Test Bank For Illustrated Anatomy of The Head and Neck 5th Edition by Fehrenbach

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ILLUSTRATED
ANATOMY OF THE
HEAD AND NECK 5TH
EDITION BY
FEHRENBACH
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Illustrated Anatomy of the Head and Neck 5th Edition Fehrenbach Test Bank
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Chapter 01: Introduction to Head and Neck Anatomy

Fehrenbach: Illustrated Anatomy of the Head and Neck, 5th Edition
MULTIPLE CHOICE
1. Which surface of the body is visualized by the clinician when performing an extraoral
examination of the patient’s eyes?
a. Anterior
b. Posterior
c. Superior
d. Lateral
ANS: A
Feedback
A The patient’s eyes are visualized on the anterior surface of the patient’s body.
B The patient’s eyes would NOT be easily visualized on the posterior of the
patient’s body.
C The patient’s eyes would NOT be easily visualized on the superior surface of the
patient’s body.
D The patient’s eyes would NOT be easily visualized on the lateral surface of the
patient’s body.
DIF: Comprehension REF: p. 3 OBJ: 2

TOP: CDA: General Chairside, I. B. Preliminary Physical Examination
MSC: NBDHE, Scientific Basis
NforRDental
I GHygiene
B.CPractice,
M 1.1.1 Head and Neck Anatomy
U S N T O
2. Which of the following is CORRECT concerning the sagittal plane of the body?
a. Parallel to the median plane
b. Parallel to the frontal plane
c. Parallel to the horizontal plane
d. Parallel to the coronal plane
ANS: A
Feedback
A A sagittal plane is parallel to the median plane.
B A sagittal plane is NOT parallel to the frontal plane but perpendicular.
C A horizontal plane is perpendicular to the median plane. A sagittal plane is
parallel to the median plane. Thus a horizontal plane is perpendicular to a
sagittal plane.
D A sagittal plane is NOT parallel to the coronal plane but perpendicular.
DIF: Recall REF: p. 3 OBJ: 1

TOP: CDA: General Chairside, I. A. Demonstrate understanding of basic oral and dental anatomy,
physiology, and development
MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1 Anatomy
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3. When a patient is in anatomic position, what is the surface of the palms of the hand
considered?
a. Anterior
b. Lateral
c. Medial
d. Posterior
ANS: A
Feedback
A The palms of the hands in anatomic position are facing toward the front and are
anterior (or ventral).
B The palms of the hands in anatomic position are NOT facing lateral or away
from the median plane but are facing toward the front and are anterior (or
ventral).
C The palms of the hands in anatomic position are NOT facing medial or toward
the median plane but are facing toward the front and are anterior (or ventral).
D The palms of the hands in anatomic position are NOT facing toward the
posterior or back of the body but are facing toward the front and are anterior (or
ventral).

MSC: NBDHE, Provision of Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics
4. What is the anatomic relationship of the right arm to the left leg?
a. Sagittal NURSINGTB.COM
b. Contralateral
c. Ipsilateral
d. Midsagittal
ANS: B
Feedback
A The two legs are contralateral to each other. Sagittal describes a plane of division
of the body created by an imaginary plane parallel to the median plane.
B Contralateral structures are located on the opposite side of the body, which is the
anatomic relationship of the right arm to the left leg.
C Ipsilateral refers to structures on the same side of the body; in contrast, the two
legs are contralateral to each other and thus are located on the opposite side of
the body.
D The two legs are contralateral to each other. Midsagittal describes a plane that
divides the body into right and left halves.

5. What is the anatomic relationship of the muscles to the skin?
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a. Anterior
b. External
c. Deep
d. Superficial
ANS: C
Feedback
A Muscles are deep to the skin.
B Muscles are deep to the skin.
C Muscles are located inward, away from the body surface, deep to the skin.
D Muscles are deep to the skin.

6. What is the anatomic relationship of the shoulders to the hips?

a. Deep
b. Medial
c. Inferior
d. Superior
ANS: D
Feedback
A NUto
The shoulders are superior RStheINhips.
GTB.COM
B The shoulders are superior to the hips.
C The shoulders are superior to the hips.
D The shoulders are superior to or closer to the head than the hips.

7. Which of the following is meant by the term “ventral”?

a. Back of an area of the body
b. Front of an area of the body
c. Inner side of an area of the body
d. Outer side of an area of the body
ANS: B
Feedback
A The back of an area of the body is referred to as the posterior surface.
B The front of an area of the body is referred to as the ventral surface.
C The inner side of an area of the body, away from the body surface, is referred to
as deep.
D The outside of an area of the body, toward the surface, is referred to as
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superficial.

8. Which of the following describes a patient’s eyes when they are in anatomic position?
a. Closed tightly
b. Looking toward the lateral
c. Looking toward the medial
d. Looking straight forward
ANS: D
Feedback
A The patient’s eyes in anatomic position are open and look forward.
B The patient’s eyes in anatomic position are open and look forward.
C The patient’s eyes in anatomic position are open and look forward.
D The patient’s eyes in anatomic position are open and look forward.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.1 Head and Neck Anatomy
9. What is the anatomic relationship of the maxillary arch to the mandibular arch?
a. Deep
b. Inferior
NURSINGTB.COM
c. Superior
d. Superficial
ANS: C
Feedback
A The maxillary arch is superior to the mandibular arch. Deep refers to structures
that are located away from the body surface.
B The maxillary arch is superior to the mandibular arch. Inferior refers to surfaces
closer to the feet or that face toward the feet.
C The maxillary arch is superior to the mandibular arch.
D The maxillary arch is superior to the mandibular arch. Superficial refers to
structures located toward the surface of the body.

10. What is the anatomic relationship of the teeth located in the front of the mouth to the teeth
located in the back of the mouth?
a. Anterior
b. Medial
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c. Posterior
d. Superficial
ANS: C
Feedback
A Teeth located in the back of the mouth are considered posterior. Teeth located in
the front of the mouth are considered anterior.
B Medial refers to structures located closer to the median plane.
C Teeth located in the back of the mouth are considered posterior to teeth located
in the front of the mouth, which are considered anterior.
D Superficial refers to structures located closer to the surface of the body.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.2 Dental Anatomy
11. The inner side of the wall of a hollow structure is referred to as internal. In contrast, the outer
side of the wall of a hollow structure is external.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second is false.
d. The first statement is false; the second is true.
ANS: A
Feedback NURSINGTB.COM
A Both statements are true. The inner side of the wall of a hollow structure is
referred to as internal. The outer side of the wall of a hollow structure is
external.
B Both statements are true. The inner side of the wall of a hollow structure is
external.
C Both statements are true. The inner side of the wall of a hollow structure is
external.
D Both statements are true. The inner side of the wall of a hollow structure is
external.

12. What is another term for a transverse section?

a. Vertical section
b. Horizontal section
c. Anterior section
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d. Posterior section
ANS: B
Feedback
A The transverse section or horizontal section is a division through a horizontal
plane.
B The transverse section or horizontal section is a division through a horizontal
plane.
C The transverse section or horizontal section is a division through a horizontal
plane.
D The transverse section or horizontal section is a division through a horizontal
plane.

13. An area closer to the median plane is considered to be distal, and an area farther from the
median plane is considered proximal.
ANS: B
NURSINGTB.COM
Feedback
A Both statements are false. An area closer to the median plane is considered to be
proximal, and an area farther from the median plane is considered distal.
B Both statements are false. An area closer to the median plane is considered to be
C Both statements are false. An area closer to the median plane is considered to be
D Both statements are false. An area closer to the median plane is considered to be

14. Structures on the same side of the body are considered ipsilateral. Structures on the opposite
side of the body are considered contralateral.
ANS: A
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Feedback
A Both statements are true. Structures on the same side of the body are considered
ipsilateral. Structures on the opposite side of the body are considered
contralateral.
B Both statements are true. Structures on the same side of the body are considered
contralateral.
C Both statements are true. Structures on the same side of the body are considered
contralateral.
D Both statements are true. Structures on the same side of the body are considered
contralateral.

15. The number of bones and muscles in the head and neck is NOT usually constant, and specific
details of these structures can vary from patient to patient.
NURSINGTB.COM
ANS: D
Feedback
A The first statement is false; the second is true. The number of bones and muscles
in the head and neck is usually constant, but specific details of these structures
can vary from patient to patient.
B The first statement is false; the second is true. The number of bones and muscles
C The first statement is false; the second is true. The number of bones and muscles
D The first statement is false; the second is true. The number of bones and muscles

16. The median plane is created by an imaginary line dividing the body into equal right and left
halves. On the surface of the body, these halves are NEVER symmetric in structure.
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ANS: C
Feedback
A The first statement is true; the second is false. The median plane or midsagittal
plane is created by an imaginary line dividing the body into equal right and left
halves. On the surface of the body, these halves are generally symmetric in
structure, yet the same symmetry does NOT apply to all internal structures.
B The first statement is true; the second is false. The median plane or midsagittal
C The first statement is true; the second is false. The median plane or midsagittal
D The first statement is true; the second is false. The median plane or midsagittal

physiology, and development N R I G B.C M
U S N T O
17. An area closer to the median plane of the body or structure is considered lateral. An area
farther from the median plane of the body or structure is considered proximal.
ANS: B
Feedback
A Both statements are false. An area closer to the median plane of the body or
structure is considered medial. An area farther from the median plane of the
body or structure is considered lateral, and an area closer to the median plane is
considered to be proximal.
B Both statements are false. An area closer to the median plane of the body or
considered to be proximal. Within the dentition, the proximal surface would be
considered mesial.
C Both statements are false. An area closer to the median plane of the body or
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D Both statements are false. An area closer to the median plane of the body or

18. What is another term for coronal plane?

a. Frontal plane
b. Coronal section
c. Horizontal plane
d. Horizontal section
ANS: A
Feedback
A A frontal plane or coronal plane is created by an imaginary line dividing the
body at any level into both anterior and posterior parts.
B The frontal plane or coronal section is a division through any frontal plane.
C A horizontal plane is created by an imaginary line dividing the body at any level
into superior and inferior parts and is always perpendicular to the median plane.
D The transverse section or horizontal
NU RSINGsection
T B.CisOMa division through a horizontal
plane.

19. Muscles may differ in size and details of their attachments. Joints, vessels, nerves, glands,
lymph nodes, fasciae, and spaces of an individual can vary in size, location, and even
presence.
ANS: A
Feedback
A Both statements are true. Muscles may differ in size and details of their
attachments. Joints, vessels, nerves, glands, lymph nodes, fasciae, and spaces of
an individual can vary in size, location, and even presence.
B Both statements are true. Muscles may differ in size and details of their
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C Both statements are true. Muscles may differ in size and details of their
D Both statements are true. Muscles may differ in size and details of their

20. What is another term for midsagittal plane?

a. Median plane
b. Coronal plane
c. Frontal plane
d. Horizontal plane
ANS: A
Feedback
A The median plane or midsagittal plane is created by an imaginary line dividing
the body into equal right and left halves.
B A frontal plane or coronal plane is created by an imaginary line dividing the
body at any level into anterior and posterior parts.
C A frontal plane or coronal
NUplane
RSIisNG created
T B.CbyOan
M imaginary line dividing the
D A horizontal plane is created by an imaginary line dividing the body at any level
into superior and inferior parts and is always perpendicular to the median plane.

21. A horizontal plane is created by an imaginary line dividing the body at any level into both
superior and inferior parts and is ALWAYS _______ to the median plane.
a. anterior
b. posterior
c. parallel
d. perpendicular
ANS: D
Feedback
A A frontal plane or coronal plane is created by an imaginary line dividing the
body at any level into both anterior and posterior parts. A horizontal plane is
created by an imaginary line dividing the body at any level into both superior
and inferior parts and is always perpendicular to the median plane.
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B A frontal plane or coronal plane is created by an imaginary line dividing the

body at any level into both anterior and posterior parts. A horizontal plane is
created by an imaginary line dividing the body at any level into both superior
and inferior parts and is always perpendicular to the median plane.
C A sagittal plane is any plane created by an imaginary plane parallel to the
median plane. A horizontal plane is created by an imaginary line dividing the
body at any level into both superior and inferior parts and is always
perpendicular to the median plane.
D A horizontal plane is created by an imaginary line dividing the body at any level
into both superior and inferior parts and is always perpendicular to the median
plane.

22. The ventral part is directed toward the anterior and is considered the opposite of the dorsal
part when considering the entire body.
ANS: A
A Both statements are true. The ventral part is directed toward the anterior and is
the opposite of the dorsal part when considering the entire body.
B Both statements are true. The ventral part is directed toward the anterior and is
C Both statements are true. The ventral part is directed toward the anterior and is
D Both statements are true. The ventral part is directed toward the anterior and is

23. The transverse section is a division through a _____ plane.

a. horizontal
b. frontal
c. sagittal
d. coronal
ANS: A
Feedback
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A The transverse section or horizontal section is a division through a horizontal

plane.
B The frontal section or coronal section is a division through any frontal plane.
C A sagittal plane is any plane created by an imaginary plane parallel to the
median plane.
D A frontal plane or coronal plane is created by an imaginary line dividing the

24. The dental professional MUST have a thorough understanding of head and neck anatomy
when performing patient examination procedures, both extraoral and intraoral. Certain terms
can be used to give information about the depth of a structure in relationship to the surface of
the body.
a. Both the statement and the reason are correct and related.
b. Both the statement and the reason are correct but NOT related.
c. The statement is correct, but the reason is NOT.
d. The statement is NOT correct, but the reason is correct.
e. NEITHER the statement NOR the reason is correct.
ANS: A
Feedback
A Both the statement and the
N reason
RSINare GTcorrect
B.COand
M related. The dental
professional MUST have U a thorough understanding of head and neck anatomy
when performing patient examination procedures, both extraoral and intraoral.
Certain terms can be used to give information about the depth of a structure in
relationship to the surface of the body.
B Both the statement and the reason are correct and related. The dental
professional MUST have a thorough understanding of head and neck anatomy
C Both the statement and the reason are correct and related. The dental
D Both the statement and the reason are correct and related. The dental
E Both the statement and the reason are correct and related. The dental
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TOP: CDA: General Chairside, I. B. Preliminary Physical Examination | CDA: General Chairside, II.
C. Describe how to perform and/or assist with intraoral procedures
25. The face is on the anterior side of the head, and the neck is superior and posterior to the face.
ANS: C
Feedback
A The first statement is true; the second is false. The face is on the anterior side of
the head, and the neck is inferior and posterior to the face. The hair is superior to
the face as well.
B The first statement is true; the second is false. The face is on the anterior side of
the face as well.
C The first statement is true; the second is false. The face is on the anterior side of
the face as well.
D The first statement is true;
NUtheRSsecond
INGTisB.Cfalse. M
The face is on the anterior side of
O to the face. The hair is superior to
the head, and the neck is inferior and posterior
the face as well.

MULTIPLE RESPONSE
1. From the following list of anatomic terms, select which terms are DIRECTLY associated with
the planes that can be noted with the body. (Select all that apply.)
a. Medial or distal
b. Median or sagittal
c. Frontal or horizontal
d. Lateral or proximal
ANS: B, C
Feedback
Correct Median, sagittal, frontal, and horizontal actually are planes, so they are
DIRECTLY associated with planes that can be noted with the body.
Incorrect Medial, distal, lateral, and proximal are descriptions for parts of the body
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in relationship to the planes, so they are NOT DIRECTLY associated with

the planes themselves.
DIF: Recall REF: p. 4, Figure 1-4 OBJ: 1

2. From the following list of anatomic terms, select which terms can be used to give information
about the depth of a structure in relationship to the surface of the body. (Select all that apply.)
a. Medial
b. Superficial
c. Deep
d. External
e. Internal
ANS: B, C
Feedback
Correct Superficial and deep are both used to give information about the depth of a
structure in relationship to the surface of the body.
Incorrect Medial is closer to the median plane (and lateral is farther away from the
median plane). Internal is on the inner side of the wall of a hollow
structure, and external is on the outer side of the wall of a hollow
structure. Both do NOT give information about the depth of a structure in
DIF: Recall REF: p.N

3URSINGOBJ: TB.C 1 OM
3. From the following list of anatomic terms, select which terms are DIRECTLY related to the
median plane of the body. (Select all that apply.)
a. Medial
b. Lateral
c. Ipsilateral
d. Contralateral
ANS: A, B
Feedback
Correct Medial is closer to the median plane, and lateral is farther away from the
median plane, so they both are DIRECTLY related to the median plane.
Incorrect Ipsilateral is on the same side of the body, and contralateral is on the
opposite side of the body, so they both are NOT DIRECTLY related to the
median plane.

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4. From the following list of anatomic terms, select which terms are DIRECTLY related to either
an inner OR an outer side of a wall of a hollow organ. (Select all that apply.)
a. Superficial
b. Deep
c. Internal
d. External
ANS: C, D
Feedback
Correct Internal is on the inner side of the wall of a hollow structure, and external
is on the outer side of the wall of a hollow structure; both are DIRECTLY
related to either an inner OR an outer side of a wall of a hollow organ.
Incorrect Superficial and deep are both used to give information about the depth of a
structure in relationship to the surface of the body; both are NOT
DIRECTLY related to either an inner OR an outer side of a wall of a
hollow organ.

5. From the following list of anatomic terms, select which terms are related to a structure being
either on the same side of the body OR on the opposite side of the body. (Select all that
apply.) NURSINGTB.COM
a. Medial
b. Lateral
c. Ipsilateral
d. Contralateral
ANS: C, D
Feedback
Correct Ipsilateral is on the same side of the body, and contralateral is on the
opposite side of the body; both are related to a structure being either on the
same side of the body OR on the opposite side of the body.
Incorrect Medial is closer to the median plane, and lateral is farther away from the
median plane; both are NOT related to a structure being either on the same
side of the body OR on the opposite side of the body.

6. Which of the following statements listed are CORRECT concerning the body in anatomic
position? (Select all that apply.)
a. The body can be standing erect.
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b. The patient’s head and neck when sitting upright in a dental chair.
c. The arms are at the sides with the palms directed forward.
d. The toes directed forward and the eyes looking forward.
ANS: A, B, C, D
In anatomic position, the body can be standing erect. The arms are at the sides with the palms
and toes directed forward and the eyes looking forward. This position is assumed with respect
to the position of the patient’s head and neck when sitting upright in a dental chair.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.0 Assessing Patient Characteristics
7. Which of the following definitions of anatomic terms listed are CORRECT? (Select all that
apply.)
a. An area that faces away from the head and toward from the feet is its superior part.
b. The ventral part is directed toward the posterior.
c. An area closer to the median plane is considered to be proximal.
d. An area closer to the median plane of the body or structure is considered medial.
ANS: C, D
Feedback
Correct An area closer to the median plane is considered to be proximal. An area
closer to the median plane of the body or structure is considered medial.
Incorrect An area that faces away from the head and toward the feet is its inferior
part and NOT its superior part that faces toward the head and away from
the feet. The dorsal
N part
RSisIdirected
GTB.C toward the posterior and NOT toward
the anterior like theUventralNpart. OM

MATCHING
From the following list of anatomic terms, match those terms with their CORRECT
definitions.
a. Area that is farther away from the median plane of the body or structure.
b. Area that is closer to the median plane of the body or structure.
c. Structure on the opposite side of the body.
d. Structure on the same side of the body.
1. Medial
2. Lateral
3. Ipsilateral
4. Contralateral
1. ANS: B DIF: Recall REF: p. 3 OBJ: 1

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2. ANS: A DIF: Recall REF: p. 3 OBJ: 1
3. ANS: D DIF: Recall REF: p. 3 OBJ: 1
4. ANS: C DIF: Recall REF: p. 3 OBJ: 1
From the following list of anatomic terms, match those terms with their CORRECT alternative
terms.
a. Coronal plane
b. Midsagittal plane
c. Horizontal section
d. Coronal section
5. Median plane
6. Frontal plane
7. Transverse section
8. Frontal section
5. ANS: B NURSINGREF:
DIF: Recall TB.C 3M
p. O OBJ: 1
OTHER
1. Place the following in the CORRECT order suggested when studying diagrams or associated
photographs of anatomic structures, especially those of dissections.
a. Note any familiar structures.
b. Note any overall descriptions.
c. Look to areas highlighted.
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ANS:
B, A, C
Feedback
Correct It is important to keep in mind when studying diagrams or associated
Order photographs of anatomic structures, especially those of dissections, to first
note any overall descriptions (e.g., view, section) as well as any nearby
directional pointers. Then note any familiar structures (e.g., apex of tongue
or nose, maxilla or mandible) to allow for basic orientation. Next look to
the areas highlighted, if noted and, of course, those structures that are
labeled.
Incorrect This process in the correct order will help overall in the study of the head
and neck.
DIF: Application REF: p. 3 OBJ: 2

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Chapter 02: Surface Anatomy

MULTIPLE CHOICE
1. The dental professional MUST be thoroughly familiar with the surface anatomy of the head
and neck in order to examine patients BECAUSE features of the surface provide essential
landmarks for deeper anatomic structures.
ANS: A
Feedback
A Both the statement and reason are correct, and they are also both related. Dental
professionals MUST have knowledge of healthy structures in order to identify
and locate deeper anatomic landmarks that are necessary in order to perform
certain dental procedures such as administration of local anesthetic or
radiographic exposures.
B Both the statement and the reason relate to each other. The dental professional
MUST have knowledge of anatomic structures in order to complete certain
dental procedures.
C NUdental
The reason is correct. The RSINprofessional
GTB.COM MUST have knowledge of
anatomic structures in order to complete certain dental procedures.
D The statement is correct. The dental professional MUST have knowledge of
anatomic structures.
E The statement and the reason are both correct. Dental professionals MUST have
knowledge of healthy structures in order to identify and locate deeper anatomic
landmarks that are necessary in order to perform certain dental procedures.

2. Which of the following is the CORRECT definition of the term labial?

a. Structures closest to the inner cheek
b. Structures closest to the facial surface
c. Structures closest to the lips
d. Structures closest to the palate
e. Structures closest to the tongue
ANS: C
Feedback
A This is the definition of the term buccal.
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B This is the definition of the term facial.

C This is the definition of the term labial.
D This is the definition of the term palatal.
E This is the definition of the term lingual.

3. The regions of the head include specific anatomic structures. Which region listed below is
NOT included in the regions of the head?
a. Frontal
b. Parietal
c. Orbital
d. Zygomatic
e. Submental
ANS: E
Feedback
A The frontal region is included in the regions of the head that consist of the
forehead and the area superior to the eyes.
B The parietal region is included in the regions of the head that consist of the area
of the skull just posterior to the frontal region.
C The orbital region is included in the regions of the head that consist of the bony
socket where the eyeballNand RSallIitsG
supporting
B.COMstructures are located.
D
U N T
The zygomatic region is included in the regions of the head that overlie the
cheekbone.
E The submental region is included in the regions of the neck and is one of the
cervical triangles.

4. The superior and posterior free margin of the auricle is the helix, which ends inferiorly at the
lobule. The lobule is a small flap of tissue that is the part of the auricle anterior to the external
acoustic meatus.
ANS: C
Feedback
A The second statement is false. The lobule is the fleshy protuberance of the
earlobe.
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B The first statement is true. The superior and posterior free margin of the auricle
is known as the helix, which ends inferiorly at the lobule.
C The first statement is true. The superior and posterior free margin of the auricle
is known as the helix, which ends inferiorly at the lobule. The second statement
is false. The second statement is the definition of the tragus, NOT the lobule.
D The first statement is true, and the second statement is false.

5. The eyeball is located in the orbital region of the head. On the eyeball is a white area with a
central area of coloration. What is the term for the white area?
a. Sclera
b. Iris
c. Pupil
d. Orbit
ANS: A
Feedback
A The sclera is the white area on the eyeball.
B The iris is the central area of coloration on the eyeball.
C The pupil is the opening in the center of the iris that appears black.
D The orbit is the bony socket where the eyeball is contained.
NURSINGTB.COM
6. Which part of the nasal region will feel flexible when palpated during an extraoral
examination by a clinician?
a. Root of the nose
b. Apex of the nose
c. Bridge of the nose
d. Nasion of the nose
ANS: B
Feedback
A The root of the nose is a bony structure located between the eyes.
B The apex of the nose is formed by cartilage located at the tip of the nose.
C The bridge of the nose is a bony structure located inferiorly to the nasion.
D The nasion is a midline junction between the nasal and frontal bones.

physiology, and development | CDA: General Chairside, I. B. Preliminary Physical Examination |
CDA: General Chairside, II. C. Describe how to perform and/or assist with intraoral procedures
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MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.1 Head and Neck Anatomy |
NBDHE, Provision of Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics |
NBDHE, Provision of Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene
Care
7. The buccal region of the head is composed of soft tissue of the cheek. Most of the upper cheek
is fleshy, mainly formed by a mass of fat and muscle. Which is the strong muscle felt in this
area when the patient clenches his or her teeth together during an extraoral examination?
a. Corrugator supercilii muscles
b. Temporalis muscles
c. Masseter muscles
d. Hyoid muscles
ANS: C
Feedback
A The corrugator supercilii muscles are located within the orbital region.
B The temporalis muscles are located within the temporalis fossa within the
temporal region.
C The masseter muscles are located within the buccal region just inferior to the
zygomatic arch.
D The hyoid muscles are located within the neck region and attach to the hyoid
bone.

CDA: General Chairside, II. C.NURSIhow
Describe NGTtoB.C OMand/or assist with intraoral procedures
perform
8. One structure within the oral cavity is the tongue, which is known as the gateway to the oral
region BECAUSE the tongue is a prominent feature of the oral cavity.
ANS: D
Feedback
A The statement is NOT correct, even though the reason is correct. The lips are the
gateway to the oral region.
B The statement is NOT correct, even though the reason is related because the
tongue and the lips are part of the oral region.
C The statement is NOT correct, but the reason is correct. The lips are the gateway
to the oral region. The tongue is a prominent feature of the oral region.
D The statement is NOT correct, but the reason is correct. The tongue is NOT the
E The reason is correct. The tongue is a prominent structure of the oral region. But
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the statement is NOT correct, even though the reason is correct. The lips are the

9. The jaws are within the oral cavity and deep to the lips. Underlying the upper lip is the
mandible, while the maxillae underlies the lower lip.
ANS: C
Feedback
A The second statement is false. The maxillae or upper jaw is under the upper lip,
and the mandible underlies the lower lip.
B The first statement is true. The jaws are within the oral cavity and deep to the
lips.
C The first statement is true, and the second statement is false. The maxillae or
upper jaw is under the upper lip, and the mandible or lower jaw underlies the
lower lip.
D The first statement is true. The jaws are located within the oral region, which
consists of the oral cavity.
N TheR Isecond statement
GTB.C M is false. The maxillae or upper
jaw is under the upper lip,UandStheNmandible Oor lower jaw underlies the lower lip.

10. What is the landmark located in the oral cavity that appears as a small elevation of tissue
located on the inner part of the buccal mucosa, just opposite the maxillary second molar?
a. Parotid papilla
b. Maxillary tuberosity
c. Labial frenum
d. Retromolar pad
ANS: A
Feedback
A The parotid papilla is located on a small elevation of tissue containing the duct
opening from the parotid gland on the inner part of the buccal mucosa opposite
the maxillary second molar.
B The maxillary tuberosity is located posterior to the maxilla.
C The labial frenum is a fold of tissue located at the midline between the labial
mucosa and alveolar mucosa of the maxilla and mandible.
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D The retromolar pad is a dense pad of tissue distal to the most distal tooth of the
mandible.

