to...

A. Are less efficacious because of the decrease pH of extracellular fluid

B. Are quickly inactivated by inflammatory mediators
C. Diffuse or penetrate more rapidly to the nerve because they are predominantly non-ionized
D. Diffuse or penetrate more rapidly to the nerve due to their ionic charge
E. Possess a prolonged duration of action A. Are less efficacious because of the decrease pH
of extracellular fluid

1) Concept: Local anesthetics are less effective in inflamed tissues because they have a decreased
pH

2) When the Henderson-Hasselbach equation is applied, the decreased pH makes the local
anesthetic molecule more likely to be protonated. Protonation of the anesthetic molecule
prevents the molecule from passing through the membrane of the nerve cell where it can block
sodium influx to prevent nerve firing.
Which of the following properties of local anesthetics increase as hydrophobicity increase?

A. Half-life
B. Neurotoxicity
C. Potency
D. Allerginicity C. Potency

1) Concept: Increase in hydrophobicity of a local anesthetic increases the potency and duration
of the anesthetic drug.

2) Higher hydrophobicity of an anesthetic

a. makes it easier for anesthetics to pass through the membrane, allowing faster diffusion into the
nerve
b. decreases drug metabolism increasing its duration of action and potency
c. is attributed to an increase chance of drug toxicity
Which of the following describes the mechanism of local anesthetic allergic reactions?

A. Improper technique of administration

B. Rapid absorption
C. Reaction with mu receptors
D. Slow detoxification
E. An antigen-antibody reaction E. An antigen-antibody reaction

1) Concept: Some individuals may exhibit hypersensitivity to a local anesthetic or the

preservatives added to it.

2) Allergic reactions have been mainly seen during the administration of ester group of local
anesthetics and are due to the release of PABA (para amino benzoic acid) or PABA related
products.
3) PABA is a strong antigen and may sensitize the lymphocytes and induce the production of
antibodies
Which of the following local anesthetics possess intrinsic vasoconstrictive action?

A. Bupivacaine
B. Cocaine
C. Lidocaine
D. Prilocaine
E. Articaine B. Cocaine

1) Concept: Cocaine is an ester and is the only local anesthetic that is an intrinsic
vasoconstrictor.
a. Cocaine is used in the form of sprays during ENT surgeries to keep the surgical field bloodless

2) Amides
a. Articaine
b. Bupivacaine
c. Lidocaine
d. Prilocaine
Vasoconstrictors are usually incorporated into local anesthetics primarily for which of the
following reasons?

A. To decrease allergic reactions

B. To diminish bleeding
C. To prolong anesthesia duration
D. To reduce the time of onset
E. To decrease systemic toxicity C. To prolong anesthesia duration

1) Concept: Vasoconstrictors
a. help to lengthen the duration of effect of anesthesia by decreasing absorption of the anesthetic
into the bloodstream
b. vasoconstrictors make the blood vessel diameter smaller, causing the slower removal of the
anesthesia in the tissues
c. because anesthesia duration is longer with vasoconstrictors, the amount of anesthetic necessary
is decreased.
Chemotherapy Chemotherapy ANswers
Which of the following tetracycline class drugs should only be taken once daily due to its long
half-life?

A. Chlortetracycline
B. Demethylchlortetracycline
C. Doxycycline
D. Oxytetracycline C. Doxycycline

1) Concept: Doxycycline
a. has the longest half life of tetracycline group and is used prophylactically and therapeutically
b. used to treat malaria, as well as to treat Lyme disease, Rocky Mounted spotted fever, and acne.
c. Taking doxycycline with dairy antacids, calcium supplements, iron products, and laxative
containing magnesium may decrease the effectiveness of the drug.
Which of the following agents is prescribed as an anti-Parkinson's drug?

A. Amantadine
B. Amphotericin B
C. Fluconazole
D. NovobiocinA. Amantadine

1) Concept: Amantadine
a. is a weak antagonist of the NMDE type glutamate receptor which increases dopamine release
and blocks dopamine reuptake.
b. has been used as an antiviral agent against Influenza A until 2009.
Prolonged tetracycline therapy is associated with each of the following adverse effects EXCEPT
ONE. Which of the following side effects is the EXCEPTION?

A. Discoloration of teeth during the mineralization stage of development

B. Photosensitivity
C. Superinfection
D. Visual disturbances
E. Diarrhea D. Visual disturbances

1) Concept: Tetracycline use is NOT associated with visual disturbances.

2) Tetracyclines
a. is incorporated into the tooth structure during the mineralization of the tooth because it forms a
chelate with calcium

3) Long term Tetracyclines use is associated with

a. Diarrhea
b. Photosensitivity
c. Superinfection
Uncomplicated respiratory tuberculosis is treated BEST with which of the following
combinations?

A. Ethambutol and isoniazid, because both inhibit bacterial folic acid synthesis
B. Griseofulvin and streptomycin because both prevent protein production
C. No answers are correct
D. Streptomycin and chloramphenical because both are hydrophobic
E. Isoniazid (INH) and rifampin, because they function by different mechanisms E. Isoniazid
(INH) and rifampin, because they function by different mechanisms

1) Concept: Isoniazid inhibits the synthesis of my colic acid a component of the mycobacterial
cell wall
2) Rifampin
a. inhibits bacterial DNA-dependent RNA polymerase, stopping bacterial RNA production

3) Tuberculosis and inactive meningitis is treated with a cocktail of pyrazinamide, isnoiazid,

ethambutol, rifampicin, and streptomycin ("PIERS")

4) Mnemonic

Tuberculosis Treatments: "If you forget your TB drugs, you'll die and might need a PRIEST"

P: Pyrazinamide
R: Rifampin
I: Isoniazid (INH)
E: Ethambutol
ST: Streptomycin
Which anti fungal drug is prescribed for oral administration to treat vaginal candidiasis

A. Fluconazole (Diflucan)
B. Griseofulvin (Grifulvin)
C. Miconazole (Monistat)
D. Nystatin (Mycostatin)
E. Clotrimazole Troche (Mycelex) A. Fluconazole (Diflucan)

1) Concept: Fluconazole
a. is an oral triazole antifungal agnet prescribed to treat and prevent superficial and systemic
fungal infections by inhibiting the fungal cytochrome P450 enzyme.
b. Inhibition of P450 prevents the conversion of lanosterol to ergosterol, and essential component
of the fungal cytoplasmic membrane.

2) Clotrimazole and Miconazole

a. are both topical drugs

3) Griseofulvin
a. primarily used to treat hair and nail fungal infections
The oral antibiotic most likely to cause failure of oral contraceptive is...

A. Cephalosporins
B. Macrolides
C. Penicillins
D. Tetracyclines
E. Rifampin E. Rifampin

1) Concept: Rifampin
a. an antibiotic that affects the metabolism of oral contraceptive drugs within the body
b. induces the cytochrome P-450 enzyme, so drugs that use this metabolic pathway undergo
accelerated elimination
c. oral contraceptive failure during rifampin treatment can be prevented by adjusting the dosage
of oral contraceptive drugs.
d. Rifampin problems can be prevented by:
1) Using drugs that are not metabolized by P-450
2) Choose non-hormonal birth control methods
The therapeutic function of nalidixic acid is best characterized as an...

A. Antifungal agent
B. Antiseptic for the urinary tract
C. Antituberculous agent
D. Antityphoid agent B. Antiseptic for the urinary tract

1) Concept: Nalidixic acid

a. is a quinolone antibiotic effective against gram (+) and (-) bacteria and is most commonly use
to treat urinary tract infections.
b. is considered bacteriostatic in low concentrations andbacteriocidal in higher concentrations
c. is no longer used because newer agents with fewer side effects like convulsions or
hyperglycemia are available.
Which of the following drugs may lead to a blockage of neuromuscular junctions of the
diaphragm, leading to respiratory difficulty?

A. Chloramphenicol
B. Penicillin
C. Streptomycin
D. Sulfonamide
E. Cephalsporin C. Streptomycin

1) Concept: Streptomycin
a. is a bacteriocidal aminoglycoside IV/IM antibiotic
b. has been reported to possess neuromuscular blocking properties. Extremely high doses of
streptomycin have allegedly resulted in lethal neuromuscular blockage of the phrenic nerve
c. is typically prescribed for Tuberculosis, infective endocarditis, and plague.
Which antibiotic is bactericidal and is prescribed specifically to treat Pseudomonas infections?

A. Carbenicillin
B. Dicloxacillin
C. Penicillin Vk
D. Tetracycline
E. Doxycycline A. Carbenicillin

1) Concept: Carbenicillin
a. is a bacteriolytic antibiotic belonging to the carboxypenicillin subgroup of the penicillins
b. has Gram (-) coverage which includes Pseudomonas aeruginosa but limited to Gram (+)
coverage
c. Carboxypenicillins are susceptible to degradation by beta-lactamase enzymes
Which of the following agents is associated with auditory nerve deafness?
A. Chloramphenicol
B. Gentamycin
C. Lidocaine
D. Tramodol
E. Amphotericin B B. Gentamycin

1) Concept: Gentamycin
a. powerful antibiotic but has to be administered with extreme caution due to its adverse effects
on its auditory nerve
b. is an aminoglycoside used in treatment of several infections
c. it may cause ototoxicity and renal dysfunction
d. Symptoms of eighth cranial nerve damage are tinnitus, ataxia, vertigo and dizziness.
Which of the following oral medications is indicated to treat a staphylococcal infection that is
known to produce penicillinase?

A. Moxalactam
B. Oxacillin
C. Penicillin G
D. Streptomycin
E. Penicillin VB. Oxacillin

1) Concept: is a penicillinase-resistant beta-lactam similar to methicillin and is used to treat

Multi-drug Resistant S. aureus (MRSA) infections..

2) Oxacillin has replaced methicillin in clinical use

3) Antibiotic-resistant strains called oxacilin-resistant Staphylococcus aureus (MRSA/ORSA)

have become increasingly prevalent worldwide.
Which of the penicillin class drugs cannot be administered orally

A. Dicloxacillin
B. Methicillin
C. Penicillin Vk
D. Amoxicillin B. Methicillin

1) Concept: Methicillin
a. narrow-spectrum parenteral beta-lactam antibiotic of the penicillin class agent used to treat
infections caused by bacteria beta-lactamase-producing Gram (+) organisms
b. has been replaced by flucloxacillin and dicloxacillin due to its high frequency of adverse
effects.
c. Methicillin-resistant Staphylococcus aureus (MRSA) is still use to describe Staphylococcus
aureus strains resistant to all penicillins.
In the case of a diabetic patient with an apical abscess requiring an extraction where penicillin
Vk is indicated, which of the following antibiotics should be prescribed for a patient if he/she is
allergic to penicillin?
A. Clindamycin
B. Doxycycline
C. Erythromycin
D. Fluroquinolones
E. Cephalosporin A. Clindamycin

1) Concept: Clindamycin
a. lincomycin antibiotic that can be used if patient is allergic to penicillin and is very effective in
fighting gram positive bacteria including Staphylococcus auerus which is responsible for
pus/abscess formation.

2) Erythromycin
a. a macrolide antibiotic with a similar mechanism of action to penicillin
b. typically prescribed when a penicillin allergy is suspected.

3) Cephalosporins
a. are similar in effect and chemical structure as penicillin, so this drug is not prescribed for
patients with a penicillin allergy

4) Sulfamethoxazole/trimethoprim, doxycycline and vancomycin are other alternative drugs to

penicillin
Which of the following describes the MOST COMMON oral infection following radiotherapy
for cancer?

A. Candida albicans
B. Herpes simplex
C. Histoplasma capsulatum
D. Staphylococcus aureus
E. Streptococcus viridans
F. Aggregatibacter Actionmycetemcomitans A. Candida albicans

1) Concept: Radiotherapy is one of the treatment modalities used in the treatment of oral cancer.

2) Radiotherapy
a. may create an imbalance in the oral microflora and a marked decrease in the production of
saliva and alteration of the oral lining
b. all of these factors contribute to the development of candidiasis, an opportunistic fungal
infection caused by Candida albicans.
Which of the following agents are prescribed to treat HIV patients?

A. Amantadine (Symmetrel)
B. Ribavarin (Virazole)
C. Zidovudine (Rerovir)
D. Isoniazid (Nydrazid)
E. Acyclovir (Zovirax) C. Zidovudine (Rerovir)
1) Concept: Zidovudine (AZT) is a nucleoside analog reverse-transcriptase inhibitor (NRTI)
antiretroviral drug used for the treatment of HIV/AIDS.

2) AZT
a. is the first U.S. government-approved treatment for HIV therapy and can also be used to
prevent HIV transmission, such as from mother to child during the period of birth or after a
needle stick.
b. if used by itself in HIV-infected patients, AZT safely slows HIV replication, but generally
does not stop it entirely.

3) Acyclovir
a. is a guanoside analogue that is used in the treatment of herpes simplex infections

4) Amantadine
a. is an anti-Parkinson's drug that is no longer recommended for use as an antiviral agent against
influenza

5) Isoniazid
a. is an antibiotic used to treat M. tuberculosis infections
Which of the following pharmaceuticals is most closely associated with dermal photosensitivity?

A. Cephalexin
B. Demeclocycline
C. Erythromycin
D. Nystatin
E. Penicillin Vk B. Demeclocycline

1) Concept: Demeclocycline
a. is a tetracycline antibiotic used in the treatment of Lyme disease, acne, and bronchitis
b. all members of this drug class may induce photosensitivity, interfere with bone development,
and discolor teeth
c. is the only tetracycline known to cause nephrogenic diabetes insipid us
d. acts by binding to the 30S and 50S ribosomal subunits, impairing protein synthesis by
bacteria.
Prolonged use (14+ days) of clindamycin (cleocin) is discouraged because...

A. Hepatotoxicity increases with the duration of ingestion

B. Incidence of allergic reactions increase while taking the drug
C. Renal failure frequently occurs
D. There is a high incidence of pseudomembranous colitis
E. There is a high rate of blood dyscrasias D. There is a high incidence of pseudomembranous
colitis

1) Concept: Clindamycin
a. is a lincoamide antibiotic used to treat anaerobic bacterial infections and its use is associated
with pseudomembranous colitis.
b. is prescribed to treat anaerobic bacterial infections and some protozoal disease, such as
malaria and is also a common topical treatment for acne.
c. the potency for oral clindamycin leads to widespread loss of normal gut flora, allowing
Clostridium difficult to take over the gut, causing pseudomembranous colitis
d. may prolong the effects of neuromuscular-blocking drugs, such as succinylcholine
Which of the following antibiotics is considered a "3rd generation" cephalosporin?

A. Cephalexin
B. Cephamandole
C. Clindamycin
D. Moxalactam
E. Amikacin D. Moxalactam

1) Concept: Moxalactam is a 3rd generation cephalosporin that has been associated with
prolonged bleeding time, and several cases of coagulopathy
b. Moxalactam is no longer marketed in the United States
c. Other 3rd generation cephalosporins include
1) Cefcapene
2) Cefdaloxime
3) Cefdinir
4) Cefixime

1st - generation rich girls are Zoli, Roxi and Lexi are irreplaceable.
Cefazolin, Cephalexin, CefadRoxil for Total joint replacement.
2nd - generation Ana is a afraid of her Fox Fur
Cefuroxime, Cefoxitin good for anaerobes.
3rd - generation Fix the T in three
CeFixime, CefTriaxone, CefoTaxime
4th - generation is Prime for Pseudomonas
CefePime used for Pseudomas and gram +
Which of the following drugs is most potent against a Mycobacterium tuberculosis infection?

A. Isoniazid
B. Methacillin
C. Penicillin Vk
D. Vancomycin A. Isoniazid

1) Concept: Isoniazid
a. is considered one of the most potent and is the most common antibiotic prescribed to treat
Mycobacterium tuberculosis infections.
b. very effective against actively multiplying bacteria
c. proscribed alone or co-administered with other antibiotics
d. Isoniazid treatment takes 6-12 months to completely eradicate tuberculosis
e. Isoniazid is usually administered orally or IM (intramuscular)
Tuberculosis Treatments: "If you forget your TB drugs, you'll die and might need a PRIEST"

P: Pyrazinamide
R: Rifampin
I: Isoniazid (INH)
E: Ethambutol
ST: Streptomycin
The relative insolubility in water of which drug may lead to an increased incidence in
renalithiasis (kidney stones)?

A. Clindamycin
B. Erythromycin
C. Sulfamethoxazole (Bactrim)
D. Tetracycline metabolites
E. Acetaminophen C. Sulfamethoxazole (Bactrim)

1) Concept: Sulfamethoxazole (Bactrim) is a sulfa drug that is relatively water insoluble, so it is

associated with a high occurrence of kidney stones.

2) Because of the risk of kidney stones, it is usually prescribed with trimethoprim, creating a
synergistic combination that allows less Bactrim to be given, thereby decreasing kidney stone
risk.

3) Bactrim is most commonly prescribed for streptococcus, staphylococcus, and E.coli

infections.

4) Sulfa drugs are structural analogs and competitive antagonists of para-aminobenzoic acid
(PABA), which is used in the bacterial synthesis of folic acid. Interfering with folic acid
synthesis prevents bacterial DNA replication.

Sulfa Drugs

Sulfonamides: common characteristics SULFA:

S: Steven-Johnson syndrome / Skin rash / Solubility low
U: Urine precipitation / Useful for UTI
L: Large spectrum (gram positive and negative)
F: Folic acids synthesis blocker (and synthesis of nuclei acid)
A: Analog of PABA
The therapeutic function of Isoniazid is best characterized as an...

A. Antifungal agent
B. Antiseptic for the urinary tract
C. Antituberculous agent
D. Antityphoid agent
E. Antiviral agent C. Antituberculous agent
1) Concept: Isoniazid is the first line medication in the prevention and treatment of tuberculosis
b. is a prodrug that must be activated by a bacterial catalase-peroxidase enzymes
c. inhibits the synthesis of mycolic acid a component of the mycobacterial cell wall

Tuberculosis Treatments: "If you forget your TB drugs, you'll die and might need a PRIEST"

P: Pyrazinamide
R: Rifampin
I: Isoniazid (INH)
E: Ethambutol
ST: Streptomycin
Which of the following is true therapeutically when comparing penicillin G to penicillin V?
Penicillin V has a...

A. Increased resistance to penicillinase

B. More broad antibacterial spectrum
C. More reliable GI absorption
D. Slower renal excretion time
E. Decreased potential for allergic reaction C. More reliable GI absorption

1) Concept: Benzylpenicilin (Penicilin G) is administered parenterally because it is unstable to

hydrochloric acid of the stomach and can achieve high tissue concentration within tissues.

2) Phenoxymethylpenicillin (Penicillin V) can be taken orally because it is more stable in the

acidic environment of the stomach an is absorbed better than Penicillin G.
Antibiotics have been discovered and harvested from...

A. Bacteria and fungi

B. Fungi and viruses
C. Mycoplasmas and rickettsiae
D. Viruses and mycoplasmas
E. Tissue cell cultures A. Bacteria and fungi

1) Concept: Antibiotics are substances derived from bacteria, fungi, or other organisms that have
the ability to disrupt or destroy the development and growth of other microorganisms.

2) Antibiotics
a. are procured by means of biosynthesis, wherein a living organism creates the antibiotic in a
controlled environment setup by the laboratory to be harvested.

3) The substances derived from these microorganisms are then studied and modified to improve
their qualities and make them last longer.
The therapeutic function of ethambutol is best characterized as an...

A. Antifungal agent
B. Antiseptic for the urinary tract
C. Antituberculous agent
D. Antityphoid agent
E. Antiviral agent C. Antituberculous agent

1) Concept: Ethambutol is a bacteriostatic antimycobacterial drug prescribed to treat tuberculosis

and is usually coadministered with isoniazid, rifampicin, or pyrazinamide.

Tuberculosis Treatments: "If you forget your TB drugs, you'll die and might need a PRIEST"

P: Pyrazinamide
R: Rifampin
I: Isoniazid (INH)
E: Ethambutol
ST: Streptomycin
The mechanism of action for the tetracycline family of drugs relates to the inhibition of...

A. Cell lysis
B. Cell wall synthesis
C. DNA/RNA synthesis
D. Protein synthesis D. Protein synthesis

1) Concept: Tetracycline is a broad-spectrum antibiotic that inhibits protein synthesis

b. binds to the 30S subunit of the bacterial ribosomes preventing the aminoacyl-tRNA is from
binding to the acceptor site.
c. considered a teratogen and is contraindicated for pregnant women and for children below 8
years of age due to the possibility of causing discoloration of teeth.
Which of the following tetracycline class antibiotics is excreted the slowest?

A. Clortetracycline
B. Doxycycline
C. Tetracycline
D. Oxytetracycline B. Doxycycline

1) Concept: Doxycycline has the longest half life of tetracycline group and is used
prophylactically and therapeutically

2) Doxyccline
a. used to prevent malaria, as well as to treat Lyme disease, Rocky Mountain spotted fever, and
acne
b. taking doxycycline with dairy antacids, calcium supplements, iron products, and laxatives
containing magnesium may decrease the effectiveness of the drug.
Which of the following medications is removed from the body primarily via secretion from the
renal tubules?

A. Ciprofloxicin
B. Penicillin-G
C. Streptomycin
D. Tetracycline B. Penicillin-G

1) Concept: Penicillin G (Pen G) is an antibiotic drug taken parenterally because it is unstable in

acids in the stomach. It undergoes rapid excretion through active tubular secretion and filtration
in patients with healthy kidney function.

2) The half-life of Pen G prior to elimination is said to be about 30 minutes.

3) Pen G will be excreted slower in neonates and babies with compromised kidney function.
Which of the following antibiotic agents if found in considerably lower concentrations in serum
than in crevicular fluid?

A. Metronidazole
B. Oxacillin
C. Penicillin
D. Tetracycline
E. Clindaycin D. Tetracycline

1) Concept: The most important feature of tetracycline is that it attains a higher level of
concentration in gingival crevicular fluid than in serum.
b. is a broad spectrum bacteriostatic antibiotic that functions by inhibiting protein synthesis
c. used to treat periodontal diseases caused by pathogen like Aggregatibacter
Actinomycetemcomitans and Porphyromonas gingival is because of the high concentration in
crevicular fluids
Penicillin derivatives can lead to which of following classes of hypersensitivity reactions?

A. Type IV only
B. Types I, II, III, and IV
C. Types I, II, and IV
D. Type I only B. Types I, II, III, and IV

1) Concept:

2) Type I - Allergy (immediate)

a. Anaphylaxis, asthma
b. Mediated by IgE and IgG

3) Type II - Cytotoxic, Autoimmune

a. Hemolytic Anemia, Graves disease
b. Mediated by IgM, IgG, and Complement

4) Type III - Immune Complex

a. Serum sickness, Rheumatoid arthritis, Lupus
b. Mediated by IgG and Complement
5) Type IV - Delayed Hypersensitivity
a. Contact dermatitis, transplant rejection, multiple sclerosis
b. Mediated by T-cells

Hypersensitivity Reactions: "ACID" or "ABCD"

A: Anaphlyaxis (Type I)
C: Cytotoxic-Mediated (Type II)
I: Immune-Complex Mediated (Type III)
D: Delayed Hypersensitivity (Type IV)

A: Anaphlyaxis
B: AntiBody Mediated
C: Immune Complex Mediated
D: Delayed Hypersensitivity
Which of the following erythromycin compounds is enterically coated and has prolonged action?

A. E.E.S
B. ERYC
C. Erythrocin
D. Liosone B. ERYC

1) Concept: ERYC capsules are enteric-coated erythromycin which is created for oral
administration

2) The enteric coating serves as a protective barrier of the erythromycin base against the
inactivating action of the gastric acids of the stomach.

3) The small size of the enteric coated capsules allows it to pass intact as it goes through the
stomach and into the intestines, allowing the erythromycin to be dissolved and absorbed in a
uniform manner.
The 1997 American Heart Association recommendations for prevention of bacterial endocarditis
suggest antibiotic premedication be used for which of the following dental procedures?

A. Orthodontic appliance adjustment

B. Placement of rubber dams
C. Restorative dentistry with or without retraction cord
D. Subgingival placement of antibiotic fibers or strips
E. Local anesthetic injections D. Subgingival placement of antibiotic fibers or strips

1) Concept: The 1997 American Heart Association recommendations suggest antibiotic

prophylaxis for patients with high and moderate risk heart conditions prior to having dental
treatments with significant bleeding in the mouth.
2) Subgingival placement of the antibiotic strips may render bleeding within the gingival sulcus
depending on the condition of the gums and the depth of insertion.

3) The orthodontic adjustments and placement rubber dams do not usually cause any significant
amount of bleeding in the process.

4) Local anesthetic injections which do not penetrate too deep into the mucosa would also not
cause significant amount of bleeding.
Nystatin (Mycostatin) is indicated to treat infections caused by which microbe?

A. Candida albicans
B. Porphrymonas gingivalis
C. Streptococcus mutans
D. Aggregatibacter actinomycetemcomitans A. Candida albicans

1) Concept: Nystatin
a. an anti fungal drug that is most effective against
infection caused by Candida species
b. very effective against candida albicans and is activated by binding to the cell membrane of
fungi and forming porosities which result in the leakage of K+ and eventually cell death.

2) Candida albicans
a. an opportunistic fungi that is considered as normal human flora specifically in the mouth, skin,
gastrointestinal and genitourinary tract. Candida albicans is opportunistic and can cause fungal
infections inimmunocompromised patients.
Crystallurea is less likely to occur with sulfonamide treatment if which of the following is used?

A. Coadministered probenecid
B. Concurrent ammonium chloride
C. Sulfonamide cocktail method
D. Coadministered corticosteroids C. Sulfonamide cocktail method

1) Concept: Adequate fluid intake may lessen the chances of urolithiasis while taking
Sulfonamids.

2) Sulfonamide cocktail method

a. used when sulfonamide antibiotics are used in conjunction with other agents to decrease the
amount of sulfonamide needed and thereby prevents crystallurea and stone formation
c. Sulfonamides should be taken with approximately 2400mL of water to facilitate better
filtration and excretion in the kidneys
d. Sulfonamides are contraindicated for patients with impaired kidney function

Sulfa Drugs

Sulfonamides: common characteristics SULFA:

S: Steven-Johnson syndrome / Skin rash / Solubility low
U: Urine precipitation / Useful for UTI
L: Large spectrum (gram positive and negative)
F: Folic acids synthesis blocker (and synthesis of nuclei acid)
A: Analog of PABA
The incosamide clindamycin (Cleocin) is best characterized by which of the following
statements?

A. It does not penetrate well into bony tissue

B. It inhibits cell wall synthesis
C. It is effective against most anaerobes
D. It is usually given in combination with erythromycin
E. It is effective against gram-negative bacteria onlyC. It is effective against most anaerobes

1) Concept: Clindamycin is a lincosamide antibiotic used to treat anaerobic bacterial infections

and its use is associated with pseudomembranous colitis.

2) Clindamycin
a. prescribed to treat anaerobic bacterial infections and some protozoal diseases, such as malaria
and is also a common topical treatment for acne.
b. potency of oral clindamycin leads to widespread loss of normal gut flora, allowing
Clostridium difficult to take over the gut, causing pseudomembranous colitis.
c. may prolong the effects of neuromuscular-blocking drugs, such as succinylcholine.
Renal tubular secretion is the primary method of excretion for which of the following drugs?

A. Benzylpenicillin
B. Polymysin
C. Streptomycin
D. Tetracycline
E. Bacitracin A. Benzylpenicillin

1) Concept: Benzylpenicillin (Pen G) is the gold standard form of penicillin and is given
parenterally due to it being unstable in stomach acid.

2) Pen G exits the body through tubular secretion primarily.

3) Because Pen G is given parenterally higher tissue concentration of Pen G can be achieved than
is possible with Pen V.

4) Penicillin G is effective mainly against Gram (+) organisms and some Gram (-) organisms
such as Neisseria gonorrhoeae and Neisseria meningitides are also reported to be susceptible to
Pen G.
Pseudomonas infections indicate proscription of which of the following penicillins?

A. Benzathine penicillin (Bicillin)

B. Nafcillin (Unipen)
C. Phenoxymethyl penicillin (Pen-Vk)
D. Ticarcillin (Ticar)
E. Amoxicillin (Amoxil) D. Ticarcillin (Ticar)

1) Concept: Pseudomonas are bacteria that most commonly cause nosocomial infections.

2) Carbenicillina nd Ticarcillin are two penicillin derived antibiotic drugs that are effective
against pseudomembranous and enterobacter infections.

3) Pseudomembranous easily multiply in the most uncommon places which include soaps, tubs,
sinks and stocked distilled water.
The fluoroquinolone antibiotic Ciprofloxacin (Cipro) is...

A. Effective against Pseudomonas Aeruginosa

B. Effective against oral anaerobes
C. Effective against anaerobic bacteria
D. Inhibits cell wall synthesis
E. An antibiotic of choice for treating otitis media in young children A. Effective against
Pseudomonas Aeruginosa

1) Concept: Ciproflosacin (Cipro) is a 2nd generation fluoroquinolone antibiotic with a broad

spectrum of activity, excellent tissue penetration.
b. can be used both orally and parenterally
c. is bacteriocidal because it interferes with the rewinding of bacterial DNA after it is copied,
stopping DNA synthesis
d. coadministration of ciprofloxacin with other drugs primarily metabolized by CYP1A2 results
in increased plasma concentrations of these drugs and could lead to clinically significant adverse
events of the coadministered drug
e. known for its tendency to cause spontaneous tendon ruptures and also may worsen the
symptoms of myasthenia gravis

2) Pseudomonas aeruginosa
a. effectively treated by Ciprofloxacin because of its effectiveness against gram (-) organisms.
Endocrines/Immunosuppressants Endocrines/ Immunsuppressants Answers
Which of the following pharmaceuticals was the etiology agent in the remission in acute
leukemia in children?

A. Aminopterin
B. Carmustine
C. Mechlorethamine
D. Mercaptopurine
E. Streptozocin A. Aminopterin

1) Concept: Aminopterin is a 4-amino analog of folic acid that acts as an anti-neoplastic agent
with immunosuppressive properties.

2) Aminopterin
a. replaced by methotrexate due to its more favorable therapeutic index
b. competes for the folate binding site of the enzyme dihydrofolate reductase, blocking
Tetrahydrofolate (THF) resulting in the depleting of nucleotide precursors and inhibition of
DNA, RNA, and protein synthesis
Corticosteroid therapy would be contraindicated for a patient suffering from which of the
following conditions?

A. Cardiovascular disease
B. Glomerular Nephritis
C. Megaloblastic Anemia
D. Peptic ulcers
E. Renalithiasis
F. Alcoholism D. Peptic ulcers

1) Concept: Peptic ulcers

a. Corticosteroids can cause panic ulcers and can therefore worsen the condition of a person who
already suffers from them.
b. have shown a marked increase in gastric acid secretion, reduction in gastric mucus, as well as
gastrin and parietal cell hyperplasia in animal studies.
c. studies have shown that corticosteroids delay healing of previous ulcers
d. are good for reducing inflammatory reactions in the body
e. high doses and prolonged use causes immune system to weaken and cause a tendency to
develop peptic ulcer
Which of the following adverse drug reactions associated with oral contraceptives is the most
frequent and most dangerous?

A. Hepatotoxicity
B. Hypotension
C. Thromboembolic disorders
D. Uterine neoplasia
E. Clitoral enlargement C. Thromboembolic disorders

1) Concept: Thromboembolisms may occur in women taking oral contraceptives due to an

increase in the activity of fibrinogen and factors VII, VIII and X

2) The activity of fibrinogen and coagulation factors VII, VIII, and X are increased due to the
increase in the blood levels of estrogen and progesterone.

3) Oral contraceptives also induce increased resistance to activated protein C.

4) Thrombus formation may block blood flow and result in severe debilitating conditions like
myocardial infarction and strokes.
A 53 year old male presents for a full mouth extraction and admits taking 10mg oral prednisone
daily to control his ulcerative colitis. After consoling with the prescribing physician, which is the
most likely course of action?
A. Ask the patient to continue taking the prednisone and consider temporarily increasing the
dose.
B. Decrease the patient's dose of prednisone by half to 5 mg on the day of surgery
C. Discontinue the patient's steroid therapy preoperatively
D. Send the patient for serum prednisone levels
E. Change the patient to another steroid for the week before the surgery A. Ask the patient to
continue taking the prednisone and consider temporarily increasing the dose.

1) Concept: Prednisone is an immunosuppresing steroid drug that can affect the health condition
of the patient during and after the surgical treatment.

2) Intake of corticosteroid drugs like prednisone should not be immediately terminated. The
patient should be advised by the physician to temporarily increase the dose he takes to help him
cope with the stress of surgery.

3) Sudden reduction or total absence of prednisone may induce a fatal crisis among patients who
take it regularly.
Which of the following is not a mechanism of action for oral diabetes drugs?

A. Act as an Insulin analogue and bind to insulin receptors.

B. Block glucagon release from the pancreas
C. Increase tissue affinity for glucose uptake
D. Stimulate insulin release from B cells in the pancreas A. Act as an Insulin analogue and
bind to insulin receptors.

1) Concept: Oral diabetic drugs do not act as insulin analogues and do not bind to insulin
receptors

2) Sulfonureas and Meglitides stimulate insulin release from B cells in the pancreas.

3) Exenatie and Liraglutide, and Pramlintide, block glucagon release from the pancreas.

4) Metformin acts to increase tissue glucose uptake.

Analgesics Analgesics Answers
In comparison to codeine, morphine is...

A. A less potent analgesic

B. More likely to be used with pediatric patients
C. Safer
D. A more potent analgesic D. A more potent analgesic

1) Concept: Morphine
a. is a very potent substance considered as the gold standard of opioid analgesics in alleviating
moderate to severe pain
b. is very useful in medicine because its analgesic property is used for managing pains caused by
myocardial infarction and labor.
2) Codeine
a. a less potent compared to morphine and is used to alleviate mild and moderate pain
Each of the following acts as a significant anti-inflammatory EXCEPT one. Which agent is the
EXCEPTION?

A. Acetaminophen
B. Acetylsalicylic acid
C. Cortisol
D. Ibuprofen
E. Ketorolac A. Acetaminophen

1) Concept: Acetaminophen
a. Acetaminophen or also known as paracetamol is an analgesic drug that also has antipyretic
property.
b. It is popularly used in relieving headaches, fever, and mild pains.
c. It also has an anti-inflammatory property but is weaker as compared with NSAIDs.
d. The antipyretic property of acetaminophen makes it very useful in controlling fever. Most of
flu and cold medications incorporate acetaminophen in their formulation for this reason.
e. Acetaminophen is also combined with opioid analgesics in managing post surgical and severe
types of pain.

2) NSAID
a. Aspirin and Ibuprofen are among the NSAIDs while cortisol is a steroid hormone that is
released by the adrenal cortex. They all provide significant anti-inflammatory effect.
Stimulation of which of the following is responsible for the feelings of nausea and vomiting
associated with opioid analgesic administration?

A. Chemoreceptor trigger zone (CTZ)

B. Emetic center
C. Limbic system
D. Opioid receptors within the GI tract
E. Solitary tract nucleus A. Chemoreceptor trigger zone (CTZ)

1) Concept: Chemoreceptor trigger zone

a. The chemoreceptor trigger zone at the medulla oblongata functions by receiving input signals
from hormones or certain blood borne medications, then relays it toward the vomiting center of
the brain to induce vomiting.
b. The neurotransmitters involved in the control of vomiting and nausea may include dopamine,
histamine, serotonin, substance P., and acetylcholine
c. The presence and activation of opioid receptors may be responsible for the reason why
administration of opioid analgesics may cause nausea and vomiting.
Which of the following constituents of IV diazepam is considered the putative agent responsible
for inducing thrombophlebitis?

A. Ethyl alcohol
B. Methanol
C. Propylene glycol
D. Sodium metabisulfite
E. Benzoic acid C. Propylene glycol

1) Concept: Propylene glycol

a. Introduction of propylene glycol may cause thrombophlebitis and hemolysis of large veins
during intravenous drug injection.
b. Propylene glycol is commonly present in intravenous drugs like digoxin, phenytoin, diazepam
and etomidate and serves to make them more soluble and stabilize
c. Propylene glycol is regarded as safe although it may become toxic in high levels with pediatric
patients.
Which of the following compounds is least likely to provide topical anesthesia to a patient?

A. Articaine (Septocaine)
B. Carbocaine (Polocaine)
C. Lidocaine (Xylocaine)
D. Procaine (Novocaine)
E. Benzocaine D. Procaine (Novocaine)

1) Concept: Procaine (Novocaine)

a. Procaine is typically no longer used because new and more potent topical anesthetic options
are already available for use.
b. Procaine is an ester type anesthetic with a short duration of action. It is mostly used in
infiltration, nerve blocks, and epidural anesthesia.
c. Procaine can induce allergic reactions due to para-amino benzoic acid (PABA) metabolite that
is formed during its metabolism.
The impurity that is theoretically found in nitrous oxide that is considered slightly toxic is...

A. Ethylene oxide
B. Methane
C. Nitric oxide
D. Cyclohexane C. Nitric oxide

1) Concept: Nitrous oxide

a. Nitrous oxide is a gas that creates analgesia and dissociated anesthesia and is commonly used
in dentistry
b. Nitrous oxide was first used by Horace Wells for his own tooth extraction by his assistant.
c. Nitrous oxide is used in general anesthesia to enhance the effect of other drugs being
administered by allowing the concentration of other drugs to be decreased without decreasing
their effect.
d. When nitrous oxide reacts with oxygen and is converted into nitric oxide, causing
vasodilation.
Which of the following agents is considered to be the most likely to cause dependence when
administered as a centrally acting analgesic?
A. Codiene
B. Oxycodone
C. Pentazocine
D. Propoxyphene
E. Tramodol B. Oxycodone

1) Concept: Oxycodone
a. is an opiate drug that is mainly used for pain control.
b. Prolonged use is NOT advised since it increases the tendency for drug dependence and
addiction to occur.
c. Oxycodone is an extended-relief drug that is typically indicated for patients suffering from
moderate, severe, and spontaneous pain because it stays long in the blood and provides relief
over a longer period of time.
d. The increased tendency of drug dependence with oxycodone use also increases the risk for
withdrawal syndrome if the drug intake is drastically stopped.
Which of the following patient conditions is the administration of opiates
CONTRAINDICATED?

A. Bronchial asthma
B. Myocardial infarction
C. Renal dysfunction
D. Severe cranial trauma
E. Allergy to meperidine D. Severe cranial trauma

1) Concept: Patients suffering severe cranial trauma are advised NOT to take opiates because of
the possible increase in intracranial pressure.

2) Opiates have the ability to significantly elevate the intracranial pressure which may cause each
of the following in cranial trauma patients:

A. Intracranial bleeding
B. Blood clot
C. Brain damage
D. Shifting of brain structures
E. Herniation of the brain
F. Impeded supply of blood to the brain
Blood dyscrasias are MOST COMMONLY caused by which of the following non steroidal anti-
inflammatory drugs (NSAIDs)?

A. Acetaminophen
B. Aspirin
C. Etotolac
D. Ibuprofen
E. Indomethacin
F. Ketorolac E. Indomethacin
1) Concept: Blood dyscrasias
a. Blood dyscrasias like leukopenia, aplastic anemia, and neutropenia are rarely caused by
NSAID but is sometimes caused by the use of indomethacin.

2) Indomethacin
a. Indomethacin is a drug that provides anti-inflammatory, antipyretic, and analgesic effect.
b. It is proven to be useful in managing conditions like chronic arthritis.
c. The use of Indomethacin is limited due to its ability to inhibit the aggregation of platelets.
d. Indomethacin inhibits the aggregation of platelets and could cause tendencies of increased
bleeding time. Therefore, utmost caution must be observed when indomethacin is used for
patients suffering with coagulation defect.
The preservative Methylparaben most likely demonstrates cross sensitivity with which of the
following agents?

A. Meta-aminobutyric acid esters

B. Para-aminobenzoic acid esters
C. Xylidides
D. Ortho-tuluidide derivatives B. Para-aminobenzoic acid esters

1) Concept: Methylparaben
a. Methylparaben can sometimes induce a cross-sensitivity reaction with the esters of Para-
aminobenzoic acid (PABA ester).
b. The cross sensitivity reaction of PABA ester with methylparaben occurs because the hydroxyl
group of paraben is located in the para position which can eventually react with the para-amino
structure of PABA ester.
c. The para position of amino group in PABA ester is a free amino group on the benzene ring
that can react with the hydroxyl group of the paraben and cause the cross-sensitivty reaction.
Which of the following DOES NOT describe Tramadol (Ultram)?

A. Inhibits uptake of norepinephrine

B. Inhibits uptake of serotonin
C. Is a centrally acting analgesic
D. Is metabolized into a more active form
E. Structurally similar to morphine E. Structurally similar to morphine

1) Concept: Tramadol has a structure similar to codeine NOT morphine.

2) Tramadol
a. is indicated as a pain reliever for moderate to severe pain
b. causes the release of serotonin and inhibition of norepinephrine reuptake mechanisms at the
same time
c. Tramadol and codeine are both metabolized in the liver following the same hepatic pathway
Which of the following opioid receptor subtypes is the primary receptor in the medication of the
supra spinal analgesic action during morphine administration?