11. The palate or roof of the mouth has two parts: an anterior part and a posterior part. The firmer,
whiter posterior part is the hard palate.
ANS: C
Feedback
A The second statement is false. The firmer, whiter anterior part is the hard palate.
The posterior part is the soft palate.
B The first statement is true. The palate has two parts: an anterior part and a
posterior part.
C The first statement is true, while the second statement is false. The second
statement is false because the firmer, whiter anterior part is the hard palate. The
posterior part is the soft palate.
D The first statement is true, and the second statement is false. The first statement
is true because the palateNUhas
RStwoINparts:
G B.C an anterior
M part and a posterior part. The
second statement is false because theTfirmer,Owhiter anterior part is the hard
palate. The posterior part is the soft palate.

12. What is the term for the top surface of the tongue?
a. Lateral
b. Dorsal
c. Ventral
d. Root
ANS: B
Feedback
A The lateral surface(s) is/are located on the sides of the tongue.
B The dorsal surface of the tongue is located on the topside of the tongue.
C The ventral surface of the tongue is located on the underside of the tongue.
D The root of the tongue is also the base of the tongue.
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13. What is the flap of cartilage located posterior to the base of the tongue and anterior to the
oropharynx?
a. Fauces
b. Mental protuberance
c. Palatine tonsils
d. Epiglottis
ANS: D
Feedback
A The fauces is located laterally at the junction or the opening between the oral
region and the oropharynx.
B The mental protuberance is located in the mental region and is part of the chin.
C The palatine tonsils are located between the fauces, which consists of the
anterior faucial pillar and the posterior faucial pillar.
D The epiglottis is a flap of cartilage located posterior to the base of the tongue and
anterior to the oropharynx.

NURdivides
14. Which muscle of the neck region SINGeach
TB.C OM
side of the neck diagonally into BOTH the
anterior cervical triangle and the posterior cervical triangle?
a. Sternocleidomastoid muscle
b. Digastric muscle
c. Omohyoid muscle
d. Trapezius muscle
ANS: A
Feedback
A The sternocleidomastoid muscle is a large paired strap muscle that divides each
side of the neck.
B The digastric muscle is a suprahyoid muscle located underneath the chin.
C The omohyoid muscle is an infrahyoid muscle that divides the posterior cervical
triangle into the occipital triangle.
D The trapezius muscle is a cervical muscle that covers the lateral and posterior
surfaces of the neck.

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15. During the extraoral examination, palpating inferior to and medial to the angles of the
mandible is important BECAUSE this will allow the dental professional to effectively palpate
the hyoid bone.
ANS: A
Feedback
A The hyoid bone is located in the anterior midline, superior to the thyroid
cartilage where the angles of the mandible are located.
B The statement and the reason are related. During the extraoral examination,
palpating inferior to and medial to the angles of the mandible is important
because this will allow the dental professional to effectively palpate the hyoid
bone.
C The reason is correct. The angle of the mandible is the landmark used to locate
the hyoid bone.
D The statement is correct. Palpation of the angles of the mandible is part of the
extraoral examination.
E The statement and the reason are correct. The hyoid bone is located in the
anterior midline, superior to the thyroid cartilage where the angles of the
mandible are located.
DIF: Application REF: p.N 21URSINGOBJ:TB.C 2 OM

Care
16. What is the vertical groove located at the midline superior to the upper lip that extends
downward on the skin from the nasal septum?
a. Philtrum
b. Tubercle
c. Labial commissure
d. Nasolabial sulcus
ANS: A
Feedback
A The philtrum is the vertical groove that extends downward on the skin from the
nasal septum at the midline superior to the upper lip.
B The tubercle is a thicker area on the upper lip inferior to where the philtrum on
the skin terminates.
C The labial commissure is also known as the corner of the mouth. This is where
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the upper and lower lips meet.

D The nasolabial sulcus is the groove that runs upward between the labial
commissure and the ala of the nose.

17. Where are foliate lingual papillae located within the oral cavity?
a. Dorsal surface of the tongue
b. Buccal mucosa
c. Anterior hard palate
d. Lateral border of the tongue
ANS: D
Feedback
A The dorsal surface of the tongue has the filiform, fungiform, and circumvallate
lingual papillae.
B The foliate lingual papillae are located on the lateral border of the tongue.
C The foliate lingual papillae are located on the lateral border of the tongue.
D The foliate lingual papillae are located on the lateral border of the tongue.

MSC: NBDHE, Scientific Basis U S N Hygiene
for Dental T O
Practice, 1.1.1 Head and Neck Anatomy
18. Trying to fully survey the areas of the scalp during an extraoral examination is NOT very
important because lesions are easily visualized by the patient and then can be shared with the
clinician.
ANS: E
Feedback
A Neither the statement nor the reason is correct. Trying to fully survey these areas
of the scalp during an extraoral examination is important because lesions may be
hidden visually from the clinician as well as the patient by the patient’s hair.
B Neither the statement nor the reason is correct. Trying to fully survey these areas
C Neither the statement nor the reason is correct. Trying to fully survey these areas
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D Neither the statement nor the reason is correct. Trying to fully survey these areas
E Neither the statement nor the reason is correct. Trying to fully survey these areas

Care
19. The frontal eminence is usually MORE pronounced in males, and the supraorbital ridge is
MORE prominent in females and children.
ANS: B
Feedback
A Both statements are false. The frontal eminence is usually more pronounced in
NUR
children and adult females, SIthe
and NGsupraorbital
TB.COMridge is more prominent in adult
males.
B Both statements are false. The frontal eminence is usually more pronounced in
children and adult females, and the supraorbital ridge is more prominent in adult
males.
C Both statements are false. The frontal eminence is usually more pronounced in
males.
D Both statements are false. The frontal eminence is usually more pronounced in
males.

physiology, and development | CDA: General Chairside, II. C. Describe how to perform and/or assist
with intraoral procedures
NBDHE, Provision of Clinical Dental Hygiene Services, 3.3 Individualized Patient Education
20. The eyes are usually near the midpoint of the vertical height of the head. The width of each
eye is usually the same as the distance between the ears.
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ANS: C
Feedback
A The first statement is true; the second is false. The eyes are usually near the
midpoint of the vertical height of the head. The width of each eye is usually the
same as the distance between the eyes.
B The first statement is true; the second is false. The eyes are usually near the
C The first statement is true; the second is false. The eyes are usually near the
D The first statement is true; the second is false. The eyes are usually near the

21. Loss of height in the lower third of the face, which contains the teeth and jaws, can occur in
certain circumstances such as with growth and effective orthodontic therapy.
a. Both the statement and theN reason
RSIN are
Gcorrect
B.Cand M related.
b. Both the statement and the Ureason are T
correct O
but NOT related.
ANS: C
Feedback
A The statement is correct, but the reason is NOT. Loss of height in the lower third
of the face, which contains the teeth and jaws, can occur in certain circumstances
such as with aging and periodontal disease. It does NOT occur with growth or
effective orthodontic therapy.
B The statement is correct, but the reason is NOT. Loss of height in the lower third
such as with aging and periodontal disease.
C The statement is correct, but the reason is NOT. Loss of height in the lower third
D The statement is correct, but the reason is NOT. Loss of height in the lower third
E The statement is correct, but the reason is NOT. Loss of height in the lower third
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physiology, and development | CDA: General Chairside, V. A. Oral Health Information
Care
22. Both the labial and buccal mucosa may vary in coloration, as do other regions of healthy oral
mucosa, in individuals with _______ skin.
a. thinner
b. pigmented
c. thicker
d. transparent
ANS: B
Feedback
A Both the labial and buccal mucosa may vary in coloration, as do other regions of
healthy oral mucosa, in individuals with pigmented skin.
B Both the labial and buccal mucosa may vary in coloration, as do other regions of
C Both the labial and buccal mucosa may vary in coloration, as do other regions of
D Both the labial and buccal mucosa may vary in coloration, as do other regions of
NURSINGwith
healthy oral mucosa, in individuals TB.C OM skin.
pigmented

23. The yellower and looser posterior part of the palate is the hard palate; it is the larger part of
the palate since it comprises approximately 85% of the total surface.
ANS: D
Feedback
A The first statement is false; the second is true. The yellower and looser posterior
part of the palate is the soft palate; it is the smaller part of the palate since it only
comprises approximately 15% of the total surface.
B The first statement is false; the second is true. The yellower and looser posterior
C The first statement is false; the second is true. The yellower and looser posterior
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D The first statement is false; the second is true. The yellower and looser posterior

24. What is the dense pad of tissue just posterior to the most distal tooth of the mandible?
a. Pterygomandibular fold
c. Parotid papilla
d. Retromolar pad
ANS: D
Feedback
A The pterygomandibular fold is a fold of tissue that extends from the junction of
hard and soft palates down to the mandible, just posterior to the most distal
mandibular molar.
B An elevation on the posterior aspects of the maxilla just posterior to the most
distal maxillary molar is the maxillary tuberosity.
C On the inner part of the buccal mucosa, just opposite the maxillary second
molar, the parotid papilla
NUisRaSsmall
INGelevation
B.COof M tissue.
D T
The area just posterior to the most distal mandibular molar is a dense pad of
tissue, the retromolar pad.

25. The line of demarcation between the firmer and pinker attached gingiva and the movable and
redder alveolar mucosa is the
a. interdental gingiva.
b. gingival sulcus.
c. mucogingival junction.
d. vestibular fornix.
ANS: C
Feedback
A The gingival tissue between the teeth is an extension of attached gingiva and is
the interdental gingiva.
B The inner surface of the marginal gingiva faces a space or gingival sulcus.
C The line of demarcation between the firmer and pinker attached gingiva and the
movable and redder alveolar mucosa is the scallop-shaped mucogingival
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junction.
D Deep within each vestibule is the vestibular fornix, where the pink and thick
labial or buccal mucosa meets the redder and thinner alveolar mucosa.

26. Which of the following borders of the oral cavity are listed CORRECTLY?
a. Cheeks are the lateral borders
b. Lips are the inferior border
c. Pharynx is the anterior border
d. Floor of the mouth is the superior border
ANS: A
Feedback
A Cheeks of the face are the lateral borders of the oral cavity.
B The lips are the anterior border of the oral cavity and NOT its inferior border.
C The pharynx is the posterior border of the oral cavity and NOT its anterior
border.
D The floor of the mouth is the inferior border of the oral cavity and NOT its
superior border.

physiology, and development NURSINGTB.COM
MULTIPLE RESPONSE
1. From the following list of structures, select which structures are located within the nasal
region of the head. (Select all that apply.)
a. Masseter muscle
b. Angle of mandible
c. Alae
d. Antitragus
e. Nasion
ANS: C, E
Feedback
Correct Both the alae and nasion are located within the nasal region of the head.
Incorrect Both the masseter muscle and angle of the mandible are located within the
buccal region of the head. The antitragus is located within the temporal
region of the head. NONE of these structures are within the nasal regions
of the head.

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2. From the following list of structures, select which structures are located within the buccal
region of the head. (Select all that apply.)
a. Masseter muscle
b. Angle of mandible
c. Alae
d. Antitragus
e. Nasion
ANS: A, B
Feedback
Correct Both the masseter muscle and angle of the mandible are located within the
buccal region of the head.
Incorrect Both the alae and nasion are located within the nasal region of the head.
The antitragus is located within the temporal region of the head. NONE of
these structures are located within the buccal region of the head.
DIF: Recall REF: pp. 14-15 OBJ: 3

3. From the following list of structures, select which structures are located within the oral region
of the head. (Select all that apply.)
a. Alae NURSINGTB.COM
b. Antitragus
c. Nasion
d. Vermilion zone
e. Philtrum
ANS: D, E
Feedback
Correct Both the vermilion zone and philtrum are located within the oral region of
the head.
Incorrect Both the alae and nasion are located within the nasal region of the head.
The antitragus is located within the temporal region of the head. NONE of
these structures are located within the oral region of the head.

4. From the following list of structures, select which structures are NOT located within the
temporal region of the head. (Select all that apply.)
a. Alae
b. Antitragus
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c. Nasion
d. Vermilion zone
e. Philtrum
ANS: A, C, D, E
Feedback
Correct The alae and nasion are located within the nasal region of the head. The
vermilion zone and philtrum are located within the oral region of the head.
NONE of these structures are located within the temporal region of the
head.
Incorrect The antitragus is located within the temporal region of the head.

5. From the following list of structures, select which structures are considered part of the
eyeball. (Select all that apply.)
a. Sclera
b. Iris
c. Conjunctiva
d. Orbit
e. Lacrimal gland
ANS: A, B
NURSINGTB.COM
Feedback
Correct Both the sclera and iris are considered part of the eyeball.
Incorrect The conjunctiva is part of the eyelid. The orbit is the bony socket
containing the eyeball, and the lacrimal gland is within the orbit. NONE of
these structures are part of the eyeball.

6. Which of the following needs to occur in order to effectively visually inspect and bidigitally
palpate the vestibular area and gingival tissue during an intraoral examination on patient?
(Select all that apply.)
a. Retracting buccal mucosa
b. Placing mouth mirror on dorsal surface of tongue
c. Retracting labial mucosa
d. Having patient say “ah”
ANS: A, C
Feedback
Correct During an intraoral examination, retract both the buccal mucosa and labial
mucosa in order to visually inspect and bidigitally palpate the vestibular
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area and the gingival tissue.

Incorrect Placing the mouth mirror with mirror side down on the middle of the
dorsal surface of tongue allows for visual inspection of the soft palate with
uvula and visible parts of the pharynx; next ask the patient to say “ah.”

with intraoral procedures | CDA: General Chairside, V. A. Oral Health Information
Care
7. Which of the following needs to occur in order to effectively examine the dorsal surface of the
tongue during an intraoral examination on a patient? (Select all that apply.)
a. Extending tongue slightly
b. Wrapping gauze around tongue
c. Grasping of tongue firmly
d. Digitally palpating surface
ANS: A, B, C, D
To examine the dorsal surface of the tongue, have the patient slightly extend the tongue and
wrap gauze around the anterior third of the tongue in order to obtain a firm grasp. First,
visually inspect and then digitally palpate the dorsal surface.

TOP: CDA: General Chairside, NI.UA.
RSDemonstrate
INGTB.C OM
understanding of basic oral and dental anatomy,
Care
8. Which of the following are palpable landmarks of the midline of the neck during an extraoral
examination by a dental professional? (Select all that apply.)
a. Thyroid cartilage
b. Vocal cords or ligaments
c. Superior thyroid notch
d. Hyoid bone
ANS: A, C, D
Feedback
Correct The thyroid cartilage and its superior thyroid notch as well as the hyoid
bone are palpable landmarks of the midline of the neck during an extraoral
examination.
Incorrect The vocal cords or ligaments of the larynx or “voice box” are attached to
the posterior surface of the thyroid cartilage and thus are not palpable
during an extraoral examination. Instead, a laryngoscopy is an
examination by medical personnel that examines the posterior surface of
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the pharynx as well as the vocal cords or ligaments of the larynx using a
laryngoscope.

Care
9. Which of the following needs to occur in order to effectively examine the floor of the mouth
during an extraoral examination on a patient? (Select all that apply.)
a. Observe salivary flow from sublingual caruncle ducts
b. Check midline lingual frenum
c. Observe salivary flow from parotid papillae ducts
d. Check midline labial frenum
ANS: A, B
Feedback
Correct When examining the floor of the mouth during an intraoral examination,
check the lingual frenum at the midline and then dry each sublingual
caruncle with gauze to observe salivary flow from the ducts.
Incorrect When examining the buccal mucosa during an intraoral examination and
NOT the floor of the mouth, observe the salivary flow from each duct near
NUafter
the parotid papillae RSI NGTitB.C
drying M When examining the labial
withOgauze.
mucosa and NOT the floor of the mouth, check the labial frenum on both
the maxilla and mandible at each one’s midline.

Care
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Chapter 03: Skeletal System

MULTIPLE CHOICE
1. Which of the following bony features listed does NOT serve as an opening in bone?
a. Foramen
b. Canal
c. Sulcus
d. Fissure
ANS: C
Feedback
A A foramen is a short windowlike opening in bone.
B A canal is a tubelike opening in bone.
C A sulcus is a shallow depression or groove on bony surface and NOT an opening
in bone.
D A fissure is a narrow cleftlike opening in bone.
DIF: Recall REF: p. 33 OBJ: 1 | 2

2. Which of the following bones

N listed
R is the
I G ONLY
B.C movable
M bone of the skull?
a. Hyoid bone U S N T O
b. Mandible
c. Palatine
d. Vomer
ANS: B
Feedback
A Even though the hyoid bone is movable and has no bony articulations, it is a
bone located in the neck and NOT the skull.
B The mandible is the only skull bone that moves; it moves at the
temporomandibular joint. Within this joint, the mandibular condyle moves
within the articular fossa of the temporal bone.
C The palatine bone may be a skull bone, but it does NOT move.
D The vomer may be a skull bone, but it does NOT move.

3. The squamosal suture is BEST observed from which view of the skull?
a. Anterior view
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b. Inferior view
c. Lateral view
d. Superior view
ANS: C
Feedback
A It is difficult to see the squamosal suture on the lateral skull surface from an
anterior view.
B It is difficult to see the squamosal suture on the lateral skull surface from an
inferior view.
C The squamosal suture is the suture between the parietal bones and temporal
bones on each side of the skull. This suture is BEST viewed from the lateral
view.
D It is difficult to see the squamosal suture on the lateral skull surface from a
superior view.

4. Which of the following openings within the orbit connects the orbit with the cranial cavity?
a. Cribriform plate
b. Infraorbital foramen
c. Inferior orbital fissure
d. Superior orbital fissure N R I G B.C M
U S N T O
ANS: D
Feedback
A The cribriform plate is a passageway for olfactory nerves from the nasal cavity
to the brain.
B The infraorbital foramen is located inferior to the orbit on the facial surface of
the maxilla.
C The inferior orbital fissure connects the orbit with both the infratemporal and
pterygopalatine fossae and NOT the cranial cavity.
D The superior orbital fissure is a slitlike opening between the lesser and greater
wings of the sphenoid bone and serves as a passageway for blood vessels and
nerves from the cranial cavity into the orbit, thus connecting the two.

5. After the seventh cranial nerve travels through the petrous part of the temporal bone, through
which opening does it exit onto the face?
a. External auditory meatus
b. Jugular notch
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c. Foramen spinosum
d. Stylomastoid foramen
ANS: D
Feedback
A The external acoustic meatus is the short external canal that leads to the
tympanic cavity.
B The jugular notch, formed by the articulation of temporal and occipital bones, is
associated with the jugular vein and the ninth, tenth, and eleventh cranial nerves.
C The foramen spinosum is more posterior and is associated with the middle
meningeal artery.
D The seventh cranial nerve enters the temporal bone through the internal acoustic
meatus, travels within the temporal bone, and exits through the stylomastoid
foramen onto the face.

6. Which of the following external foramina can ONLY be observed from an inferior view of the
skull?
a. Hypoglossal canal
b. Foramen ovale
c. Foramen spinosum
d. Stylomastoid foramen NURSINGTB.COM
ANS: D
Feedback
A The hypoglossal canal can be viewed from both inferior and superior aspects of
the skull.
B The foramen ovale can be viewed from both inferior and superior aspects of the
skull.
C The foramen spinosum can be viewed from both inferior and superior aspects of
the skull.
D The stylomastoid foramen is NOT visible from a superior view of the skull and
can ONLY be observed from an inferior view of the skull. It is located between
the mastoid process and the styloid process on the inferior surface of the petrous
part of the temporal bone.

7. Through which of the following openings in the skull does the twelfth cranial nerve pass?
a. Internal acoustic meatus
b. Foramen rotundum
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c. Foramen spinosum
d. Hypoglossal canal
ANS: D
Feedback
A The internal acoustic meatus is located on the superior internal surface of the
temporal bone and is associated with both the seventh and eighth cranial nerves.
B The foramen rotundum is located within the sphenoid bone and is associated
with the maxillary nerve or second division of the fifth cranial nerve.
C The foramen spinosum is located within the sphenoid bone and is associated
with the middle meningeal artery.
D The twelfth cranial nerve passes through the hypoglossal canal, an opening in
the skull that is located in the occipital bone on each side of the foramen
magnum.

8. Why is the pterygoid process of the sphenoid bone an important feature of the skull to the
dental professionals?
a. Serves as an attachment for the muscles of mastication
b. Serves as an attachment for muscles involved in swallowing
c. Serves as a landmark observed on maxillary posterior periapical radiographs
d. Serves as a landmark observed
N R onI mandibular
G B.C posterior
M periapical radiographs
U S N T O
ANS: A
Feedback
A The pterygoid process is an attachment for both the lateral and medial pterygoid
muscles, which are two muscles of mastication.
B The pterygoid process does NOT provide attachment for the muscles involved in
swallowing.
C The pterygoid process is NOT a landmark usually observed on maxillary
periapical radiographs.
D The pterygoid process is NOT a landmark observed on mandibular periapical
radiographs.

Care
9. Through which of the following bony landmarks is the sense of smell carried by olfactory
nerves?
a. Crista galli of the ethmoid bone
b. Frontal sinuses of the frontal bone
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c. Cribriform plate of the ethmoid bone

d. Perpendicular plate of the ethmoid bone
ANS: C
Feedback
A The crista galli is the vertical projection of the ethmoid bone into the cranial
cavity. It is an area of attachment for the meninges.
B The frontal sinuses of the frontal bone do NOT have openings for passage of the
olfactory nerves to the brain.
C The cribriform plate is the superior horizontal part of the ethmoid bone that is
perforated for passage of olfactory nerves for the sense of smell.
D The perpendicular plate of the ethmoid bone forms part of the nasal septum.

10. Which of the following bony features increases the surface area within the nasal cavity?
a. Perpendicular plate of the ethmoid bone
b. Inferior nasal conchae
c. Lacrimal bones
d. Nasal bones
ANS: B
A The vertical plate is straight and serves as part of the nasal septum.
B The scroll-like shape of the inferior nasal conchae assists in increasing the
surface area since it is covered with mucous membranes.
C The lacrimal bones are small, fragile bones that form a part of the anterior
medial wall of the orbit.
D The nasal bones form the bridge of the nose.

11. Which of the following skull bones are considered to be paired cranial bones?
a. Nasal bones
b. Temporal bones
c. Lacrimal bones
d. Zygomatic bones
ANS: B
Feedback
A The nasal bones are paired facial bones but NOT cranial bones.
B The temporal bones are paired cranial bones.
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C The lacrimal bones are paired facial bones but NOT cranial bones.
D The zygomatic bones are paired facial bones but NOT cranial bones.

12. Through which bony opening do BOTH the right and left nasopalatine nerves exit onto the
palate?
a. Posterior superior alveolar foramina
b. Incisive foramen
c. Greater palatine foramina
d. Lesser palatine foramina
ANS: B
Feedback
A The posterior superior alveolar foramina are passageways for the posterior
superior alveolar nerves and blood vessels and NOT the nasopalatine nerves.
B Both the right and left nasopalatine nerves and blood vessels travel from the
nasal cavity to the anterior palate through the incisive foramen.
C The greater palatine foramina are located in the posterolateral region of the
palatine bones and are NOT passageways for the nasopalatine nerves and blood
vessels but for the greater palatine nerve and blood vessels.
D The lesser palatine foramina are located in the palatine bones and are NOT
passageways for the nasopalatine
NURSINnervesGTB.C nor blood
M vessels but for the lesser
palatine nerve and blood vessels.
O

13. Which of the following landmarks needs to be noted during the administration of a local
anesthetic agent to the maxillary posterior teeth?
a. Infraorbital foramen
b. Retromolar pad
c. Maxillary tuberosity
d. Zygomatic process of the maxilla
ANS: C
Feedback
A The infraorbital foramen is located on the facial surface of the maxilla and is
NOT a passageway for nerves to the maxillary posterior teeth.
B The retromolar pad is located on the mandible posterior to the mandibular
molars and is NOT used as a landmark for administration of maxillary local
anesthesia.
C The posterior superior alveolar foramina serve as openings for the passage of the
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posterior superior alveolar nerve and blood vessels. These foramina are
posterosuperior and medial to the maxillary tuberosity and perforate the
infratemporal surface of the maxilla multiple times. They need to be noted
during the administration of a local anesthetic agent to the maxillary posterior
teeth.
D The zygomatic process of the maxilla does NOT serve as a landmark for the
administration of local anesthesia to maxillary posterior teeth.

14. Which of the following sutures of the skull is an immovable articulation between the occipital
bone and the parietal bones?
a. Coronal suture
b. Lambdoidal suture
c. Sagittal suture
d. Squamosal suture
ANS: B
Feedback
A The coronal suture is an immovable articulation between the frontal bone and the
parietal bones.
B The lambdoidal suture is an immovable articulation between the occipital bone
and the parietal bones meet.
NURSINGTB.COM
C The sagittal suture is an immovable articulation between the two parietal bones.
D The squamosal suture is an immovable articulation between the temporal bones
and parietal bones on each side.

15. Which of the following bony landmarks is a depression located between the coronoid process
and the mandibular ramus?
a. Coronoid notch
b. Mandibular notch
c. Mandibular foramen
d. Submandibular fossa
ANS: B
Feedback
A The coronoid notch is a depression located on the anterior border of the
mandibular ramus inferior to the coronoid process.
B The depression between the coronoid process and the mandibular ramus is the
mandibular notch.
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C The mandibular foramen is located on the medial surface of the mandibular

ramus.
D The submandibular fossa is a depression located inferior to the mylohyoid line or
ridge on the medial surface of the body of the mandible.

16. Which of the following paranasal sinuses can be palpated during an extraoral examination by
a clinician?
a. Frontal and sphenoidal sinuses
b. Sphenoidal and ethmoidal sinuses
c. Ethmoidal and maxillary sinuses
d. Maxillary and frontal sinuses
ANS: D
Feedback
A The frontal sinuses can be palpated during an extraoral examination, but the
sphenoidal sinuses CANNOT be palpated as part of the extraoral examination
due to their location within the sphenoid bone.
B NEITHER the sphenoidal NOR ethmoidal sinuses can be palpated during an
extraoral examination due to their location within their respective bones.
C The ethmoidal sinuses CANNOT be palpated during the extraoral examination
due to their location within
NUR the I
ethmoid
GTB.Cbone. M
D S N O
Both the maxillary and frontal sinuses can be palpated during an extraoral
examination.

Care
17. How does the mandibular condyle move in relationship to the temporal bone?
a. Articular eminence
b. Coronoid notch
c. Articular fossa
d. Mandibular fossa
ANS: C
Feedback
A The mandibular condyle does NOT move within the articular eminence of the
temporal bone.
B The coronoid notch is part of the mandible.
C The articular fossa of the temporal bone is the articulation area for movement of
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the mandibular condyle as part of the temporomandibular joint.

D The mandibular notch is part of the mandible.

18. When viewing the medial surface of the mandible, which of the following bony landmarks
CANNOT be observed?
a. Internal oblique ridge
b. Genial tubercles
c. Mandibular foramen
d. Mental foramen
ANS: D
Feedback
A The internal oblique ridge can be observed on the medial surface of the
mandible.
B The genial tubercles can be observed on the medial surface of the mandible.
C The mandibular foramen can be observed on the medial surface of the
mandibular ramus.
D When viewing the medial surface of the mandible, ALL of the other structures
can be observed. The mental foramen is located on the lateral surface of the
mandible and CANNOT be viewed on the medial surface of the mandible.
NURSINGTB.COM
19. Which of the following landmarks is the MOST inferiorly located on the mandible?
a. Lingula
b. Mylohyoid line
c. Submandibular fossa
d. Retromolar triangle
ANS: C
Feedback
A The lingula is located on the medial surface of the mandibular ramus, which is
superior to the body of the mandible.
B The mylohyoid line is located on the medial surface of the body of the mandible,
which is superior to the submandibular fossa.
C The submandibular fossa is located on the medial surface of the mandible and is
inferior to the other landmarks listed: the lingula, mylohyoid line, and retromolar
triangle, so overall it is the most inferiorly located mandibular landmark.
D The retromolar triangle is located on the posterior part of the alveolar ridge of
the mandible, which is located superior to the submandibular fossa.
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20. Which of the following bony landmarks is formed by the vertical plates of the palatine bones?
a. Nasal septum
b. Posterior hard palate
c. Lateral walls of the nasal cavity
d. Superior wall of the orbit
ANS: C
Feedback
A The nasal septum is located in the midline of the nasal cavity, and the palatine
bones are NOT located there.
B The posterior hard palate is formed by the horizontal plates of the palatine bones.
C The vertical plates of the palatine bones form the posterior lateral walls of the
nasal cavity.
D The palatine bones are NOT located superior to the orbit and therefore do NOT
form the superior orbital wall.

NURSINGTB.COM
21. Which of the following processes forms the lateral part of the infraorbital rim?
a. Temporal process of the zygomatic bone
b. Maxillary process of the zygomatic bone
c. Frontal process of the maxilla
d. Alveolar process of the maxilla
ANS: B
Feedback
A The temporal process of the zygomatic bone articulates with a part of the
temporal bone and forms the zygomatic arch.
B The maxillary process of the zygomatic bone is the part that articulates with the
maxilla and forms the lateral part of the infraorbital rim.
C The frontal process of the maxilla forms the medial infraorbital rim.
D The alveolar process of the maxilla is the part that surrounds the teeth by way of
the alveoli or tooth sockets.

22. Where is the pterygoid process of the skull located?
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a. Inferior to the greater wing of the sphenoid bone

b. Posterior to the greater wing of the sphenoid bone
c. Anterior to the greater wing of the sphenoid bone
d. Anterior to the body of the sphenoid bone
ANS: A
Feedback
A The pterygoid process is located inferior to the greater wing of the sphenoid
bone.
B The pterygoid process is located inferior to the greater wing of the sphenoid
bone.
C The pterygoid process is located inferior to the greater wing of the sphenoid
bone.
D The pterygoid process is located inferior to the greater wing of the sphenoid
bone.

23. The pterygopalatine fossa communicates with the middle cranial fossa via the
a. foramen rotundum.
b. superior orbital fissure.
c. foramen ovale.
d. inferior orbital fissure. N R I G B.C M
U S N T O
ANS: A
Feedback
A Pterygopalatine fossa communicates with the middle cranial fossa via the
foramen rotundum; more specifically, the pterygoid canal.
B Lateral to the optic canal is the curved and slitlike superior orbital fissure,
between the greater and lesser wings of the sphenoid bone. Similar to the optic
canal, the superior orbital fissure connects the orbit with the cranial cavity. The
third cranial or oculomotor nerve, the fourth cranial or trochlear nerve, the sixth
cranial or abducens nerve, and the ophthalmic nerve or first division from fifth
cranial or trigeminal nerve and vein travel through this fissure.
C The larger anterior oval opening on the sphenoid bone is the foramen ovale for
the mandibular nerve or third division of the fifth cranial or trigeminal nerve.
D The inferior orbital fissure can also be noted between the greater wing of the
sphenoid bone and the maxilla. The inferior orbital fissure connects the orbit
with the infratemporal and pterygopalatine fossae. The infraorbital and
zygomatic nerves, branches of the maxillary nerve, and infraorbital artery enter
the orbit through this fissure. The inferior ophthalmic vein travels through this
fissure to join the pterygoid plexus of veins.

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24. . The ______ is resorbed with tooth loss, and this loss can be noted on patients
radiographically.
a. body of the maxillae
b. body of the mandible
c. base of the mandible
d. alveolar process of the mandible
ANS: D
Feedback
A The body of the maxillae is NOT resorbed with tooth loss.
B The body or base of the mandible is NOT resorbed with tooth loss.
C The base or body of the mandible is NOT resorbed with tooth loss.
D The alveolar process of the mandible can be resorbed with tooth loss and can be
noted on patients to some extent radiographically.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.2 Dental Anatomy | NBDHE,
Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision of Clinical Dental
Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care
NURSdensity
25. The differences in alveolar process INGTdetermine
B.COM the easiest and MOST clinically
effective region for bony fracture used during tooth extraction, if needed. Thus the maxillary
teeth are surgically BEST removed by fracturing the thinner facial cortical plate rather than
the thicker lingual cortical plate.
a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
ANS: A
Feedback
A Both the statement and reason are correct and related. The differences in alveolar
process density determine the most clinically effective region for bony fracture
used during tooth extraction. Thus the maxillary teeth are surgically BEST
removed by fracturing the thinner facial cortical plate rather than the thicker
lingual cortical plate, if needed.
B Both the statement and reason are correct and related. The differences in alveolar
C Both the statement and reason are correct and related. The differences in alveolar
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D Both the statement and reason are correct and related. The differences in alveolar
E Both the statement and reason are correct and related. The differences in alveolar

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.2 Dental Anatomy | NBDHE,
Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision of Clinical Dental
MULTIPLE RESPONSE
1. From the following list of structures, select which structures are associated with the nasal
cavity. (Select all that apply.)NURSINGTB.COM
a. Nasion
b. Conchae
c. Meatus
d. Fissure
e. Canal
ANS: A, B, C
Feedback
Correct The nasion, nasal conchae, and nasal meatus are associated with the nasal
cavity.
Incorrect The fissure and canal are associated with the orbit (superior and inferior
orbital fissure as well as the optic canal) and NOT the nasal cavity; fissure
and canal are also associated with other areas of the skull but NOT the
nasal cavity.

2. From the following list of structures, select which structures are associated with the occipital
bone. (Select all that apply.)
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a. Condyle
b. Tubercle
c. Notch
d. Glabella
e. Eminence
ANS: A, B, C
Feedback
Correct The occipital condyle, pharyngeal tubercle, and jugular notch are
associated with the occipital bone.
Incorrect The supraorbital notch, glabella, and frontal eminence are associated with
the frontal bone and NOT the occipital bone.

3. From the following list of structures, select which structures are associated with the frontal
a. Condyle
b. Tubercle
c. Notch
d. Glabella
e. Eminence
ANS: C, D, E NURSINGTB.COM
Feedback
Correct The supraorbital notch, glabella, and frontal eminence are associated with
the frontal bone.
Incorrect The occipital condyle, pharyngeal tubercle, and jugular notch are
associated with the occipital bone and NOT the frontal bone.

4. From the following list of skull bones, select which skull bones are associated with the
paranasal sinuses. (Select all that apply.)
a. Occipital bone
b. Mandible
c. Maxillary bone
d. Sphenoid bone
e. Ethmoid bone
ANS: C, D, E
Feedback
Correct The maxilla, sphenoid bone, and ethmoid bone are associated with
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paranasal sinuses.
Incorrect The occipital bone and mandible are NOT associated with paranasal
sinuses.

5. From the following list of skull bones, select which skull bones articulate with the ethmoid
a. Frontal bone
b. Sphenoid bone
c. Lacrimal bones
d. Occipital bones
e. Parietal bones
ANS: A, B, C
Feedback
Correct The frontal bone, sphenoid bone, and lacrimal bones articulate with the
ethmoid bone.
Incorrect The occipital bone and parietal bones do NOT articulate with the ethmoid
bone.

6. From the following list of structures, select which structures are associated with the petrous
part of the temporal bone. (Select all that apply.)
a. Articular fossa
b. Postglenoid fossa
c. External acoustic meatus
d. Mastoid process
e. Carotid canal
ANS: D, E
Feedback
Correct The mastoid process and carotid canal are associated with the petrous part
of the temporal bone.
Incorrect The articular fossa and postglenoid fossa are associated with the squamous
part of the temporal bone and NOT the petrous part. The external acoustic
meatus is associated with the tympanic part of the temporal bone and NOT
the petrous part.

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7. Inadequate or disproportionate bone growth of the upper face or mandible may leave
inadequate room for the developing dentition and cause occlusal complications. How can
these difficulties with growth involving the dentition BEST be addressed? (Select all that
apply.)
a. Performing osseous surgery
b. Checking for underlying endocrine disorder
c. Undergoing orthodontic therapy
d. Extracting third molars
ANS: A, B, C
Feedback
Correct These difficulties with growth involving the dentition can BEST be
addressed by orthodontic therapy and osseous surgery, if needed, after
ruling out any underlying endocrine disorder.
Incorrect Extracting third molars to accommodate growth is a controversial
procedure.

with intraoral procedures | CDA: General Chairside, II. D. Patient Management | CDA: General
Chairside, V. A. Oral Health Information
NBDHE, Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision of Clinical
N R and
Dental Hygiene Services, 3.0 Planning I G
U S N T B.C Dental
Managing M Hygiene Care
O
8. From the list below, choose the factors that cause the sphenoid bone to be one of the more
difficult bones of the skull to describe and visualize. (Select all that apply.)
a. Bone is only noted from one viewpoint
b. Centrally located within the skull
c. Complex with body and processes
d. Few features and openings
ANS: B, C
Feedback
Correct Since this bone is complex and centrally located, parts of the sphenoid are
encountered in almost every significant juncture of the skull. The bone
itself consists of a body and its processes along with a number of features
and openings. Both of these factors allow the sphenoid bone to be noted
from various viewpoints of the skull. Thus it is one of the more difficult
bones of the skull to describe and visualize.
Incorrect Since this bone is complex and centrally located, parts of the sphenoid are
encountered in almost every significant juncture of the skull. The bone
itself consists of a body and its processes along with a number of features
and openings and NOT few features or openings. Both of these factors
allow the sphenoid bone to be noted from various viewpoints of the skull
and NOT one viewpoint. Thus it is one of the more difficult bones of the
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skull to describe and visualize.

Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care
9. From recent studies concerning chronic sinus infection, new concepts of its etiology and
treatment have been discovered. What are these new concepts? (Select all that apply.)
a. Cause lies in the nasal mucus
b. Targeting nasal and sinus tissue
c. Cause lies in the bacterial infection
d. Targeting underlying damaging inflammation
ANS: A, D
Feedback
Correct Recent studies have found that the cause of chronic sinus infections lies in
the nasal mucus. This suggests a beneficial effect of treatments that target
primarily the underlying and presumably damage-inflicting nasal and
sinus membrane inflammation.
Incorrect Recent studies have found that the cause of chronic sinus infections lies
NOT in the nasal and sinus tissue targeted by standard treatment. This
NURSshould
suggests that treatments INGTNOTB.Ctarget
OM the secondary bacterial
infection that has been the primary target of past treatments for the
disease.

MATCHING
From the following list of foramina and openings of the sphenoid bone, match these openings
with the CORRECT nerve within.
a. Maxillary nerve
b. Ophthalmic nerve
c. Mandibular nerve
d. Meningeal branch nerve
1. Superior orbital fissure

2. Foramen rotundum
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3. Foramen ovale
4. Foramen spinosum
1. ANS: B DIF: Recall REF: p. 35, Table 3-3

OBJ: 2
2. ANS: A DIF: Recall REF: p. 35, Table 3-3
OBJ: 2
3. ANS: C DIF: Recall REF: p. 35, Table 3-3
OBJ: 2
4. ANS: D DIF: Recall REF: p. 35, Table 3-3
OBJ: 2
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Chapter 05: Temporomandibular Joint

MULTIPLE CHOICE
1. The temporal bone and mandible come together to form the temporomandibular joint
BECAUSE a joint is defined as a junction or union between two or more bones.
a.Both the statement and the reason are correct and related.
b.Both the statement and the reason are correct but NOT related.
c.The statement is correct, but the reason is NOT.
d.The statement is NOT correct, but the reason is correct.
e.NEITHER the statement NOR the reason is correct.
ANS: A
Feedback
A The statement is correct. The temporomandibular joint is a junction between the
temporal bone and the mandible. The reason is correct. A joint is defined as a
union between two or more bones.
B The statement and the reason are related. The temporal bone and mandible form
the temporomandibular joint, which is a union between two bones.
C The reason is correct. A joint is formed by the union of two or more bones.
D The statement is correct. The temporal bone and the mandible join to form the
temporomandibular joint.
E The statement and the reason are correct. The temporomandibular joint is a
junction between the temporal bone and the mandible, and a joint is defined as a
union between two or more bones.

2. The temporomandibular joint is innervated by the maxillary nerve or second division of the
fifth cranial or trigeminal nerve. The blood supply to the joint is from branches of the external
carotid artery.
ANS: D
Feedback
A The first statement is false. The temporomandibular joint is innervated by the
mandibular nerve or third division of the fifth cranial or trigeminal nerve.
B The second statement is true. The temporomandibular joint receives blood
supply from branches of the external carotid artery.
C The first statement is false. The temporomandibular joint is innervated by the
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mandibular nerve or third division of the fifth cranial or trigeminal nerve. The
second statement is true because the temporomandibular joint receives blood
supply from branches of the external carotid artery.
D The first statement is false. The temporomandibular joint is innervated by the
mandibular nerve or third division of the fifth cranial or trigeminal nerve, NOT
the maxillary nerve or second division. The second statement is true because the
temporomandibular joint receives blood supply from branches of the external
carotid artery.

3. What is another term used for articular fossa of the temporomandibular joint?
a. Submandibular
b. Mandibular
c. Pterygoid
d. Temporal
ANS: B
Feedback
A The submandibular fossa is located on the medial surface of the mandible,
inferior to the mylohyoid line.
B The mandibular fossa or articular fossa is located on the temporal bone that
articulates with the mandible at the temporomandibular joint.
C The pterygoid fossa is located between the medial and lateral pterygoid plates
of the sphenoid bone.
D The temporal fossa is located on the lateral surface of the skull that contains the
body of the temporalis muscle.

4. What is the depression located between the condyle and coronoid process of the
temporomandibular joint?
a. Sublingual fossa
b. Supraorbital notch
c. Temporal space
d. Mandibular notch
ANS: D
Feedback
A The sublingual fossa is located on the medial surface of the mandible, superior
to the mylohyoid line.
B The supraorbital notch is located on the frontal bone superior to the orbit.
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C The temporal space is formed by the temporal fascia covering the temporalis
muscle.
D The mandibular notch is located on the mandible between the condyle and the
coronoid process.

5. The joint disc of the temporomandibular joint is a fibrous disc located between the temporal
bone and the coronoid process of the mandible on each side. This disc conforms to the shape
of the bones and is related to joint movement.
ANS: D
Feedback
A The first statement is false. The joint disc of the temporomandibular joint is
located between the temporal bone and the condyle, NOT the coronoid process.
B The second statement is true. The shape of the joint disc conforms to the shape
of the adjacent articulating bones of the temporomandibular joint and is related
to joint movements.
C The first statement is false. The joint disc of the temporomandibular joint is
The second statement is true. The shape of the joint disc conforms to the shape
to joint movements.
D The first statement is false. The joint disc of the temporomandibular joint is
The second statement is true. The shape of the joint disc conforms to the shape
to joint movements.

6. Including examination of the temporomandibular joint during the extraoral examination is

important to detect changes such as disc perforation BECAUSE disc perforation is commonly
found in females and males during puberty.
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ANS: C
Feedback
A The reason is NOT correct. Disc perforation is caused by the age process or
from traumatic injury.
B The reason is incorrect. Disc perforation is caused by the age process or from
traumatic injury. Also, the statement and reason are related.
C The statement is correct. Examination of the temporomandibular joint must be
part of the extraoral examination in order to determine if changes or deviations
within the joint have occurred. The disc perforation is caused by the age process
or traumatic injury.
D The statement is correct. Examination of the temporomandibular joint must be
within the joint have occurred.
E The statement is correct. Examination of the temporomandibular joint must be
within the joint have occurred.

CDA: General Chairside, II. C. Describe how to perform and/or assist with intraoral procedures |
CDA: General Chairside, V. A. Oral Health Information
Dental Hygiene Services, 1.0 Assessing Patient Characteristics | NBDHE, Provision of Clinical Dental
7. Which of the following ligaments is NOT associated with the temporomandibular joint?
a. Temporomandibular joint ligament
b. Sphenomandibular ligament
c. Stylomandibular ligament
d. Stylohyoid ligament
ANS: D
Feedback
A The temporomandibular joint ligament is associated with the
temporomandibular joint. The oblique, or outer, component goes from the
articular tubercle to the neck of the mandible. The horizontal, or inner,
component goes from the lateral pole of the condyle and the posterior aspect of
the joint disc to the articular tubercle.
B The sphenomandibular ligament is associated with the temporomandibular
joint. It attaches the angular spine of the sphenoid bone superiorly to the lingula
of the mandible foramen.
C The stylomandibular ligament is associated with the temporomandibular joint.
It connects the styloid process of the temporal bone with the angle of the
mandible.
D The stylohyoid ligament is NOT associated with the temporomandibular joint.
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It connects the styloid process with the lesser horn of the hyoid bone.
DIF: Recall REF: pp. 125-127 OBJ: 2 | 3

8. Which ligament associated with the temporomandibular joint prevents excessive retraction or
moving backward of the mandible?
a.Temporomandibular joint ligament
b.Sphenomandibular ligament
c.Stylomandibular ligament
d.Stylohyoid ligament
ANS: A
Feedback
A The temporomandibular joint ligament prevents excessive retraction or moving
backward of the mandible, a situation that might lead to problems with the
B The sphenomandibular ligament becomes accentuated and taut when the
mandible is protruded.
C The stylomandibular ligament is also engaged when the mandible is protruded.
D The stylohyoid ligament is NOT associated with the temporomandibular joint.

9. Which ligament associated with the temporomandibular joint is a landmark for the
administration of inferior alveolar local anesthetic nerve block?
a.Temporomandibular joint ligament
b.Sphenomandibular ligament
c.Stylomandibular ligament
d.Stylohyoid ligament
ANS: B
Feedback
A The temporomandibular joint ligament is NOT a landmark for the
administration of inferior alveolar local anesthetic nerve block.
B The sphenomandibular ligament is a landmark for the administration of the
inferior alveolar local anesthetic nerve block. The injection site for the inferior
alveolar block injection is at the depth of the pterygomandibular space, which is
lateral to both the pterygomandibular fold and the sphenomandibular ligament.
C The stylomandibular ligament is NOT a landmark for the administration of the
inferior alveolar local anesthetic nerve block.
D The stylohyoid ligament is NOT a landmark for the administration of the
inferior alveolar local anesthetic nerve block.
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10. The temporomandibular joint allows for movement of the mandible during speech and
mastication. Two basic types of movement are performed by the joint and its associated
muscles: a gliding movement and a rotational movement.
ANS: A
Feedback
A Both statements are true. The temporomandibular joint does allow for
movement during speech and mastication with a gliding and rotational
movement.
B Both statements are true. The temporomandibular joint does allow for
movement during speech and mastication with a gliding and rotational
movement.
C The second statement is true. The temporomandibular joint moves with gliding
and rotational movements.
D The first statement is true. The temporomandibular joint allows for movement
of the mandible during speech and mastication.

11. The gliding movement of the temporomandibular joint allows the lower jaw to move forward
or backward. What movement of the mandible is involved when the lower jaw moves
forward?
a. Retraction
b. Protrusion
c. Elevation
d. Depression
ANS: B
Feedback
A Bringing the lower jaw backward involves retraction of the mandible.
B Bringing the lower jaw forward involves protrusion of the mandible.
C Lowering the lower jaw involves depression of the mandible.
D Raising the lower jaw involves elevation of the mandible.

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12. What movement of the temporomandibular joint occurs MAINLY between the joint disc and
the condyle of the mandible in the lower synovial cavity?
a. Retraction
b. Protrusion
c. Rotation
d. Gliding
ANS: C
Feedback
A Retraction is a gliding movement that occurs between the joint disc and the
articular eminence of the temporal bone in the upper synovial cavity.
B Protrusion is a gliding movement that occurs between the joint disc and the
articular eminence of the temporal bone in the upper synovial cavity.
C The rotation movement of the temporomandibular joint occurs mainly between
the joint disc and the condyle of the mandible in the lower synovial cavity.
D Gliding movements of the temporomandibular joint occur between the joint
disc and the articular eminence of the temporal bone in the upper synovial
cavity.

13. Opening the jaws during speech and mastication involves BOTH elevation and retraction of
the mandible. When the jaws close, this involves BOTH depression and protrusion of the
mandible.
ANS: B
Feedback
A Both statements are false. The opening of the jaws during speech and
mastication involves both depression and protrusion of the mandible. When the
jaws close, this involves both elevation and retraction of the mandible.
B Both statements are false. The opening of the jaws during speech and
mastication involves both depression and protrusion of the mandible. When the
jaws close, this involves both elevation and retraction of the mandible.
C The first statement is false. The opening of the jaws during speech and
mastication involves both depression and protrusion of the mandible.
D The second statement is false. When the jaws close, this involves both elevation
and retraction of the mandible.
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DIF: Comprehension REF: pp. 127-128 OBJ: 3

14. What type of temporomandibular joint movement(s) occurs during lateral deviation of the
mandible or shifting of the lower jaw to one side?
a.Gliding movement on both sides
b.Rotational movement on both sides
c.Gliding movement on one side and no movement on the other side
d.Gliding movement on one side and rotational movement on the other side
ANS: D
Feedback
A Lateral deviation involves both the gliding and rotational movements of the
opposing temporomandibular joints in their respective joint cavities.
B Lateral deviation involves both the gliding and rotational movements of the
opposing temporomandibular joints in their respective joint cavities.
C Movement is required of the opposing temporomandibular joints in their
respective joint cavities.
D Lateral deviation involves both the gliding and rotational movements of the
opposing temporomandibular joints in their respective joint cavities. During
lateral deviation, one disc plus the condyle glide forward and medially on the
articular eminence in the upper synovial cavity, while the other condyle and
disc remain relatively stable in position, producing a rotation around the more
stable condyle.

15. The rest position of the temporomandibular joint is NOT with the teeth biting together
BECAUSE as we observe during mastication of food, the mandible returns to the center.
a.Both the statement and the reason are correct and related.
b.Both the statement and the reason are correct but NOT related.
c.The statement is correct, but the reason is NOT.
d.The statement is NOT correct, but the reason is correct.
e.NEITHER the statement NOR the reason is correct.
ANS: B
Feedback
A Even though the statement and reason are correct, they are NOT related. The
statement describes the rest position of the temporomandibular joint, while the
reason describes the power stroke that occurs during mastication.
B Both statements are true but are NOT related. The statement describes the rest
position of the temporomandibular joint, while the reason describes the power
stroke that occurs during mastication.
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C The reason is correct. The mandible is brought back to the center during
mastication due to the power stroke or the teeth crunching the food.
D The statement is correct. The teeth are NOT occluding or biting together when
the temporomandibular joint is at rest.
E The statement and the reason are both correct. The teeth are NOT occluding or
biting together when the temporomandibular joint is at rest. The mandible is
brought back to the center during mastication due to the power stroke or the
teeth crunching the food.

16. The dental professional plays an important role in the recognition, treatment, and maintenance
of patients with temporomandibular disorder. All signs and symptoms related to
temporomandibular disorder need to be recorded by the dental professional, as well as any
parafunctional habits and related systematic diseases.
ANS: A
Feedback
A Both statements are true. The dental professional is skilled and has knowledge
of the temporomandibular joint, which is examined during the extraoral
examination. All relevant information, such as the amount of the mandibular
opening and facial pain, needs to be recorded by the dental professional.
B Both statements are true. The dental professional is skilled and has knowledge
examination. All relevant information, such as the amount of the mandibular
opening and facial pain, needs to be recorded by the dental professional.
C The second statement is true. All relevant information, such as the amount of
the mandibular opening and facial pain, needs to be recorded by the dental
professional.
D The first statement is true. The dental professional is skilled and has knowledge
examination.

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17. When examining the joint, joint sounds may be heard because of disc derangement. Joint
sounds are a reliable indicator of temporomandibular disorder.
ANS: C
Feedback
A The second statement is false. Joint sounds are NOT a reliable indicator of
temporomandibular disorder because they can change over time.
B The first statement is true. Joint sounds occur because of disc derangement. The
posterior portion of the joint disc gets caught between the condyle head and the
articular eminence.
C The first statement is true: joint sounds occur because of disc derangement. The
second statement is false because joint sounds are NOT a reliable indicator of
temporomandibular disorder since they can change over time.
D The first statement is true; the second statement is false. Joint sounds occur
because of disc derangement. Joint sounds are NOT a reliable indicator of
temporomandibular disorder because they can change over time.

18. What occurs with the dislocation of BOTH the temporomandibular joints on a patient?
a. Subluxation
b. Cellulitis
c. Paresthesia
d. Thrombus
ANS: A
Feedback
A Subluxation occurs when the head of the condyle moves too far anterior on the
articular eminence.
B Cellulitis is the diffuse inflammation of soft tissue spaces.
C Paresthesia is an abnormal sensation from an area such as burning or prickling.
D Thrombus is an intravascular clot.

19. What is the fossa located on the temporal bone that articulates with the mandible?
a. Temporal fossa
b. Infratemporal fossa
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c. Pterygopalatine fossa
d. Articular fossa
ANS: D
Feedback
A The temporal fossa is a flat, fan-shaped paired depression on the lateral surface
of the skull.
B The infratemporal fossa is a paired depression that is inferior to the anterior part
of the temporal fossa.
C The pterygopalatine fossa is a cone-shaped paired depression deep to the
infratemporal fossa and posterior to the maxilla on each side of the skull.
D The articular fossa is posterior to the articular eminence and consists of an oval-
shaped depression on the temporal bone, posterior and medial to the zygomatic
process of the temporal bone.