A. Epsilon
B. Kappa
C. Mu
D. Sigma
E. Delta C. Mu

1) Concept: Delta, Kappa, and Mu are the three basic opioid receptors, each of which has a
different mode of action

2) Mu receptor activation creates

a. sedation, itching, analgesia, and euphoria
b. decreased respiration, constricted pupils or mitosis and reduced blood pressure
c. decreased bowel movement that eventually leads to constipation

3) Delta receptors
a. are responsible for spinal anesthesia.

4) Morphine Side Effects: "MORPHINE"

M: Myosis
O: Out of it (sedation)
R: Respiratory Depression
P: Pneumonia (Aspiration)
H: Hypotension
I: Infrequency (constipation, urinary retention)
N: Nausea
E: Emesis
Which of the following clinical signs is NOT the characteristics of opioid overdose?

A. Comatose state
B. Dilated pupils
C. Pin-point pupils
D. Decreased respiration rate B. Dilated pupils

1) Concept: Opioid side effects

a. sedation
b. euphoria
c. respiratory depression
d. constipation

2) Opiate overdose includes:

a. Pin-point pupils or pupillary miosis
b. Seizures
c. Muscle spasms
d. Decreased heart rate
e. Decreased respiratory rate
3) Opioids are potent analgesics that can decrease pain perception, decrease pain reaction, and
increase pain tolerance.
Which of the following is the only local anesthetic that increases blood pressure raising activity
of both epinephrine and norepinephrine?

A. Carbocaine
B. Mepivacaine
C. Articaine
D. Cocaine
E. Lidocaine D. Cocaine

1) Concept: Cocaine
a. Cocaine causes an increase in the amount of norepinephrine in synapses by blocking the
reuptake of norepinephrine along the peripheral sympathetic nerve endings, resulting in an
increased in heart rate.
b. Cocaine can also cause an increased blood pressure level through increasing epinephrine
levels which induces a rapid heart rate and an increase in cardiac output.
c. Cocaine is also the only anesthetic drug that can induce vasoconstriction of blood vessels
which can also increase blood pressure.
Which of the following is most effective as a topical anesthetic?

A. Prilocaine
B. Bupivacaine
C. Lidocaine
D. Procaine
E. Articaine C. Lidocaine

1) Concept: Lidocaine
a. Lidocaine is proven to be an effective topical anesthetic drug that can effectively numb the
mucosal surfaces of the oral cavity.
b. It is a strong anesthetic drug usually delivered in gel, liquid, lotion, spray or cream form
c. Lidocaine topical anesthetic can penetrate approximately 2-3mm deep into the mucosal layer
when applied properly.
The concentration of which ion is most closely associated with an opioid agonist or antagonist's
binding affinity with the opioid receptor?

A. Chloride (Cl-)
B. Potassium (K+)
C. Sodium (Na+)
D. Calcium (Ca+2) C. Sodium (Na+)

1) Concept: Sodium ions regulate the binding affinity of opioid agonists and antagonists to
opioid receptors

2) The pharmacodynamic effects of opioids are dependent on their ability to inhibit the release of
neurotransmitters.
3) Opioids inhibit neurotransmitter release through:
a. Reducing entry of calcium ions into the nerve
b. Increasing the outward movement of potassium ions
c. Inhibiting adenylate cyclase.

4) Binding affinity depends on:

a. Receptor type
b. Affinity of sodium with the receptor
c. Whether the substance is an opioid agonist or antagonist
Tylenol 3 contains what amount of codeine?

A. 10mg
B. 15mg
C. 20mg
D. 30mg
E. 60mg
F. 7.5mg
G. 5mg D. 30mg

1) Concept: Tylenol is a proprietary name for the drug paracetamol/acetaminophen. Tylenol has
antipyretic and analgesic effects and is sold in several formulations containing codeine

2) Formulation of acetaminophen and codeine in Tylenol:

a. Tylenol-1: contains 325mg acetaminophen / 8 mg codeine
b. Tylenol-2: contains 300mg acetaminophen / 15mg codeine
c. Tylenol-3: contains 300mg acetaminophen / 30mg codeine
d. Tylenol-4: contains 300mg acetaminophen / 60 mg codeine
Which of the following analgesics can be given orally or by intramuscular (IM) injection?

A. Ibuprofen (Motrin, Advil)

B. Ketorolac (Toradol)
C. Lidocaine (zylocaine)
D. Naproxen Sodium (Aleve)
E. Paracetamol (Tylenol) B. Ketorolac (Toradol)

1) Concept: Ketorolac
a. Ketorolac is an anti-inflammatory that can be administered through intravenous, intramuscular
and oral route.
b. Ketorolac is primarily used to relieve moderate levels of pain. It is usually used prescribed as
post-operative pain reliever or after any other painful procedures.
c. The administration of Ketorolac injection together with ketorolac tablets should not exceed or
go beyond 5 days to avoid the increased risk of experiencing severe adverse effects.
Antihistamine and Autocoids Antihistamine and Autocoids Answers
Xerostomia is most likely to occur after taking...
A. Chloral hydrate
B. Hydroxyzine
C. Phenobarbital
D. Diphenhydramine B. Hydroxyzine

1) Concept: Hydroxyzine is a drug that primarily acts as an anxiolytic and antihistamine. It is

also used in the dental field as a tranquilizer.

2) Hyodroxyzine functions
a. act as a tranquilizer in dental procedures where the patient manifests uncontrolled anxiety and
tension
b. use can cause xerostomia or dry mouth due to its antimuscarinic effect.
Which of the following would be indicated as an effective and safe infiltrative local anesthetic
agent for a patient who is allergic to both amide and ester anesthetic derivatives?

A. Bupivacaine
B. Diphenhydramine
C. Ethylaminobenzoate
D. Nitrous oxide
E. Phenylephrine B. Diphenhydramine

1) Concept: Injectable 1% diphenhydramine hydrochloride can be used as a safe and effective

local anesthetic for patients having allergic reactions from an ester or amide derivative
anesthetic.

2) Diphenhydramine
a. can be applied topically as an antipruritic and anesthetic drug.
b. its ability to provide local anesthesia is probably because of its chemical structure that is
similar to some of the known local anesthetic drugs.
Which of the following describes the way the effects of histamine is antagonized by epinephrine
administration?

A. Competitive inhibition of histamine on receptors

B. Inducing physiologic effects opposite to histamine
C. Non-competitive inhibition of histamine on receptors
D. Prevention of histamine release by mast cells
E. Action on the central nervous system B. Inducing physiologic effects opposite to
histamine

1) Concept: The physiologic response of the body to epinephrine is the opposite to the effects of
histamine release.

2) Histamine release causes contraction of the smooth muscle of the lungs, bronchoconstriction,
swelling, difficulty breathing, and anaphylaxis
3) Adrenaline release or epinephrine administration produces bronchodilation, blood vessel
constriction, and an increase in cardiac output of the hurt.

4) Epinephrine is the best drug for managin anaphylaxis due to its ability to counteract the effects
that cause anaphylaxis.
A serious drug may occur involving the cardiovascular system of patient taking erythromycin
that may cause death in certain individuals. Which antihistamine drug is contraindicated for use
with erythromycin due to that interaction?

A. Chlorpheniramine
B. Diphenhydramine
C. Promethazine
D. Pseudophedrine
E. Terfenadine
F. Hydroxyzine E. Terfenadine

1) Concept: Terfenadine is a relatively safe antihistamine that may cause cardiac arrhythmias
with overdose.
2) Terfenadine
a. became popular because of its less sedating effect compared to other antihistamines
b. Erythromycin is a macrolide antibiotic able to inhibit the metabolism of terfenadine, making
overdose and cardiac arrhythmia more likely.
Static positional records can be utilized to adjust posterior articular controls. In order to set the
RIGHT condylar inclination and the RIGHT side-shift , which of the following are minimally
required for setting posterior controls?

A. Left lateral excursive record

B. Protrusive cheekbite in incisal edge-to-edge position
C. Right lateral excursive record
D. Protrusive cheekbite in extreme protrusive position A. Left lateral excursive record

1) Right lateral excursive record may be used as a guide in setting up the left condylar inclination
with an ARCON stimulator

2) left and right condylar inclinations are both important for copying the condylar movements of
the patient during excursive movements

3) jaw movement during the right lateral excursive movement allows for left side shifting to
occur. With these, the left condylar inclination can be determined
True/False: The long-term prognosis of a single-abutment cantilever fixed partial denture (FPD)
with a single abutment may have a compromised long term prognosis. The term prognosis may
be compromised because occlusal forces for multiple teeth are only accommodated by
periodontal structures when directed along the long axis of the single tooth. Both the
statement and the reason are correct and related

1) Cantilever fixed partial dentures

a. rarely indicated when restoring a missing tooth because one tooth abutment will carry the
occlusal load of two teeth
b. can damage the abutment tooth's periodontal support when excessive force is transmitted by
the large occlusal table of a cantilevered FPD
c. prognosis of cantilever FPD becomes increasingly compromised with continuous damage
incurred by the periodontium of the abutment
The MOST probable cause of plastic denture teeth being dislodged from the acrylic resin of a
denture base?

A. Excessive occlusal force

B. Residual wax on teeth during denture processing
C. Retentive undercuts not placed in the teeth
D. Excessive artificial tooth structure was removed during occlusal adjustment B. Residual
wax on teeth during denture processing

1) Residual wax
a. left surrounding denture teeth during processing, acrylic is not able to adequate flow around
the tooth to locket into place optimally, making it more like that the tooth will fall out
Which of the following is the most valuable aid in determining the psychological prognosis for a
complete denture patient?

A. An evaluation of the patient's present dentures and attitudes

B. Evaluation of the patient's occupational background
C. Evaluation of the resorption of the ridges
D. A classification of the ridge relation A. An evaluation of the patient's present dentures
and attitudes

1) Evaluation the appearance of a patient's dentures at present will provide an insight in how they
use their dentures

2) Examine the condition of the denture informs the dentist about the oral hygiene status of the
patient as well as their eating and chewing habits

3) Quality of dentures will also show how the patient maintains his set of denture teeth
The location of the maxillary anterior teeth of a complete denture will be most esthetic if based
off of which of the following anatomical landmarks?

A. Anterior labial frenum

B. Incisive papilla
C. Middle of the nasal cartilage
D. Vibrating line
E. Anterior edentulous ridge B. Incisive papilla

1) Incisive papilla
a. stable landmark that does not change its position with the palate
b. used as a guide in placing and positioning of the maxillary anterior teeth during denture tooth
placement
c. incisive papilla is expected to be lingually positioned in between the maxillary central incisors
d. most labial surface of the maxillary central incisor denture tooth should be placed
approximately about 8-10mm anterior to the incisive papilla
Dentists usually send their metal and ceramic restorations to dental laboratories for fabrication.
The most common complaint of the technicians at the lab is:

A. Inaccurate impressions or casts

B. Inadequte description of shades and texture of the surrounding teeth
C. Insufficient tooth reduction
D. Ill-defined marginsC. Insufficient tooth reduction

1) Insufficient tooth reduction

a. dental laboratories tend to fabricate bulky and overcontoured crowns to compensate for the
insufficient tooth preparations
b. leads to overhanging and over contoured crowns that invite plaque deposition and induce
periodontal disease
The posterior denture teeth of patients with bilateral crossbones will most likely require the teeth
be set with which of the following relationships?

A. Class I normal horizontal overlap

B. Class II occlusion
C. Unilateral crossbite
D. Bilateral crossbite D. Bilateral crossbite

1) important to set teeth denture teeth in a bilateral crossbite position in order to maintain the
normal occlusal harmony during mastication

2) arrangement of teeth and their intercuspation greatly affects the occlusion of teeth during
mastication

3) adjusting teeth out of their normal position in the arch could cause occlusal disharmony and
TMJ problems

4) arranging teeth following the normal occlusal relationship of upper and lower arch can help
achieve balance articulation and reduce the patient's difficulty of adjusting to a new set of
dentures
How far should the tray extend posteriorly when selecting an impression tray for a preliminary
maxillary impression?

A. Slighty beyond the tuberosity

B. To the uvula
C. To the fovea palatine
D. To the pterygomaxillary notches
E. Beyond the vibrating line E. Beyond the vibrating line
1) ideally, impression trays should only extend slightly beyond the vibrating line to provide
coverage beyond functional limit

2) vibrating line is a denture landmark that designates where the soft palate and hard palate join
and where the posterior palatal border of the denture should be placed

3) Extending beyond the vibrating line can cause the activation of the gag reflex when making
the impression
Why is it indicated that you dispense the liquid component of cement immediately before
commencing mixing?

A. To allow tampering of the power by the mixing slab

B. To avoid absorption of moisture from the air
C. To prevent evaporation of the volatile components
D. To reduce the temperature influence of the mixing slab
E. To avoid spreading over a large area of the slab D. To reduce the temperature influence of
the mixing slab

1) liquid component of a cement is very volatile and dispensing it too early before mixing
commences will lead to evaporation of some of it, causing incomplete wetting of the cement
powder during spatulation

2) Having deficient liquid in proportion to cement powder results in a grainy consistency and
premature setting of the cement mixture
Each of the following is true about addition silicones (polyvinyl siloxanes) EXCEPT one. Which
one is this EXCEPTION?

A. They can be poured after 24 hours after being made and still remain accurate
B. They produce ethyl alcohol during their setting reaction
C. They remain accurate after the first pour
D. They can rebound from undercuts without permanent deformation B. They produce ethyl
alcohol during their setting reaction

1) Addition silicones
a. impression materials that remain accurate for several days even after the initial pour
b. can accurately pour the details of tooth preparations while displaying low dimensional change
once the material has set

2) Condensation silicones
a. release alcohol as by-product during the setting reaction
General Considerations General Considerations Answers
Which of the following is the best description of a Bennett angle?

A. It is the angle that is formed by the non-working condyle and the sagittal plane during lateral
movements
B. It is the difference in condylar inclination between protrusive and lateral movements
C. It is the difference between the condylar and incisal inclinations
D. It is the angle that is formed by the condyle and the horizontal plane during protrusive
movements A. It is the angle that is formed by the non-working condyle and the sagittal plane
during lateral movements

1) Bennett angle
a. The angle obtained after the non-working side condyle has moved anteriorly and medially
relative to the sagittal plane. The flatter the cusp the greater the side shift.

2) Bennet shift
a. The lateral movement of the mandible towards the working side during lateral excursions

3) Bennett movement
a. The left and right condylar motions caused by lateral movements of the mandible
Adding silver (Ag) to ceramo-metal alloy will...

A. Cause green discoloration of the overlying porcelain

B. Increase strength
C. Provide resistance to corrosion
D. Increase melting temperature A. Cause green discoloration of the overlying porcelain

1) Silver
a. Silver causes green discoloration of porcelain
b. PFM crowns incorporate silver to balance to increase thermal expansion coefficient to account
for the properties of Palladium
c. Silver balanced the red color of copper and gold in the metal alloy and decrease the melting
point.
d. New types of porcelain are color stable and not greened by incorporation of silver.
The physical property of cast gold to be burnished is...

A. Modulus of elasticity
B. Modulus of thermoplasticity
C. Percentage elongation
D. Compressive strength A. Modulus of elasticity

1) Concept: Gold has a relatively low modulus of elasticity meaning that it can easily be
deformed, shaped, and burnished using an adequately controlled force.

2) Gold can be easily burnished into and against margins to:

a. Improve adaptation of the restoration
b. Decrease marginal leakage
c. Increase cleansibility

3) Gold is an ideal restorative material

a. adapts well into the margins
b. very durable
c. wear resistant
d. some populations consider it esthetic
The term "flexural strength" describes a material with the ability do which of the following

A. Be visually detectable in radiographs

B. Resist fracture during bending
C. Resist the propagation of a crack
D. Sustain deformation without permanent change in size or shape B. Resist fracture during
bending

1) Concept: Flexural Strength

a. is the ability of a material to resist fracture while bending and is also known as modulus of
rupture, bend strength, or fracture strength
b. The transverse bending test is most frequently employed to evaluate the flexural strength of a
material using a 3-point flexural test technique.
c. The flexural strength gives the highest stress experienced within the material at its moment of
rupture.
d. The significance of flexural strength is commonly expressed in Class V cervical restorations.
A material with a low tensile strength and high compressive strength can be described as which
of the following?

A. Ductile
B. Malleable
C. Resilient
D. Tough
E. Brittle E. Brittle

1) Concept: Brittle materials

a. Brittle materials can be hard solid materials that can withstand heavy compression but not
tension
b. Exhibit low tensile strength and may fracture or break instead of being deformed when under
tensile stress
c. Ductile materials exhibit tensile strength and low compressive strength, making them capable
of being drawn into wires.
On the inner aspects of which of the following teeth do non-working interferences usually occur

A. Buccal cusps of mandibular molars

B. Buccal cusps of maxillary molars
C. Buccal cusps of maxillary premolars
D. Lingual cusps of mandibular molars A. Buccal cusps of mandibular molars

1) Concept: Non-working interferences

a. usually involve the buccal cusps of mandibular molars
b. These interferences result due to the occlusal contact between maxillary and mandibular teeth
on the side opposite the direction the mandible has moved.
c. Non-working interferences are the most destructive type of interference.
d. Non-working intertferences are when there is contact between the maxillary buccal facing
cusp inclines and mandibular lingual facing cusp inclines on the non-working side.
The thinnest/weakest portion of a wax pattern should be placed...

A. Against the ring

B. In the deepest part of the ring
C. Same direction of the casting arm
D. Opposite the direction of the casting arm B. In the deepest part of the ring

1) Concept: Proper placement of the sprue is essential in the success of casting

2) Sprue
a. conduit where molten metal may flow into the mold when the wax pattern is already gone
b. sprue formers should be attached to the bulkiest part of the wax pattern to ensure the smooth
flow of the alloy
c. diameter of the sprue former must be larger than the area of the wax pattern it is attached with
to minimize distortion of the thinnest portion of the wax pattern
d. The thinnest portion of the wax pattern must be found in the deepest part of the ring or farthest
from the sprue base to ensure that the margins of the wax pattern will not be insufficient when
contraction occurs.
Which term describes a material that possess a high compressive strength and low tensile
strength?

A. Brittle
B. Malleable
C. Resilient
D. Ductile A. Brittle

1) Concept: Brittle Materials

a. A material is considered brittle when a material is subjected to force and fractures easily
without substantial dimensional changes

2) Ductile Materials
a. like wires are resistant to permanent deformation when exposed to tensile stress

3) Malleable Materials
a. are resistant to permanent deformation and are resilient to compressive stress

4) Resilience
a. amount of energy that a material has to absorb for the material to be deformed
Which of the following is the best method for evaluating centric occlusion on an onlay that was
just cemented?

A. Occlusal indicator spray (Occlude)

B. Patient feedback
C. Shim stock
D. Articulating paper C. Shim stock

1) Concept: Shim Stock

a. Shim Stock is a metal foil or Mylar used in assessing any unusual occlusal interferences
b. Shim Stock provides a very thin and almost negligible thickness of film that will stay resilient
and stable as it is being used during occlusal testing
c. Shim Stock is a strong material that does not tear easily and accurately records the proper
occlusion of teeth making it useful during cementation procedures
Zinc-oxide eugenol setting times can be accelerated by adding...

A. Acylic monomer
B. Petroleum jelly
C. Water
D. Glycerin C. Water

1) Zinc-oxide eugenol (ZOE) sets through acid-base reaction that yields zinc eugenolate chelate
that can be accelerated by adding water.

2) The setting time of zinc oxide eugenol may be altered

a. Accelerate by adding a small amount of zinc acetate, or water, or accelerator paste while
mixing
b. Slow by cooling the spatula and glass slab and by adding a small amount of base paste while
mixing
Which of the following is the DISADVANTAGE of polyether elastomeric impression materials
compared to other impression materials?

A. Decreased accuracy
B. High stiffness
C. Long working time
D. Stick to teeth
E. Tear easily B. High stiffness

1) Concept: The main drawback of using polyether impression material is its high stiffness.

2) Polyethers
a. main drawback is high stiffness
b. Polyether impression material is difficult to remove sometimes compared to other elastomeric
materials.
c. Polyether is also more expensive than other impression materials except for addition silicones
d. Polyether impression material has adequate tear strength and can be poured multiple times
e. The hydrophilic nature of polyethers makes it worthy to use it in conditions where moisture
control cannot be achieved
PFM crowns with a high-noble base typically have the highest percentage of...

A. Chrome-Cobalt
B. Gold
C. Palladium
D. Platinum
E. Silver
F. Nickel B. Gold

1) Gold
a. High noble alloys contain a minimum of 60% noble metals with gold approximating 40% of
the noble metal content.

2) High noble metals

a. highly resistant to corrosion and oxidation
b. Gold
c. Palladium
d. Platinum
e. Silver
The purpose of flux in soldering is...

A. To displaced gasses and dissolve corrosion products

B. To keep the solder from running after the melting point is reached
C. To prevent solder from incorporating into areas where the technician does not want it to be
D. To provide an oxidized area so the solder will bond to the metal
E. To clean the surface to be soldered of debris A. To displaced gasses and dissolve
corrosion products

1) Concept: Flux
a. Flux functions in 3 ways during the soldering process
b It acts to dissolve oxides along he adjoining metal surface and become a protective barrier
against oxygen
c. Flux is a chemical agent responsible for preventing corrosion along the metals being soldered
during the soldering process. It helps in preventing the oxidation of metals.
d. Flux dissolves oxides and facilitates the wetting of the surface of the molten metal which
makes the metal joint stronger and more durable
Patients with natural dentition generate the most occlusal load during...

A. Mastication
B. Protrusion
C. Swallowing
D. Centric relation A. Mastication

1) Concept: During mastication, the natural teeth occlude against each other and generate most
occlusal load as they function to tear and grind food

2) Centric Relation
a. is a jaw position used as a stable guide in complete denture fabrication
b. is defined as the position of the mandible when the condyle is in its most anterior and superior
position

3) Protrusion
a. is the sliding motion of the mandible and it does not require heavy occlusal load

4) Swallowing
a. The force of occlusion between upper and lower arch during swallowing is less when
compared to the force of mastication.
Which of the following terms describes the length of a patient's face when the occlusion rims and
central bearing point are in contact while the mandible is in centric relation?

A. Freeway space
B. Interocclusal rest space
C. Leeway Space
D. Physiologic rest position
E. Vertical dimension of occlusion E. Vertical dimension of occlusion

1) Concept: Vertical dimension of occlusion:

a. describes the length of the face for a patient when their teeth, occlusion rims, and central
bearing point are in contact while the mandible are in centric relation.
b. The teeth, occlusal rims, and the central bearing point should be in contact. The condyle
mandible should be in its most anterior superior position.
c. Vertical dimension of occlusion indicates the superior-inferior relationship of the maxilla and
the mandible when the teeth are situated in maximum intercuspation.
For patients with canine lateral guidance and an anterior overbite is 2mm or less.

The buccal cusp height should be kept low in order to provide proper protrusive disclusion.
Statement is correct but reasons in incorrect

1) Concept: Canine guidance allows the disclusion of posterior teeth during lateral protrusive and
excursive jaw movement

2) The buccal cusp height should not be altered because anterior and canine guided occlusions
should be adduced to provide proper protrusive disclusions on he posterior teeth

3) Anterior guidance encompasses the proper positioning of the anterior teeth in harmony with
the mandibular envelope of motion that allows proper disclusion of posterior teeth while lateral
excursive movement are performed.
When casting Chrome-Cobalt, how much shrinkage should you expect?

A. 1.6%
B. 1.8%
C. 2.2%
D. 2.6%
E. 1.2% C. 2.2%
1) Concept: Base metal alloys such as Chrome-Cobalt (Cr-Co) have a very high casting
temperatures, and prone to increased casting shrinkage.
2) CrCo alloy has a casting shrinkage of 2.2%
3) CrCo alloy has can be used as a denture framework, in all metal restorations, and in porcelain
fused to metal restorations.
4) Other base metal alloys used in dentistry include nickel-chromium-berrylium and nickel-
chromium alloys.
When casting gold, shrinkage porosity is associated with...

A. Cooling the casting too quickly

B. Neglecting to use flux
C. Sprue diameter
D. Too much flux
E. Too much burnout time C. Sprue diameter

1) Concept: Shrinkage porosity is associated with the diameter of the sprue being used

2) Sprue
a. sprue is the channel that allows the molten alloy to reach the mold within the investing
material after the wax out procedure
b. too narrow of a sprue will prevent the smooth flow of the molten material into the mold,
allowing the molten alloy to harden without flowing into all areas of the mold, resulting in
shrinkage porosities

3) Placement of sprue
a. The placement of sprue is also important to proven shrinkage porosities. The sprue must be
placed ideally where the wax pattern has its greatest bulk at about 45 degrees perpendicular to
the flat surface of the wax pattern.
Which of the following records is the minimum requirement to set the left condylar inclination
and left side shift after the posterior controls have been set on an ARCON articulator?

A. Left lateral excursive record

B. Protrusive checkbite in incisal edge-to-edge position
C. Right lateral excursive record
D. Protrusive checkbite in extreme protrusive position C. Right lateral excursive record

1) The right lateral excursive record may be used as a guide in setting up the left condylar
inclination with an ARCON articulator

2) The left and right condylar inclinations are both important for copying the condylar movement
of the patient during excursive movements.

3) The jaw movement during the right lateral excursive movement allows for left side shifting to
occur. With these, the left condylar inclination can be determined.
Each of the following are characteristics of addition silicone (Polyvinyl siloxane) impressions
EXCEPT one. Which of the following is the EXCEPTION?

A. They can be poured after 24 hours after being made and still remain accurate
B. They produce ethyl alcohol during their setting reaction
C. They remain accurate after the first pour
D. They can rebound from undercuts without permanent deformation B. They produce ethyl
alcohol during their setting reaction

1) Concept: Addition Silicones

a. Addition silicones are a class of impression materials that remain accurate for several days
even after the initial pour.
b. Addition silicones can accurately copy the details of tooth preparations while displaying low
dimensional change once the material has set

2) Condensation Silicones
a. Condensation silicones NOT addition silicones release alcohol as a by-product during their
setting reaction.
How far should an impression tray extend posteriorly when making a maxillary impression for
diagnostic casts?

A. Slightly beyond the tuberosity

B. To the uvula
C. To the fovea palatine
D. To eh pterygomaxillary nothces
E. Beyond the vibrating line E. Beyond the vibrating line

1) Impression Trays
a. Ideally, impression trays should only extend beyond the vibrating line to provide coverage
beyond functional limit

2) Vibrating Line
a. is a denture landmark that designates where the soft palate and hard palate join and where the
posterior palatal border of the denture should be placed.
b. extending beyond the vibrating line can cause the activation of the gag reflex when making the
impression
Which of the following describes a property of a material to resist fracture under bending BEST?

A. Flexural Strength
B. Force/Load
C. Fracture Toughness
D. Strain
E. Stress A. Flexural Strength

1) Flexural Strength
a. can be BEST described as a property of a material which is critical in thin layers or sections
such as margins of a restoration
b. It is the ability of a material to resist fracture under bending.
c. The main significance of flexural strength in restorative dentistry is observed in Class V
cervical restorations
d. Cervical flexure in Class V preparations is the major reason for the failure of these
restorations.
Blade and root form dental implants are examples of which class of implants?

A. Endosseous
B. Glass
C. Subperiosteal
D. Transosteal A. Endosseous

1) Concept: Root form implants are the most popularly used end osseous implants today.

2) Endosseous Implants
a. placed directly into the bone and act as an anchor or root that will hold the crown, bridge or
implant-supported denture in place

3) Transosteal Implants
a. less likely to be used because of the complicated and very extensive surgical procedure that
the patient undergoes

4) Subperiosteal implants
a. Placement of subperiosteal implants is technique sensitive and is quite expensive
b. They are indicated for patient who want implants but have inadequate bone height and width
True/False

Light sources have an effect on the perception of color BECAUSE light sources must contain the
wavelength of color to be matched if the color is to be seen by the eye. Both statements are
True

1) Concept: For the perception of color through the light sources, these must contain matching
wavelength of the colors. It makes the color visible to the eye.

2) Metamerism
a. matching of apparent color of objects with different spectral power distributions
b. colors that match this way are called me tamers
What is the purpose of using a liner when casting gold with a casting ring?

A. It allows for quicker cooling of the casting and less shrinkage

B. It allows for the casting to be removed from the investment
C. It helps prevent porosity
D. It allows for uniform setting of the casting D. It allows for uniform setting of the
casting
1) Concept: Liners are placed along the internal aspect of the casting ring and provide space for
uniform investment expansion, allowing for uniform setting of the casting.

2) Liners
a. allow investment expansion and prevents distortion of the wax pattern during investment,
b. act as a spacer that prevents pressure from building up between the investment material and
the casting ring during the expansion of the investment
c. are usually placed 3mm shorter than the casting ring and demonstrate a thickness of 1mm
Anterior occlusion is determined by...

A. Both horizontal and vertical overlap of anterior teeth

B. Cusp inclination
C. Horizontal overlap of anterior teeth only
D. Vertical overlap of anterior teeth only
E. Cusp heightA. Both horizontal and vertical overlap of anterior teeth

1) Concept: Anterior occlusion is determine by both the horizontal and vertical overlap of
anterior teeth.

2) Overbite:
a. Vertical overlap of maxillary incisors over the mandibular incisor during maximum
intercuspation
b. Ranges from 3-5mm depending on tooth size and the occlusion type of the patient

3) Overjet
a. Horizontal overlap of maxillary incisors over the mandibular incisors during maximum
intercuspation
b. Ranges from 2-4mm depending on the type of skeletal facial profile and the occlusion type of
the patient
Which of the following properties of base alloys is lower than gold alloys in numerical value?

A. Fusion temperature
B. Hardness
C. Modulus of elasticity
D. Specific Gravity
E. Tensile Strength D. Specific Gravity

1) Concept: Density of pure substance and metal mixture are different since gold is heavier and
more dense than base-metal alloys
a. Specific Gravity: ratio between the density of one material against the density of another
material which is considered as a standard as their densities are weighed in air

2) The properties shown below are lower in numerical value compared to base alloys
a. tensile strength
b. hardness
c. fusion temperature
d. modulus of elasticity
Elastomeric impression material works best when the tooth preparation is...

A. Covered with thin layer of a petroleum gel

B. Covered with a surface tension-reducing agent
C. Covered with a thin layer of water soluble lubricant
D. Free of surface moisture D. Free of surface moisture

1) Concept: Four types of elastomeric impression materials are polysulfides, condensation

silicones, addition silicones, and polyethers

2) Each material differs in their setting mechanism and their physical and chemical properties

3) Surface moisture is not good for elastomeric impression materials because the moisture
decreases the accuracy of the impression.
The pickling procedures involves heating a gold alloy restoration to redness then plunging it into
an acid bath that can lead to which of the following?

A. Increased porosity of the casting

B. Oxidation of the alloy
C. Surface roughness of the restoration
D. Warping of the restoration D. Warping of the restoration

1) Concept: Dipping a red hot gold alloy restoration into an acid bath causes a sudden change in
temperature of the heated metal resulting in an unwanted warping of the restoration

2) The heating of gold alloy restoration until it is cherry red causes the metal molecules to
expand. During this phase the metal is easier to shape and contour.

3) If the reddish heated metal is suddenly soaked in an acid bath of different temperature, the
molecules will suddenly contract and this rapid cooling results to thermal shock.

4) In order to avoid warping of the restoration during pickling, it is best to let the metal cool
down a bit prior to plunging it to an acid bath. Adding to this, using a warm acid bath is also a
good way to lessen the difference of temperature between the hot metal and the acid bath
solution.
Backpressure porosity...

A. Can be diagnosed by rounded edges of the casting when they should be sharp
B. Describes the same phenomena as occluded gas porosity
C. Is caused by too large of sprue size
D. Is caused by excessive burnout A. Can be diagnosed by rounded edges of the casting when
they should be sharp
1) Concept: Back pressure porosity is suggested by the presence of rounded edge of the casting
instead of sharp and angled edges.

2) Rounded edges of the casting suggesting gas was still present within the area, so the material
could not flow in.

3) Too short of sprue is also a cause of back pressure porosity since inadequate length causes
incomplete venting of gas.
Wax patterns for cast restoration should be invested as soon as possible after they are completed
to minimize distortion caused by...

A. Continue expansion of the wax

B. Microfractures caused by vibrations from laboratory instruments in the area
C. Relaxation of the internal stress of the wax pattern
D. Evaporation of water from the wax C. Relaxation of the internal stress of the wax
pattern

1) Concept: Wax patterns build up internal stress through with continuous heating, molding,
carving, and pressing.

2) Internal stress
a. introduced into the wax pattern during wax manipulation will slowly release their internal
tension and undergo relaxation after the wax cools down

3) Relaxation
a. results in distortion in the shape and contour of the wax, and may decrease the accuracy of fit
of the final restoration
Which of the following outcomes may result from a tray lacking occlusal stops that is to be used
for a polysulfide impression?

A. An inaccurate final impression due to distortion incurred during the removal of the impression
tray from the patient's mouth
B. An inaccurate final impression due to permanent distortion incurred during the setting
reaction
C. Increased setting time in the mouth before the tray can be removed
D. The clinician holding the ray during the entire time of the polymerization procedure A. An
inaccurate final impression due to distortion incurred during the removal of the impression tray
from the patient's mouth

1) Concept: Permanent distortion may occur in a final impression made with polysulfide
impression material if occlusal stops are not present in the tray.

2) Polysulfides require custom trays containing occlusal stops for the making of the impression.

3) Both addition and condensation polysulfide impression materials undergo polymerization

shrinkage during setting.
4) Condensation silicones show additional shrinkage due to the evaporation of products like
alcohols.
After removing retraction cord for a final impression, heme is noticed in the sulcus. The correct
management of this case would be to...

A. Achieve hemostasis, place cord again, make impression

B. Place an overcontoured temporary restoration to move the gingival tissue out of the way and
re-appoint the patient for another impression
C. Use Sodium Hypochlorite to stop the hemorrhaging
D. Procede with the impression as planned since injection of the impression material will move
the heme out of the way A. Achieve hemostasis, place cord again, make impression

1) Concept: Hemostasis should be achieved by placing a new retraction cord before the final
impression is made

2) Retraction cord
a. should be placed to ensure displacement of gingiva so the gingival margins of the preparation
can be recorded by the final impression
b. sulcular hemorrhage prevents the impression material from accurately recording the gingival
margin of the tooth preparation
Which of the following factors should a clinician give the greatest consideration when selecting
which dental base to utilize in a case?

A. It's biocompatibility
B. It's strength
C. The thickness of the remaining dentin
D. Which tooth is being restore C. The thickness of the remaining dentin

1) Concept: The thickness of the remaining layer of dentin that protects the pulp is the MOST
important thing to consider when selecting the type of base material because some materials can
cause pulpal irritation as it approximates the pulp.

2) Dental Bases
a. are used in order to provide pulpal protection specifically on teeth having deep cavities
b. may provide pulpal protection
c. provide thermal insulation
d. provide sedative effects which give the pulp enough time to recover

e. The strength of the material and its biocompatibility are also important things to consider
when choosing a dental base but they will only be considered after evaluating the thickness of
the remaining dentin.
Which of the following syringe-delivered impression materials is the most rigid and difficult to
remove from the mouth?

A. Condensation silicones
B. Polyether
C. Polysulfide
D. Reversible hydrocolloid
E. Addition Silicone (poly-vinyl siloxane) B. Polyether

1) Concept : Polyether
a. Polyether is a non-aqueous hydrophilic elastomeric impression material that is considered the
most rigid impression material
b. It is the stiffest among the elastomeric impression materials and will fracture when forcefully
removed when it is engaged in an undercut
c. It is a stable impression material and can be used in a moist environment since it is
hydrophilic.
When Gypsum-bonded casting investments are mixed thin, you should expect...

A. Decreased porosity
B. Decreased setting expansion
C. Decreased thermal expansion
D. Increased thermal expansion
E. Increased setting expansion B. Decreased setting expansion

1) Concept: Setting expansion of gypsum-bonded casting investments may be modified by

altering the water-powder ratio

2) Crystallization is observed during the conversion of hemihydrate to dehydrate forms

3) As gypsum-bonded casting investment sets, crystals are formed from the nuclei of
crystallization, and continue to expand in an outward direction

4) Thick mix = setting expansion is increased due to the saturation of nuclei of crystallization
5) Thin mix = setting expansion is decreased since the nuclei of crystallization are less dense
When using an ARCON articulator, which of the following jaw-relation records should be
utilized to set both the medial and superior condylar guides?

A. Centric relation
B. Lateral interocclusal records
C. Maximum intercuspation
D. Protrusive interocclusal records B. Lateral interocclusal records

1) Concept: Lateral interocclusal records should be utilized in order to achieve both the medial
and superior condylar guides. The arcon articulator resembles the human anatomy correctly.

2) The arcon articulator contains the condylar element attached to the lower member and
condylar guidance attached to the upper member.
Group function is distinguished by having multiple of which of the following?

A. A long centric contacts

B. Non-working contacts
C. Protrusive contacts
D. Working contacts D. Working contacts

1) Concept: Group function occlusion (Unilateral balanced occlusion)

a. there are multiple tooth contacts between the mandibular teeth and maxillary teeth along the
working side during a lateral jaw movement
b. multiple contacts of the maxillary and mandibular dentition act as a group of teeth which
distributes the occlusal load on the working side
c. stress is transmitted to several teeth, reducing the heavy occlusal load and distributing it
among all teeth in excursive contact
Modulus of elasticity is a measure of which of the following?

A. Ductility or malleability
B. Stiffness or rigidity
C. Tensile strength
D. Ultimate strength
E. Yield strength B. Stiffness or rigidity

1) Concept: Modulus of elasticity is the measure of stiffness or rigidity of a metal that describes
the tendency of a substance to undergo elastic or non-permanent deformation

2) A stiffer or rigid substance will have a higher elastic modulus and vice versa

3) Elastic modulus is also defined as a measure of stress divided by strain

Functional occlusal bite registration presumes that...

A. The patient is edentulous

B. The opposing teeth in both arches are in equilibrium
C. The teeth to be restored are supra-erupted
D. Vertical dimension of occlusion (VDO) is lost B. The opposing teeth in both arches are in
equilibrium

1) Concept: Functional occlusal bite registration

a. presumes that the opposing teeth in both arches are in equilibrium
b. provides a stable guide to reproduce the patients' occlusion during the articulation and
mounting of the casts
c. During functional occlusion, the upper and lower teeth occlude against their respective
antagonists
When comparing high-noble alloys to base metal alloys, base metal alloys have a

A. Higher modulus of elasticity

B. Higher specific gravity
C. Lower yield strength
D. Higher melting point D. Higher melting point
1) Concept: High noble alloys have lower melting point than base metal alloys
2) Other differences include:
a. High noble metals resist oxidation
b. High noble alloys are easier to cast because of their lower melting point
c. Base metal alloys possess 0-25% noble metals
d. Base metal alloys are harder and stronger than high noble
Which of the following is the BEST rationale for pouring an impression made with condensation
material as soon as possible?

A. Condensation impression materials expand as they absorb water from the air if left unpaired
B. Condensation polymers begin reacting with the impression tray, which may cause distortion
over time
C. Evaporation of volatile by-products result in shrinkage of the impression
D. The amount of polymerization is initially high then decreases with time, making the
impression less accurate C. Evaporation of volatile by-products result in shrinkage of the
impression

1) Concept: Condensation silicones produce volatile by-products (alcohols) after reacting which
are vaporized into air, leaving behind gaps in the impressions.

2) An impression made with condensation silicones should be poured immediately to prevent

shrinkage.

3) Shrinkage occurs in it and details are lost rendering the impression defective if the impression
is kept without pouring.

4) Addition silicones do not produce by-products.

Which of the following mechanical properties are INCORRECTLY paired?

A. Elastic modulus - ability to sustain deformation without permanent change in size or shape
B. Flexural strength - measures the ability of a material to resist fracture under bending loads
C. Fracture toughness - ability to resist the propagation of a crack
D. Tensile strength - volume loss due to abrasion and opposing contact area D. Tensile
strength - volume loss due to abrasion and opposing contact area

1) Concept: Tensile Strength

a. maximum stress that a material can withstand while being stretched or pulled before failing or
breaking. It is an important property of a restorative material.

2) Elastic modulus
a. ability to sustain deformation without permanent change in size or shape

3) Flexural strength
a. measure the ability of the material to resist fracture under bending loads

4) Fracture toughness
a. ability to resist the propagation of a crack
Increasing the proportion of water to Class IV gypsum die stone will most likely result in...

A. less expansion and less strength

B. more expansion and less strength
C. more expansion and more strength
D. less expansion and more strength B. more expansion and less strength

1) Concept: When the water concentration is increased in the mixture, the distance between
gypsum particles increase, thereby increasing the setting time.

2) The porosity in the final mixture and the gap in between the gypsum particles increases as
more water is added in the mix. This will result to a more soluble and weaker cast.

3) Increased expansion compromises stone strength because excess water makes the die stone
less dense and less compact.
Which of the following conditions makes it critical that the patient casts are mounted on the true
hinge axis?

A. When a Class II occlusion is present

B. When the treatment plan includes fabrication of complete dentures with high-cusped teeth
C. When the treatment plan includes fixed partial dentures on opposing arches
D. When the treatment plan is to change the vertical dimension of occlusion through fixed
restorations D. When the treatment plan is to change the vertical dimension of occlusion
through fixed restorations

1) Concept: Changing the vertical dimension of occlusion through fixed restorations require the
mountain of patient's cast in a true hinge position.