20. The joint disc of the temporomandibular joint is attached to the lateral and medial poles of the
mandibular condyle. The disc is fully attached to the temporal bone to all sides of the bone.
a.Both statements are true.
b.Both statements are false.
c.The first statement is true; the second is false.
d.The first statement is false; the second is true.
ANS: C
Feedback
A The first statement is true; the second is false. The joint disc of the
temporomandibular joint is attached to the lateral and medial poles of the
mandibular condyle. The disc is NOT attached to the temporal bone anteriorly,
except indirectly through the capsule.
B The first statement is true; the second is false. The joint disc of the
C The first statement is true; the second is false. The joint disc of the
D The first statement is true; the second is false. The joint disc of the

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21. As a person ages or undergoes trauma to the area, the joint disc of the temporomandibular
joint can become thicker or even perforated. Perforation can lead to clinical problems.
ANS: D
Feedback
A The first statement is false; the second is true. As a person ages or undergoes
trauma to the area, the joint disc of the temporomandibular joint can become
thinner or even perforated. Perforation can lead to clinical problems.
B The first statement is false; the second is true. As a person ages or undergoes
C The first statement is false; the second is true. As a person ages or undergoes
D The first statement is false; the second is true. As a person ages or undergoes

22. The sphenomandibular ligament is a landmark for the administration of (long) buccal nerve
block and is also involved in troubleshooting the injection due to its location.
ANS: B
Feedback
A Both statements are false. The sphenomandibular ligament is a landmark for the
administration of inferior alveolar nerve block and is also involved in
troubleshooting the inferior alveolar nerve block due to its location since it may
actually block the injection if the needle does NOT contact the mandible.
B Both statements are false. The sphenomandibular ligament is a landmark for the
C Both statements are false. The sphenomandibular ligament is a landmark for the
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D Both statements are false. The sphenomandibular ligament is a landmark for the

23. The base of the triangular temporomandibular ligament is attached to the zygomatic process
of the temporal bone and the articular tubercle; its apex is fixed to the lateral side of the neck
of the mandible. This ligament prevents the excessive protrusion or moving forward for the
mandible, a situation that might lead to problems with the temporomandibular joint.
ANS: C
Feedback
A The statement is correct, but the reason is NOT. The base of the triangular
temporomandibular ligament is attached to the zygomatic process of the
temporal bone and the articular tubercle; its apex is fixed to the lateral side of
the neck of the mandible. This ligament prevents the excessive retrusion or
moving backward of the mandible, a situation that might lead to problems with
the temporomandibular joint.
B The statement is correct, but the reason is NOT. The base of the triangular
C The statement is correct, but the reason is NOT. The base of the triangular
D The statement is correct, but the reason is NOT. The base of the triangular
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E The statement is correct, but the reason is NOT. The base of the triangular

24. The resting position of the temporomandibular joint can be noted with the teeth _____ so as to
allow a physiologic rest for the mandible.
a. biting gently together
b. apart at approximately 2 to 4 mm
c. resting firmly together
d. apart at approximately 6 to 10 mm
ANS: B
Feedback
A The resting position of the temporomandibular joint is not with the teeth biting
together. Instead, the muscular balance and proprioceptive feedback allow a
physiologic rest for the mandible, an interocclusal clearance or freeway space,
which is approximately 2 to 4 mm between the teeth.
B The muscular balance and proprioceptive feedback allow a physiologic rest for
the mandible, an interocclusal clearance or freeway space, which is
approximately 2 to 4 mm between the teeth.
C The resting position of the temporomandibular joint is NOT with the teeth
resting together. Instead, the muscular balance and proprioceptive feedback
allow a physiologic rest for the mandible, an interocclusal clearance or freeway
space, which is approximately 2 to 4 mm between the teeth.
D The muscular balance and proprioceptive feedback allow a physiologic rest for
the mandible, an interocclusal clearance or freeway space, which is
approximately 2 to 4 mm between the teeth.

25. When considering temporomandibular disorders, MOST symptoms seem to originate from the
nerve surrounding the joint. In addition, MOST recent studies support the role of
temporomandibular disorders in directly causing headaches, neck or back pain, or instability.
ANS: B
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Feedback
A Both statements are false. Most symptoms seem to originate from the muscles.
Most recent studies do NOT support the role of temporomandibular disorders in
directly causing headaches, neck or back pain, or instability; headaches are
usually caused by muscle tension or vascular changes.
B Both statements are false. Most symptoms seem to originate from the muscles.
C Both statements are false. Most symptoms seem to originate from the muscles.
D Both statements are false. Most symptoms seem to originate from the muscles.

MULTIPLE RESPONSE
1. From the following list of actions involving the temporomandibular joint, select those that are
DIRECTLY associated with lateral deviation of the joint. (Select all that apply.)
a. Single lateral pterygoid muscle contraction
b. Gliding movement
c. Rotational movement
d. Both lateral pterygoid muscle contractions
ANS: A, B, C
Feedback
Correct Lateral deviation is directly associated with a single lateral pterygoid
muscle contraction and gliding movement but also includes rotational
movement of the temporomandibular joint.
Incorrect Lateral deviation is directly associated with a single lateral pterygoid
muscle contraction and NOT contractions of both lateral pterygoid
muscles, as well as including both gliding and rotational movements of

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Care
2. From the following list of actions, select the procedures USUALLY used during an
examination of the temporomandibular joint. (Select all that apply.)
a. Patient biting on wax impression
b. Bilateral palpation of all joint movements
c. Digital palpation of external acoustic meatus
d. Ausculation of the joint
e. Extraoral radiography of the joint region
ANS: B, C, D
Feedback
Correct The usual procedures for the examination of the temporomandibular joint
include the bilateral palpation of all joint movements, digital palpation of
the external acoustic meatus, and possibly auscultation.
Incorrect The patient biting on wax impression and extraoral radiography of the
joint are NOT a part of the usual procedures for examining the

3. From the following list of descriptions, select those that can occur with aging of the joint disc
of the temporomandibular joint. (Select all that apply.)
a. Thinner
b. Perforated
c. Dislocated
d. Thicker
ANS: A, B
Feedback
Correct When the joint disc of the temporomandibular joint ages, it can become
thinner and even perforated.
Incorrect When the joint disc of the temporomandibular joint ages, it does NOT
become thicker but thinner and even perforated. At any age, the disc may
become dislocated by injury to its attachments and NOT just due to aging
but instead injury to the joint.

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4. From the following list of descriptions, select those descriptions that can be applied to the
joint capsule of the temporomandibular joint. (Select all that apply.)
a. Wraps around only the superior part
b. Wraps around articular eminence and fossa
c. Wraps around the condyle circumference
d. Wraps around the coronoid process circumference
e. Wraps around only the inferior part
ANS: B, C
Feedback
Correct The joint capsule of the temporomandibular joint encloses the entire joint
and NOT just its superior or inferior parts; it wraps around the temporal
bone’s articular eminence and articular fossa as well as the circumference
of the mandibular condyle, including the condyle’s neck.
Incorrect The joint capsule of the temporomandibular joint encloses the entire joint
and NOT just the superior or inferior parts, and it does NOT wrap around
the circumference of the coronoid process but the circumference of the
mandibular condyle, including the condyle’s neck as well as the temporal
bone’s articular eminence and articular fossa.

5. From the following list of descriptions, select those descriptions that can be applied to the
stylomandibular ligament of the temporomandibular joint. (Select all that apply.)
a. Anatomically variable ligament
b. Formed from sphenomandibular ligament extension
c. Formed from thickened area cervical fascia
d. Consistent ligament anatomically
e. Becomes taut with mandibular protrusion
ANS: A, C, E
Feedback
Correct The stylomandibular ligament of the temporomandibular joint is a
variable ligament anatomically, formed from thickened area cervical
fascia, and becomes taut with mandibular protrusion.
Incorrect The stylomandibular ligament of the temporomandibular joint is NOT
formed from a sphenomandibular ligament extension and is NOT
consistent anatomically as a ligament but is a variable ligament
anatomically and formed from thickened area cervical fascia.

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Care
6. If your patient has a history of impaired movement of the temporomandibular joint, what may
be occurring? (Select all that apply.)
a. Disc degeneration may be involved
b. Calcifications may be present
c. Joint disc may be thinner or even perforated
d. Aging or trauma may be involved
ANS: A, B, C, D
With aging or trauma to the area, the joint disc of the temporomandibular joint can become
thinner or even perforated. Recent studies suggest this disc degeneration may also cause
calcifications within the disc, changes that may lead to impaired movement of the joint.

7. Which of the following needs to be included during an effective extraoral examination of the
temporomandibular joint of a patient? (Select all that apply.)
a. Opening and closing the mouth several times
b. Moving the jaw only forward and backward
c. Palpating the depression inferior to the zygomatic arch
d. Placing a finger over the maxillary sinus region during movement
ANS: A, C
Feedback
Correct The temporomandibular joint is palpated laterally at a depression inferior
to the zygomatic arch during an extraoral examination. This includes
asking the patient to open and close the mouth several times and then to
move the opened lower jaw to the left, then to the right, and then forward.
To further assess the mandible moving, use digital palpation by gently
placing a finger into the outer part of the external acoustic meatus.
Incorrect Moving the jaw only forward and backward is NOT effective in the
extraoral examination of the temporomandibular joint NOR is placing a
finger over the maxillary sinus region during movement.

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Chapter 04: Muscular System

MULTIPLE CHOICE
1. The ______ of a muscle is generally attached to the LEAST movable structure.

a. insertion
b. origin
c. middle
d. beginning
ANS: B
Feedback
A The insertion of a muscle is generally attached to the more movable structure.
B The origin of a muscle is generally attached to the least movable structure.
C The insertion is the end of a muscle attached to the more movable structure.
D The insertion is the end of a muscle attached to the more movable structure.

2. Which of the following muscles originates on the inferior border of the mandible and inserts
at each of the labial commissures?
a. Levator anguli oris muscle
b. Depressor labii inferioris muscle
c. Depressor anguli oris muscle
d. Orbicularis oris muscle
ANS: C
Feedback
A The levator anguli oris muscle originates on the canine fossa of the maxilla and
inserts into each labial commissure, elevating the labial commissure.
B The depressor labii inferioris muscle inserts into the skin of the lower lip.
C The depressor anguli oris muscle originates on the inferior border of the
mandible. It inserts into each labial commissure and pulls each labial
commissure down.
D The orbicularis oris muscle encircles the mouth.

3. Which of the following muscles is NOT considered a suprahyoid muscle?

a. Digastric muscle
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b. Mylohyoid muscle
c. Stylohyoid muscle
d. Sternothyroid muscle
ANS: D
Feedback
A The digastric muscle has two bellies; one that is an anterior and one that is a
posterior suprahyoid muscle. The anterior belly originates on a tendon on the
body of the hyoid bone and inserts onto the mandibular symphysis on the
medial surface of the mandible. The posterior belly originates on the mastoid
notch and inserts into the intermediate tendon on the hyoid bone.
B The mylohyoid muscle is a suprahyoid muscle that forms the floor of the
mouth. It originates on the mylohyoid line of the mandible and inserts medially
into the opposite mylohyoid muscle and onto the hyoid bone.
C The stylohyoid muscle is a suprahyoid muscle that originates on the styloid
process and inserts onto the hyoid bone.
D The sternothyroid muscle is located inferior to the hyoid bone. It originates on
the sternum and inserts into the thyroid gland and cartilage.

4. Which of the following muscles raises each labial commissure of the lips to contribute to a
patient’s smile?
a. Zygomaticus major muscle
b. Buccinator muscle
c. Platysma muscle
d. Epicranius muscle
ANS: A
Feedback
A The zygomaticus major muscle elevates each labial commissure and pulls it
laterally. It originates on the zygomatic bone and inserts into each labial
commissure.
B The buccinator muscle forms the anterior part of the cheek and lateral wall of
the oral cavity. It pulls each labial commissure laterally and compresses the
cheek to force food onto the occlusal table during chewing.
C The platysma muscle is located inferior to the mouth and acts to pull each labial
commissure down.
D The epicranius muscle is located within the scalp area and does NOT insert into
either labial commissure.

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5. Which of the following intraoral landmarks is one of the origins of the buccinator muscle?
a. Maxillary tuberosity
b. Pterygomandibular raphe
c. Glossopalatine arch
d. Internal oblique ridge
ANS: B
Feedback
A The buccinator muscle does NOT originate on the maxillary tuberosity.
B The three origins for the buccinator muscle are the alveolar processes of the
maxilla and mandible as well as the pterygomandibular raphe.
C The pterygomandibular raphe does NOT originate on the glossopalatine arch.
D The pterygomandibular raphe does NOT originate on the internal oblique ridge.

6. Which of the following muscles is considered an extrinsic tongue muscle that retracts the
tongue?
a. Palatoglossus muscle
b. Inferior longitudinal muscle
c. Styloglossus muscle
d. Genioglossus muscle
ANS: C
Feedback
A The palatoglossus muscle elevates the tongue against the soft palate during
swallowing but is an extrinsic tongue muscle.
B The inferior longitudinal muscles are intrinsic tongue muscles.
C The styloglossus muscle moves the tongue superiorly and posteriorly and is an
extrinsic tongue muscle.
D The genioglossus muscle acts to protrude the tongue but is an extrinsic tongue
muscle.

7. All three pharyngeal constrictors work to raise the pharynx and larynx during
a. swallowing.
b. gagging.
c. sneezing.
d. chewing.
ANS: A
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Feedback
A All three pharyngeal constrictors work to raise the pharynx and larynx during
swallowing.
B All three pharyngeal constrictors work to raise the pharynx and larynx during
swallowing.
C All three pharyngeal constrictors work to raise the pharynx and larynx during
swallowing.
D All three pharyngeal constrictors work to raise the pharynx and larynx during
swallowing.

8. Which of the following muscles inserts onto the coronoid process?

a. Lateral pterygoid muscle
b. Masseter muscle
c. Medial pterygoid muscle
d. Temporalis muscle
ANS: D
Feedback
A The lateral pterygoid muscle inserts onto the pterygoid fovea of the neck of the
condyle, and some fibers insert onto the capsule of the temporomandibular
joint.
B The masseter muscle inserts onto the mandibular ramus and angle of the
mandible.
C The medial pterygoid muscle inserts both heads onto the medial surface of the
mandibular ramus and angle of the mandible.
D The temporalis muscle, which originates on the temporal fossa, inserts onto the
coronoid process of the mandible, working to elevate the mandible.
DIF: Recall REF: p. 104, Table 4-3 OBJ: 3

9. When a patient swallows, how are the suprahyoid muscles involved?

a. Elevate the hyoid bone
b. Depress the hyoid bone
c. Retract the hyoid bone
d. Depress the mandible
ANS: A
Feedback
A The suprahyoid muscles will elevate the hyoid bone and larynx if the mandible
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is stabilized when swallowing.

B The suprahyoid muscles do NOT depress the hyoid bone during swallowing.
C The suprahyoid muscles do NOT retract the hyoid bone during swallowing.
D The suprahyoid muscles do NOT depress the mandible during swallowing.

10. Into which of the following categories of head and neck muscles is the omohyoid muscle
placed?
a. Intrinsic tongue muscle
b. Extrinsic tongue muscle
c. Suprahyoid muscle
d. Infrahyoid muscle
ANS: D
Feedback
A The omohyoid muscle is NOT located within the tongue, so it is NOT an
intrinsic tongue muscle.
B The omohyoid muscle does NOT insert into the tongue, so it is NOT an
extrinsic tongue muscle.
C The omohyoid muscle is located inferior to the hyoid bone and thus is NOT a
suprahyoid muscle.
D The omohyoid muscle is located inferior to the hyoid bone, so it is an
infrahyoid muscle. It originates on the scapula; travels deep to the
sternocleidomastoid muscle, where it attaches to a short tendon; and inserts on
the hyoid bone.

11. Which of the following muscles originates on the inferior border of the mandible and inserts
into the skin tissue of the chin?
a. Depressor labii inferioris muscle
b. Mentalis muscle
c. Depressor anguli oris muscle
d. Orbicularis oris muscle
ANS: B
Feedback
A The depressor labii inferioris muscle originates on the inferior border of the
mandible but inserts into the lower lip.
B The mentalis muscle originates on the inferior border of the mandible and
inserts into the skin of the chin, wrinkling the chin and protruding the lower lip
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when activated.
C The depressor anguli oris muscle originates on the inferior border of the
mandible but inserts into each labial commissure.
D The orbicularis oris muscle encircles the mouth.

12. Which of the following muscles works to protrude the tongue on a patient?
a. Hyoglossus muscle
b. Styloglossus muscle
c. Genioglossus muscle
d. Superior longitudinal muscles
ANS: C
Feedback
A The hyoglossus muscle depresses the tongue.
B The styloglossus muscle retracts the tongue.
C The genioglossus muscle originates on the genial tubercles and inserts into the
tongue. Its action is to pull the insertion area toward the origin, which will
result in pulling the tongue anterior and protruding it.
D Superior longitudinal muscles work with the inferior longitudinal muscles to
shape the tongue by shortening and thickening it. These muscles will also curl
the tongue in various ways when activated individually.

13. Extrinsic tongue muscles are innervated by the _____ cranial nerve.
a. fifth
b. seventh
c. ninth
d. twelfth
ANS: D
Feedback
A The fifth cranial nerve is the trigeminal nerve and does NOT innervate the
extrinsic tongue muscles.
B The seventh cranial nerve is the facial nerve and does NOT innervate the
extrinsic tongue muscles.
C The ninth cranial nerve is the glossopharyngeal nerve and does NOT innervate
the extrinsic tongue muscles.
D The twelfth cranial nerve is the hypoglossal nerve and innervates the extrinsic
tongue muscles.
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14. Which of the following muscles BOTH elevates the tongue and depresses the soft palate
during swallowing?
a. Levator veli palatini muscle
b. Palatoglossus muscle
c. Palatopharyngeal muscle
d. Muscle of the uvula
ANS: B
Feedback
A The levator veli palatini muscle raises the soft palate and does NOT elevate the
tongue.
B The palatoglossus muscle’s action is to elevate the base of the tongue as the soft
palate is depressed toward the tongue. This action helps separate the soft palate
and pharynx during swallowing to prevent movement of the food bolus into the
nasal cavity.
C The palatopharyngeal muscle moves the soft palate posteroinferiorly and the
posterior pharyngeal wall anterosuperiorly and does NOT elevate the tongue.
D The muscle of the uvula muscle shortens and broadens the uvula, helping to
close off the nasopharynx during swallowing. It does NOT elevate the tongue.

15. Which of the following muscles can show enlargement due to repetitive muscle contraction
associated with clenching of the teeth in a patient?
a. Buccinator muscle
b. Masseter muscle
c. Temporalis muscle
d. Zygomatic muscle
ANS: B
Feedback
A The buccinator muscle is NOT actively involved in closing the mouth while
grinding (bruxing) or clenching the teeth.
B The masseter muscle, a strong muscle of mastication involved in elevating the
mandible and closing the mouth, can become enlarged in people who habitually
clench or grind their teeth (bruxism).
C The temporalis muscle, while involved in elevating and retracting the mandible
when closing the mouth, does NOT become enlarged as a result of clenching
the teeth.
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D The zygomatic muscle is a muscle of facial expression associated with lifting

each labial commissure when smiling.

16. Which of the following muscles divides the neck region into anterior and posterior cervical
triangles?
a. Omohyoid muscle
b. Platysma muscle
c. Sternocleidomastoid muscle
d. Trapezius muscle
ANS: C
Feedback
A The omohyoid muscle, which is located more inferiorly, serves to further divide
the anterior and posterior triangles of the neck into smaller triangles.
B The platysma muscle is located anteriorly in the neck within the anterior
cervical triangle and does NOT divide the neck into anterior and posterior
triangles.
C The sternocleidomastoid muscle, which originates on the medial part of the
clavicle and the sternum and inserts into the mastoid process, is prominently
positioned on the side of the neck to divide the neck region into anterior and
posterior cervical triangles.
D The trapezius muscle is a flat, triangular-shaped muscle that is located on the
lateral and posterior surfaces of the neck and does NOT divide the neck region
into anterior and posterior triangles.

17. Which of the following muscles listed below does NOT serve to elevate the upper lip?
a. Levator anguli oris muscle
b. Levator labii superioris alaeque nasi muscle
c. Risorius muscle
d. Zygomaticus major muscle
ANS: C
Feedback
A Levator anguli oris muscle does elevate each labial commissure, helping to lift
the lip as in a smile.
B The levator labii superioris alaeque nasi muscle does work to elevate the upper
lip.
C The risorius muscle does NOT elevate the upper lip. Instead it works to retract
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the corners of the lip as in a grimace and has some fibers that connect with the
platysma muscle.
D The zygomaticus major muscle does work to elevate each labial commissure,
helping to lift the lip as in a smile.

18. Which of the following muscles when unilaterally contracted deviates the mandible to one
side?
a. Masseter muscle
b. Lateral pterygoid muscle
c. Medial pterygoid muscle
d. Temporalis muscle
ANS: B
Feedback
A The masseter muscle works only to elevate the mandible.
B An action of both of the lateral pterygoid muscles is to protrude the mandible. If
only one lateral pterygoid muscle contracts, the lower jaw shifts toward the
opposite side, causing lateral deviation of the mandible.
C The medial pterygoid muscle only works to elevate the mandible.
D The temporalis muscle only works to elevate and retract the mandible.

19. Which of the following muscles when contracted dilates the nostrils?
a. Orbicularis oris muscle
b. Levator labii superioris muscle
c. Levator anguli oris muscle
d. Levator labii superioris alaeque nasi muscle
ANS: D
Feedback
A The orbicularis oris muscle encircles the mouth.
B The levator labii superioris muscle inserts into the skin of the upper lip, NOT
into the ala of the nose.
C The levator anguli oris muscle inserts into the labial commissure and does NOT
insert into the ala of the nose.
D Some fibers of the levator labii superioris alaeque nasi muscle insert into the
skin tissue of the ala of the nose and thus can dilate the nose when the muscle
contracts.
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20. Which of the following muscles will serve to depress the lower lip?
a. Depressor labii inferioris and depressor anguli oris muscles
b. Depressor labii inferioris and orbicularis oris muscles
c. Depressor labii inferioris and mentalis muscles
d. Depressor labii inferioris and risorius muscles
ANS: A
Feedback
A Both the depressor labii inferioris and the depressor anguli oris muscle serve to
depress a part of the lower lip.
B The orbicularis oris muscle does NOT serve to depress the lower lip.
C The mentalis muscle does NOT serve to depress the lower lip.
D The risorius muscle does NOT serve to depress the lower lip.

21. Which of the following muscles when contracted causes a surprised facial expression on a
patient?
a. Corrugator supercilii muscle
b. Epicranius muscle
c. Orbicularis oculi muscle
d. Zygomaticus major muscle
ANS: B
Feedback
A The corrugator supercilii muscle pulls the skin tissue of the eyebrow medially
and inferiorly, as when one frowns.
B The epicranius muscle inserts into the skin tissue of the eyebrow and root of the
nose and raises the eyebrows, as when surprised.
C The orbicularis oculi muscle encircles the eye and closes the eye.
D The zygomaticus major muscle lifts each labial commissure and contributes to a
smile.

22. On what structure do BOTH heads of the masseter muscle originate?

a. Zygomatic process of the maxilla
b. Coronoid process
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c. Zygomatic process of the frontal bone

d. Zygomatic arch
ANS: D
Feedback
A The masseter muscle does NOT originate on the maxilla alone.
B The masseter muscle does NOT originate on the coronoid process of the
mandible.
C The masseter muscle does NOT originate on the frontal bone.
D Both heads of the master muscle originate on the zygomatic arch.

23. Which of the following muscles when contracted allows for the retraction of the mandible?
a. Masseter muscle
b. Temporalis muscle
c. Lateral pterygoid muscle
d. Medial pterygoid muscle
ANS: B
Feedback
A The master muscle elevates the mandible.
B The temporalis muscle works to elevate the mandible and, if only the posterior
part contracts, the muscle then retracts or moves the mandible backward.
Retraction of the jaw often accompanies the closing of the jaw.
C The lateral pterygoid muscle protrudes and depresses the mandible.
D The medial pterygoid muscle elevates the mandible.

24. What are the two parts of the epicranial muscle named?
a. Frontal and occipital bellies
b. Superior and inferior bellies
c. Anterior and posterior bellies
d. Superior and inferior heads
e. Superficial and deep heads
ANS: A
Feedback
A The frontal belly arises from epicranial aponeurosis. The epicranial aponeurosis
is superficial to where the parietal and occipital bones meet, the most superior
part of the skull. The frontal belly or frontalis muscle then inserts into the skin
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of the eyebrow and root of the nose. The occipital belly or occipitalis muscle
originates from the superior nuchal line of the occipital bone and mastoid
process of the temporal bone and then inserts in the epicranial aponeurosis.
B The superior belly of the omohyoid muscle originates from the short tendon
attached to the inferior belly and then inserts on the lateral border of the body of
the hyoid bone. The inferior belly originates from the scapula. The inferior belly
then passes anteriorly and superiorly, crossing the internal jugular vein deep to
the sternocleidomastoid muscle, where it then attaches by a short tendon to the
superior belly.
C The anterior belly of digastric muscle originates from the intermediate tendon,
which is loosely attached to the body and greater cornu of the hyoid bone and
then passes superiorly and anteriorly to insert close to the symphysis on the
medial surface of the mandible. The posterior belly arises from the mastoid
notch, medial to the mastoid process of the temporal bone, and then passes
anteriorly and inferiorly to insert on the intermediate tendon.
D The superior head of the lateral pterygoid muscle originates from the
infratemporal surface and infratemporal crest of the greater wing of the
sphenoid bone and passes inferiorly to insert on the anterior surface of the neck
of the mandible at the pterygoid fovea. The inferior head originates from the
lateral surface of the lateral pterygoid plate of the sphenoid bone and inserts on
the anterior margin of the temporomandibular joint disc and capsule.
E The superficial head of the masseter originates from the zygomatic process of
the maxilla and from the anterior two thirds of the inferior border of the
zygomatic arch. The deep head originates from the posterior one third and the
entire medial surface of the zygomatic arch. Both of these heads then pass
inferiorly to insert on different parts of the external surface of the mandible: the
superficial head on the lateral surface of the angle and the deep head on the
mandibular ramus superior to the angle of the mandible.

25. Which of the following are considered cervical muscles?

a. Masseter and medial pterygoid muscles
b. Medial and lateral pterygoid muscles
c. Sternocleidomastoid and trapezius muscles
d. Buccinator and epicranial muscles
ANS: C
Feedback
A Both the masseter and medial pterygoid muscles are muscles of mastication and
are NOT considered cervical muscles.
B Both the medial and lateral pterygoid muscles are muscles of mastication and
C Both the sternocleidomastoid and trapezius muscles are cervical muscles and
are thus both located in the neck.
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D Both the buccinator and epicranial muscles are muscles of facial expression and

MULTIPLE RESPONSE
1. From the following list of muscles, select which are considered muscles of facial expression.
a. Buccinator
b. Risorius
c. Platysma
d. Temporalis
e. Masseter
ANS: A, B, C
Feedback
Correct Buccinator, risorius, and platysma muscles are muscles of facial
expression.
Incorrect Both the temporalis and masseter muscles are muscles of mastication and
are NOT muscles of facial expression.

2. From the following list of muscles, select which are considered muscles of mastication.
a. Buccinator
b. Risorius
c. Platysma
d. Temporalis
e. Masseter
ANS: D, E
Feedback
Correct Both the temporalis and masseter muscles are muscles of mastication.
Incorrect Buccinator, risorius, and platysma muscles are muscles of facial
expression and NOT mastication.