2) Determining the hinge axis is essential in constructing dental prostheses and correcting
occlusal interferences.

3) A true hinge axis is a line that passes through the left and right mandibular condyles and
coincides with the center of rotation of the mandible.
Complete Denture Prosthodontics Complete Denture Prosthodontics Answers
Which anatomical structure is used as a guideline to provide the most esthetic result for the
location of the maxillary anterior teeth in a complete denture?

A. Anterior edentulous ridge

B. Anterior labial frenum
C. Incisive papilla
D. Vibrating line C. Incisive papilla

1) Concept: The incisive papilla is a stable landmark that does not change its position within the
palate.
2) Incisive papilla
a. used as a guide in placing and positioning of the maxillary anterior teeth during denture tooth
replacement
b. is expected to be lingually positioned in between the maxillary central incisors

3) The most labial surface of the maxillary central incisor denture tooth should be placed
approximately about 8-10mm anterior to the incisive papilla
Which of the following characteristics a prominent disadvantage of immediate complete dentures
as a treatment option?

A. Excessive resorption of the residual ridges

B. Impossibility of an anterior try-in appointment
C. Increased post-operative infection risk
D. Increased trauma to extraction siteB. Impossibility of an anterior try-in appointment

1) Concept: Immediate dentures are delivered immediately after the teeth are extracted, which
therefore gives NO ezra time for dentist and patient to have an anterior try-in.

2) Immediate dentures
a. are indicated for when anterior teeth are to be extracted and the patient still wants to appear
"normal" after the extraction
b. typically become loose and ill-fitting after a few weeks because the pre-extraction ridge is
very different from the totally-healed alveolar ridge a month later

3) The difference in the pre and post extraction ridge often necessitates that the immediate
dentures are either relined or sometimes remade.
Which of the following is associated with a flabby maxillary anterior ridge under a complete
denture?

A. A "U" shaped ridge

B. A "V" shaped ridge
C. A patient with Class II occlusion
D. Osteoporosis
E. Retained mandibular anterior teeth E. Retained mandibular anterior teeth

1) Concept: Combination syndrome: is a condition that usually occurs when retained mandibular
anterior teeth opposes a maxillary complete denture

2) Combination Syndrome
a. anterior aspect of upper maxillary ridge becomes highly resorbed and flabby due to the biting
force against its natural tooth antagonist

3) Since the occlusal force of a natural tooth is stronger than the force of a denture supported by
an alveolar ridge, the area under pressure will exhibit higher resorption pattern than the rest of
the denture.
Which of the following 3 factors have an effect on the correct positioning of the lips of complete
denture patients? Select all that apply.

A. Anterior border thickness, face-bow transfer

B. Anterior border thickness, face-bow transfer, and vertical dimension of rest
C. Anterior border thickness, position of teeth and vertical dimension of rest
D. Anterior border thickness, position of teeth, and vertical dimension of occlusion
E. Vertical dimension of occlusion B. Anterior border thickness, face-bow transfer, and
vertical dimension of rest

D. Anterior border thickness, position of teeth, and vertical dimension of occlusion

1) Concept: The anterior thickness of the denture flange and the position of the anterior teeth in
relation to the alveolar ridge greatly affects the lip profile of the patient.

2) Denture flanges
a. that are made too thick and too labially positioned cause the teeth to make the lips appear more
protruded, creating a convex lip profile.
b. that are made too thin, together with denture teeth positioned too far lingually will make the
lips appear unsupported, thin, and sunken. Unsupported lips typically make the patient appear
older.

3) Attaining the correct vertical dimension restores proper lip and facial profile by lifting
unsupported soft tissues up and brining the natural look of the face and lips back to when the
teeth were still present.

4) Decreased vertical dimension results in the formation of deep labiomental grooves and
deepening of the angles of the mouth
Which of the following factors is the most likely reason for a midline fracture of a denture that
has been used for many years?

A. Advanced resorption of the alveolar ridge

B. Inadequate extension of the posterior palatal seal
C. Over-relief of the incisive papilla area
D. Porosity of the denture base material acquired during processingA. Advanced resorption of
the alveolar ridge

1) Concept: Advanced resorption of the alveolar ridge causes the dentures to rock or move in a
seesaw motion using the palatal area of the denture as a fulcrum.

2) As the dentures move back and forth, the force of mastication creates stress along the midline
of the denture

3) Through time, the stress created along the midline of the ill fitting denture causes it to crack
then fracture completely
Accurate adaptation of anterior maxillary denture flange helps which of the following the
MOST?

A. Esthetics
B. Retention
C. Speech
D. Stability
E. Support A. Esthetics

1) Concept: Accurate adaptation of anterior maxillary denture flange improves esthetics the most
because it restores the facial profile and lip profile of the patient

2) When anterior denture flanges are made to accurately adapt to the labial ridge within the
functional limit, the profile of the lip may appear natural and wearing the dentures will cause less
bother to the patient.

3) Peripheral seal along the labial aspect is also achieved following accurate denture adaptation.
This promotes better retention and stability, as well as a decreased chance of food debris getting
stick between the denture and mucosa.

4) Speech is also improved when dentures fit perfectly since the patient doesn't feel any fear that
the denture may fall off while speaking.
Which of the following is indicated to correct a facial discrepancy where an edentulous patient
has a lower 1/3 of their face that is considered too short and a lack of vermillion border?

A. Increasing the interocclusal distance

B. Increasing the vertical dimension of occlusion
C. Moving the anterior teeth facially
D. Using bilateral balanced occlusion
E. Decreasing the vertical dimension of occlusion B. Increasing the vertical dimension of
occlusion

1) Unsupported lips and absence of vermilion border together with a relatively short lower 1/3 of
the face is indicative of an incorrect vertical dimension of occlusion.

2) Presence of labial commissure and deep labiomental groove are also indications of a short and
incorrect vertical dimension of occlusion.

3) Increasing the vertical dimension of occlusion can help achieve adequate lip support,
esthetically pleasing and properly proportioned facial profile and satisfactory phonetics.

4) Too high of a vertical dimension of occlusion may cause straining of the muscles of
mastication and facial pain.
Which suture technique is indicated for closure of an immediate denture case?

A. Continuous
B. Horizontal mattress
C. No use sutures because the immediate dentures acts as a stent
D. Vertical mattress
E. Interrupted E. Interrupted

1) Concept: Interrupted sutures are more stable and provide better adaptation of the wound edge
b. Interrupted sutures are placed individually

2) Continuous sutures
a. pose a greater possibility of coming loose under frictional and occlusal forces from the tissue
side of immediate dentures
b. if continuous sutures unwind and become loose, the stabilization of the wound is altered.
c. disturbing the closure of the wound could result in the reopening of the wound.
An 89 year-old patient, Adam, reports to you that he has not been wearing the mandibular partial
the dentist you bought your practice from made for him 20 years ago when his maxillary
complete denture was made because it bothered him. What is the finding you would most likely
make after examining Adam's mouth?

A. Extrusion of the mandibular anterior teeth

B. Intrusion of the mandibular anterior teeth
C. Posterior maxillary ridges that are flabby
D. Advanced resorption of the maxillary anterior arch D. Advanced resorption of the
maxillary anterior arch

1) Concept: Combination syndrome (CS) is observed in patients with a maxilla complete denture
occluding against a Kennedy Class I partial denture (only anterior teeth remain).

2) The compressive force from the lower anterior teeth is transmitted by the tissue-borne upper
denture to the anterior maxillary residual ridge causing bone loss and replacement of the bone
with hypertrophic fibrous soft tissue.

3) 7 symptoms of combination syndrome are:

a. Bone loss in the pre maxilla
b. Dropping of the posterior maxilla (tuberosities)
c. Extrusion of the lower anterior teeth
d. Posterior bone loss in the mandible under RPD
e. Papillary hyperplasia of the maxilla
f. Decreased vertical dimension of occlusion (VDO)
g. Facial esthetics often altered dramatically
When fabricating dentures, what would be the most likely outcome if the lab compressed/packed
the acrylic during the rubbery stage?

A. A lot of extra resin being attached to the denture that will take a long time to trim
B. Higher porosity than normal
C. Incomplete picking up of anatomical details
D. The denture would have an increased VDO C. Incomplete picking up of anatomical
details

1) Concept: Packing and compressing acrylic during denture fabrication should be done in its
doughy stage.

2) Doughy stage
a. is the ideal for packing acrylic resin because it is the moment when acrylic is most packable
and workable

3) Rubbery stage
a. Rubbery stage of acrylic denotes the start of the setting when heat is released from the setting
acrylic
b. Rubbery acrylic also has a tendency to revet back to its original position regardless of the
forces applied to it during packing, resulting in incomplete packing
Dentists should include post palatal seals in complete maxillary dentures to compensate for
which of the following factors?

A. Errors in fabrication
B. Inaccuracy of the impression material
C. Polymerization and cooling shrinkage of the acrylic
D. Tissue displacement C. Polymerization and cooling shrinkage of the acrylic

1) Concept: Posterior palatal seals are crated and incorporated into a fabricated denture to
compensate for the shrinkage of acrylic after the processing of dentures.

2) Processed acrylic dentures exhibit polymerization shrinkage and cooling shrinkage which may
cause the denture to have a slight clearance from soft tissue contact.

3) Posterior palatal seal

a. A dentist created a posterior palatal seal is necessary because of the polymerization error
b. to create the posterior seal, the master cast is slightly carved around the area of the vibrating
ling to create more acrylic thickness to make up for shrinkage

4) Alternative method
a. Another method is to place IOWA wax along the area where the soft movable tissue meets the
hard palate and the body heat will melt the wax to create an impression of the area with extra
bulk
Which of the following is most important factor when evaluating how a patient will
psychologically adapt to a new set of complete dentures?

A. A classification of the ridge relation

B. An evaluation of the patient's present dentures and attitudes
C. Evaluation of the resorption of the ridges
D. Evaluation of the patient's occupational background B. An evaluation of the patient's
present dentures and attitudes
1) Concept: Evaluating the appearance of patient's dentures at present will provide an insight in
how they use their dentures.

2) Examining the condition of a denture informs the dentist about the oral hygiene status of the
patient as well as their eating and chewing habits.

3) Quality of dentures will also show how the patient maintains his set of denture teeth.
Which of the following should a dentist consider when fabricating a set of complete dentures for
a patient with a knife-edge mandibular ridge that is chronically tender?

A. A broad occlusal table to provide firmer contact during eccentric jaw movements
B. Decreased vertical dimension of occlusion to decrease masticatory forces
C. Maximum extension of the denture distally to distribute the masticatory forces over a broader
area
D. Minimal distal extension of he denture to limit the amount of tender area covered by the
denture. C. Maximum extension of the denture distally to distribute the masticatory forces
over a broader area

1) Concept: Maximizing the denture coverage helps to balance the distribution of forces,
especially when the remaining alveolar ridges are already compromised.

2) Through maximizing the area covered by the denture bases, the forces of occlusion will be
carried by a larger area, thus reducing the stress along the knife-edge mandibular ridge.

3) Another way of reducing the stress load along the knife edge mandibular ridge is by utilizing
the selective pressure impression technique.

4) Through this impression technique, knife edge margins are relieved and the occlusal load is
transmitted to the solid cortical bone of the buccal shelves.
Which of the following factors regulate(s) the path of the condyles in mandibular movements
during denture fabrication?

A. Centric relation, degree of compensating curve, and vertical dimension of occlusion

B. The degree of horizontal and vertical overlap
C. The posterior cusp height
D. The size and shape of the fossae, the menisci, and muscular influences D. The size and shape
of the fossae, the menisci, and muscular influences

1) The Concept: The path of the condyles in mandibular movements during the fabrication of a
denture is regulated by the following factors:
a. size and shape of the fossae
b. size and shape of the menisci
c. muscular influences and movements
Which of the following reasons describes why mandibular denture molars should NOT be placed
over the ascending portion of the ramus?
A. Teeth placed here would interfere with the contraction of the masseter muscle
B. The molars would interfere with the retromolar pad.
C. The occlusal forces over the inclined ramus would dislodge the mandibular denture
D. The teeth would encroach on the tongue space
E. The denture base terminates where the mandible ascends C. The occlusal forces over the
inclined ramus would dislodge the mandibular denture

1) Concept: As the ramus of the mandible ascends, it approximates the bulbous maxillary
tuberosity which makes the placement of denture teeth more difficult

2) Denture molar teeth will not occlude properly along the ascending ramus because of their
angulated position and stress from strong forces from the muscles of mastication.

3) Denture molar teeth are best positioned along the residual ridge before the ascending ramus
and retromolar pad.
In balanced complete denture occlusion, the Buccal cusps of maxillary posterior teeth on the
working side contacts which of the following areas of mandibular posterior teeth?

A. The buccal inclines of buccal cusps

B. The central fossae
C. The lingual inclines of the buccal cusps
D. The lingual inclines of the lingual cusps
E. The buccal inclines of the lingual cusps A. The buccal inclines of buccal cusps

1) Concept: The lingual inclines of the maxillary posterior teeth on the non-working side
contacts the lingual inclines of the buccal cusps of mandibular posterior teeth.

2) Simultaneously, the buccal and lingual cusp of the maxillary posterior teeth on the working
side contacts their respective buccal and lingual mandibular cusp counterparts

3) Setting up denture teeth to achieve balanced articulation prevents the denture from being
dislodged or tipped off during masticatory function. The presence of contacts between the cusps
of maxillary and mandibular posterior denture teeth enables the denture to stay in balance during
mastication.
Increasing the vertical dimension of occlusion may incur which of the following adverse effects?

A. The closing muscles may become too relaxed and create wrinkles
B. The closing muscles may experience strain
C. The corners of the mouth may exhibit soreness
D. The opening muscles may become strained B. The closing muscles may experience
strain

1) Concept: Masticatory muscles will experience excessive strain on closing the mouth due to an
increased vertical dimension of occlusion.
2) This will adversely affect the muscular movements during eating, talking, and other functions.

3) It is necessary to determine the required vertical dimension of occlusion

4) Unnecessary increases in the vertical dimension of occlusion will cause stress and muscular
pain.
Excess height of the posterior palatal seal of a complete maxillary denture will usually result in
which of the following?

A. Gagging
B. Increased retention
C. Unseating of the denture
D. A tingling or tickling sensation C. Unseating of the denture

1) Concept: Overcontouring or excessive beading on the posterior palatal seal causes too much
pressure to be exerted on the palatal tissues resulting in the unseating of upper dentures

2) The posterior palatal seal is typically placed approximately on the vibrating line between the
hard and soft palate and proves a physiologically acceptable tissue pressure within the
compressible portion of the soft palate to attain retention and peripheral seal.

3) Over extending the coverage of seal will cause haggling and painful swallowing for the part of
the patient.
A patient presents to your office with dreams of having a removable partial denture fabricated.
The floor of the mouth is 6mm to the free gingival margin and the only mandibular teeth present
are the 6 mandibular anterior teeth with a diastema between each tooth. Which major connector
design is appropriate for this patient's case?

A. Kennedy bar
B. Lingual plate
C. Lingual plate with interruptions in the plate between the diastemas
D. Lingual bar C. Lingual plate with interruptions in the plate between the diastemas

1) Concept: Lingual plate major connector is the best option for patients with shallow lingual
vestibule.

2) Patients with a 6mm total vestibular depth with respect to the free gingival margins must be
restored with the lingual plate major connector.

3) The free gingival margin connector must be about 6mm away from a major connector. Since
this distance is not possible with a shallow vestibule, the placement of a lingual plate is
indicated.

4) Interruptions in major connectors are supposed to prevent plaque deposition and facilitate
cleaning.
The strict acrylic processing temperature guidelines during denture fabrication are meant to
ensure...

A. Boil off hydroquinone inhibitor

B. Prevent degradation of the camphorquinone initiator
C. The monomer is not boiled off
D. The proper color is achieved C. The monomer is not boiled off

1) Concept: Heat cured acrylic must be processed slowly to prevent immediate vaporization of
the monomer
a. The boiling point of the monomer is 100.3oC
b. Polymerization of the acrylic occurs effectively at 70oC
c. Temperature may reach 100oC since conversions is an exothermic process

2) Longer curing allows for gradual polymerization gradually, so a smaller amount of monomer
is available for vaporization.

3) Short curing times requires large amount of monomer to account for vaporization due to
additional heat. Boiling off monomer causes porosities which render the denture less durable and
more prone to plaque accumulation.
An incorrect vertical dimension of occlusion causes patient to over close and exhibit a poor
facial profile. Which of the following should the clinician do to correct this?

A. DECREASE the vertical dimension of occlusion and INCREASE the interocclusal distance
B. DECREASE the vertical dimension of rest and DECREASE the interocclusal distance
C. DECREASE the vertical dimension of rest and INCREASE the interocclusal distance
D. INCREASE the vertical dimension of occlusion and INCREASE the interocclusal distance
D. INCREASE the vertical dimension of occlusion and INCREASE the interocclusal
distance

1) Concept: Increasing the vertical dimension of occlusion will result in the correction of facial
profile in this case. It will prevent them from over closing the mouth during normal occlusion.

2) An interocclusal distance between 2-4mm is considered typical in most patients.

3) Determination of the vertical dimension of occlusion is very important during the fabrication
of complete dentures.

4) Proper recording of jaw relations and interocclusal distance is of prime importance.

A patient wanting an immediate maxillary denture presents with a moderate bony undercut
facially from canine-to-canine and a tuberosity that is severely undercut. Which of the following
treatment plans is indicated to treat this patient?

A. Only reduce the facial bony undercut surgically

B. Only reduce the tuberosity surgically
C. Only relive the denture base to bypass the undercuts
D. Reducing the tuberosity and facial bony undercut surgically B. Only reduce the tuberosity
surgically

1) Concept: Surgical reduction of the severely undercut tuberosity is indicated in this case.

2) Severe undercut present in the tuberosity presents serious problems for the placement of an
immediate denture.

3) The moderate undercut in the anterior region can be overlooked at this stage.
After packing acrylic resin into the denture flasks, one should wait to cure the resin to...

A. Allow the monomer to reach all acrylic polymer

B. Assure full flow of acrylic into the denture mold
C. Make sure temperature equilibrium exists between the flask and acrylic
D. Allow for pressure to be equalized between the acrylic and flaskC. Make sure temperature
equilibrium exists between the flask and acrylic

1) Concept: Allowing the dental flask to be packed with acrylic to remain under the bench press
until equilibrium in temperature is achieved will give enough time for the acrylic to achieve
better monomer-polymer interaction and create stronger chemical bond.

2) The curing of rain should be uniformly completed to lessen any chances of distortion before
and during the time the flask is immersed in a water bath.
Which of the following should be done to correct protrusive disclusion of posterior teeth during a
try-in appointment of balanced occlusion complete dentures?

A. After the condylar inclination

B. Increase the compensating curve
C. Increase the incisal guidance
D. Use a flat plane cusp for posterior teeth B. Increase the compensating curve

1) Concept: Increasing the compensating curve (which includes the curves of Spee and Wilson)
help to establish a more balance occlusion during lateral excursive and protrusive movements.

2) Protrusive disclusion occurs when the denture teeth are set up without following the
compensating curve of the patient.

3) Compensating curves follow the anatomical positioning of the natural dentition accordion go
their relation to the condylar and incisal inclination.

4) Following the correct compensating curves will help reduce or eliminate the Christensen's
phenomenon observed when upper and lower incisors are in protrusive contacts due to improper
posterior tooth setups.

5) Increasing the incisal guidance causes deepening of the bite, and a wider protrusive disclusion
of posterior teeth.
6) Altering the condylar inclination and the use of flat plane cusps for posterior teeth does NOT
help to proven the Christensen phenomenon.
Which of the following speech sounds bring the maxilla and mandible in the closest proximity?

A. "F" and "V" sounds

B. "T" and "Th" sounds
C. vowel sounds
D. "S" sounds D. "S" sounds

1) Concept: The "S" sound is created when there is very slight space in between the upper and
lower teeth where the air can escape and create a sibilant sound or a hissing sound.

2) "F" and "V" sounds can only be made when the air escapes out of the mouth while the upper
anterior teeth slowly closes down and touches the lower lip.

3) "T" and "Th" sounds are formed with the mouth slightly open and the tongue contacts with the
tip or lingual surface of the upper anterior teeth.
The coronoid process can do which of the following in edentulous patients?

A. Affect the position and arrangement of posterior teeth

B. Determine the location of the palatal seal of the maxillary denture
C. Limit the amount of distal extension of the mandibular denture
D. Limit the thickness of the denture flange in the maxillary buccal vestibule D. Limit the
thickness of the denture flange in the maxillary buccal vestibule

1) Concept: The thickness of the denture flange in the maxillary buccal vestibule needs to be
reduced due to the presence of coronoid process of mandible.

2) This is required for the stability and retention of denture in edentulous maxilla.

3) Dislodgement of maxillary denture may result otherwise.

When border molding the lingual border of the mandibular final impression for a complete
denture, the contractions of which muscles are being accounted for?

A. Genioglossus, mylohyoid, posterior belly of digastric

B. Hyoglossus, mylohyoid, medial pterygoid, digastrics
C. Palatoglossus, superior pharneygeal constrictor, mylohoid, genioglossus
D. Mylohyoid, styloglossus, medial pterygoid, deprssor anguli oris C. Palatoglossus, superior
pharneygeal constrictor, mylohoid, genioglossus

1) Concept: During the border molding process, the tongue has to move and mimic its
physiologic function limits of the tongue.

2) Creating denture that follow the functional limit allows for normal movement of muscles
during function without causing denture dislodgment.
3) The palatoglossus muscle and mylohyoid muscle both help in elevating the tongue

4) Th gengioglossus muscle protrudes the tongue.

Which of the following should be done to correct protrusive disclusion of posterior teeth during a
try-in appointment of balance occlusion complete dentures?

A. Alter the condylar inclination

B. Increase the compensating curve
C. Increase the incisal guidance
D. Use a flat plane cusp for posterior teeth B. Increase the compensating curve

1) Concept: Increasing the compensating curve (which includes the curves of Spee and Wilson)
help to establish a more balance occlusion during lateral excursive and protrusive movements.

2) Protrusive disclusion occurs when the denture teeth are set up without following the
compensating curve of the patient.

3) Compensating curves follow the anatomical positioning of the natural dentition accordion go
their relation to the condylar and incisal inclination.

4) Following the correct compensating curves will help reduce or eliminate the Christensen's
phenomenon observed when upper and lower incisors are in protrusive contacts due to improper
posterior tooth setups.

5) Increasing the incisal guidance causes deepening of the bite, and a wider protrusive disclusion
of posterior teeth.

6) Altering the condylar inclination and the use of flat plane cusps for posterior teeth does NOT
help to proven the Christensen phenomenon.
Which of the following muscles is the pterygomandibul raphe a tendon between?

A. Anterior belly of digastric and Buccinator

B. Buccinator and masseter
C. Buccinator and superior constrictor
D. Masseter and medial pterygoid
E. Medial pterygoid and lateral pterygoid
F. C. Buccinator and superior constrictor

1) Concept: Pterygomandibular rap he acts as a tendon between the buccinator and superior
constrictor muscle.

2) It is a landmark used often for the identification of the pterygomandibular space for the
administration of an inferior alveolar nerve block.
3) The injecting needle pierces the buccinator muscle to inject the local anesthetic solution in the
pterygomandibular space.
True/False:

The hamular notch is important to the fabrication of complete dentures BECAUSE it helps the
dentist position the maxillary posterior teeth.The statement is correct, but the reason is NOT.

1) Concept: The hamular notch helps in determining the distolateral border of the maxillary
denture

2) The arrangement of maxillary posterior teeth is NOT directly influenced by hamular notch. In
an ideal occlusion, the lingual cusps of maxillary posterior teeth are set-up pointing towards the
alveolar crest of lower arch.

3) The hamular notch

a. an anatomical landmark and a limiting structure that serves as a guide for where the denture
should terminate posteriorly.
b. is made up of loose areolar tissue that are compressible. The distolateral border of a denture
may rest and compress this particular anatomical landmark to allow complete sealing of the
posterior area.
In regard to porcelain denture teeth, the structure only found in anterior teeth is a...

A. All answers are correct

B. Finish line
C. Intaglio surface
D. No answers are correct
E. Pin
F. Collar E. Pin

1) Concept: Porcelain has no ability to bond to acrylic, so mechanical retention must be achieved
with use of pins and diatorics.

2) Anterior porcelain denture teeth are fabricated with pins

3) Posterior porcelain denture teeth are fabricated with diatorics

4) Mechanical retention is achieved when the pins and the diatorics become embedded in the
acrylic

5) Porcelain denture teeth are more

a. esthetic
b. abrasion resistant
c. stain resistant compared to acrylic
d. brittle

6) Porcelain is very strong, so it may cause severe abrasion of the opposing dentition
Which of the following should a dentist do when making an impression of an edentulous patient
with hyper plastic and mobile tissue in their maxillary anterior region?

A. Make an impression of the tissue in its passive position

B. Use a high-fusing impression compound
C. Use maximum pressure
D. Use the closed-mouth technique A. Make an impression of the tissue in its passive position

1) Concept: Hyperplastic and mobile tissues should be recorded in a passive position because
passive tissues are fully relaxed.

2) In their active position, tissues are contracted, and the resulting prosthesis will NOT be able to
compensate for when the tissue are in their relaxed state.
A denture that is fabricated with excessive vertical dimension of occlusion (VDO) may result
in...

A. Inefficient mastication
B. Sagging oral commisures
C. Trauma to supporting/underlying soft tissue
D. Perioral rhytides (wrinkles) C. Trauma to supporting/underlying soft tissue

1) Concept: excessive vertical dimension of occlusion (VDO) causes pain in the soft tissue under
the denture because excessive force is created during occlusion.

2) Excessive VDO manifests as a "full mouth" as well as difficulty pronouncing words.

3) Perioral rhytides, sagging oral commisures and deep labiomental groove is an indication that
the vertical dimension of occlusion is insufficient.
Following a reline of a maxillary denture, the patient returned repeatedly with erythematous
areas on the crest of their alveolar ridge for adjustment. Which of the following is the most likely
reason for the need for repeated adjustments?

A. Allergy to the relining material

B. Decrease in vertical dimension of occlusion
C. Loss of even contacts in centric relation
D. Presence of a pressure spot in the reline impression C. Loss of even contacts in centric
relation

1) Concept: Loss of even contacts account for the need of repeated adjustments in the denture
when the mouth is in centric relation.

2) Erythematous areas result in high pressure spots making the denture uncomfortable for the
patient.

3) For comfortable seating of the denture, even contacts are desired in the centric relation.
4) Centric relation
a. is the mandibular jaw position in which the head of the condyle is situated as far anterior and
superior as it possibly can within the mandibular fossa/glenoid fossa and is the most retruded
position of the mandible.
Which of the following should be done to correct protrusive disclusion of posterior teeth during a
try-in appointment of balanced occlusion complete dentures?

A. Alter the condylar inclination

B. Increase the compensating curve
C. Increase the incisal guidance
D. Use a flat plan cusp for posterior teeth B. Increase the compensating curve

1) Concept: Increasing the compensating curve (which includes the curves of Spee and Wilson)
help to establish a more balance occlusion during lateral excursive and protrusive movements.

2) Protrusive disclusion occurs when the denture teeth are set up without following the
compensating curve of the patient.

3) Compensating curves follow the anatomical positioning of the natural dentition accordion go
their relation to the condylar and incisal inclination.

4) Following the correct compensating curves will help reduce or eliminate the Christensen's
phenomenon observed when upper and lower incisors are in protrusive contacts due to improper
posterior tooth setups.

5) Increasing the incisal guidance causes deepening of the bite, and a wider protrusive disclusion
of posterior teeth.

6) Altering the condylar inclination and the use of flat plane cusps for posterior teeth does NOT
help to proven the Christensen phenomenon.
Excessive temperatures during acrylic processing may result in...

A. Discoloration of acrylic
B. Evaporation of acrylic monomer
C. Excessive expansion
D. Excessive shrinkage B. Evaporation of acrylic monomer

1) Concept: Excessive temperature during the acrylic processing will make the monomer boil,
causing it to evaporate, creating porosities.

2) Porosities created by monomer evaporation will make the acrylic denture base weaker in both
its chemical composition and physical durability

3) The end result is a poorly fabricated denture with voids and an inaccurate fit.
It was determined during the wax try-in appointment that the patient's denture teeth should be
adjusted to correct an improper centric occlusion. Which of the following should the clinician do
to accomplish this?

A. Make anew face bow record and centric contact record

B. Make slight adjustments intramurally
C. None of the answers are correct
D. Make a new centric relation record and remount the case D. Make a new centric relation
record and remount the case

1) Concept: The best method for managing an incorrect centric occlusion of a denture is by
making a new centric relation record to serves as a guide of remounting the casts.

2) Using the new centric relation record as a guide, the artificial teeth should be repositioned and
re-articulated to achieve proper occlusion
Partial Denture Prosthodontics Partial Denture Prosthodontics Answers
Removable partial dentures frames made of base metals are resistant to tarnish and corrosion due
to it's

A. Malleability
B. Noble metal content
C. Surface oxide layer
D. Grain structure C. Surface oxide layer

1) Surface oxide layer

a. covering base metals prevents the oxidation that causes tarnish and corrosion
b. when metals are oxidized they form a brownish red metal-oxidey layer known as rust
c. metals will not interact or have chemical reaction with oxygen and oxygen containing
compounds such as water if they are below the surface oxide layer
What is the most common etiology of acrylic dentures teeth breaking loose from dentures?

A. Excessive occlusal forces

B. Residual wax on teeth during denture processing
C. Retentive undercuts not placed in the teeth
D. Excessive artificial tooth structure was removed during occlusal adjustment B. Residual
wax on teeth during denture processing

1) When residual was is left surrounding denture teeth during processing, acrylic is not able to
adequately flow around the tooth to lock it into place optimally, making it more likely that the
tooth will fall out.
Where should the tip of the retentive clasp arm be placed?

A. At the junction of the middle and occlusal 1/3 of the clinical crown
D. At the junction of the gingival and middle 1/3 of the clinical crown D. At the junction of
the gingival and middle 1/3 of the clinical crown
1) Retentive clasp
a. placed at the junction of the cervical and middle 1/3 of the clinical crown where it can provide
retention
b. junction of the cervical and middle 1/3 of a tooth is usually the place where the desirable
natural tooth undercut is located
c. undercut is the location where only the retentive clasp should engage to avoid damaging the
tooth structure
Which of the following removable partial denture direct retainers is considered the most
esthetic?

A. Bar clasp
B. Circumferential clasp
C. Embrasure clasp
D. Intracoronal attachment
E. Round, wrought wire claspD. Intracoronal attachment

1) Intracoronal attachment
a. type of direct retainer that uses a precision attachment material that is built within the crown
portion of an abutment tooh
b. esthetically pleasing since they are NOT seen along the labial aspect of the patient (unlike
regular direct retainers)
c. ability to provide great retention due to their key and keyhole precision attachments

d. disadvantages
1) remaining abutment has to be prepared before it can be placed.
Which of the following factors commonly causes interferences for removable partial denture
major connectors?

A. Buccally tilted maxillary molars

B. Buccally tilted maxillary premolars
C. Lingually tilted mandibular premolars
D. Lingually tilted maxillary molars
E. Bony exostoses on the facial aspect of edentulous spaces C. Lingually tilted mandibular
premolars

1) Lingually tilted mandibular premolars

a. will cause difficulty when placing and removing the major connector because the severe
lingual undercut impedes the path of denture insertion and removal
b. mandibular major connectors are placed lingually an should be designed to adapt properly
onto the mucosa

2) Bony exostoses along the buccal surface, buccally tilted molars and premolars do not pose
problems in placement of major connectors since the major connector is in the palatal or lingual
position
Why is a lingual/cingulum rest preferred to an incisal rest on a maxillary canine for a removable
partial denture?
A. The force is more evenly distributed by the lingual/cingulum rest
B. The morphology of the canine cingulum is almost already in the shape of the rest
C. There is more enamel on the lingual surface, so it is considered a more conservative
preparation
D. The pulp is less irritated by a lingual/cingulum preparation A. The force is more evenly
distributed by the lingual/cingulum rest

1) Cingulum rest
a. maxillary canine rests are placed within the cingulum instead of the incisal because occlusal
force is more evenly distributed by the cingulum rest
b. more prominent, allowing them to distribute occlusal load better
c. more esthetically pleasing than incisal rests
d. stronger because they are closer to the major connector
e. forces transmitted to the cingulum rest is directed to the long axis of the tooth sine the rest is
centered on the tooth
Which of the following situations would a lingual plate be preferred over a lingual bar major
connector for a mandibular removable partial denture?

A. When Kennedy Class III conditions are present

B. When the remaining anterior teeth are mobile
C. When there is insufficient space to the floor of the mouth
D. When the remaining teeth are spaced widely C. When there is insufficient space to the
floor of the mouth

1) The space between the floor of the mouth and the marginal gingiva is the primary factor when
determining the type of major connector to be used for the lower arch.

2) Lingual bar major connector requires a minimum of 4mm in cervicoocclusal height and
should be approximately 6mm away form the marginal gingiva

3) Because of a very limited space, a lingual plate of adequate width is preferred over a lingual
bar.
Which of the following reasons explains why the tripod marks are made on casts after being
surveyed?

A. To assist in the mounting of the casts onto and articulator

B. To record the orientation of the cast to the articulator
C. To record the orientation of the casts to the surveyor
D. To record the undercut depths of the proposed abutment teeth C. To record the orientation
of the casts to the surveyor

1) Tripod marks
a. are meant to keep a record of the casts in relation to the surveyor
b. made at three different places on the cast when it is placed on the surveyor
c. will guide the dentist or lab tech to place the cast back in the same relation once it has been
removed

2) Dental surveyor
a. instrument which is used to determine the relative parallelism of 2 or more surfaces of the
teeth or other parts of the cast of a dental arch

3) Surveyor
a. determine the path of insertion and removal of a removable partial denture
Acrylic teeth are used primarily in removable partial dentures because they are...

A. Better retained in acrylic resin

B. Esthetically preferred
C. Stain resistant
D. Wear resistance A. Better retained in acrylic resin

1) Acrylic teeth
a. are retained better than other denture teeth (porcelain and metal) because they are able to bond
to the acrylic resin of the denture base
b. NOT stain resistant and are NOT as color stable as porcelain teeth
A patient requires a reline of both their maxillary complete denture and their mandibular
Kennedy Class I removable partial denture (RPD). Which of the following describes the proper
method to complete these procedures?

A. Relate the mandibular partial denture frame first

B. Relieve and reline the least stable prosthesis first
C. Relieve both of the dentures and make the impressions simultaneously
D. Relieve mandibular partial denture and make the mandibular impression first
E. Relieve the maxillary denture and make the maxillary impression first A. Relate the
mandibular partial denture frame first

1) Presence of teeth that support the mandibular partial denture make it more stable than a
loosely adapted complete maxillary denture whose support is determined by the palate and
reabsorbed alveolar ridge.

2) The remaining teeth help to establish correct vertical dimension during a reline procedure
since its form and position does not change (unlike the residual ridge).

3) When a mandibular RPD is placed correctly within its abutment teeth, the amount of ridge
resorption is easily determine and corrected.
Which of the following is the BEST way to record centric relation for a patient needing a
Kennedy Class I mandibular removable partial denture replacing the 2nd premolars and molars?

A. Manually articulate the casts and secure them with stick way
B. Place an occlusal rim on the framework and record the registration with soft wax
C. Utilize a plaster record of the interdigitation of teeth
D. Utilizing occlusal rims made on the master cast with soft wax to record the registration
E. Utilizing wax registration that covers the anterior teeth and premolars of the mandibular arch
B. Place an occlusal rim on the framework and record the registration with soft wax

1) Centric relation
a. best way to correctly record the centric relation in this case is to establish first the correct
vertical dimension of the patient before taking the centric record with a soft wax
b. centric relation record may vary depending on the established vertical dimension of the patient
c. by placing an occlusal rim on the framework, the vertical dimension of the patient is correctly
established and a correct centric relation may be recorded.
Tips of clasp arms are placed in undercuts for retention. This is because flexible arms are
required for reciprocation The statement is correct, but the reason is NOT.

1) Tips of retentive clasp arms

a. placed in the undercuts created by the axial contours of teeth to provide retention for
removable devices
b. need to be flexible in order to be removed from the undercut so the prosthodontic device can
be removed from the mouth
c. Clasped teeth must have 360o encirclement so that the prosthodontic devices does not apply
orthodontic forces upon the teeth

2) Reciprocation clasp arms

a. do not need to be flexible since they are placed above the height of contour and not in
undercuts.
Need for a removable partial denture (RPD) to be relined is indicated MOST by which of the
following?

A. Indirect retainers are not seated when the distal extension are depressed
B. Loss of retention
C. Soreness on the crest of the alveolar ridges
D. The acrylic resin teeth are abraded and there is a loss of the vertical dimension of occlusion
A. Indirect retainers are not seated when the distal extension are depressed

1) Indirect retainers
a. will NOT seat properly when the distal extensions are depressed due to the loss of support
along the distal alveolar ridge
b. presence of bone resorption causes instability to the removable partial denture
c. improper seating of indirect retainers indicates that there is already a noticeable amount of
bone loss along the residual bone underlying the distal extension base and that the denture has to
be relined
d. designed to provide stability, limit the tissue ward movement of the denture and prevent the
destructive anterior-posterior twisting of dentures during the function
e. act as a fulcrum when the distal extension based is no longer adapted to the residual ridge and
cause the instability and displacement of denture against forces acting on it.
Which of the following occlusion schemes would a patient with bilateral posterior crossbite will
most likely require their denture teeth set in?
A. Bilateral crossbite
B. Class I normal horizontal overlap
C. Class II occlusion
D. Unilateral crossbite A. Bilateral crossbite

1) Bilateral crossbite
a. important to set denture teeth in a bilateral crossbite position in order to maintain the normal
occlusal harmony during mastication
b. arrangement of teeth and their intercuspation greatly affect the occlusion of teeth during
mastication
c. adjusting teeth out of their normal position in the arch could cause occlusal disharmony and
TMJ problems
d. arranging teeth following the normal occlusal relationship of upper and lower arch can help
achieve balance articulation and reduce the patient's difficulty of adjusting to a new set of
dentures
The quantity of adjustment for base metal clasp arms on removable partial dentures (RPDs) is
limited by which of the following mechanical properties?

A. Elongation
B. Hardness
C. Malleability
D. Stiffness
E. Tensile Strength A. Elongation

1) Elongation
a. degree of elongation of metal limits the number of times a base metal clasp can be adjusted
before it breaks or fractures
b. elongation of metal is a property related to its ductility and tensile strength
c. base metal clasps are casted and designed to follow a particular form
d. during the casting process, the metal becomes hard and rigid
e. basemetal clasps are designed to be rigid and semi-rigid. The ductility of metal is limited and
therefore, elongation is also limited.
f. excessive adjustment of the clasp may cause it to be deformed beyond the correction or it may
fracture.
Fixed Prosthodontics Fixed Prosthodontics Answers
Each of the following patient situations is considered a contraindication for an all-ceramic crown
EXCEPT one. Which one is the EXCEPTION?

A. Amalgam restorations with marginal breakdown

B. Extensive wear of tooth structure or restorations
C. Severe bruxism
D. Previous history of ceramic crown fractures A. Amalgam restorations with marginal
breakdown
1) Concept: History of ceramic crown fractures and extensive wear of opposing tooth structure or
restorations suggest to the clinician that a heavy occlusal load is present during occlusion

2) People who chew hard foods and brux severely will place the all-ceramic crown under strong
occlusal forces that may cause it to fracture or overly wear the opposing teeth.

3) Amalgam restorations
a. extensive and faulty amalgam restorations that are displayed or are not placed esthetically can
be better replaced with an all-ceramic crown
b. with marginal leakage and/or breakdown can be replaced in the core build-up for the PFM
crown
Which of the following factors is most common reason for porosities to be found in porcelain
restorations?

A. Excessive firing temperature

B. Inadequate condensation of porcelain
C. Moisture contamination
D. Improper degassing B. Inadequate condensation of porcelain

1) Concept: Inadequate condensation of porcelain allows for voids between particles, causing
porosities during sintering.

2) Controlled and gentle mechanical condensation of porcelain allows the particles to settle and
become closer, eliminating voids.

3) Surface tension condensation allows the drawing of the porcelain particles together by
draining the excess fluid from the mixture.
When preparing a partial veneer crown for tooth #8, the proximal grooves are placed parallel to
the...

A. Incisal 2/3 of the facial axial wall

B. Long axis of the clinical crown
C. Long axis of the tooth
D. Incisal 1/3 of the facial axial wall A. Incisal 2/3 of the facial axial wall

1) Placement of the proximal grooves parallel to the incisal 2/3 of the facial surfaces ensure that
the partial veneer crown has only one path of insertion.

2) Proximal grooves and flares should be made continuous with the facial wall to provide
retention, resistance and structural durability.

3) Proximal grooves created in a proper way also relieves the tooth of unsupported enamel.
Which of the following dimensions is the recommend optimal incisal reduction for a porcelain
fused to metal crown preparation?

A. 1.5mm
B. 2.0mm
C. 2.5mm
D. 3.0mm
E. 1.0mm B. 2.0mm

1) Concept: The optimal incisal reduction for a porcelain fused to metal crown is 2mm.