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3. From the following list of muscles, select which muscles are considered suprahyoid muscles.
a. Digastric
b. Mylohyoid
c. Stylohyoid
d. Sternothyroid
e. Omohyoid
ANS: A, B, C
Feedback
Correct Digastric, mylohyoid, and stylohyoid muscles are considered suprahyoid
muscles.
Incorrect Sternothyroid and omohyoid muscles are considered infrahyoid muscles
and are NOT considered suprahyoid muscles.
DIF: Recall REF: p. 107, Box 4-1 OBJ: 3

4. From the following list of muscles, select which are considered infrahyoid muscles. (Select all
that apply.)
a. Digastric
b. Mylohyoid
c. Stylohyoid
d. Sternothyroid
e. Omohyoid
ANS: D, E
Feedback
Correct Both the sternothyroid and omohyoid muscles are considered infrahyoid
muscles.
Incorrect Digastric, mylohyoid, and stylohyoid are considered suprahyoid muscles
and are NOT considered infrahyoid muscles.
DIF: Recall REF: p. 107, Box 4-1 OBJ: 3

5. From the following list of muscles, select which muscles create the faucial pillars within the
oral cavity. (Select all that apply.)
a. Palatoglossus
b. Tensor veli palatini
c. Palatopharyngeus
d. Levator veli palatini
ANS: A, C
Feedback
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Correct Palatoglossus creates the anterior faucial pillar; palatopharyngeus creates

the posterior faucial pillar within the oral cavity.
Incorrect Tensor veli palatini stiffens the soft palate; levator veli palatini raises the
soft palate. Both do NOT create the faucial pillars within the oral cavity.
DIF: Comprehension REF: p. 115, Table 4-7

OBJ: 3
6. Facial paralysis can be present with a patient, either temporary or permanent, when involving
which of the following patient case histories? (Select all that apply.)
a.Trigeminal neuralgia
b.Cerebrovascular accident
c.Parotid salivary gland cancer
d.Peripheral neurectomy
ANS: B, C
Feedback
Correct Facial paralysis involves damage to the facial nerve as presented in
cerebrovascular accident (stroke) and parotid salivary gland cancer
(malignant neoplasm) since the facial nerve travels within the gland.
Incorrect Trigeminal neuralgia involves damage to the trigeminal nerve and NOT
the facial nerve that could lead to paralysis; peripheral neurectomy is a
possible treatment for trigeminal neuralgia and thus does NOT involve
the facial nerve involved when damaged in facial paralysis.
DIF: Application REF: p. 97, Table 4-2 OBJ: 5

physiology, and development | CDA: General Chairside, VI. A. 4. Describe how to respond to and
assist in the management of the signs and symptoms related to specific medical
conditions/emergencies likely to occur in the dental office | CDA: General Chairside, VI. B. 1.
Recognize the signs and symptoms related to specific dental conditions/emergencies likely to occur in
the office
Dental Hygiene Services, 1.1 Medical and Dental History | NBDHE, Provision of Clinical Dental
Hygiene Services, 3.3 Individualized Patient Education
7. During an extraoral examination of a patient, which of the following needs to be considered

with the sternocleidomastoid muscle? (Select all that apply.)
a. If one of the muscles contracts, the head and neck bend to the contralateral side.
b. Effective palpation of the muscle occurs when the patient moves the head to the
contralateral side.
c. If both muscles contract, the head will flex at the neck and extend at the junction
between the neck and skull.
d. If one of the muscles contracts, the face and anterior part of the neck rotate to the
ipsilateral side.
ANS: B, C
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Feedback
Correct If one of the muscles contracts, the head and neck bend to the ipsilateral
side, and the face and anterior part of the neck rotate to the contralateral
side. If both muscles contract, the head will flex at the neck and extend at
the junction between the neck and skull. It is effectively palpated on each
side of the neck when the patient moves the head to the contralateral side.
Incorrect If one of the muscles contracts, the head and neck do NOT bend to the
contralateral side but to the ipsilateral side. If one of the muscles
contracts, the face and anterior part of the neck do NOT rotate to the
ipsilateral side but to the contralateral side.
DIF: Application REF: p. 93 OBJ: 4 | 5

CDA: General Chairside, VI. A. 4. Describe how to respond to and assist in the management of the
signs and symptoms related to specific medical conditions/emergencies likely to occur in the dental
office | CDA: General Chairside, VI. B. 1. Recognize the signs and symptoms related to specific dental
conditions/emergencies likely to occur in the office
Dental Hygiene Services, 3.3 Individualized Patient Education
8. Which of the following are considerations when dealing with a history of cervical muscle
pathology in a dental setting? (Select all that apply.)
a. Patients always can be made to sit themselves in an ergonomically correct position
in the dental chair.
b. Patients may not be able to raise the chin as requested during treatment.
c. Patients may possibly have related headaches in the anterior skull region.
d. Additional supports and stabilizers such as pillows may make the patient more
comfortable.
ANS: B, D
Feedback
Correct Patients may not be able to raise the chin as requested during treatment.
Additional supports and stabilizers such as pillows may make the patient
more comfortable.
Incorrect Patients may possibly have related headaches in the posterior skull region
and NOT in the anterior skull region. Patients may NOT be able to
always sit themselves in an ergonomically correct position in the dental
chair.

the office
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9. Which of the following are considerations when dealing with a history of facial paralysis in a
dental setting? (Select all that apply.)
a. Inability to form facial expressions on one side of the face may be present.
b. Twitching, spasms, and weakness can be evident.
c. Loss of voluntary muscle action is always permanent.
d. Reduced drooling and the usual taste sensations are evident.
ANS: B, D
Feedback
Correct Inability to form facial expressions on one side of the face may be
present. Twitching, spasms, and weakness can be evident.
Incorrect Loss of voluntary muscle action can be either temporary or permanent; it
is NOT always permanent. Excessive drooling and altered taste
sensations are evident, NOT reduced drooling and the usual taste
sensations.

the office
MATCHING
From the following list of lip-related movements of the orbicularis oris muscle, match those
movements with their CORRECT facial action.
a. With pursing lips
b. With pouting and kissing
c. With grimacing
d. With closing lips
1. With pressing together

2. With tightening and thinning
3. Rolling inward between the teeth
4. With thrusting outward
1. ANS: D DIF: Comprehension REF: p. 99

OBJ: 3
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2. ANS: A DIF: Comprehension REF: p. 99
OBJ: 3
3. ANS: C DIF: Comprehension REF: p. 99
OBJ: 3
4. ANS: B DIF: Comprehension REF: p. 99
OBJ: 3
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Chapter 06: Vascular System

MULTIPLE CHOICE
1. Which term is BEST used to describe a blood vessel that travels to the heart carrying blood?
a. Arteriole
b. Artery
c. Capillary
d. Vein
ANS: D
Feedback
A An arteriole is a smaller artery that branches off an artery and connects with a
capillary.
B An artery is a type of blood vessel that carries blood away from the heart.
C A capillary is a smaller blood vessel that branches off an arteriole blood supply
directly to the tissue.
D A vein is a type of blood vessel that travels to the heart carrying blood.

2. The dental professional MUST be able to locate the larger blood vessels of the head and neck
BECAUSE these vessels may become compromised due to a disease process or during a
dental procedure such as a local anesthetic injection.
ANS: A
Feedback
A The statement and the reason are correct and related. The dental professional
must be familiar with the location of large blood vessels of the head and neck so
as to NOT compromise the patient’s health during certain dental procedures.
B The statement and reason are correct, but they are also related. Having
knowledge of blood vessels will avoid injury or disease transmission through
the blood system during dental procedures.
C The reason is correct. Blood vessels may become compromised due to a disease
process or during a dental procedure, such as a local anesthetic injection.
D The statement is correct. The dental professional must be able to locate the
larger blood vessels of the head and neck.
E Both the statement and the reason are correct. The dental professional must be
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able to locate the larger blood vessels of the head and neck mainly because
blood vessels may become compromised due to a disease process or during a
dental procedure such as a local anesthetic injection.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1 Anatomy | NBDHE, Scientific Basis
for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision of Clinical Dental Hygiene Services,
1.0 Assessing Patient Characteristics | NBDHE, Provision of Clinical Dental Hygiene Services, 4.0
Performing Periodontal Procedures
3. Blood vessels are MORE numerous than lymphatic vessels. However, the venous blood
vessels MAINLY parallel the lymphatic vessels.
ANS: D
Feedback
A The first statement is false. Blood vessels are less numerous than lymphatic
vessels.
B The second statement is true. The venous part mainly parallels the lymphatic
vessels.
C The first statement is false. Blood vessels are less numerous than lymphatic
vessels. The second statement is true. The venous blood vessels mainly parallel
the lymphatic vessels.
D The first statement is false. Blood vessels are less numerous than lymphatic
vessels. The second statement is true. The venous blood vessels mainly parallel
the lymphatic vessels.

4. Which of the following statements BEST explains why BOTH facial and dental infections can
lead to serious complications for the patient?
a. Antibiotics do NOT work well to combat facial and dental infections.
b. Communication by way of anastomoses and blood flow direction is involved in
the spread of infection in the head and neck.
c. Both facial and dental infections have been found to be difficult to detect and treat
early.
d. Blood supply is based on a one-to-one relationship of blood vessel to muscle.
ANS: B
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Feedback
A Antibiotics are available to treat facial and dental infections effectively.
B Communication by way of anastomoses and blood flow direction is involved in
the spread of infection in the head and neck. This is the reason that facial or
dental infections can lead to serious complications.
C Both facial and lingual infections can be detected early by completing a
comprehensive medical history, taking vital signs, and conducting extraoral and
intraoral examination on patients.
D Blood supply is regional, unlike that for innervation supplied by the nerves to
the muscles, which is a one-to-one relationship.

4.0 Performing Periodontal Procedures
5. What does the term anastomosis mean?

a. Communication of blood vessels with another connecting channel
b. Foreign material in the blood
c. A large network of blood vessels
d. Clot that forms on the inner blood vessel walls
ANS: A
Feedback
A Anastomosis is communication of blood vessels with another connecting
channel.
B A foreign material in the blood is an embolus.
C A large network of blood vessels is a plexus.
D A clot that forms on the inner blood vessel wall is a thrombus.

6. Which are the MAJOR arteries that supply the head and neck?
a. Aorta, brachiocephalic
b. Common carotid, subclavian
c. Posterior auricular, occipital
d. Superficial temporal, facial
ANS: B
Feedback
A The aorta is a major artery that gives rise to the common carotid and subclavian
arteries on the left side of the body and to the brachiocephalic artery on the right
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side. The brachiocephalic artery is an artery that branches directly off the aorta
on the right side of the body and gives rise to the right common carotid and
subclavian arteries.
B The common carotid and subclavian arteries are the major supply of arterial
blood to the head and neck. The common carotid artery travels in the carotid
sheath superiorly along the neck to branch into the internal and external carotid
arteries. The subclavian arteries arise from the aorta on the left and the
brachiocephalic artery on the right and give off branches to supply both
intracranial and extracranial structures, as well as the arm.
C The posterior auricular artery is a posterior arterial branch from the external
carotid artery that supplies the tissue around the ear. The occipital artery is also
a posterior arterial branch from the external ear.
D The superficial temporal artery is a terminal arterial branch from the external
carotid artery that arises in the parotid salivary gland and gives off the
transverse facial and middle temporal arteries, as well as frontal and parietal
branches. The facial artery is an anterior arterial branch from the external
carotid artery with a complicated path as it gives off the ascending palatine,
submental, inferior and superior labial, and angular arteries.

7. Which of the following arteries is a DIRECT branch off of the aorta?

a. Common carotid artery
b. External carotid artery
c. Pterygoid artery
d. Brachiocephalic artery
ANS: D
Feedback
A The common carotid artery travels in the carotid sheath superiorly along the
neck to branch into the internal and external carotid arteries.
B The external carotid artery arises from the common carotid artery and supplies
the extracranial tissue of the head and neck, including the oral cavity.
C The pterygoid artery is a branch of arteries from the maxillary artery that
supplies the pterygoid muscles.
D The brachiocephalic artery is an artery that branches directly off the aorta on the
right side of the body and gives rise to the right common carotid and subclavian
arteries.

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8. The common carotid artery is branchless and travels superiorly along the neck, lateral to the
trachea and larynx to the superior border of the thyroid cartilage. The common carotid artery
travels in a sheath deep to the superior, middle, and inferior pharyngeal constrictor muscle.
ANS: C
Feedback
A The second statement is false. The common carotid artery travels in a sheath
deep to the sternocleidomastoid muscle.
B The first statement is true. The common carotid artery is branchless and travels
superiorly along the neck, lateral to the trachea and larynx to the superior
border of the thyroid cartilage.
C The first statement is true. The common carotid artery is branchless and travels
border of the thyroid cartilage. The second statement is false. The common
carotid artery travels in a sheath deep to the sternocleidomastoid muscle.
D The first statement is true. The common carotid artery is branchless and travels
border of the thyroid cartilage. The second statement is false. The common
carotid artery travels in a sheath deep to the sternocleidomastoid muscle.

9. What is the MAJOR destination of the subclavian artery as it travels in the body?
a. Intracranial structures
b. Upper extremity or arm
c. Tissue inferior to the hyoid bone
d. External scalp tissue
ANS: B
Feedback
A The intracranial structures are supplied by the internal carotid artery.
B The subclavian artery also supplies the upper extremity or arm, so that is its
major destination.
C The superior thyroid artery supplies tissue inferior to the hyoid bone.
D The occipital artery supplies the suprahyoid and sternocleidomastoid muscles,
as well as the external scalp and meningeal tissue in the occipital region.

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10. Which of the following structures listed is NOT supplied by the lingual artery?
a. Suprahyoid muscles
b. Floor of the mouth
c. Mylohyoid muscle
d. Tongue
ANS: C
Feedback
A The lingual artery supplies the suprahyoid muscles.
B The lingual artery supplies the floor of the mouth.
C The lingual artery does NOT supply the mylohyoid muscle. The sublingual
artery supplies the mylohyoid muscle.
D Branches of the lingual artery supply the tongue.

11. Which of the following listed is NOT a branch of the external carotid artery?
a. Middle meningeal
b. Facial
c. Ascending pharyngeal
d. Posterior auricular
ANS: A
Feedback
A The middle meningeal artery is a branch of the maxillary artery, which supplies
the meninges of the brain and bones of the skull.
B The facial artery is part of the anterior branch of the external carotid artery.
C The ascending pharyngeal artery is a medial branch of the external carotid
artery.
D The posterior auricular artery is a posterior branch of the external carotid artery.
DIF: Recall REF: p. 137, Figure 6-4 OBJ: 2

12. During the extraoral examination of a patient, an artery is visually noted under the skin of the
patient in the temporal region. Which artery can be visualized in this manner during the
examination?
a. Middle temporal artery
b. Transverse facial artery
c. Superficial temporal artery
d. Maxillary artery
ANS: C
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Feedback
A The middle temporal artery is small and supplies the temporalis muscle along
with parts of the scalp in the frontal and parietal regions.
B The transverse facial artery supplies the parotid salivary gland and nearby facial
tissue.
C The superficial temporalis artery branches off into several directions in the area
of the temporalis bone.
D The maxillary artery begins at the neck of the mandibular condyle within the
parotid salivary gland.

CDA: General Chairside, II. D. Patient Management
MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1 Anatomy | NBDHE, Provision of
Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics | NBDHE, Provision of
Clinical Dental Hygiene Services, 4.0 Performing Periodontal Procedures
13. Which branch of the maxillary artery supplies the maxillary anterior teeth by way of each
tooth’s apical foramen?
a. Infraorbital artery
b. Inferior alveolar artery
c. Sphenopalatine artery
d. Anterior superior alveolar artery
ANS: D
Feedback
A Although the infraorbital artery supplies the maxillary anterior teeth, it does so
by providing orbital branches to the orbit, as well as giving off the anterior
superior alveolar artery, but it does NOT actually enter through the apical
foramen of each tooth.
B The inferior alveolar artery supplies the mandibular teeth, the floor of the
mouth, and mental region.
C The sphenopalatine artery supplies the nasal cavity and anterior hard palate.
D The anterior superior alveolar artery supplies the maxillary anterior teeth by
entering each tooth’s apical foramen.

14. The veins of the head and neck start out as large venules and become smaller as they near the
base of the neck on their way to the heart. The veins of the head and upper neck are usually
symmetric in location with limited or NO variance regarding their location.
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ANS: B
Feedback
A Both the first and second statements are false. Veins of the head and neck start
out as small venules and become larger as they near the base of the neck on
their way to the heart. The veins of the head and upper neck are usually
symmetric in location; however, they have a greater variability in location than
do the arteries.
B Both statements are false. Veins of the head and neck start out as small venules
and become larger as they near the base of the neck on their way to the heart.
The veins of the head and upper neck are usually symmetric in location;
however; they have a greater variability in location than do the arteries.
C The first statement is false. Veins of the head and neck do NOT start out as large
venules. They also become larger as they near the base of the neck on their way
to the heart.
D The second statement is false. The veins of the head and upper neck are usually
symmetric in location and have greater variability regarding their location than
do arteries.

15. Which of the following oral structures or regions is NOT drained DIRECTLY by the facial
vein?
a. Upper lip
b. Lower lip
c. Submental space
d. Lateral scalp
ANS: D
Feedback
A The facial vein drains the upper lip by way of the superior labial drainage vein.
B The facial vein drains the lower lip by way of the inferior labial drainage vein.
C The facial vein drains the submental space by way of the submental drainage
vein.
D The facial vein does NOT drain the lateral scalp. The retromandibular and
external jugular veins drain this area.

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16. Which of the following blood vessels NOT only protects the maxillary artery from being
compressed during mastication but also accommodates changes in volume of the
infratemporal fossa that occur when the mandible moves?
a. Posterior superior alveolar veins
b. Pterygoid plexus of veins
c. Maxillary vein
d. Middle meningeal vein
ANS: B
Feedback
A The posterior superior alveolar veins drain the pulp of the maxillary teeth by
way of each tooth’s apical foramen. It also drains the periodontium of the
maxillary teeth.
B The pterygoid plexus of veins is a collection of small anastomosing vessels
located around the pterygoid muscles and surrounding the maxillary artery. It
protects the maxillary from being compressed during mastication by allowing
changes in volume of the infratemporal fossa that occur when the mandible
moves.
C The maxillary vein is a deep vein that begins in the infratemporal fossa by
collecting blood from the pterygoid plexus. The maxillary vein receives other
veins from the nose and palate before draining into and from the
retromandibular vein.
D Middle meningeal vein drains blood from the meninges of the brain into the
pterygoid plexus of veins.

17. Which of the following veins listed drains MOST of the head and neck?
a. Internal jugular vein
b. External jugular vein
c. Inferior alveolar vein
d. Anterior jugular vein
ANS: A
Feedback
A The internal jugular vein originates in the cranial cavity and leaves the skull
through the jugular foramen. It receives tributaries, including the veins, from
the lingual, sublingual, and pharyngeal areas, as well as the facial vein.
B The external jugular vein moves inferiorly along the neck, terminating in the
subclavian vein.
C The inferior alveolar vein drains the periodontium of the mandibular teeth,
including the gingival tissue.
D The anterior jugular vein begins inferior to the chin, communicating with veins
in the area, and moves inferiorly near the midline, within the superficial fascia,
receiving branches from superficial cervical structures.
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18. What is a serious, life-threatening blood vessel lesion that occurs when a blood vessel is
seriously traumatized, allowing large amounts of blood to escape into the surrounding tissue
without clotting?
a. Hematoma
b. Thrombus
c. Bacteremia
d. Hemorrhage
ANS: D
Feedback
A A hematoma is a bruise resulting from a blood vessel being injured and a small
amount of blood escaping into and clotting into the surrounding tissue. It is
NOT a serious, life-threatening blood vessel lesion.
B A thrombus is a clot that forms on the inner vessel wall. It is NOT a serious,
life-threatening blood vessel lesion unless it breaks away and becomes an
embolus.
C A bacteremia occurs when bacteria travel within the blood system. It is NOT
always a serious, life-threatening blood vessel lesion unless the patient is
medically compromised.
D A hemorrhage occurs when large amounts of the blood escape into the
surrounding tissue without clotting and thus is a serious, life-threatening blood
vessel lesion.

physiology, and development | CDA: General Chairside, II. D. Patient Management | CDA: General
Chairside, VI. A. 1. Identify medical conditions that can cause medical emergencies in patients
1.0 Assessing Patient Characteristics
19. What is the blood supply that is DIRECTLY provided to the sternocleidomastoid muscle?
a. Internal carotid artery
b. Superior thyroid artery
c. Lingual artery
d. Angular artery
ANS: B
Feedback
A The internal carotid artery has NO branches in the neck but continues adjacent
to the internal jugular vein within the carotid sheath to the skull base, where it
enters the cranium. The internal carotid artery supplies intracranial structures
and is the source of the ophthalmic artery, which supplies the eye, orbit, and
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lacrimal gland.
B The superior thyroid artery is an anterior branch from the external carotid artery
that has a sternocleidomastoid branch to supply the sternocleidomastoid muscle.
C The lingual artery is an anterior branch from the external carotid artery and
arises superior to the superior thyroid artery at the level of the hyoid bone. The
lingual artery travels anteriorly to the apex of the tongue by way of its inferior
surface. The lingual artery supplies the tissue superior to the hyoid bone,
including the suprahyoid muscles and floor of the mouth by the dorsal lingual,
deep lingual, sublingual, and suprahyoid branches. The tongue is also supplied
by branches of the lingual artery.
D The angular artery is the termination of the facial artery and supplies the side of
the nose.

20. A branch of the maxillary artery reaches the nasal cavity through the
a. infraorbital foramen.
b. incisive foramen.
c. sphenopalatine foramen.
d. greater and lesser palatine foramina.
ANS: C
Feedback
A After giving off branches in the infraorbital canal, the infraorbital artery
emerges onto the face from the infraorbital foramen. The artery’s terminal
branches supply parts of the infraorbital region of the face and anastomose with
the facial artery.
B The sphenopalatine artery gives rise to the posterior lateral nasal branches and
septal branches, including a nasopalatine branch that accompanies the
nasopalatine nerve through the incisive foramen on the maxillae.
C The sphenopalatine artery is a branch of the maxillary artery that reaches the
nasal cavity through the sphenopalatine foramen.
D The maxillary artery gives rise to the descending palatine artery, which travels
to the palate through the pterygopalatine canal, which then terminates in both
the greater palatine artery and lesser palatine artery by way of the greater and
lesser palatine foramina to supply the hard and soft palates, respectively.

21. What is the relationship of the maxillary vein to the superficial temporal vein?
a. Shallower
b. Deeper
c. Superior
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d. Inferior
ANS: B
Feedback
A The maxillary vein or internal maxillary vein is deeper than the superficial
temporal vein and begins in the infratemporal fossa by collecting blood from
the pterygoid plexus, accompanying the maxillary artery.
B The maxillary vein or internal maxillary vein is deeper than the superficial
C The maxillary vein or internal maxillary vein is deeper than the superficial
D The maxillary vein or internal maxillary vein is deeper than the superficial

22. The pterygoid plexus of veins is a collection of small anastomosing vessels located around the
pterygoid muscles and DIRECTLY surrounding which artery?
a. External carotid artery
b. Maxillary artery
c. Inferior alveolar artery
d. Internal carotid artery
ANS: B
Feedback
A The pterygoid plexus of veins is a collection of small anastomosing vessels
located around the pterygoid muscles and directly surrounding the maxillary
artery.
B The pterygoid plexus of veins is a collection of small anastomosing vessels
artery.
C The pterygoid plexus of veins is a collection of small anastomosing vessels
artery.
D The pterygoid plexus of veins is a collection of small anastomosing vessels
artery.

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23. What is the relationship of the subclavian artery to the common carotid artery?
a. Anterior
b. Posterior
c. Medial
d. Lateral
ANS: D
Feedback
A The subclavian artery arises lateral to the common carotid artery.
B The subclavian artery arises lateral to the common carotid artery.
C The subclavian artery arises lateral to the common carotid artery. The external
carotid artery travels superiorly in a more medial position (in relationship to the
internal carotid artery) after arising from the common carotid artery.
D The subclavian artery arises lateral to the common carotid artery.

24. What is the usual number of anterior branches that arise from the external carotid artery?
a. One
b. Two
c. Three
d. Four
ANS: C
Feedback
A There are three anterior branches from the external carotid artery: superior
thyroid, lingual, and facial. Only one medial branch is from the external carotid
artery: the small ascending pharyngeal artery.
B There are three anterior branches from the external carotid artery: superior
thyroid, lingual, and facial. There are two posterior branches of the external
carotid artery: occipital and posterior auricular.
C There are three anterior branches from the external carotid artery: superior
thyroid, lingual, and facial.
D There are three anterior branches from the external carotid artery: superior
thyroid, lingual, and facial. The external carotid artery has four sets of branches
grouped according to their location relative to the main artery: anterior, medial,
posterior, and terminal.

25. With what nerve is the occipital artery closely associated at its origin?
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a. Trigeminal nerve
b. Facial nerve
c. Hypoglossal nerve
d. Mandibular nerve
ANS: C
Feedback
A At its origin, the occipital artery is closely associated with the twelfth cranial or
hypoglossal nerve.
B At its origin, the occipital artery is closely associated with the twelfth cranial or
hypoglossal nerve.
C At its origin, the occipital artery is closely associated with the twelfth cranial or
hypoglossal nerve.
D The maxillary artery also has branches that are located near the muscle they
supply. These arteries all accompany branches of the mandibular nerve or third
division of the fifth cranial or trigeminal nerve.

MULTIPLE RESPONSE
1. From the following list of descriptions, select which descriptions can be used for the pathway
of the external carotid artery. (Select all that apply.)
a. Begins at inferior border of thyroid cartilage
b. Travels upward medial to internal carotid artery
c. Begins at the termination of common carotid artery
d. Travels upward lateral to internal carotid artery
ANS: B, C
Feedback
Correct The external carotid artery travels upward medial to the internal carotid
artery and begins at the termination of the common carotid artery; this
artery does NOT begin at the inferior border of the thyroid cartilage and
does NOT travel lateral to the internal carotid artery.
Incorrect The external carotid artery begins at the superior border of the thyroid
cartilage and NOT its inferior border as well as traveling upward medial
and NOT lateral to the internal carotid artery.

2. From the following list of blood vessels, select those blood vessels that anastomose with the
pterygoid plexus of veins located around the pterygoid muscles. (Select all that apply.)
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a. Facial artery
b. Maxillary artery
c. Facial vein
d. Retromandibular vein
e. Maxillary vein
ANS: C, D
Feedback
Correct The pterygoid plexus of veins anastomoses with both the facial vein and
retromandibular vein.
Incorrect The pterygoid plexus of veins surrounds the maxillary artery and does
NOT anastomose with either the facial artery or maxillary artery; the
plexus drains into the maxillary vein.

3. From the following list of terms concerning compromised blood vessels, select the terms that
are associated DIRECTLY with clot formation. (Select all that apply.)
a. Thrombus
b. Embolus
c. Hematoma
d. Hemorrhage
e. Varicosity
ANS: A, B, C
Feedback
Correct The terms concerning compromised blood vessels that are DIRECTLY
associated with clot formation are thrombus (plural, thrombi), embolus
(plural, emboli), and hematoma.
Incorrect The terms concerning compromised blood vessels that are NOT
DIRECTLY associated with clot formation are hemorrhage and
varicosity.

of the external jugular vein. (Select all that apply.)
a. Drains only a small part of extracranial structures
b. Terminates in the subclavian vein
c. Visible near the sternocleidomastoid muscle
d. Usually only one vein is present
ANS: A, B, C
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Feedback
Correct The external jugular vein drains only a small part of extracranial
structures. It terminates in the subclavian vein and is visible as it crosses
the sternocleidomastoid muscle in the neck.
Incorrect Usually there are two external jugular veins but there can be ONLY one
anterior jugular vein.

of the maxillary artery. (Select all that apply.)
a. May be superficial to lateral pterygoid muscle
b. Runs between mandible and temporomandibular ligament
c. May be deep to lateral pterygoid muscle
d. Runs through infratemporal fossa
ANS: A, C, D
Feedback
Correct The maxillary artery runs either superficial or deep to the lateral
pterygoid muscle and through the infratemporal fossa superiorly.
Incorrect The maxillary artery runs between the mandible and the
sphenomandibular ligament anteriorly and NOT the temporomandibular
ligament.

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Chapter 07: Glandular Tissue

MULTIPLE CHOICE
1. At which of the following bony junctions does the nasolacrimal duct begin?
a. Nasal and lacrimal bones
b. Nasal and palatine bones
c. Maxilla and nasal bone
d. Maxilla and lacrimal bone
ANS: D
Feedback
A The nasal bones form the bridge of the nose and do NOT form part of the
nasolacrimal duct.
B The nasal bones form the bridge of the nose, and the palatine bones are posterior
to the lacrimal bones. Neither bone forms part of the nasolacrimal duct.
C The nasal bones do NOT form part of the nasolacrimal duct.
D The nasolacrimal duct begins at the junction of the maxilla and lacrimal bone.

N R I G B.C M
U glands
S N produces
T Oapproximately 60% to 65% of the total
2. Which of the following exocrine
volume of saliva for the oral cavity?
a. Sublingual gland
b. Submandibular gland
c. Parotid gland
d. Lacrimal gland
ANS: B
Feedback
A The sublingual salivary gland produces approximately 10% of the total volume
of saliva and is an exocrine gland.
B The submandibular salivary gland produces approximately 60% to 65% of the
total volume of saliva and is an exocrine gland.
C The parotid salivary gland produces approximately 25% of the total volume of
saliva and is an exocrine gland.
D The lacrimal gland is NOT a salivary gland but is an exocrine gland.

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3. Which of the following glands can be palpated as part of an extraoral examination by a

clinician?
a. Lacrimal gland
b. Thyroid gland
c. Parathyroid gland
d. Thymus gland
ANS: B
Feedback
A The lacrimal gland is located in the lacrimal fossa of the frontal bone, on the
lateral portion of the supraorbital ridge inside the orbit. It CANNOT be palpated.
B The thyroid gland is palpated in the anterior neck region.
C The parathyroid glands are located on the posterior surface or inside the
posterior surface of the thyroid gland. They CANNOT be palpated.
D The thymus gland is located in the thorax, deep to the sternum and to the
sternohyoid and sternothyroid muscles. It CANNOT be palpated.
DIF: Application REF: pp. 164-165 OBJ: 2

4. Both the major and minor salivary glands are _______ glands.
a. endocrine
b. exocrine
c. large
NURSINGTB.COM
d. small
ANS: B
Feedback
A All of the salivary glands are exocrine. They secrete saliva into the oral cavity
through ducts or directly into the oral cavity. They do NOT secrete saliva into
the vascular system like exocrine glands.
B All of the salivary glands are exocrine, so this answer is correct. They do NOT
secrete saliva into the vascular system like exocrine glands.
C Major glands are large glands, and minor glands are small glands.
D Major glands are large glands, and minor glands are small glands.

5. Which of the following nerves innervates the minor salivary glands?

a. Fifth cranial nerve
b. Seventh cranial nerve
c. Ninth cranial nerve
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d. Twelfth cranial nerve

ANS: B
Feedback
A The fifth cranial nerve does NOT innervate the minor salivary glands. It
innervates the parotid salivary gland.
B The seventh cranial nerve innervates the minor salivary glands.
C The ninth cranial nerve does NOT innervate the minor salivary glands. It
innervates the parotid salivary gland.
D The twelfth cranial nerve does NOT innervate the minor salivary glands. It
innervates the extrinsic tongue muscles.

6. Which of the following glands listed below is NOT an endocrine gland?

a. Lacrimal gland
b. Parathyroid gland
c. Thyroid gland
d. Thymus gland
ANS: A
Feedback
A The lacrimal gland is anNexocrine
URSINgland.GTB.C OM tears through the fine tubules
It secretes
that allow the tears to lubricate the eye. After lubricating the eye, the tears empty
into the nasolacrimal duct.
B The parathyroid glands are endocrine glands.
C The thyroid gland is an endocrine gland.
D The thymus gland is an endocrine gland.

7. Which of the following glands can be palpated within the sublingual space in the floor of the
mouth during an extraoral examination by a clinician?
a. Parotid gland
b. Parathyroid gland
c. Sublingual gland
d. Submandibular gland
ANS: C
Feedback
A The parotid salivary gland is located in the parotid fascial space, anterior and
inferior to the ear and posterior to the mandibular ramus. It would NOT be
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palpated in the floor of the mouth.

B The parathyroid glands are located on the posterior surface or inside the
posterior surface of the thyroid gland. They would NOT be palpated in the floor
of the mouth.
C The sublingual salivary gland is located in the sublingual fossa in the anterior
floor of the mouth and can be palpated within the sublingual space.
D The submandibular salivary gland is located more posterior along the
submandibular fossa, in the submandibular space, inferior and posterior to the
body of the mandible.

NBDHE, Provision of Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics
8. Which of the following glands wraps around the mylohyoid muscle?

a. Parotid gland
b. von Ebner glands
c. Sublingual gland
ANS: D
Feedback
A The parotid salivary gland
NUisRNOT
S INGlocated
T B.CinOthe
M floor of the mouth and does
NOT wrap around the mylohyoid muscle.
B The minor salivary glands, von Ebner glands, are associated with the
circumvallate papillae located on the dorsum of the tongue.
C The sublingual salivary gland is located anterior in the floor of the mouth and
does NOT wrap around the posterior border of the mylohyoid muscle.
D The submandibular salivary gland has two lobes, and the smaller lobe wraps
around the posterior border of the mylohyoid muscle.

9. If there is an infection involving the submandibular salivary gland, what lymph nodes would
be initially involved?
a. Submental nodes
b. Submandibular nodes
c. Superior deep cervical nodes
d. Inferior deep cervical nodes
ANS: B
Feedback
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A The submental lymph nodes are NOT the primary nodes for the submandibular
salivary gland.
B The submandibular lymph nodes are the primary nodes for the submandibular
salivary gland.
C The superior deep cervical lymph nodes are NOT the primary nodes for the
submandibular salivary gland.
D The inferior deep cervical lymph nodes are NOT the primary nodes for the
submandibular salivary gland.

NBDHE, Scientific Basis for Dental Hygiene Practice, 5.0 Pathology
10. The lacrimal glands are considered exocrine glands because their secretion enters directly into
the vascular system without the use of any ducts.
ANS: C
Feedback
A
NURSINGTB.COM
The reason is NOT correct, but the statement is correct. Secretions from the
lacrimal glands do NOT enter into the vascular system but do use ducts, so they
are considered exocrine glands.
B The lacrimal glands are considered exocrine glands, but their product (tears) is
secreted onto the eye through ducts but does NOT enter directly into the vascular
system, so the statement is correct, but the reason is NOT correct.
C The reason is NOT correct, but the statement is correct. Secretions from the
lacrimal glands do NOT enter into the vascular system but do use ducts, so they
D The reason is NOT correct, but the statement is correct. Secretions from the
lacrimal glands do not enter into the vascular system but do use ducts, so they
E The reason is not correct, but the statement is correct. Secretions from the
lacrimal glands do not enter into the vascular system but do use ducts, so they

11. Which of the following glands secrete only a serous type of saliva?
a. Parotid and submandibular glands
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b. Sublingual and submandibular glands

c. Parotid and von Ebner glands
d. Sublingual and von Ebner glands
ANS: C
Feedback
A The parotid salivary glands produce a serous type of saliva but the
submandibular salivary glands produce a mixed type of saliva.
B The submandibular salivary glands produce a mixed type of saliva, and the
sublingual salivary glands produce a mixed, mostly mucous type of saliva.
C Both von Ebner glands and the parotid salivary glands produce a serous type of
saliva.
D Of the minor glands, von Ebner glands produce a serous type of saliva, but the
sublingual salivary glands produce a mixed, mostly mucous type of saliva.
DIF: Recall REF: pp. 160, 163 OBJ: 2

12. Which type of secretion is produced from MOST minor salivary glands within the oral cavity?
a. Only mucous secretion
b. Only serous secretion
c. Mainly mucous secretion
d. Mainly serous secretion
ANS: C NURSINGTB.COM
Feedback
A Most of the minor salivary glands produce a mainly mucous type of saliva.
B Most of the minor salivary glands produce a mainly mucous type of saliva.
C The minor salivary glands produce a mainly mucous type of saliva.
D The minor salivary glands produce a mainly mucous type of saliva.

13. Which of the following lymph nodes are initially involved when the patient has contracted
mumps?
a. Superior deep cervical nodes
b. Deep parotid nodes
c. Superficial parotid nodes
d. Submandibular nodes
ANS: B
Feedback
A The superior deep cervical lymph nodes are NOT the primary nodes for the
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parotid salivary gland that becomes involved with mumps.

B The primary nodes for the parotid gland that becomes involved with mumps are
the deep parotid lymph nodes.
C The superficial parotid lymph nodes are NOT the primary nodes for the parotid
salivary gland that becomes involved with mumps.
D The submandibular lymph nodes are NOT the primary nodes for the parotid
salivary gland that becomes involved with mumps.

physiology, and development | CDA: General Chairside, V. A. Oral Health Information | CDA:
General Chairside, VI. A. 4. Describe how to respond to and assist in the management of the signs and
symptoms related to specific medical conditions/emergencies likely to occur in the dental office
Dental Hygiene Services, 1.0 Assessing Patient Characteristics
14. What is the location for the parathyroid glands?

a. On the anterior surface of the thyroid gland
b. Inferior to the hyoid bone, superficial and lateral to the trachea
c. On or within the posterior surface of the thyroid gland
d. In the parotid space, posterior to the mandibular ramus
ANS: C
Feedback
A The parathyroid glands are NOT located on the anterior surface of the thyroid
gland. NURSINGTB.COM
B The parathyroid glands are NOT located superficial and lateral to the trachea.
C The parathyroid glands are located on or within the posterior surface of the
thyroid gland.
D The parathyroid glands are NOT located in the parotid space, posterior to the
mandibular ramus.

15. Which of the following lingual papillae are DIRECTLY associated with salivary glands?
a. Circumvallate papillae
b. Filiform papillae
c. Foliate papillae
d. Fungiform papillae
ANS: A
Feedback
A The minor salivary glands, von Ebner glands, are associated with the
circumvallate papillae.
B The filiform papillae are NOT associated with any salivary gland.
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C The foliate papillae are NOT associated with any salivary gland.
D The fungiform papillae are NOT associated with any salivary gland.

16. Which of the following glands is associated with Wharton duct?

a. Lacrimal gland
b. Parotid gland
c. Sublingual gland
ANS: D
Feedback
A The lacrimal gland is associated with the nasolacrimal duct, NOT Wharton duct
or the submandibular duct.
B The parotid salivary gland is associated with Stensen or the parotid duct.
C The sublingual salivary gland is associated with Bartholin or the sublingual duct.
D Wharton duct is another name for the submandibular duct, which is the duct of
the submandibular salivary gland.

MSC: NBDHE, Scientific Basis U S N Hygiene
for Dental T O
Practice, 1.1.1 Head and Neck Anatomy
17. Which of the following nerves can be damaged during surgery on the submandibular salivary
gland?
a. Cervical nerve
b. Inferior alveolar nerve
c. Lingual nerve
d. Mental nerve
ANS: C
Feedback
A The cervical nerves are associated with the neck or deeper structures.
B The inferior alveolar nerve passes through the mandibular foramen on the
mandibular ramus and runs within the mandibular canal. It is NOT in the vicinity
of the submandibular salivary gland.
C The duct of the submandibular salivary gland, which begins in the deeper lobe,
runs close to the lingual nerve, and there is the potential for damage to the
lingual nerve during surgery in the area.
D The mental nerve is in the area of the chin and enters into the mandible through
the mental foramen on the external surface of the mandible.
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18. Which of the following nerves when damaged can affect the production of the serous type of
saliva?
a. Chorda tympani nerve
b. Greater petrosal nerve
c. Seventh cranial nerve
d. Ninth cranial nerve
ANS: D
Feedback
A The chorda tympani nerve innervates the sublingual salivary gland, which
produces a mixed type of saliva but mostly a mucous type of saliva, and the
submandibular salivary gland, which produces a mixed type of saliva, with NOT
one type of saliva predominating.
B The greater petrosal nerve innervates the lacrimal gland, which is NOT a
salivary gland.
C The seventh cranial nerve innervates the minor salivary glands, which produce a
mostly mucous type of saliva.
D The ninth cranial nerve provides motor innervation to the parotid salivary gland,
which produces only a serous type of saliva.

TOP: CDA: General Chairside,NI. A.
R Demonstrate
I G B.C understanding
M of basic oral and dental anatomy,
physiology, and development U S N T O
19. Which of the ducts when blocked is involved in the formation of a ranula in the posterior floor
of the mouth?
a. Bartholin duct
b. Nasolacrimal duct
c. Stensen duct
d. Wharton duct
ANS: D
Feedback
A The sublingual salivary gland is located more anterior than the submandibular
salivary gland associated with Wharton duct. Bartholin duct is shorter and does
NOT travel in the posterior floor of the mouth. A ranula associated with this duct
would be located more anterior in the floor of the mouth.
B The nasolacrimal duct is NOT located within the oral cavity.
C The Stensen duct, also called the parotid duct, is NOT located in the floor of the
oral cavity.
D Wharton duct, which is the duct for the submandibular salivary gland, runs from
the posterior floor of the mouth anterior to the sublingual caruncle. Blockage of
the duct may cause a ranula in the posterior floor of the mouth.
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20. Which of the following glands is associated with the pterygopalatine ganglion?
a. Lacrimal gland
b. Parotid gland
c. Sublingual gland
ANS: A
Feedback
A The preganglionic and postganglionic parasympathetic fibers of the greater
petrosal nerve synapse in the pterygopalatine ganglion as they provide
innervation to the lacrimal gland.
B Nerves that innervate the parotid salivary gland are NOT associated with the
pterygopalatine ganglion.
C Innervation of the sublingual salivary gland is NOT associated with the
D Innervation of the submandibular salivary gland is NOT associated with the

21. Which of the following arteries can be associated with bleeding with trauma to the sublingual
salivary glands?
a. Inferior thyroid artery
b. Sublingual artery
c. Facial artery
d. Lingual artery
ANS: B
Feedback
A The inferior thyroid artery does NOT provide blood supply to the sublingual
salivary gland.
B The sublingual salivary glands are innervated by the sublingual (and submental)
arteries.
C The facial artery does NOT provide blood supply to the sublingual salivary
gland. The facial artery gives off the submental artery and then passes over the
inferior border of the mandible and travels up the anterior surface of the face.
D The lingual artery does NOT provide direct blood supply to the sublingual
salivary gland.
DIF: Comprehension REF: p. 159, Table 7-1
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OBJ: 3
physiology, and development | CDA: General Chairside, VI. A. 1. Identify medical conditions that can
cause medical emergencies in patients
22. What is the relationship of the submandibular duct to the lingual nerve as it courses from
posterior to anterior?
a. Inferior and posterior to superior and anterior
b. Inferior and medial to superior and lateral
c. Lateral and anterior to medial and posterior
d. Superior and lateral to inferior and medial
ANS: D
Feedback
A The lingual nerve in relationship to the submandibular duct is first superior and
lateral and then inferior and medial.
B The lingual nerve in relationship to the submandibular duct is first superior and
C The lingual nerve in relationship to the submandibular duct is first superior and
D The lingual nerve in relationship to the submandibular duct is first superior and
DIF: Recall N161-162

REF: pp. URSINGOBJ: TB.C 2 OM
23. The smaller palpebral part lies close to the eye, along the inner surface of the eyelid; if the
upper eyelid is everted, the palpebral part can be seen.
ANS: A
Feedback
A Both statements are true. The smaller palpebral part lies close to the eye, along
the inner surface of the eyelid; if the upper eyelid is everted, the palpebral part
can be seen.
B Both statements are true. The smaller palpebral part lies close to the eye, along
can be seen.
C Both statements are true. The smaller palpebral part lies close to the eye, along
can be seen.
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D Both statements are true. The smaller palpebral part lies close to the eye, along
can be seen.

24. From the nasolacrimal sac, the lacrimal fluid continues into the nasolacrimal duct, ultimately
draining into the inferior nasal meatus. This connection explains why crying leads to extra
saliva.
ANS: C
Feedback
A The statement is correct, but the reason is NOT. From the nasolacrimal sac, the
lacrimal fluid continues into the nasolacrimal duct, ultimately draining into the
inferior nasal meatus. This connection explains why crying leads to a runny
nose.
B The statement is correct, but the reason is NOT. From the nasolacrimal sac, the
lacrimal fluid continuesNintoRtheInasolacrimal duct, ultimately draining into the
S NGTB.C
inferior nasal meatus. ThisUconnection OMwhy crying leads to a runny
explains
nose.
C The statement is correct, but the reason is NOT. From the nasolacrimal sac, the
nose.
D The statement is correct, but the reason is NOT. From the nasolacrimal sac, the
nose.
E The statement is correct, but the reason is NOT. From the nasolacrimal sac, the
nose.

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25. In contrast to the usual moisture of the eye or even crying, there can be persistent dryness,
scratching, and burning in the eyes of a patient. These are signs of xerostomia.
ANS: C
Feedback
A The first statement is true; the second is false. In contrast to the usual moisture of
the eye or even crying, there can be persistent dryness, scratching, and burning
in the eyes, which are signs of dry eye syndrome. Xerostomia is dry mouth.
B The first statement is true; the second is false. In contrast to the usual moisture of
C The first statement is true; the second is false. In contrast to the usual moisture of
D The first statement is true; the second is false. In contrast to the usual moisture of

General Chairside, VI. B. 1. Recognize
NURSItheNG signsB.C
and symptoms
M related to specific dental
conditions/emergencies likely to occur in the T
office O
26. A new patient comes in for an emergency examination due to constant unilateral facial pain
after a five-year lapse in dental as well as medical appointments. The clinician also notes a
change in the consistency of the parotid salivary gland to bony hard on that side of the face
but no overall glandular enlargement. Which of the following may be the present status of this
patient?
a. Transient facial paralysis
b. Glandular cancer
c. Hyposalivation with xerostomia
d. Mumps with parotitis
e. Perineural invasion of facial nerve
ANS: B
Feedback
A The parotid salivary gland can be pierced and the facial nerve temporarily
traumatized when an inferior alveolar block is incorrectly administered causing
transient facial paralysis, but this does NOT involve constant pain.
B The parotid salivary gland can be involved in cancer that can change the
consistency of the gland to bony hard and may, in a lesser number of cases,
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cause unilateral facial pain on the involved side because the facial nerve or
seventh cranial nerve travels through the gland; there then is perineural invasion
due to the cancer.
C Certain medications, disease, or destruction of salivary tissue by radiation
therapy may result in hyposalivation by the salivary glands, which is a reduced
production of saliva. This can result in xerostomia or dry mouth, but NO pain or
change in salivary consistency is usually present unless DIRECTLY after
radiation therapy or with an immune disorder that would involve glandular
enlargement.
D The parotid salivary gland also becomes enlarged and tender when a patient has
mumps but NOT bony hard or constantly painful.
E This contagious viral infection usually involves bilateral inflammatory
enlargement or parotitis.

General Chairside, VI. A. 1. Identify medical conditions that can cause medical emergencies in
patients
MULTIPLE RESPONSE
1. From the following list of descriptions, select which descriptions could CORRECTLY be
used to describe the lacrimalN URS(Select
gland. INGTall
B.C OM
that apply.)
a. Secretes a mucous fluid
b. Innervated by parasympathetic fibers
c. Drains into superficial parotid lymph nodes
d. Lubricates the inside of the eyelids
ANS: B, C, D
Feedback
Correct The lacrimal gland is innervated by parasympathetic fibers, drains into the
superficial parotid lymph nodes, and lubricates the inside of the eyelids.
Incorrect The lacrimal gland does NOT secrete a mucous fluid but a watery fluid
instead.

2. From the following list of descriptions, select which descriptions could be used
CORRECTLY to describe the thyroid gland. (Select all that apply.)
a. Produces parathyroid hormone
b. Secretes thyroxine
c. Visible and palpable if present
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d. Not visible or palpable

ANS: B, C
Feedback
Correct The thyroid gland produces and secretes thyroxine. The thyroid gland is
both visible and palpable, if present.
Incorrect The thyroid gland does NOT produce parathyroid hormone; instead, the
parathyroid gland produces and secretes parathyroid hormone. The thyroid
gland is both visible and palpable, if present.

3. From the following list of descriptions, select which descriptions could be used
CORRECTLY to describe the thymus gland. (Select all that apply.)
a. Matures lymphocytes
b. Undergoes involution
c. Easily palpable in mandibular region
d. Innervated by branches of vagus nerve
ANS: A, B, D
Feedback
Correct The thymus gland matures T-cell lymphocytes, shrinks as an adult to
undergo involution,
NUand
RSisINinnervated
GTB.CO byMbranches of vagus nerve.
Incorrect The thymus gland is NOT easily palpated and is located in the thorax and
anterior region of the base of the neck, inferior to the thyroid gland, and
NOT the mandibular region.

4. From the following list of glands, select which glands DIRECTLY drain into the
submandibular lymph nodes. (Select all that apply.)
a. Sublingual salivary gland
b. Submandibular salivary gland
c. Parotid salivary gland
d. Thyroid gland
e. Thymus gland
ANS: A, B
Feedback
Correct The sublingual salivary gland and submandibular salivary gland both
DIRECTLY drain into the submandibular lymph nodes.
Incorrect The parotid gland DIRECTLY drains into the deep parotid lymph nodes,
and the thyroid gland DIRECTLY drains into the superior deep cervical
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lymph nodes. The thymus gland has lymphatics that arise within the
substance of the gland and terminate in the internal jugular vein.

5. From the following list of glands, select which glands DIRECTLY drain into the superior
deep cervical lymph nodes. (Select all that apply.)
a. Sublingual salivary gland
b. Submandibular salivary gland
c. Parotid salivary gland
d. Thyroid gland
e. Thymus gland
ANS: C, D
Feedback
Correct Both the thyroid gland and parathyroid glands DIRECTLY drain into the
superior deep cervical lymph nodes.
Incorrect The sublingual salivary gland and submandibular salivary gland both
DIRECTLY drain into the submandibular lymph nodes. The thymus gland
has lymphatics that arise within the substance of the gland and terminate
in the internal jugular vein.

TOP: CDA: General Chairside,NI.UA.
RSDemonstrate
INGTB.C OM
understanding of basic oral and dental anatomy,
6. A patient of record recently on a new antidepressant states that their eyes are also drier than in
the past. Which of the following may also be present with this patient? (Select all that apply.)
a. Less lacrimal fluid
b. Dry eye syndrome
c. Hyposalivation
d. Xerostomia
ANS: A, B, C, D
In contrast to the usual moisture level of the eyes or even crying, there can be persistent
dryness, which is one of the signs of dry eye syndrome. With this syndrome, the lacrimal
glands produce less lacrimal fluid, which mainly occurs with aging or certain medications
such as antidepressants, especially when newly taken. Medications or diseases that cause dry
eye syndrome can also cause hyposalivation with xerostomia or dry mouth.

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7. Which of the following descriptive statements CORRECTLY concern the minor salivary
glands of the oral cavity? (Select all that apply.)
a. Smaller in size than major salivary glands
b. Secrete mainly a serous type of salivary product
c. Less numerous than major salivary glands
d. Found within soft palatal tissue
e. Each has a single duct that secretes saliva
ANS: A, D, E
Feedback
Correct The minor salivary glands are smaller than the larger major salivary
glands. Most of the minor salivary glands are scattered in the tissue of the
buccal, labial, and lingual mucosa, the soft palate, the lateral parts of the
hard palate, and the floor of the mouth as well as associated with the
circumvallate lingual papilla’s base. Each gland has a single duct that
secretes saliva.
Incorrect The minor salivary glands are NOT less numerous than major salivary
glands. Most minor salivary glands secrete a mainly mucous type of
salivary product, with some serous secretion and NOT mainly a serous
type of product. The exception is von Ebner glands, which secrete only a
serous type of salivary product.

NURSINGTB.COM
8. When palpating the right submandibular salivary gland, the clinician notes a stony, hard mass
during the extraoral examination and observes that the gland’s superficial lobe is slightly
enlarged and tender. What information can be shared with the patient concerning this
situation? (Select all that apply.)
a. Can be uncomfortable but is not a dangerous situation
b. Gland may be involved with salivary stone(s)
c. Computed tomography can confirm diagnosis
d. May only need manipulation of stone or minor surgery
ANS: A, B, C, D
Salivary stones are uncomfortable but not dangerous and can involve one or more enlarged,
tender salivary glands. The clinician may also be able to palpate the stony, hard salivary
stone(s) during examination. Facial radiographs or computed tomography can confirm the
diagnosis. Salivary stones are usually removed manually or with minor surgery.