2) The porcelain fused to metal crown requires a minimum of 1.5mm incisal reduction to provide
adequate thickness of metal and porcelain.

3) Porcelain thickness can be 1.2mm to 1.5mm thick, while the metal thickness should be at
about 0.5mm to 0.3mm minimally.
Most dentists utilize dental laboratories for the fabrication of porcelain fused to metal (PFM)
restorations. What is the most common difficulty experiences by the laboratories?

A. Inaccurate impressions or casts

B. Inadequate description of shades and texture of the surrounding teeth
C. Insufficient tooth reduction
D. Ill-defined marginsC. Insufficient tooth reduction

1) Insufficient tooth reduction

a. dental laboratories tend to fabricate bulky and overcontoured crowns to compensate for the
insufficient tooth preparations
b. leads to overhanging and over contoured crowns that invite plaque deposition and induce
periodontal disease
c. sufficient tooth reduction is necessary to fabricate a porcelain fused to metal crown with
sufficient bulk and dimensions to withstand masticatory forces

* Good Pictures of Anterior Crown Preparation Dimensions

Which of the following factors most directly affects the faciolingual dimension of the occlusal
surface of a hygienic pontic on a 3-unit fixed partial denture?

A. The masticatory force applied on average by the patient

B. The position of the opposing contact areas
C. The width and position of the edentulous alveolar ridge
D. The span length of the pontic B. The position of the opposing contact areas

1) Position of the contact areas of the upper and lower arch are considered greatly prior to
designing the buccolingual width of hygienic pontiffs.

2) The buccolingual width of a hygienic pontic must be thick enough to withstand the occlusal
force exerted by the antagonist during mastication.

3) Narrowing the occlusal table of the pontic can lessen the force exerted by its antagonist.
What is the most common reason for a crown not to fully seat upon delivery?
A. Excessive proximal contacts
B. Over extended margins
C. Undercuts on the axial surfaces of the prepared tooth
D. Positives on the intaglio surface A. Excessive proximal contacts

1) Excessive proximal contacts

a. sometimes accidentally made by dental technicians effort to prevent open contacts on their
fabricated dental crown/bridge.
b. can also be created when wax patterns are not immediately invested, causing dimensional
changes in the final restoration.

2) The respective tooth preparations on the die casts are sawed to separate each component and
provide better visualization of the prep. Dental technicians may accidentally scrape a portion of
the contact area of the adjacent teeth causing a future excessive contact in the final crown
restoration.
Which of the following is orange stain used for?

A. Change the hue or porcelain color

B. Decrease the chroma of the porcelain
C. Increase the inter proximal translucency
D. Increase the value of the porcelainA. Change the hue or porcelain color

1) Concept: Orange stain is commonly used to change the hue of porcelain

2) Staining methods
a. used to change the monochromatic nature of porcelain veneers

3) The most common esthetic problem associated with porcelain veneers their lack of color
differentiation between the gingival and incisal portions of the restoration.

4) Staining methods are used to transform a monochromatic porcelain veneer into polychromatic
restoration restoring the beauty of natural tooth.
A 3-unit fixed partial denture (FPD) from tooth #28 to tooth #30 is treatment planned for a 75-
year-old patient. Tooth #30 is tipped 30 degrees mesially. The long-term prognosis for this FPD
would be most diminished by which of the following possible concerns?

A. A short distal axial wall

B. A short mesial axial wall
C. Pulp exposure
D. Irreversible pulpitis A. A short distal axial wall

1) Concept: A mesially tilted crown decreases the length of the distal axial wall and may increase
the risk of excessive tooth reduction on the mesial wall during the tooth preparation.
2) When preparing a 3-unit FPD to have a single path of insertion, the tilted tooth needs to be
prepared with the same path of insertion as the other abutment tooth, decreasing the distal wall in
the process.

3) A reduction in the height of abutment tooth will cause problems in crown retention and may
compromise the success of the FPD restoration.
Which of the following alterations would increase the strength of a soldered connector of a fixed
partial denture most?

A. Increasing its width

B. Increasing the gap
C. Using a higher carat solder
D. Using a lower carat solder
E. Increasing its height E. Increasing its height

1) Concept: Increasing connector heigh increases the strength of the connector due to the
cervicoocclusal reinforcement.

2) Connectors for PFM fixed partial dentures should demonstrate a minimum 3mm
cervicoocclusal height ideally to ensure adequate bulk and strength to resist the occlusal forces
without failure.

3) Increasing the gap in-between artificial teeth increases the stress on solder joint, thereby
weakening the connector.
A clinician plans to make an impression of a crown preparation after using an electrosurgery unit
to prepare the tissues. When used as intended, an electrosurgery unit will...

A. Permanently alter the gingival tissue contour

B. Reduce the gingival height
C. Remove a thin layer of crevicular gingival tissue
D. Vaporize the tissues using light C. Remove a thin layer of crevicular gingival tissue

1) Concept: electrosurgery unit can remove a thin layer of crevicular gingival tissue required to
take an impression of the crown preparation

2) Such fine removal cannot be accomplished by other methods.

3) An electrosurgical unit can carry out sub gingival tissue preparation for impression taking
with fineness and delicacy.
When trying in a full gold fixed partial denture (FPD), you evaluate proximal contacts, Intaglio
fit, contour, surface finish, marginal adaptation, and occlusion. What should you do next?

A. Cement the FPD with temporary cement and reassess the fit
B. Fabricate a plaster soldering index
C. Polish the FPD with rouge
D. Mix glass ionomer cement A. Cement the FPD with temporary cement and reassess the fit
1) Concept: After evaluating the fit of a fixed partial denture (FPD), the next step is to
temporarily cement the FPD and reassess the occlusion, fit, and marginal adaptation.

2) Cementing the FPD with temporary cement allows for rechecking the overall bridge form and
its effect on the occlusion.

3) Temporarily cementing the FPD enables the dentist to practice the proper insertion since there
are two abutments to contend with.
Cantileverd fixed partial dentures (FPD) with a single abutment may have a compromised long
term prognosis. The prognosis may be compromised because occlusal forces for multiple teeth
are only accommodated by periodontal structures when directed along the long axis of the single
tooth. Both the statement and the reason are correct and related

1) Cantilever fixed partial dentures

a. rarely indicated when restoring a missing tooth because one tooth abutment will carry the
occlusal load of two teeth
b. can damage the abutment tooth's periodontal support when excessive force is transmitted by
the large occlusal table of a cantilevered FPD
c. prognosis of cantilever FPD becomes increasingly compromised with continuous damage
incurred by the periodontium of the abutment
Each of the following describe an aspect of the proper pontic design EXCEPT one. Which of the
following is the EXCEPTION?

A. Bi-directional concavity
B. Contact with the residual ridge
C. Faciolingual concavity
D. Mesiodistal convexity A. Bi-directional concavity

1) Concept : Bi-directional concavity of a pontic allows for entrapment of food, plaque

accumulation, and build up of calculus

2) Pontics
a. should be designed in such a way that is appears similar to a natural tooth
b. must maintain proper height and tightness of contact areas between teeth and must be easy to
clean
What is the best reason for why the liquid component of a cement to be dispensed immediately
before mixing is commenced?

A. To allow tempering of the powder by the mixing slab

B. To avoid absorption of moisture from the air
C. To prevent evaporation of the volatile components
D. To reduce the temperature influence of the mixing slab
E. To avoid spreading over a large area of the slab C. To prevent evaporation of the volatile
components
1) The liquid component of a cement is very volatile and dispensing it too early before mixing
commented will lead to evaporation of some of it, causing incomplete wetting of the cement
powder during spatulation.

2) Having deficient liquid in proportion to cement powder results in a grainy consistency and
premature setting of the cement mixture.
Which of the following MOST ACCURATELY describes osseointegrated dental implants?

A. They are attached directly to living bone as determined by analysis by radiographs and light
microscopy.

B. They create a junctional epithelium with the surrounding tissue.

C. They create a pseudo-periodontal ligament.

D. They possess a direct structural and functional connection with bone only at the radiographic
level of detection A. They are attached directly to living bone as determined by analysis by
radiographs and light microscopy.

1) Concept: Osseointegrated implants

a. are able to create a direct interface with bone cells after they grown and interlock, without any
interposing layer of soft tissue

2) Osseointegration: the bone directly attaches to the implant material because the titanium
dioxide fuses with the surrounding bone.

b. no scar, fibrous or connective tissues get in between the bone and the implant material.
Osseointegration can be verified through microscopic and radiographic images as well as by
tapping the implant with a mirror and hearing a sharp metallic ring (not a dull thud).
The path of insertion of the key into the keyway should be parallel to the path of insertion of
which of the following objects when using a non-rigid connector for a fixed partial denture?

A. Both retainers
B. Neither retainer
C. The retainer NOT carrying the keyway
D. The retainer carrying the keyway C. The retainer NOT carrying the keyway

1) The path of insertion of the key portion of the non-rigid connector should always be parallel to
the retainer that is NOT carrying the keyway.

2) Use of a non-rigid connector is indicated for fixed partial dentures having tilted abutments or
teeth with different angulation and path of placement

3) Using non-rigid connectors in a fixed partial dentures relieves the tilted and upright abutments
from stress and strain of occlusal forces acting over the bridge restoration.
Which of the following is the BEST way to avoid porcelain failure in all-ceramic restorations?
A. Minimal occlusal forces
B. Porcelain is 3.5mm thick
C. Porcelain is not more than 0.5mm thick
D. Rounded angles of the preparationD. Rounded angles of the preparation

1) Concept: All-ceramic restorations should include rounded angles in the tooth preparation in
order to reduce stress concentration along these areas.

2) Sharp angles within tooth preparations are areas where stress is concentrated, and may cause
fracturing

3) Porcelain thickness
a. all-porcelain crowns should have a minimum thickness of 1mm circumferentially and about
1.5mm along the occlusal/incisal to achieve strength (Not including the framework of the
restoration.)

4) Proper case selection and occlusal load analysis is also an important factor in preventing
failure of an all ceramic restoration.
The most important reason zinc oxide eugenol cements are better than zinc phosphate cements
for crown delivery is because zinc oxide cements demonstrate...

A. All answers are correct

B. Decreased film thickness
C. Decreased solubility in saliva
D. Decreased potential to irritate the pulp D. Decreased potential to irritate the pulp

1) Concept: Zinc oxide eugenol cement is a dental material capable of providing sedative effects
to the pulp

2) Eugenol "oil of cloves" provides soothing relief to hyperemic pulp.

3) Zinc phosphate cement uses phosphoric acid for its chemical reaction and is irritating to the
pulp.
Which of the following is the MOST PROBABLE explanation for when the margins of a metal
framework for PFM crown are sealed during the framework try-in, then are NOT sealed after
porcelain is applied 2-days later?

A. The casting distortion created during the porcelain firing

B. The die was over-trimmed
C. The lab cut off the margins
D. The porcelain proximal contacts were over contoured
E. Tooth eruption D. The porcelain proximal contacts were over contoured

1) Placement of over contoured proximal surfaces in a PFM crown results in premature contact
with the proximal surface of adjacent teeth, preventing the crown from being properly fitted.
2) Concept: Most over contoured crowns tend to have tight proximal contact but has open
margins. In order to correct this order, articulating paper may be used on the proximal contacts of
PFM crown during its placement to pinpoint and trim the premature contact.

3) Overcontouring of crowns during the placement of porcelain may be prevented if the proximal
surfaces adjacent to the tooth preparation is NOT trimmed or altered in the master cast.
Which of the following determines the parallelism of abutment preparation for a Fixed Partial
Denture (FPD)?

A. Amount of chamfer
B. Angulation of finish lines
C. Degree of convergence
D. Long axis of the preparations D. Long axis of the preparations

1) Concept: Long axis of the abutments should be prepared parallel to each other in order to
achieve the same path of insertion/displacement.

2) The abutments should ideally be prepared parallel to each other in order to prevent problems
in placement of the final crown restoration.

3) Degree of convergence does NOT determine parallelism of the abutments but rather, it
provides guidance in creating slightly converging parallel walls of individual tooth preparation
that is needed for the retention form.

4) Angulation of finish lines and amount of chamfer is NOT at all related to parallelism of
abutment teeth.
Which of the following locations are the initial interferences encountered when first seating a
cast restoration?

A. Axial walls
B. Margins
C. Occlusal surface
D. Proximal contacts D. Proximal contacts

1) Concept: Proximal contacts are where initial interferences occurs when seating a cast
restoration because these areas are usually over contoured.

2) Over countered proximal contacts are usually related to some errors in fabrication.

3) There are instances when laboratories tend to over contour the proximal in hope of achieving
tight proximal contacts.

4) A simple chip or a trim along the proximal surface of the tooth adjacent to the cavity
preparation on the master cast may provide significant change in the fabricated proximal contact
of a cast restoration.
5) Overcontoured proximal areas will result in premature contacts that will prevent proper
seating of the restoration.
Which of the following would be the result of a dentist placing a crown on tooth #11 that altered
the existing canine-guided occlusion in left-lateral excursive movement to a group function
occlusion scheme?

A. Decreased clearance on the right side and a greater possibility on a non-working contact
B. Increased clearance on the right side with less possibility for a non-working contact
C. No effect on the non-working side clearance A. Decreased clearance on the right side and
a greater possibility on a non-working contact

1) Concept: The decrease in clearance occurs due to the placement of the crown on the left upper
canine without restoring the canine guidance. Group function occlusion due to this crown will
decrease the vertical distance on the right side.

2) During lateral excursions, there is disocclusion of all the teeth except for the canine in canine
guided occlusion. In group function occlusion, multiple tooth contacts occur during lateral
excursion on the working side only.
What is the minimum amount of occlusal clearance necessary for a PFM crown?

A. 1.0mm
B. 1.5mm
C. 2.0mm
D. 2.5mm
E. 3.0mm
F. 0.5mm B. 1.5mm

1) Concept: The minimum occlusal clearance during tooth preparation for a PFM crown also
corresponds to the combined thickness of porcelain and the metal coping.

2) Porcelain is brittle and requires adequate bulk to gain strength.

3) The porcelain layer and the metal coping used in fabricating PFM crowns should account for
at least:
a. 0.5mm metal coping
b. 1.0mm porcelain

4) Functional cusps and incisors require more clearance

a. 2.0-2.5mm clearance

* Good image about PFM crown preparation

Which of the following is the MOST SERIOUS problem you may encounter when placing a
fixed partial denture to be supported by an oseointegrated implant and a natural tooth?

A. Difficulty attaining proper esthetics

B. Obtaining a favorable path of insertion would be difficult
C. The implant and the natural tooth will exhibit different mobility
D. The natural tooth has no screw to retain the fixed partial denture C. The implant and the
natural tooth will exhibit different mobility

1) Concept: Osseointegrated implants should NOT be partnered with a natural tooth as an

abutment for fixed partial dentures because they have different type of bone support an degree of
physiologic mobility.

2) Fixed partial dentures carry occlusal load which is transmitted to its abutment teeth

3) If one of the abutments DO NOT show any degree of mobility as of an implant material, the
force exerted onto the natural abutment tooth will elicit a cantilevering effect to the implant,
breaking the cement seal.

4) Osseointegrated implants are directly attached to bone and therefore doesn't have a
periodontal ligament which provide a cushioning effect for natural teeth. This will increase the
torque forces between the abutment teeth.

5) The periodontal ligament of the natural tooth exhibit slight compression and cushion to
compensate for the occlusal load. However, this is NOT possible for the implant material.
What is the primary reason why dentists splint adjacent abutment teeth in a fixed partial denture?

A. Improve spacing mesiodistally

B. Improve the distribution of the occlusal load
C. Stabilize abutment teeth
D. Improve embrasure contours B. Improve the distribution of the occlusal load

1) Concept: Abutment teeth are included in a fixed partial dentures to provide retention and help
disperse the occlusal load placed on the restoration

2) Abutment teeth provides support and stability to the pontic.

3) Abutment teeth allows better distribution of the occlusal forces acting on all teeth and pontic
in the fixed partial denture
When soldering a fixed partial denture before porcelain application, the greatest risk of failure
is...

A. Pre-heating the pieces about to be soldered

B. Underheating
C. Using an incompatible solder
D. Overheating D. Overheating

1) Concept: greatest risk of failure occurs if there is overheating of precious metal solder and
wire during the soldering process
2) Overheating
a. cause diffusion between solder and wire, and may also lead to recrystallization and grain
growth
b. a single-orifice oxygen gas/oxygen torch is usually used before soldering with the flame
focused only on the soldering site prevents overheating or unevenly heating the material.

3) Surface pitting, internal porosity, and other microstructure changes are caused by overheating
and all result in a weak joint.

4) High-fusing precious metal solder is necessary to maintain structural form and avoid melting
or distortion during the firing of porcelain for pre-ceramic soldering.
Radiographically, the size of the focal spot of the x-ray tube influences which of the following?

A. Definition
B. Density
C. Distortion A. Definition

1) Definition
a. Definition and detail of the radiographic image are influenced by the focal spot size
b. The smaller the size of the focal spot, the better is the detail, definition or sharpness of the
radiographic image created
c. The larger the size of the focal spot, the wider the coverage of the beam and more penumbra is
created in the radiograph. This results in an unclear demarcation of the image outline and an
increase in the blurriness of the image.
d. proper angulation of the beam and size of the cone of an x-ray machine affects the size of the
focal spot
Which of the following types of cells are the LEAST likely to die from exposure to radiation and
are the MOST radio resistant?

A. Erythroblasts
B. Granulocytes
C. Lymphocytes
D. Muscle cells
E. Epithelial cells D. Muscle cells

1) immature cells that are highly active or dividing rapidly are MORE sensitive to radiation than
mature cells
2) cells that are more radiosensitive while they are undergoing the late G1 phase up until the
early S-phase in the cell cyle
3) Cellular Radiosensitivity
a. Low
1) Muscle cells
2) Chondrocytes
3) Nerve cells

b. Moderate
1) Osteoblast
2) Fibroblast
3) Spermatids
4) Endothelial cells

c. High
1) Erythroblast
2) Lymphocyte
3) Granulocyte
4) Epithelial cells
5) Spermatozoid
The radiographic density of which of the following materials varies the MOST?

A. Amalgam
B. Composite
C. Gold
D. Soft tissue
E. Acrylic B. Composite

1) Composite radiographic density

a. varies because the manufacturers may place a different amount of barium salts or other opaque
filling materials

2) Amalgam and Gold

a. appear radiopaque

3) Acylic
a. typically does not possess any opaquers
b. totally radiolucent

4) Soft tissue
a. fairly radiolucent
Which of the following is the greatest risk for a patient who needs teeth #18 and 19 extracted
after receiving radiotherapy for cancer in their jaw 6 months ago?

A. Localized alveolar osteitis

B. Mandibular fracture
C. Osteoradionecrosis
D. Delayed healing C. Osteoradionecrosis

1) Osteoradionecrosis
a. tooth extraction in patients who have previously received radiotherapy 6+ months ago may
pose greater risk for having osteoradionecrosis
b. may not manifest symptoms immediately during the radiotherapy but could manifest months
or years after the treatment
c. probability of osteoradionecrosis is higher with mandibular extractions because there is limited
source of blood compared to the maxilla
d. patients who had radiotherapy and poor oral hygiene are at higher risk for osteoradionecrosis
Which of the following interactions is responsible for the creating of Bremsstrahlung/Braking
radiation?

A. Electrons falling from the K shell to the J shell

B. Interaction of electrons with electrons
C. Interaction of electrons with nuclei
D. Conversion of photons into electrons C. Interaction of electrons with nuclei

1) Bremsstrahlung radiation
a. created when high-speed electrons interact with the Tungsten nuclei at the target
b. fast-moving electron loses kinetic energy when it interacts with the nuclei, coverting the lost
kinetic energy into a photon
Incorrect horizontal angulation of the x-ray tube head while making posterior molar bite wings
will probably result in...

A. Elongation of teeth
B. Foreshortening of crowns
C. Foreshortening of roots
D. Overlapping of interproximals
E. Overexposure of film D. Overlapping of interproximals

1) Slight horizontal angulation

a. cause overlapping of the inter proximal contacts

2) Elongation of the teeth or foreshortening of its roots

a. due to incorrect vertical angulation with respect to the tooth and the x-ray film
Which of the following is the reason intensifying screens are used with extraoral radiographic
films?

A. Decrease the radiation dose of the patient

B. Improve the image quality
C. Increases the exposure time
D. Increase the kVp A. Decrease the radiation dose of the patient

1) Intensifying films
a. MUST be used with extraoral radiographic films in order to decrease the dose of radiation to
the patient
b. when used with x-ray films using emulsions, make them more sensitive to blue or green light
c. X-ray photons are converted to visible light photons when they strike the screen.
Which of the following does the term "latent period" describe in radiology. The time between...