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MATCHING
From the following list of exocrine glands, match those with their CORRECT associated
location.
a. Within fossa of frontal bone
b. Posterior to mandibular ramus
c. Superficial and posterior to mylohyoid muscle
d. At floor of the mouth
1. Lacrimal gland
2. Submandibular salivary gland
3. Sublingual salivary gland
4. Parotid salivary gland
1. ANS: A DIF: Recall REF: p. 159, Table 7-1

OBJ: 2
2. ANS: C DIF: Recall REF: p. 159, Table 7-1
OBJ: 2
3. ANS: D DIF: Recall
N R I GREF:
B.C p. 159,
M Table 7-1
OBJ: 2 U S N T O
4. ANS: B DIF: Recall REF: p. 159, Table 7-1
OBJ: 2
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Chapter 08: Nervous System

MULTIPLE CHOICE
1. Which of the following effects is prevented from occurring on the target nerve during the
administration of a local anesthetic agent?
a. Resting potential
b. Action potential
c. Refractory period
d. Repolarization
ANS: B
Feedback
A The resting potential occurs when the difference in charge exists and the outside
of the nerve cell membrane has a positive charge, while the inside has a negative
charge. It occurs in the nonstimulated nerve.
B Local anesthetic agents are administered to prevent an action potential, which is
a rapid depolarization of the nerve cell membrane resulting in generation of a
nerve impulse. An action potential temporarily reverses the resting potential that
exists.
C The refractory period refers to a brief period after an action potential, during
which the nerve CANNOT be stimulated.
D The repolarization reestablishes the resting potential.
NURSINGTB.COM
for Dental Hygiene Practice, 2.0 Physiology
2. Sympathetic and parasympathetic nerves are antagonistic to one another. BOTH nerve
systems function as part of the somatic nervous system.
ANS: C
Feedback
A Although the nerves are antagonistic to one another, they are part of the
autonomic nervous system, NOT the somatic nervous system.
B Although the nerves are antagonistic to one another, they are part of the
C Although the nerves are antagonistic to one another, they are part of the
D Although the nerves are antagonistic to one another, they are part of the
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3. Which of the following actions could result from involvement by the efferent part of the fifth
cranial nerve?
a. Puckering the lips
b. Feeling when biting the tongue
c. Toothache in the jaw
d. Chewing a piece of gum
ANS: D
Feedback
A The muscles that surround the lip are muscles of facial expression such as that
which occurs with puckering of the lips and are innervated by the seventh cranial
nerve or facial nerve.
B Sensations such as pain from biting the tongue are carried by the afferent or
sensory component of the fifth cranial nerve or trigeminal nerve.
C Sensations such as pain from a toothache are carried by the afferent or sensory
component of the fifth cranial nerve or trigeminal nerve.
D The efferent or motor part of the fifth cranial nerve or trigeminal nerve
innervates the muscles of mastication such as that which occurs with chewing.
N R I G B.C M
U S N REF: T p. O179
DIF: Comprehension OBJ: 4
4. Which of the following skull foramina are associated with the pathway of the seventh cranial
nerve from the brain to the facial region?
a. Foramen ovale and foramen rotundum
b. Foramen spinosum and external acoustic meatus
c. Internal acoustic meatus and external acoustic meatus
d. Internal acoustic meatus and stylomastoid foramen
ANS: D
Feedback
A Both the foramen ovale and foramen rotundum are associated with the maxillary
and mandibular nerves, the second and third divisions, respectively, of the fifth
cranial nerve or trigeminal nerve.
B Seventh cranial nerve or facial nerve is NOT associated with and does NOT
travel through the foramen spinosum and external acoustic meatus.
C Although the seventh cranial nerve or facial nerve enters the skull and travels
through the temporal bone, it does NOT exit the temporal bone through the
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external acoustic meatus, which is the opening to the external ear.

D The seventh cranial nerve or facial nerve leaves the brain through the internal
acoustic meatus, travels through the temporal bone, and exits the skull through
the stylomastoid foramen.

5. When a patient complains of pain associated with a thermal burn caused by hot coffee on the
anterior dorsal surface of the tongue, which of the following nerves transmits this pain?
a. Glossopharyngeal nerve
b. Facial nerve
c. Vestibulocochlear nerve
d. Hypoglossal nerve
ANS: B
Feedback
A The glossopharyngeal nerve or ninth cranial nerve provides sensory innervation
to the posterior tongue, which is the base (posterior one-third) and NOT that as
noted in the case study discussed.
B The facial nerve or seventh cranial nerve provides sensory innervation to the
body of the tongue (anterior one-third) such as that noted in the case study
discussed. NURSINGTB.COM
C The vestibulocochlear nerve or eighth cranial nerve provides sensory innervation
for hearing and balance and does NOT provide any innervation to or from the
tongue.
D The hypoglossal nerve or twelfth cranial nerve is a motor nerve for both the
intrinsic and extrinsic tongue muscles.

Individualized Patient Education
6. Discomfort from an infection of BOTH the frontal and ethmoidal sinuses would be associated
with involvement of which of the following nerves?
a. Facial nerve
b. Frontal nerve
c. Nasociliary nerve
d. Optic nerve
ANS: C
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Feedback
A The facial nerve or seventh cranial nerve does NOT innervate the sinuses.
B The frontal nerve, a branch off the ophthalmic nerve that is the first division of
the trigeminal nerve or fifth cranial nerve, provides sensory innervation to the
anterior scalp and forehead, as well as the bridge of the nose and part of the
upper eyelid, but NOT the sinuses.
C The nasociliary nerve, a branch off the ophthalmic nerve that is the first division
of the trigeminal nerve or fifth cranial nerve, provides sensory innervation to the
nasal cavity and paranasal sinuses.
D The optic nerve or second cranial nerve provides sensory innervation necessary
for vision.

7. Which of the following nerves listed below does NOT go on to form the maxillary nerve
within the pterygopalatine fossa?
a. Nasopalatine nerve
b. Infraorbital nerve
c. Incisive nerve
d. Anterior superior alveolar nerve
ANS: C
A The nasopalatine nerve joins other branches of the maxillary nerve, the second
division of the trigeminal nerve or fifth cranial nerve, within the pterygopalatine
fossa.
B The infraorbital nerve joins other branches of the maxillary nerve, the second
division of the trigeminal nerve or fifth cranial nerve, in the pterygopalatine
fossa.
C The incisive nerve provides sensory innervation to the mandibular incisors and
premolars along with their associated periodontium and is included as a branch
of the inferior alveolar nerve. It is part of the mandibular nerve or third division,
NOT the maxillary nerve or second division of the trigeminal nerve.
D The anterior superior alveolar nerve joins other branches of the maxillary nerve,
the second division of the trigeminal nerve or fifth cranial nerve, within the
pterygopalatine fossa.

8. During a dental procedure on the buccal surface of the maxillary molars, a patient reports
discomfort in the buccal gingival tissue. Which of the following nerves carries this sensation
to the brain and may need to be anesthetized?
a. Buccal nerve
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b. Posterior superior alveolar nerve

c. Zygomaticofacial nerve
d. Chorda tympani nerve
ANS: B
Feedback
A The buccal nerve, a branch of the mandibular nerve that is the third division of
the trigeminal nerve or fifth cranial nerve, provides sensory innervation from the
buccal gingival tissue of mandibular molars, NOT maxillary molars.
B The maxillary buccal gingival tissue of the maxillary molars is innervated, along
with the pulpal tissue of the maxillary molars and associated periodontium, by
the posterior superior alveolar nerve, a branch of the maxillary nerve that is that
is the second division of the trigeminal nerve or fifth cranial nerve.
C The zygomaticofacial nerve, a branch of the zygomatic nerve that joins the
maxillary nerve or second division of the trigeminal nerve or fifth cranial nerve,
serves as a sensory nerve for the skin of the cheek.
D The chorda tympani nerve, a branch of the facial nerve or seventh cranial nerve,
is a parasympathetic efferent (motor) nerve to the submandibular and sublingual
salivary glands.

for Dental Hygiene Practice, 2.0NPhysiology
R I G| NBDHE,
B.C Provision of Clinical Dental Hygiene Services,
M
U S N T O
Planning and Managing Dental Hygiene Care | NBDHE, Provision of Clinical Dental Hygiene
Services, 4.0 Performing Periodontal Procedures
9. During an oral surgical procedure on the posterior hard palate, which of the following nerves
MUST be anesthetized to provide patient comfort?
b. Posterior superior alveolar nerve
c. Greater palatine nerve
d. Lesser palatine nerve
ANS: C
Feedback
A The nasopalatine nerve, a branch off the maxillary nerve or second division of
the trigeminal nerve or fifth cranial nerve, is the sensory nerve for the anterior
hard palate that is mesial to both maxillary premolars.
B The posterior superior alveolar nerve, a branch off the maxillary nerve or second
division of the trigeminal nerve or fifth cranial nerve, is the sensory nerve for the
maxillary molars, their periodontium, and associated buccal gingival tissue.
C The greater palatine nerve, a branch off the maxillary nerve or second division of
the trigeminal nerve or fifth cranial nerve, is the sensory nerve for the posterior
palatal gingival tissue and posterior hard palate. It needs to be anesthetized to
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provide patient comfort during an oral surgical procedure on the posterior hard
palate.
D The lesser palatine nerve, a branch off the maxillary nerve or second division of
the trigeminal nerve or fifth cranial nerve, is the sensory nerve for the soft palate
and palatine tonsils; it sometimes is anesthetized with the greater palatine nerve,
leading to a heightened gag response.

Clinical Dental Hygiene Services, 4.0 Performing Periodontal Procedures
10. Which of the following nerves communicates with the lingual nerve within the submandibular
ganglion?
b. Hypoglossal nerve
c. Greater petrosal nerve
d. Mylohyoid nerve
ANS: A
Feedback
A The chorda tympani nerve, a branch off the facial nerve or seventh cranial nerve,
travels alongside the lingual nerve, communicates with it within the
submandibular ganglion, and provides parasympathetic motor innervation to the
NURSsalivary
submandibular and sublingual
INGTB.C OM
glands.
B The hypoglossal nerve or twelfth cranial nerve provides efferent (motor)
innervation for the extrinsic and intrinsic muscles of the tongue.
C The greater petrosal nerve, a branch of the facial nerve, provides afferent
(sensory) nerve fibers for taste from the palate.
D The mylohyoid nerve, a branch of the inferior alveolar nerve that is of the
mandibular nerve off the trigeminal nerve or fifth cranial nerve, serves as an
efferent nerve to the mylohyoid muscle and anterior belly of the digastric muscle
after it exits the mandibular foramen.

11. After administration of an inferior alveolar nerve block, the patient reports that the lingual
gingival tissue of the mandibular premolars and molars is still sensitive. Which nerve usually
provides sensation from the gingival tissue in this area?
a. Mylohyoid nerve
b. Lingual nerve
c. Mental nerve
d. Incisive nerve
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ANS: B
Feedback
A The mylohyoid nerve, a branch of the inferior alveolar nerve that is of the
mandibular nerve off the trigeminal nerve or fifth cranial nerve, is the motor
nerve to the inferior mylohyoid and anterior digastric muscles. In some cases, it
may provide some sensory innervation from the lingual gingival tissue of the
mandibular first molar but NOT from the mandibular premolars and other
mandibular molars.
B The lingual nerve, a branch of the mandibular nerve off the trigeminal nerve or
fifth cranial nerve, is the sensory nerve for the body of the tongue, floor of the
mouth, and lingual gingival tissue of ALL the mandibular teeth. As it travels
superiorly, it eventually runs anterior and slightly medial to the inferior alveolar
nerve and is usually anesthetized along with the nearby inferior alveolar nerve
due to diffusion. Possibly the inferior alveolar block has NOT been correctly
administered.
C The mental nerve, a branch of the inferior alveolar nerve of the mandibular nerve
off the trigeminal nerve or fifth cranial nerve, is the sensory nerve from the chin,
lower lip, and labial mucosa of the mandibular anterior teeth and premolars.
D The incisive nerve, a branch of the inferior alveolar nerve of the mandibular
nerve off the trigeminal nerve or fifth cranial nerve, is sensory from the
mandibular anterior teeth and premolars, their surrounding periodontium, and
facial gingival tissue.
DIF: Application REF: pp. 189, 192 OBJ: 7

physiology, and development | N URSGeneral
CDA: INGTChairside,
B.COMI. B. Preliminary Physical Examination |
for Dental Hygiene Practice, 2.0 Physiology | NBDHE, Provision of Clinical Dental Hygiene Services,
Individualized Patient Education | NBDHE, Provision of Clinical Dental Hygiene Services, 4.0
Performing Periodontal Procedures
12. Which of the following nerve branches of the facial nerve supplies motor innervation to the
buccinator, risorius, and upper lip muscles?
a. Temporal nerve branch
b. Zygomatic nerve branch
c. Buccal nerve branch
d. Mandibular nerve branch
ANS: C
Feedback
A The temporal branch of the facial nerve or seventh cranial nerve provides motor
innervation to muscles located more superiorly. These muscles include the
frontal belly of the epicranial muscle, muscles anterior to the ear, and the
superior orbicularis oculi and corrugator muscles.
B The zygomatic branch of the facial nerve or seventh cranial nerve innervates the
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orbicularis oculi and zygomatic muscles.

C The buccal branch of the facial nerve or seventh cranial nerve supplies motor
innervation to the muscles of the upper lip and nose, as well as the buccinator,
risorius, and orbicularis oris muscles.
D The mandibular branch of the facial nerve or seventh cranial nerve supplies the
mentalis muscles, as well as the muscles of the lower lip.

13. Which of the following pairs of nerves merges posterior to the mental foramen to form the
inferior alveolar nerve?
a. Incisive and lingual nerves
b. Incisive and mental nerves
c. Mylohyoid and mental nerves
d. Mylohyoid and inferior dental plexus nerves
ANS: B
Feedback
A The lingual nerve does NOT travel within the mandibular canal and does NOT
provide sensory innervation to the teeth and periodontium like the incisive nerve.
B The incisive and mental nerves do merge posterior to the mental foramen to
form the inferior alveolar
N nerve
RSIthatGtravels within the mandibular canal.
C The mylohyoid nerve doesUNOT N TB.C
travel OM
within the mandibular canal like the
mental nerve but provides innervation to the floor of the mouth. However, the
mylohyoid does NOT merge with the mental nerve like the incisive nerve does.
D The mylohyoid nerve does NOT travel within the mandibular canal like the
mental nerve but travels along the medial surface of the mandible and provides
innervation about the floor of the mouth. The mylohyoid nerve does NOT merge
with the inferior dental plexus nerves.

14. Which of the following structures is/are innervated by the motor fibers within the mandibular
nerve or third division of the trigeminal nerve?
a. Muscles of mastication
b. All parts of the tongue
d. Submandibular salivary glands
ANS: A
Feedback
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A The muscles of mastication do receive motor innervation from the mandibular

nerve or third division of the trigeminal nerve or fifth cranial nerve.
B The tongue receives motor innervation from the hypoglossal nerve or twelfth
cranial nerve and NOT from the mandibular nerve or third division of the
trigeminal nerve.
C The sternocleidomastoid muscle is innervated by motor fibers from the
accessory nerve or eleventh cranial nerve and NOT from the mandibular nerve
or third division of trigeminal nerve or fifth cranial nerve.
D Motor innervation to the submandibular salivary gland comes from the chorda
tympani nerve, which is a branch of the facial nerve or seventh cranial nerve,
and NOT from the mandibular nerve or third division of the trigeminal nerve or
fifth cranial nerve.

15. After a serious car accident, a fracture of the patient’s mandibular ramus has damaged nerve
tissue within the mandibular canal. The associated oral structures or tissue MOST likely to be
affected by this nerve damage would be the
a. tongue.
b. posterior buccal mucosa.
c. lingual alveolar mucosa.
d. mandibular teeth.
NURSINGTB.COM
ANS: D
Feedback
A The lingual nerve does NOT travel within the mandibular canal but does
innervate the tongue.
B The buccal nerve does NOT travel within the mandibular canal but does
innervate the posterior buccal mucosa.
C The lingual nerve, which receives gives sensory innervation to the floor of the
mouth and the lingual gingival tissue of the mandible, does NOT travel within
the mandibular canal.
D Sensory innervation from the mandibular teeth and their surrounding
periodontium travels via the inferior alveolar nerve within the mandibular canal.

CDA: General Chairside, V. A. Oral Health Information | CDA: General Chairside, VI. A. 4. Describe
how to respond to and assist in the management of the signs and symptoms related to specific medical
conditions/emergencies likely to occur in the dental office
Planning and Managing Dental Hygiene Care
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16. Which of the following structures listed below is innervated by the vagus nerve?
a. Parotid salivary gland
b. Floor of the mouth
d. Soft palate muscles
ANS: D
Feedback
A The parotid salivary gland receives motor innervation from the glossopharyngeal
nerve or ninth cranial nerve.
B The floor of the mouth has sensory innervation provided by the lingual nerve
and receives motor innervation from the mylohyoid nerve, both branches off the
trigeminal nerve or fifth cranial nerve.
C The sternocleidomastoid muscle is innervated by the accessory nerve or eleventh
cranial nerve.
D The soft palate, palatine tonsils, pharynx, and larynx are among the types of
tissue that are innervated by the vagus nerve or tenth cranial nerve.

17. Which of the following nerves is NOT part of the maxillary nerve or second division of the
trigeminal nerve? NURSINGTB.COM
a. Anterior superior alveolar nerve
b. Infraorbital nerve
c. Buccal nerve
d. Zygomaticotemporal nerve
ANS: C
Feedback
A The anterior superior alveolar nerve is a branch of the maxillary nerve or second
division of the trigeminal nerve or fifth cranial nerve.
B The infraorbital nerve is a branch of the maxillary nerve or second division of
the trigeminal nerve or fifth cranial nerve.
C The buccal nerve is a branch off the mandibular nerve or third division of the
trigeminal nerve or fifth cranial nerve and therefore is NOT part of the maxillary
division.
D The zygomaticotemporal nerve is a branch off the zygomatic nerve that joins the
maxillary nerve or second division of the trigeminal nerve or fifth cranial nerve.

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18. Which of the following pairings of nerve to bony opening is INCORRECT?

a. Mandibular nerve, foramen ovale
b. Olfactory nerve, cribriform plate
c. Oculomotor nerve, inferior orbital fissure
d. Vagus nerve, jugular foramen
ANS: C
Feedback
A The mandibular nerve or third division of the trigeminal nerve or fifth cranial
nerve is associated with the foramen ovale.
B The olfactory nerve or first cranial nerve is associated with the cribriform plate
of the ethmoid bone.
C There is NO association between the nerve and bony opening. The oculomotor
nerve or third cranial nerve travels through the superior orbital fissure and NOT
the cribriform plate.
D The vagus nerve or tenth cranial nerve is associated with the jugular foramen.

19. Where does the infraorbital nerve receive the posterior superior alveolar nerve in order to
form the maxillary nerve?
a. Infratemporal fossa
b. Inferior orbital fissure NURSINGTB.COM
c. Maxillary tuberosity
d. Pterygopalatine fossa
ANS: D
Feedback
A The infratemporal fossa is located posterior to the meeting place of these two
nerves. Instead, both nerves are pterygopalatine fossa branches of the maxillary
nerve or second division of the trigeminal nerve or fifth cranial nerve.
B The inferior orbital fissure is too anterior for the meeting of these two nerves.
C The posterior alveolar nerve enters the posterior superior alveolar foramina that
are posterosuperior and medial to the maxillary tuberosity on the surface of the
maxilla after it meets the infraorbital nerve.
D The infraorbital and posterior superior alveolar nerves do meet within the
pterygopalatine fossa.

20. Which of the following nerves carry pulpal sensations from the maxillary canine?
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b. Anterior superior alveolar nerve

c. Middle superior alveolar nerve
d. Greater palatine nerve
ANS: B
Feedback
A The nasopalatine nerve, a branch off the maxillary nerve or second division of
anterior palate from the mesial of one maxillary premolar to the mesial of the
maxillary premolar on the contralateral side.
B The anterior superior alveolar nerve, a branch off the maxillary nerve or second
pulp tissue of the maxillary canine as well as the maxillary incisors.
C The middle superior alveolar nerve, a branch off the maxillary nerve or second
pulp tissue of the maxillary premolars and the mesiobuccal root of the maxillary
first molar, if present.
D The greater palatine nerve, a branch off the maxillary nerve or second division of
posterior hard palate from the maxillary premolars and molars to the midline.

N R I G B.C M
21. Which of the following nervesU S N motor
provides T innervation
O to the floor of the mouth?
a. Inferior alveolar nerve
c. Glossopharyngeal nerve
d. Mylohyoid nerve
ANS: D
Feedback
A The inferior alveolar nerve, a branch of the mandibular nerve or third division of
the trigeminal nerve or fifth cranial nerve, is an afferent nerve that provides
sensory innervation to the mandibular teeth and associated periodontium.
B The hypoglossal nerve or twelfth cranial nerve provides efferent (motor)
innervation to the tongue and NOT the floor of the mouth.
C The glossopharyngeal nerve or ninth cranial nerve provides efferent innervation
to some pharyngeal muscles and the parotid salivary gland and NOT to the floor
of the mouth.
D The mylohyoid nerve, a branch of the mandibular nerve or third division of the
trigeminal nerve or fifth cranial nerve, provides efferent innervation to the floor
of the mouth and the anterior belly of the digastric muscle.

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22. Which part of the brain is involved in the regulation of BOTH the heartbeat and breathing?
a. Medulla
b. Pons
c. Cerebellum
d. Midbrain
ANS: A
Feedback
A The medulla plays an important role in regulating heartbeat, breathing, blood
pressure, and reflex centers.
B The pons serves as a connection between the medulla and other parts of the
brain.
C The cerebellum is important for muscle coordination and tone, along with
balance.
D The midbrain includes relay stations for hearing, vision, and motor pathways.

23. Branches of the facial nerve traverse all of the following openings EXCEPT the
a. foramen rotundum.
b. internal auditory meatus.NURSINGTB.COM
c. stylomastoid foramen.
d. pterygoid canal.
ANS: A
Feedback
A The foramen rotundum allows the maxillary nerve or second division of the
trigeminal nerve to traverse instead of the facial nerve.
B Branches of the facial nerve or seventh cranial nerve traverse the internal
auditory meatus.
C Branches of the facial nerve or seventh cranial nerve traverse stylomastoid
foramen.
D Branches of the facial nerve or seventh cranial nerve traverse pterygoid canal.

24. Which of the following nerves convey parasympathetic fibers to the lacrimal gland?
b. Oculomotor nerve
c. Glossopharyngeal nerve
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d. Zygomatic nerve
ANS: D
Feedback
A The chorda tympani nerve, a branch of the facial nerve or seventh cranial nerve,
is a parasympathetic efferent nerve for the submandibular and sublingual
salivary glands and also serves as an afferent nerve for taste sensation for the
body of the tongue.
B The oculomotor nerve or third cranial nerve serves as an efferent nerve to some
of the eye muscles that move the eyeball. The nerve also carries preganglionic
parasympathetic fibers to the ciliary ganglion near the eyeball.
C The glossopharyngeal nerve or ninth cranial nerve carries an efferent component
for the pharyngeal muscle, the stylopharyngeus muscle, and the preganglionic
gland parasympathetic innervation for the parotid salivary gland (relaying the
otic ganglion).
D The zygomatic nerve that joins the maxillary nerve or second division of the
trigeminal nerve or fifth cranial nerve conveys the postganglionic
parasympathetic fibers for the lacrimal gland to the lacrimal nerve.

25. What structure when DIRECTLY damaged also results in the disruption of the nasopalatine
nerve? NURSINGTB.COM
a. Nasal bones
b. Nasal septum
c. Frontal bone
d. Bridge of nose
ANS: B
Feedback
A The nasal bones are paired small oblong facial bones that lay side by side, fused
to each other to form the bridge of the nose in the midline superior to the
piriform aperture. Instead, the nasopalatine nerve travels along the nasal septum.
B Anteriorly, the nasal septum is formed by both the perpendicular plate of the
ethmoid bone superiorly and the nasal septal cartilage inferiorly. The posterior
parts of the nasal septum are formed by the vomer. The nasopalatine nerve
originates in the mucosa of the anterior hard palate, palatal to the maxillary
central incisors. The right and left nasopalatine nerves enter the incisive canal by
way of the incisive foramen, deep to the incisive papilla, thus exiting the oral
cavity. The nerve then travels along the nasal septum.
C The frontal bone is a single cranial bone that forms the anterior part of the skull
superior to the eyes in the frontal region, and includes the forehead, the roof of
the orbits, and part of the nasal cavity. Instead, the nasopalatine nerve travels
along the nasal septum.
D The nasal bones are small, oblong, paired facial bones that lie side by side, fused
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to each other to form the bridge of the nose in the midline superior to the
piriform aperture. Instead, the nasopalatine nerve travels along the nasal septum.

26. When periodontal scaling on the palatal gingival tissue of the maxillary right second molar
under block anesthesia administered ONLY to the maxillary right posterior sextant, the patient
begins to gag without initiation by the clinician. What nerve was inadvertently anesthetized so
as to cause this situation?
b. Greater palatine nerve
c. Lesser palatine nerve
d. Middle superior alveolar nerve
ANS: C
Feedback
Correct When administered anesthesia to greater palatine nerve by way of a block,
some patients may become uncomfortable and may gag if the soft palate
becomes inadvertently and harmlessly anesthetized even without clinician
initiation, which is possible given the proximity of the lesser palatine
nerve.
Incorrect Greater palatine nerve is already anesthetized by a block and is NOT
inadvertent anesthesia since the clinician is scaling the anesthetized palatal
gingival tissue ofNtheRmaxillary
INGTsecond
B.C M molar. The anesthesia of the
nasopalatine nerveU by S
a block results O
in anesthesia of the anterior hard
palate within the maxillary anterior sextant and NOT the posterior hard
palate within the maxillary posterior sextant. The middle superior alveolar
nerve may be anesthetized by a block due to its coverage of the
mesiobuccal root of the maxillary first molar that is within the maxillary
right posterior sextant, if the nerve is present, but this does NOT cause
gagging as a result of soft palate anesthesia.

with intraoral procedures | CDA: General Chairside, V. A. Oral Health Information | CDA: General
Chairside, VI. A. 4. Describe how to respond to and assist in the management of the signs and
symptoms related to specific medical conditions/emergencies likely to occur in the dental office
for Dental Hygiene Practice, 2.0 Physiology | NBDHE, Scientific Basis for Dental Hygiene Practice,
1.0 Assessing Patient Characteristics | NBDHE, Scientific Basis for Dental Hygiene Practice, 3.0
Planning and Managing Dental Hygiene Care | NBDHE, Scientific Basis for Dental Hygiene Practice,
MULTIPLE RESPONSE
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1. From the following list of descriptions, select those that can be used to describe the middle
superior alveolar nerve. (Select all that apply.)
a. Present in all patients
b. Communicates with adjacent nerves
c. May be absent in some patients
d. Never communicates with adjacent nerves
ANS: B, C
Feedback
Correct The middle superior alveolar nerve may be absent in some patients. But if
present, the nerve communicates with adjacent nerves within the maxillary
arch, both the anterior and posterior superior alveolar nerves.
Incorrect The middle superior alveolar nerve may be absent in some patients, so it is
NOT present in all patients. But if present, the nerve communicates with
the adjacent nerves in the maxillary arch, the anterior and posterior
superior alveolar nerves.

2. From the following list of nerves, select those nerves that supply the parotid salivary gland.
a. Glossopharyngeal nerve
c. Auriculotemporal nerve NURSINGTB.COM
d. Facial nerve
e. Accessory nerve
ANS: A, C
Feedback
Correct The parotid salivary gland is supplied by both the glossopharyngeal nerve
or ninth cranial nerve (efferent) and the auriculotemporal nerve, a branch
off the mandibular nerve, which is the third division off the trigeminal
nerve or fifth cranial nerve (afferent).
Incorrect The tongue muscles are supplied by the hypoglossal nerve or twelfth
cranial nerve (efferent), and the facial nerve or seventh cranial nerve
supplies the muscles of facial expression (efferent) and well as the
submandibular and sublingual salivary glands (efferent). The accessory
nerve or eleventh cranial nerve supplies the trapezius and
sternocleidomastoid muscles (efferent).

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3. From the following list of terms, select those terms that can be used to describe the part of the
fifth cranial nerve that is formed by the merger of two trunks. (Select all that apply.)
a. Second division
b. Maxillary nerve
c. Third division
d. Mandibular nerve
ANS: C, D
Feedback
Correct The part of the fifth cranial nerve (or trigeminal nerve) that is formed by
the merger of two trunks is the mandibular nerve or third division; a
smaller anterior trunk and a larger posterior trunk form this nerve.
Incorrect The maxillary nerve is the second division of the fifth cranial nerve or
trigeminal nerve and is NOT formed by two trunks but is instead one
nerve trunk that is formed from the convergence of many nerves.