A. film exposure and image development

B. radiation exposure and the onset of symptoms
C. the first and last does in radiation therapy
D. G0 phase and mitosis of cells B. radiation exposure and the onset of symptoms

1) Latent period
a. time period from the moment a person is initially exposed to radiation up to the moment when
the clinical symptoms begin to manifest
b. irradiated person may experience long term or short term effects varying in severity depending
on the amount of radiation a person has absorbed

2) Prodromal syndrome
a. symptoms that immediately manifests after exposure to any radiation
Which of the following materials is responsible for making gutta-percha radiopaque?

A. Barium salts
B. Silver
C. Titanium dioxide
D. Zinc oxide
E. Acrylic A. Barium salts

1) Gutta percha
a. rigid natural latex that is
1) inert
2) biocompatible
3) radiolucent materials used to obturate root canals

2) Barium salts
a. added to the gutta-percha to add radiopacity to the material so it can be visualized
radiographically
Which of the following describes the etiology of cone-cutting?

A. Excessive kVp
B. Inadequate exposure time
C. Incorrect placement of X-ray machine
D. Incorrect source-object distance
E. Excessive mA C. Incorrect placement of X-ray machine

1) Cone cutting
a. occurs when x-ray machine is not lined up properly with the X-ray sensor or film

2) Correct position
a. film or sensor should be placed perpendicular to the X-ray collimator to ensure that all of the
necessary information is picked up
A dentist makes a radiograph of a patient's 3rd molar at 0o vertical angulation that looks like the
superior border of the mandibular canal contacts the apices of the tooth. The dentist then makes
another radiograph at a -20 vertical angulation that suggest that the mandibular canal is separated
from the apices of the 3rd molar by several millimeters. Using the information provided by these
2 radiographs, which of the following is true about the relation of the mandibular canal to the
root apices of the 3rd molar? The mandibular canal is...

A. Superior and facial

B. Superior and lingual
C. In contact with the root apices
D. Inferior and facial
E. Inferior and lingual E. Inferior and lingual

1) When the tube head of the x-ray machine was tilted in a (-) vertical angulation, the mandibular
canal followed the position of the tube head and became more inferior to the apex of the 3rd
molar

2) SLOB rule
a. the anatomical structure that follows the position of the tube head is in the lingual position
while the other structure opposite the tube head is positioned toward the buccal
b. by angulating the tube head in a -2 vertical angulation, the more superiorly positioned
structure will move at the opposite direction of the tube head while the inferior anatomical
structure will move in a similar direction with the tube head

3) BOMM rule
a. stands for (buccal object moves most) when thinking about the 3rd molar roots
Osteoradionecrosis is more likely in patients who exhibit damage to which of the following?

A. Lymph vessels
B. Muscles
C. Nerves
D. Salivary glands
E. Blood vessels E. Blood vessels

1) Osteoradionecrosis
a. occurs in patients with damaged blood vessels because the blood needed for bone healing
CANNOT circulate properly to heal the wound
b. disrupts normal blood circulation within the bone, causing severe damage to the blood vessels
by endarteritis and thrombosis that eventually results in the blockage or obliteration of the blood
flow.
c. MORE LIKELY to occur in cases where bone exposed during radiation
d. oral mucosal tissues exhibit a more rapid turnover of cells than alveolar bone, making it more
affected by radiation
e. radiation causes free radical formation and immature development of cells that are supposedly
needed for the remodeling and healing of body tissues
A periapical radiographs suggest an opaque mass over the apex of the maxillary right 2nd molar.
A second periodical radiograph is made with the X-ray head adjusted in a more medial direction.
The second periodical suggests that the object in question has moved distally compared to the 1st
radiograph. Which of the following directions describes the location of the object?
A. Buccal to the tooth
B. In-between the roots
C. Not enough information is provided
D. Lingual to the tooth A. Buccal to the tooth

1) SLOB
a. Same Lingual Opposite Buccal rule suggest that the object is buccal to the tooth.
b. because the object moved opposite to the positioning of the X-ray device for the 2nd
radiograph it demonstrates buccal positioning
c. if the object move medially with the head of the X-ray head being moved medially, it would
have demonstrates lingual/palatal positioning
The anode of an X-ray machine is composed of which of the following materials?

B. Lead
C. Tin
D. Tungsten
F. Aluminum D. Tungsten

1) X-ray machines
a. have an anode made from Tungsten because it has a high atomic number and is highly
resistant to heat

2) Tungsten
a. has relatively high atomic number (74), which allows it to make relatively high energy x-rays
b. has the highest melting point of any metal, and because over 99% of the energy put into the x-
ray tube is turned into heat energy, the ability to dissipate the heat is critical.

3) Elements
a. Lead = used as a collimator to focus the beam
b. Aluminum = used as a filter to reduce the exposure of the patient by removing the low-energy
X-rays
c. Europium is often used in digital radiographic sensors
The recommend vertical angulation when making bite-wing radiographs of the posterior teeth
may vary from

A. +5 degrees to +10 degrees

B. -5 degrees to 10 degrees
C. 0 degrees to +5 degrees
D. -10 degrees to -5 degrees A. +5 degrees to +10 degrees

1) Recommended angulation
a. for bite-wing radiographs usually ranges from +5 to +10 degrees because the upper and lower
portion of the film contacts the palate and the lingual of lower posterior teeth at a different angle
b. the upper part of the film is usually positioned at an angle of +20 degrees while it contacts the
palate and the lower part of the film is upright
Your patient works at the local nuclear power facility and comes into your office with a tooth
ache. Why does patient not need to wear his employee radiation film badge while the
radiographs are being made?

A. His badge only records gamma rays and not X-rays

B. The badge must only be used to measure his occupational dose of radiation
C. The dose of radiation from the dental x-ray unit is too low for the badge to accurately measure
D. It is highly unlikely that his exposure will exceed occupational visits during the dental visit
B. The badge must only be used to measure his occupational dose of radiation

1) Radiation film bade

a. usually worn by employees whose work entails exposure to ionizing radiation.
b. special monitoring is enforced to ensure the employee's safety if they are exposed to excessive
ionizing radiation
An increase in radiographic density is most likely cause by a decrease in...

A. Milliamperate (mA)
B. Object-film distance (OFD)
C. Exposure time
D. Kilovoltage (kVp)
E. Source-film distance (SFD) * E. Source-film distance (SFD)

1) Decreased source-film distance

a. enables more X-ray beam photons to reach the object and the film resulting to an increase in
radiographic density

2) Increased kVp
a. increases the ability of the x-ray beams to penetrate into hard and soft tissues which decreases
radiographic density

3) Decreased mA
a. decreases the quantity of x-ray photons created which also decreases radiographic density

4) Decreased exposure time

a. exposes the film to insufficient amount of x-rays thereby decreasing radiographic density
Which type of financial arrangement allows the dentist to charge the patient the difference
between what the insurance plan agrees to pay and the dentist's usual customary rate (UCR)?

A. Balance Billing
B. Managed care
C. No answers apply
D. Payment differential
E. Prospective reimbursement A. Balance Billing

1) Balance Billing
a. describes when the dentist charges the patient the difference between what the insurance plan
pays and the usual customary rates (UCR)

2) Prospective reimbursement
a. pays the dentist before the treatment is provided

3) Managed Care
a. when a third party negotiates payments between providers and patients for services
Which of the following describes what lead is used for in X-ray machines?

A. Filtration
B. Heat dissipation
C. No answers apply
D. X-ray production
E. Collimation E. Collimation

1) Lead
a. used for collimation or shaping of the beam due to its ability to block x-ray photons going in
directions that are not needed
b. allows the clinician to keep the radiation dose as low as reasonable achievable (ALARA) since
excess radiation is booked before it reaches the patient.

2) Aluminum
a. used to filter out low-energy x-ray beams
Accidental radiation exposure is prevented by covering X-ray film with which of the following
materials?

A. Cardboad
B. Europium
C. Lead
D. No answer is correct
E. Plastic
F. Aluminum C. Lead

1) Lead
a. X-ray film manufacturers used lead foil to prevent film from being accidentally exposed to
radiation before it is used
Which of the following describes the indicated time to take the first bite-wing radiograph of a
child that appears clinically free of caries?

A. During the first dental visit

B. When the entire primary dentition is completely erupted
C. When the permanent 1st molars have erupted
D. When the spaces between the posterior teeth have closed* D. When the spaces between the
posterior teeth have closed
1) Bitewings
a. Best indicated time for making the first bite-wing radiograph of a clinically caries free child is
after the closure of spaces between the posterior teeth.
b. best used for the evaluation of inter proximal spaces of posterior teeth

2) Periapicals
a. most commonly used for assessing the presence or absence of lesions around the apex of teeth
An adult patient presents to your practice with tooth pain. A complete mouth survey was made
less than a year ago and there is no evidence of caries or periodontal disease, what treatment is
indicated (according to United States and Drug radiological guidelines).

A. Another complete mouth survey

B. Bitewing radiographs
C. No radiographs are indicated at this time
D. Periapical radiographs of the area in question
E. Pantomograph * C. No radiographs are indicated at this time

1) No radiographs must be taken if a patient has underwent a complete mouth survey less than
one year ago without suggestion of the presence of caries or periodontal disease.

2) Angina symptoms and other systemic disease sometimes mimic a toothache.

3) Tooth pain
a. can be reversible condition like a hyperemic pulp
Which of the following materials appears most radiopaque in radiographs?

A. Composite
B. Enamel
C. Glass ionomer
D. Gold
E. Porcelain
F. Acrylic * D. Gold

1) Most radiopaque
a. gold

2) Radiolucent
a. acrylic and soft tissues

3) Composite resins
a. range from completely radiolucent to radiopaque
A 6-year-old patient presents for their first dental appointment in their life. The child's permanent
1st molars have started erupting and all primer teeth are present with no proximal contacts. No
clinical evidence of caries or pathology is evident. Which of the following radiographs are
recommended for this patient?
A. 2 bite-wings
B. 2 bite-wings and a pantomograph
C. 2 bite-wings, an occlusal, and a pantomograph
D. 4 periapicals, and 2 occlusal
E. Conebeam Computed Tomography (CBCT) * A. 2 bite-wings
Which of the following radiographic view will demonstrate lesions of the maxillary sinus BEST?

A. Pantomograph
B. Periapical
C. Towne's
D. Water's
E. Bitewing D. Water's

1) Maxillary sinus
a. evaluate best using the Waters view because it provides a larger image, better angle, and
exposure of the frontal and maxillary sinus

2) Pantomographs
a. provide a wide view of teeth and other structures of the head
b. CANNOT be used to completely evaluate the location and position of lesions within the
maxillary sinus because of the image overlap
Properties Properties Answers
In radiography, a longer gray scale of contest can be accomplished through

A. Increasing the focal spot-skin distance

B. Increasing the kilovoltage
C. Increasing the milliamperage
D. Decreasing the filtration B. Increasing the kilovoltage

1) Concept: Longer gray scales of contrast can be achieved by increasing the kilovoltage peak.

2) Increasing the kilovoltage causes the radiographic image to have low contrast and longer gray
scales.

3) Low kilovoltage creates low energy x-rays responsible of producing high contrast and shorter
gray scale.

* High contest = black and white --> Short scale contrast = low kilovoltage
* Low contrast = gray shades --> Long scale contrast = high kilovoltage
The tissue most sensitive to radiation is...

A. Cartilagenous
B. Endothelial *
C. Hemopoietic *
D. Muscular
E. Neural C. Hemopoietic
1) Concept: Hemopoietic cells are sensitive to radiation because they are actively dividing and
undergoing several cellular processes to form many different cell types like red and white blood
cells and their derivatives.

2) Hemopoietic cells tie rise to several types of cells in the body including myeloid and lymphoid
cells.

3) Hemopoietic cells produce blood cell components through continuous cellular processes
which can be disrupted by ionizing radiation.
Which of the following is NOT caused by exposure to radiation?

A. Abscess *
B. Oseoradionecrosis
C. Xerostomia
D. Mucositis *A. Abscess

1) Concept: Abscess
a. are formed when dead neutrophils that reacted against bacterial infection accumulate within
tissue, so radiation has no means of causing abscess formation.

2) Over exposure to radiation may result in

a. Xerostomia (dry mouth) occurs when salivary production and flow is decreased
b. Mucositis wherein the mucosal basal cell layer inside the mouth becomes damaged by the x-
ray beam
c. Osteoradionecrosis is the death of bone cells due to exceeding number of X-rays as compared
to the recovery period of the bone cells.
The mean energy (Wavelength) or an X-ray beam is affected by which of the following factors?
Select all that apply.

A. Filtration
B. Voltage
C. kVp
D. mA A. Filtration
C. kVp

1) Concept: The wavelength of the X-ray beam is affected by the kVp and amount of filtration of
the beam.
2) The kVp affects the amount of energy in the beam, and so affects the mean energy
(wavelength) of the beam.
3) The amount of filtration determines how much of the low-energy particles are removed from
the beam, so it affects the mean energy of the beam.
4) mA affects the number of X-ray photons that are produced, which has NO EFFECT on the
mean energy of the beam.
As a Crook's tube operates, electrons carry energy from the cathode to the anode. Which of the
following is most of this energy converted into at the target?
A. Electricity
B. Heat
C. Microwaves
D. X-rays
E. Magnetism B. Heat

1) Concept: As the electrons travel in a rapid motion to hit the target, the heat is created and
photons are also formed.

2) Approximately about 99% of these electrons are converted to heat as it hits the target.

3) Only about <1% of the electrons that hit the target are converted to photons.
Which of the following types of radiation poses the greatest danger to clinicians during
radiography procedures?

A. Alpha particles
B. Direct primary-beam
C. Gamma *
D. Secondary radiation and scatter * D. Secondary radiation and scatter *

1) Concept: Secondary and scatter radiations poses the greater danger to clinicians during the
radiography procedures and is the main source of occupational radiation exposure.

2) Even though a radiologic technologist is not in the path of the radiation beam, he/she is
susceptible to scatter radiation that mainly emanates from the patient.

3) Low-energy beams are more readily absorbed by the patient's protective equipment and
produce less scatter radiation. Oblique projections increase the kilovoltage peak and result in an
increase in scatter radiation exposure to the patient and staff.
The heat of the filament in a crooks tube determines the amount of electrons produced. Which of
the following does the quantity of electrons determine?

A. Both the quantity and quality of X-rays produced

B. The quantity of X-rays produced
C. The quality of X-rays produced B. The quantity of X-rays produced

1) Concept: The quantity of x-rays in the beam depends on the quantity of electrons that the
filament releases after being heated.

2) The quality and quantity of X-ray depends on the number of electrons and the amount of
energy they release. The control over the x-rays produced is based on the kVp and mA of the X-
ray machine.

3) Crookes tubes are able to create free electrons through the ionization of the air present within
the tube with the use of a high voltage direct current.
4) The high voltage current excites and accelerates the electrons that originated from the cathode.
The excitation of electrons causes them to move rapidly, hit the anode and produce x-rays.
Increasing the mA on an X-ray unit increases...

A. Effective energy of the resultant beam

B. Number of photons generated
C. Photon wavelength
D. Voltage between anode and cathode
E. Photon speed B. Number of photons generated

1) Concept: Increasing the mA or milliamperage on the x-ray unit increases the number of
photons created.

2) Higher mA results in the production of higher amounts of radiation while lowering the mA
reduces the amount of x-rays produced.

3) The mA setting will set the amount of energy that will cause the filament to become hot. As
the filament gets hotter, more electrons are released. These electrons are later or converted to
photons to create a greater quantity of x-rays.
Which of the following is not on the electromagnetic spectrum?

A. Gamma x-rays
B. Infrared radiation
C. Microwaves Radiowaves
D. Visible light
E. X-rays
F. Alpha rays F. Alpha rays

1) Concept: Alpha rays are created from the energy released by the degradation or decay of alpha
particles and is not part of the electromagnetic spectrum.

2) The following rays are part of the electromagnetic spectrum:

3) Gamma rays and X-rays

a. are utilized in the field of medicine.
b. used in PET scans and cancer therapy while x-rays provide diagnostic radiographic images

4) Radio waves
a. carry and transmit information through antennas.
b. Radio waves are very helpful in the field of communication, entertainment, and data
transmission.

5) Microwaves
a. are useful in many industrial processes and is used at home for reheating foods
6) Visible Light
a. is commonly seen as the one emitted by the sun as a clear white light
A dose of 4Gray of X-ray radiation administered locally to a patient's hand would most likely
result in...

A. Bone marrow death

B. Carcinoma of the skin *
C. Erythema
D. Acute radiation syndrome * C. Erythema

1) Concept: The excessive amount of x-ray exposure to the hand of a patient will result to
erythema or reddening of the skin.

2) Exposure to x-ray radiation beyond the allowable limit causes the top layer of the skin to
experience tissue damage that is almost comparable with the damage of suburb.

3) The damaged skin will elicit erythema and its effect may last for a few weeks.
The amount of penetration by X-ray beams is most likely associated with...

A. Exposure time
B. Kilovoltage (kVp)
C. Milliamperage (mA)
D. Focal film distance B. Kilovoltage (kVp)

1) Concept: The amount of Kilovoltage (kVp) used for the production of X-ray beam affects the
intensity and degree of penetration of the beam.

2) Increased amount of KVp will increase the energy of X-rays therefore increasing the degree of
penetration oft the beam.

3) Milliamperage on the other hand affects the number of X-ray photons produced. Increase in
mA increases the amount of x-rays produced.

4) Exposure time only affects the quality of the image produced in the film. It varies relatively as
kVp and mA is changed.
Which of the following is the term for pain that has no organic basis and is fixed in one anatomic
structure?

A. Phantom *
B. Pseudo *
C. Psychogenic
D. Referred
E. False A. Phantom

1) Concept: Phantom pain refers to the sensations and perceptions which are experience which
are experienced in the area of a specific limb or an organ that is no longer a part of the body.
2) Such sensations are commonly experience in areas of amputated leg or arms that have no
organic basis and are confined to a specific part of the body.
Which of the following is/are considered adverse effect(s) of being exposed to high amount of
X-radiation?

A. All answers are correct

B. DNA damage
C. Free radical formation
D. No answers are correct
E. Oncogenesis A. All answers are correct

1) Concept: Excessive exposure to X-radiation may cause the creation of free radicals that may
damage DNA, causing genetic mutation and cancer growth.

2) X-rays are considered high energy emissions of ionizing radiation.

3) Ionizing radiation does not really affect the DNA directly, it affects it through free radical
formation.
Which of the following aspects of the X-ray beam is affected by a chance in kVp?

A. No answers apply
B. Quality of X-ray photons only
C. Quantity and quality of X-ray photons
D. Quantity of X-ray photons only B. Quality of X-ray photons only

1) Concept: The amount of kilovoltage (kVp) used for the production of X-ray beam affects the
intensity and degree of penetration, or the quality of the beam.

2) Increased amount of kVp will increase the energy (quality) of X-rays therefore increasing the
degree of penetration of the beam.

3) Milliamperage on the other hand affects the quantity of X-ray photons produced. Increase in
milliamperage increases the amount of x-rays produced.

4) Exposure time only affects the quality of the image produced in the film. It varies inversely as
kVp and mA is changed.
Which of the following describes X-ray photons?

A. High-energy electromagnetic waves *

B. Low-energy electromagnetic waves
C. Low-energy electromagnetic waves
D. No answers apply
E. High-energy particles * A. High-energy electromagnetic waves

1) Concept: X-ray photons exist as high energy electromagnetic waves.

2) X-rays and gamma rays are considered high-energy waves.

3) Radio waves, light, and infrared light are considered low-energy waves

4) Alpha particles, beta particles, and neutrons are considered particulate radiation.
Which of the following is the function of fixing solution?

A. Reduce the silver ions to metallic silver

B. Remove the atomic silver from the film
C. Remove undeveloped silver salts
D. Accelerate film processingC. Remove undeveloped silver salts

1) Concept: Fixing solution (fixer) ensures that the image on the film is fixed permanently by
removing the silver halide crystals which were unexposed or underdeveloped and by preserving
the emulsion.

2) Fixer Solutions contains the following:

a. Clearing agent = to remove undeveloped silver halide crystals (ammonium thiosulfate)

b. Tanning agent = hardening and preserving the emulsion (aluminum salts)

c. Activator = maintains the fixer's level of acidity and also neutralizes the developer (acetic
acid)

d. Preservative = prolongs shelf life of the sodium (sodium sulfite)

e. Solvent = Dissolves the other substance and ingredients (Water)

Which of the following is measured by the half-value layer?

A. Dosimetry
B. Filtration *
C. No answers apply *
D. Collimation B. Filtration

1) Concept: The half-value layer is the thickness of a material (usually aluminum) that decreases
the intensity of the X-ray beam by 1/2.

2) The higher the half-value layer, the thicker the piece of aluminum needed to block the X-ray
beam.

3) Quarter-value layer is the amount of a material that reduces the beam intensity to 1/4 of the
value obtained without any test filters.