4. From the list of regions of the oral cavity, select the regions where crossover-innervation
occurs in the jaws of patients that may complicate local anesthesia procedures. (Select all that
apply.)
a. Maxillary anterior sextant
b. Maxillary posterior sextants
c. Mandibular anterior sextantNURSINGTB.COM
d. Mandibular posterior sextants
ANS: A, C
Feedback
Correct Both the maxillary and mandibular anterior sextants may be involved in
the crossover-innervation involving the anterior superior alveolar nerve
and the incisive nerve, respectively. This presence of
crossover-innervation may complicate local anesthesia procedures in
patients in these sextants.
Incorrect Both the maxillary and mandibular posterior sextants are NOT involved in
the crossover-innervation.

CDA: General Chairside, V. A. Oral Health Information | CDA: General Chairside, VI. A. 4. Describe
how to respond to and assist in the management of the signs and symptoms related to specific medical
conditions/emergencies likely to occur in the dental office
3.0 Planning and Managing Dental Hygiene Care | NBDHE, Provision of Clinical Dental Hygiene
Services, 4.0 Performing Periodontal Procedures
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5. From the following list of descriptions, select those that can be used to describe the chorda
tympani nerve. (Select all that apply.)
a. Afferent taste sensation for base of the tongue
b. Communicates with the lingual nerve via the pterygopalatine ganglion
c. Parasympathetic efferent nerve for the salivary glands
d. Exits the skull by way of the petrotympanic fissure
ANS: C, D
Feedback
Correct The chorda tympani nerve, a branch of the facial nerve or seventh cranial
nerve, serves as a parasympathetic efferent nerve for salivary glands
(submandibular and sublingual) and exits the skull by way of the
petrotympanic fissure.
Incorrect The chorda tympani nerve, a branch of the facial nerve or seventh cranial
nerve, serves the afferent taste sensation for the body of the tongue and
NOT the base; the lingual nerve communicates with the chorda tympani
nerve via the submandibular ganglion and NOT the pterygopalatine
ganglion.

6. Which of the following local anesthetic nerve blocks can be administered that will anesthetize
NURSall
the inferior alveolar nerve? (Select INthat
GTapply.)
B.COM
a. Incisive nerve block
b. Gow-Gates nerve block
c. Inferior alveolar nerve block
d. Vazirani-Akinosi mandibular block
ANS: B, C, D
Feedback
Correct The Gow-Gates nerve block and the Vazirani-Akinosi mandibular nerve
block will anesthetize the inferior alveolar nerve as well as the inferior
alveolar block.
Incorrect Incisive nerve block ONLY anesthetizes the incisive nerve, which is part
of the inferior alveolar nerve, but NOT the entire inferior alveolar nerve
will be blocked. With the incisive block, the facial tissue and pulpal tissue
of the mandibular anteriors and premolars on one side will be
anesthetized. The entire lingual tissue and pulpal tissue of the mandibular
molars on one side will not be anesthetized.

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7. What should a clinician expect when working on a patient with a history of trigeminal
neuralgia? (Select all that apply.)
a. Unilaterally involves the maxillary or mandibular branches
b. Usually more involvement of the left side of the face
c. Pattern of pain follows along the seventh cranial nerve branch involved
d. Excruciating short-term pain when facial trigger zones are touched
ANS: A, D
Feedback
Correct It usually unilaterally involves either the maxillary or mandibular nerve
branches but not the ophthalmic branch. The patient may feel excruciating
short-term pain on one side of the face when facial trigger zones are
touched.
Incorrect The right side of the face, with its regions and structures, is affected more
commonly than the left side. The pattern of pain follows along the
pathway of the trigeminal nerve or fifth cranial nerve branch involved and
NOT the seventh cranial nerve or facial nerve.

Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics | NBDHE, Provision of
Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care | NBDHE,
NURSServices,
Provision of Clinical Dental Hygiene INGT4.0B.C OM Periodontal Procedures
Performing
MATCHING
From the following list of terms related to the nervous system, match the more commonly used
term with its alternative term.
a. Motor nerve
b. Sensory nervous system
c. Sensory nerve
d. Motor nervous system
1. Afferent nervous system

2. Afferent nerve
3. Efferent nervous system
4. Efferent nerve
1. ANS: B DIF: Recall REF: p. 172 OBJ: 3

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OTHER
1. Place the following in the CORRECT order of occurrence after rapid depolarization of the cell
membrane happens.
a. Sodium gates suddenly open in the membrane to allow sodium ions to pour in.
b. Rapid depolarization of the cell membrane results in an action potential.
c. Resting potential is reestablished again.
d. Propagation of the nerve impulse along the membrane occurs.
e. Sodium gates close and potassium channels open to allow potassium ions to pass to the
outside of the membrane.
ANS:
B, D, A, E, C
Feedback
Correct The rapid depolarization of the cell membrane results in an action
Order potential, which then causes propagation of the nerve impulse along the
NURpotential
membrane. An action SINGTisB.C OM reversal of the electric
a temporary
potential along the membrane for a brief period. Sodium gates suddenly
open in the membrane to allow sodium ions to pour in, bringing a positive
charge. At the height of the membrane potential reversal, sodium gates
close and potassium channels open to allow potassium ions to pass to the
outside of the membrane, reestablishing the resting potential.

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Chapter 09: Anatomy of Local Anesthesia

MULTIPLE CHOICE
1. Which of the following local anesthesia nerve blocks can be used during cosmetic
restorative procedures because, after procedures are completed, the clinician can
immediately and accurately access the patient’s smile line?
a. Anterior superior alveolar nerve block
b. Posterior superior alveolar nerve block
c. Anterior middle superior alveolar nerve block
d. Middle superior alveolar nerve block
ANS: C
Feedback
A The anterior superior alveolar nerve block can cause anesthesia to the soft tissue
of the patient’s lip and face.
B The posterior superior alveolar nerve block can cause anesthesia to the soft
tissue of the patient’s lip and face.
C The anterior middle superior alveolar nerve block can anesthetize multiple
maxillary teeth from the maxillary second premolar through the maxillary
central incisor, ALL without causing the usual collateral anesthesia to the soft
tissue of the patient’s lip and face as with most maxillary blocks near the
alveolar process of the maxilla.
D The middle superior alveolar nerve block can cause anesthesia to the soft tissue
of the patient’s lip and face.

TOP: CDA: General Chairside, I. A. Demonstrate understanding of basic oral and dental
anatomy, physiology, and development | CDA: General Chairside, II. C. Describe how to
perform and/or assist with intraoral procedures | CDA: General Chairside, V. A. Oral Health
Information
MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1 Anatomy | NBDHE,
Provision of Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics |
NBDHE, Provision of Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental
Hygiene Care | NBDHE, Provision of Clinical Dental Hygiene Services, 4.0 Performing
Periodontal Procedures
2. Which of the following local anesthesia nerve blocks is usually NOT used bilaterally due to
possible complications associated with swallowing and speech?
a. Incisive nerve block
b. Inferior alveolar nerve block
c. Posterior superior alveolar nerve block
d. Greater palatine nerve block
ANS: B
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Feedback
A The incisive nerve block anesthetizes teeth and tissue of the anterior and part of
the most anterior part of the posterior mandible but does NOT affect speech and
swallowing.
B A bilateral inferior alveolar nerve block can cause complete anesthesia of the
body of the tongue and floor of the mouth, resulting in speech and swallowing
difficulties.
C The posterior superior alveolar nerve block anesthetizes the teeth and
periodontium, including buccal gingival tissue of the maxillary molars, but does
NOT affect speech and swallowing.
D The greater palatine nerve block anesthetizes the hard palate. Gagging by the
patient may sometimes be a problem as the nearby lesser palatine nerve is also
anesthetized that serves the soft palate is also anesthetized, but the patient’s
speech is NOT usually affected by this block.

Information
3. As a result of a bicycle accident, a patient has suffered trauma to the right upper lip and
maxillary right central incisor. Which of the following local anesthetic blocks may be used
on the involved side when treating the injured tissue?
a. Anterior superior alveolar, infraorbital, and incisive nerve blocks
b. Infraorbital and nasopalatine nerve blocks
c. Anterior superior alveolar, middle superior alveolar, and greater palatine nerve
blocks
d. Infraorbital, greater palatine, and Gow-Gates mandibular nerve blocks
ANS: B
Feedback
A The incisive nerve block is used on the mandibular anterior teeth and premolars
and does NOT provide any anesthesia to maxillary arch.
B The infraorbital nerve block provides anesthesia to the maxillary facial tissue
for the maxillary anteriors and the maxillary labial mucosa as well as providing
anterior superior alveolar and middle superior alveolar nerve anesthesia that
would anesthetize the pulp tissue of the maxillary central incisor and associated
periodontium as well as nearby maxillary anteriors on the involved side. The
nasopalatine nerve block anesthetizes the anterior hard palate and associated
palatal gingival tissue.
C The middle superior alveolar nerve block would NOT be the best choice for
anesthetizing the maxillary anterior teeth since is associated mainly with
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anesthesia of pulp of the maxillary premolars and associated structures;

additionally, the greater palatine nerve block is used ONLY for the posterior
hard palate and associated palatal gingival tissue on one side.
D The greater palatine nerve block is used for the posterior hard palate ONLY, and
the Gow-Gates mandibular block is used to provide anesthesia to nerves that are
part of the mandibular nerve or third division of the trigeminal nerve for the
mandibular arch and NOT the maxillary arch.

anatomy, physiology, and development | CDA: General Chairside, I. B. Preliminary Physical
Examination | CDA: General Chairside, II. C. Describe how to perform and/or assist with
intraoral procedures | CDA: General Chairside, V. A. Oral Health Information
4. Orientation of the syringe for the anterior middle superior alveolar nerve block SHOULD be
from the contralateral premolars. The angle of the needle SHOULD be placed at
approximately 45 degrees to the injection site.
ANS: A
Feedback
A The needle is placed at an approximately 45-degree angle to the injection site of
the palate for the anterior middle superior alveolar nerve block.
B The injection site for the anterior middle superior alveolar nerve block is
approached from the contralateral maxillary premolars on the palate.
C The anterior middle superior alveolar nerve block is achieved by approaching
the site from the contralateral premolars and maintaining the needle at an
approximately 45-degree angle to the injection site of the palate.
D The anterior middle superior alveolar nerve block is achieved by approaching
the site from the contralateral premolars and maintaining the needle at an
approximately 45-degree angle to the injection site of the palate.

Information
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5. Which of the following local anesthetic nerve blocks uses the apex of the maxillary canine
for a landmark during administration?
a. Infraorbital nerve block
b. Anterior superior alveolar nerve block
c. Middle superior alveolar nerve block
d. Posterior superior alveolar nerve block
ANS: B
Feedback
A The height of the mucobuccal fold at the apex of the maxillary first premolar is
used as the injection site for the infraorbital nerve block.
B The height of the mucobuccal fold at the apex of the maxillary canine is used as
the injection site for the anterior superior alveolar nerve block.
C The injection site for the middle superior alveolar nerve block is at the height of
the mucobuccal fold at the apex of the maxillary second premolar.
D The injection site for the posterior superior alveolar nerve block is at the height
of the mucobuccal fold at the apex of the maxillary second molar.

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6. When administering a local anesthetic agent to a patient’s teeth and their related dental
structures, which three bones of the head and neck have the landmarks essential for
clinically effective injection technique?
a. Maxillae, mandible, and temporal bones
b. Maxillae, mandible, and zygomatic bones
c. Maxillae, mandible, and palatine bones
d. Maxillae, mandible, and sphenoid bones
ANS: C
Feedback
A The temporal bone is NOT involved in either maxillary or mandibular
injections.
B The zygomatic bone is NOT involved in either maxillary or mandibular
injections.
C The maxillae, mandible, and palatine bones contain the foramina or alveolar
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processes, through which sensory nerves from dental structures travel. These
bones also have external and internal landmarks that help the clinician identify
target areas for needle placement.
D Sphenoid bone is NOT involved in either maxillary or mandibular injections.

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7. Only one injection is necessary when anesthetizing BOTH the right and left maxillary
anterior palate and associated palatal gingival tissue. Pressure anesthesia during the
nasopalatine local anesthetic nerve block is NOT helpful with patient comfort.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: C
Feedback
A The first statement is true. Both nasopalatine nerves are anesthetized with one
injection. The second statement is false. Pressure anesthesia is helpful in
decreasing patient discomfort.
B Both the right and left nasopalatine nerves are anesthetized by the nasopalatine
nerve block. Pressure anesthesia is helpful to decrease patient discomfort in this
sensitive area. Thus the first statement is true, and the second statement is false.
C The first statement is true. Both nasopalatine nerves are anesthetized with one
D The first statement is true. Both nasopalatine nerves are anesthetized with one

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8. Which of the following descriptions concerning the injection site for the anterior middle
superior alveolar local anesthetic nerve block is CORRECT?
a. Approximately midway between the median palatine raphe and the palatal
gingival margin of the maxillary premolars
b. Approximately10 mm medial and directly superior to the palatal gingival margin
of the maxillary third molar, anterior to the depression of the greater palatine
foramen
c. At the height of the mucobuccal fold at the apex of the maxillary canine
d. At the height of the mucobuccal fold at the apex of the maxillary first premolar
ANS: A
Feedback
A This injection site of approximately midway between the median palatine raphe
and the palatal gingival margin of the maxillary premolars will allow
penetration of the local anesthetic agent through the small pores of the maxilla
of the hard palate, thus reaching the anterior to middle part of the superior
dental nerve plexus.
B This is the injection site for the greater palatine nerve block.
C This is the injection site for the anterior superior alveolar nerve block.
D This is the injection site for the middle superior alveolar nerve block.
DIF: Comprehension REF: p. 223 OBJ: 3 | 4

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9. Which of the following local anesthetic nerve blocks when administered together would
provide the GREATEST area of anesthesia to a maxillary quadrant?
a. Anterior superior alveolar, posterior superior alveolar, and greater palatine nerve
blocks
b. Middle superior alveolar and greater palatine nerve blocks
c. Middle superior alveolar, posterior superior alveolar, and greater palatine nerve
blocks
d. Anterior middle superior alveolar and posterior superior alveolar nerve blocks
ANS: D
Feedback
A The palatal tissue of the maxillary anteriors would NOT be anesthetized as well
as the maxillary premolars if the middle superior alveolar nerve is present but is
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NOT being anesthetized.

B The pulp tissue of the maxillary anterior and posterior teeth, along with their
associated facial tissue, would NOT be anesthetized.
C The pulp tissue of the maxillary anterior teeth and associated palatal tissue
would NOT be anesthetized.
D Both the anterior middle superior alveolar and posterior superior alveolar nerve
blocks when administered together will anesthetize the pulp tissue of the teeth
and associated facial tissue, as well as the relevant palatal tissue thus providing
the greatest area of anesthesia to the maxillary quadrant. However, this protocol
is NOT without its possible setbacks due to the need for large amount of agent,
slow onset, and rapid removal of anesthesia with the anterior middle superior
alveolar block. In addition, the block does not provide a high enough level of
hemostatic control.
DIF: Application REF: pp. 211, 221 OBJ: 2

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10. Before periodontal scaling near the periodontal tissue clefting present on the facial surface
of ALL the mandibular incisors of a patient, which local anesthetic block(s) would be the
BEST to have administered bilaterally?
a. Infraorbital block
b. Incisive block
c. Mental block
d. Inferior alveolar block
ANS: B
Feedback
A The infraorbital block provides anesthesia for the maxillary anteriors and
premolars, both pulpal and for the associated facial periodontium, and can be
used bilaterally without complications but does NOT provide anesthesia for the
mandibular incisors.
B The incisive block provides anesthesia for the mandibular anteriors and
premolars, both pulpal and for the associated facial periodontium that would
involve the periodontal tissue clefting, and can be used bilaterally without
complications.
C The mental block provides anesthesia for the mandibular anteriors and
premolars but only for the associated facial periodontium, and it can be used
bilaterally without complications. However, it does NOT provide pulpal
anesthesia for the mandibular incisors that may be sensitive to periodontal
scaling.
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D The inferior alveolar block provides anesthesia for the pulp tissue of ALL the
mandibular teeth as well as for the associated facial periodontium of the
mandibular anteriors and premolars, but it is NOT recommended to use
bilaterally due to complications with swallowing.

11. Which local anesthetic nerve block would be necessary for a patient undergoing oral surgery
on an edentulous left mandibular alveolar process in the area of the extracted molars?
a. Left buccal nerve block
b. Right buccal nerve block
c. Left mental nerve block
d. Right infraorbital nerve block
ANS: A
Feedback
A The left buccal nerve block anesthetizes the buccal gingival tissue of alveolar
process in the area of the extracted mandibular molars.
B The right incisive nerve block anesthetizes ONLY the contralateral side of the
alveolar process of the mandible.
C The left mental nerve block would anesthetize the facial gingival tissue of the
alveolar process in the area of mandibular premolars and anterior teeth but NOT
the edentulous area of the extracted mandibular molars.
D The infraorbital nerve block is used ONLY for maxillary arch anesthesia.

12. A restoration will be placed on the occlusal surface of the maxillary first premolar, but no
rubber dam will be used. However, which of the following local anesthetic nerve blocks
MUST be administered?
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b. Middle superior alveolar nerve block
c. Greater palatine nerve block
d. Inferior alveolar nerve block
ANS: B
Feedback
A The anterior superior alveolar nerve block will provide pulpal anesthesia to the
maxillary canine and maxillary incisors but NOT the maxillary first premolar.
B The middle superior alveolar nerve block provides pulpal anesthesia to the
maxillary premolars as well as the mesiobuccal root of the maxillary molar.
C The greater palatine nerve block does NOT provide pulpal anesthesia but ONLY
palatal anesthesia to the maxillary first premolar.
D The inferior alveolar nerve block is used for mandibular arch, NOT maxillary
arch.

13. Which of the following local anesthetic nerve blocks anesthetizes the buccal gingival tissue
of the maxillary first molar?
a. Infraorbital nerve block
b. Anterior superior alveolar nerve block
c. Buccal nerve block
d. Posterior superior alveolar nerve block
ANS: D
Feedback
A The infraorbital nerve block anesthetizes the maxillary incisors, canines, and
premolars.
B The anterior superior alveolar nerve block anesthetizes maxillary anterior teeth.
C The buccal nerve block anesthetizes buccal gingival tissue of the mandibular
molars.
D The buccal gingival tissue of maxillary molars is anesthetized by the posterior
superior alveolar nerve block.

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14. Which of the following complications can result from a greater palatine local anesthetic
nerve block?
a. Cheek bite by patient
b. Anesthesia of the upper lip
c. Stimulation of the gag reflex
d. Hematoma in the infratemporal fossa
ANS: C
Feedback
A The greater palatine nerve block is administered on the palate and does NOT
anesthetize the cheeks.
B The greater palatine nerve block is administered on the palate and does NOT
anesthetize the upper lip.
C Stimulation of the gag reflex is a distinct possibility because of the proximity of
the greater palatine nerve block to the lesser palatine nerve that may
inadvertently anesthetize the soft palate.
D The greater palatine nerve block is administered on the palate and does NOT
anesthetize the infratemporal fossa to allow for trauma that would induce a
hematoma.

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15. Which of the following angulations of the needle MUST be followed during the
administration of the posterior superior local anesthetic nerve block?
a. Superiorly at approximately 45 degrees and medially at approximately 90 degrees
to the occlusal plane
b. Superiorly at approximately 90 degrees and medially at approximately 45 degrees
c. Superiorly at approximately 45 degrees and medially parallel to the occlusal plane
d. Superiorly at approximately 45 degrees and medially at approximately 45 degrees
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ANS: D
Feedback
A The needle should NOT be at a 90-degree angle medially to the occlusal plane.
B The needle should NOT be at an approximately 90-degree angle superiorly to
the occlusal plane.
C The needle should NOT be parallel to the occlusal plane.
D Both the superior and medial angulation of the needle to the injection site will
be at an angle of approximately 45 degrees to the occlusal plane.

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16. Which of the following locations is the BEST injection site for the inferior alveolar local
anesthetic nerve block?
a. Medial to the pterygomandibular fold
b. Lateral to the pterygomandibular fold
c. Superior to the pterygomandibular fold
d. Inferior to the pterygomandibular fold
ANS: B
Feedback
A The needle will NOT be in the pterygomandibular space lateral to the
sphenomandibular ligament for the injection site if inserted medial to the
pterygomandibular fold.
B Finding the pterygomandibular fold helps determine the anteroposterior
positioning for needle insertion, which will be in the most posterior part of the
pterygomandibular space when lateral to the pterygomandibular fold.
C Positioning the needle too high from being superior to the pterygomandibular
fold will NOT ensure deposition of the local anesthetic agent in the CORRECT
needle insertion site to achieve anesthesia.
D Positioning the needle too low from being inferior to the pterygomandibular
fold will NOT ensure deposition of the local anesthetic agent in the CORRECT
needle insertion site to achieve anesthesia.

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17. When administering the inferior alveolar local anesthetic nerve block, it is important to
contact bony medial surface of the mandibular ramus because this will decrease the risk of
depositing a local anesthetic agent into the parotid salivary gland.
ANS: A
Feedback
A It is important to contact bony medial surface of the mandibular ramus to
prevent too posterior of a penetration, which might result in deposition of local
anesthetic agent into the parotid salivary gland, causing complications such as
transient facial paralysis.
B It is important to contact bony medial surface of the mandibular ramus to
C It is important to contact bony medial surface of the mandibular ramus to
D It is important to contact bony medial surface of the mandibular ramus to
E It is important to contact bony medial surface of the mandibular ramus to

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18. A 9-year-old child is having a restoration placed on the occlusal surface of the mandibular
left first molar. Which of the following heights of the inferior alveolar local anesthetic nerve
block injection sites should be followed during the pain control procedure?
a. Approximately 6 to 10 mm superior to the occlusal plane of the mandibular molars
b. Slightly inferior to the occlusal plane of the mandibular molars
c. At the same height as the occlusal plane of the mandibular molars
d. More than approximately 10 mm superior to the occlusal plane of the mandibular
molars
ANS: C
Feedback
A This is the height for the injection site for inferior alveolar nerve block when it
is administered to adults.
B An injection site’s height being inferior to the occlusal plane would NOT
deposit the local anesthetic agent superior enough to anesthetize the inferior
alveolar nerve.
C The height of the injection site is NOT as superior in children and even small
adults due to the length of the mandibular ramus. The injection site should be
the same height as the occlusal plane of the mandibular molars.
D Using a placement of approximately10 mm superior to the occlusal plane for
the height of the injection site would be too superior for children and even for
most average-sized adults.

19. Which of the following ligaments can act as a barrier to the inferior alveolar nerve block if
mandibular bone is NOT contacted during the injection?
a. Sphenomandibular ligament
b. Temporomandibular ligament
c. Stylomandibular ligament
d. Anterior cruciate ligament
ANS: A
Feedback
A The sphenomandibular ligament can act as a barrier to the inferior alveolar
nerve block if mandibular bone is NOT contacted during the injection since it
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runs from the angular spine of the sphenoid bone to the lingula of the
mandibular foramen on the medial aspect of the mandible.
B The temporomandibular ligament is the major ligament for the
temporomandibular joint but does NOT act as a barrier during the inferior
alveolar nerve block.
C The stylomandibular ligament runs from the styloid process of the temporal
bone to the angle of the mandible and separates the parotid and submandibular
salivary glands but does NOT act as a barrier during the inferior alveolar nerve
block.
D The anterior cruciate ligament (ACL) is one of the most important of four
strong ligaments connecting the bones of the knee joint and can become injured.

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20. Which of the following complications can occur during an incorrect administration of the
inferior alveolar local anesthetic nerve block, resulting in inability to close the eyelid?
a. Motor function of the abducens nerve
b. Motor function of the facial nerve
c. Motor function of the oculomotor nerve
d. Sensory function of the facial nerve
ANS: B
Feedback
A The abducens nerve is NOT in the area of the inferior alveolar nerve block and
affects movement of the eye, NOT the eyelid.
B The facial nerve provides motor innervation to the muscles of facial expression
and can result in the inability to close the eyelid with an incorrect
administration of the inferior alveolar nerve block. This can occur with a deeper
injection into the parotid salivary gland that contains the facial nerve, causing
temporary anesthesia of the nerve and its related structures. This is considered
transient facial paralysis. To prevent this complication, the needle needs to
contact the medial surface of the mandibular ramus.
C The oculomotor nerve affects movement of the eye, NOT the eyelid.
D The sensory part of the facial nerve does NOT move the eyelid.

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21. Which of the following local anesthetic nerve blocks can be involved in the spread of
infection to the cavernous sinus?
b. Inferior alveolar nerve block
d. Infraorbital nerve block
ANS: C
Feedback
A There is less risk of spread of infection to the cavernous sinus with the anterior
superior alveolar nerve block than with the posterior superior alveolar nerve
block.
B There is less risk of spread of infection to the cavernous sinus with the inferior
alveolar nerve block than with the posterior superior alveolar nerve block.
C The posterior superior alveolar nerve block is administered close to the
pterygoid plexus of veins, which communicate with the cavernous sinus. If the
needle becomes contaminated, this increases the risk for infection in the area,
which can then spread.
D There is less risk of spread of infection to the cavernous sinus with the
infraorbital nerve block than with the posterior superior alveolar nerve block.

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22. Which of the following local anesthetic nerve blocks MAINLY uses an extraoral landmark
on the face when locating the injection site?
a. Inferior alveolar nerve block
b. Infraorbital nerve block
d. Mental nerve block
ANS: B
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Feedback
A The inferior alveolar nerve block is administered at the mandibular foramen on
the medial surface of the mandibular ramus. The coronoid notch is used to help
locate the injection site and can be palpated intraorally.
B Palpation of the infraorbital rim on the facial surface is used to help locate the
infraorbital foramen for the infraorbital nerve block; thus, an extraoral landmark
of the face is used when locating the injection site. In addition, extraoral
pressure is applied to the infraorbital foramen during the injection.
C It is NOT necessary to palpate any extraoral structure to administer the posterior
superior alveolar nerve block.
D It is NOT necessary to palpate any extraoral structure to administer the mental
nerve block. Instead, the mental foramen is palpated intraorally.

23. There MUST never be an injection through an area with an abscess, cellulitis, or
osteomyelitis so as to prevent the spread of dental infection.
ANS: A
Feedback
A Both the statement and the reason are correct and related. There MUST never
be an injection through an area with an abscess, cellulitis, or osteomyelitis so as
to prevent the spread of dental infection; this is considered a needle tract
infection.
B Both the statement and the reason are correct and related. There MUST never
infection.
C Both the statement and the reason are correct and related. There MUST never
infection.
D Both the statement and the reason are correct and related. There MUST never
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infection.
E Both the statement and the reason are correct and related. There MUST never
infection.

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24. Less variation exists in the anatomy of the maxillae and palatine bones and associated
nerves with respect to local anesthetic landmarks as compared with similar mandibular
structures, making the maxillary injections less routine and usually with the need for any
troubleshooting of failure cases.
ANS: C
Feedback
A The statement is NOT correct, but the reason is correct. Less variation exists in
the anatomy of the maxillae and palatine bones and associated nerves with
respect to local anesthetic landmarks as compared with similar mandibular
structures, making the maxillary injections MORE routine and usually without
the need for troubleshooting of failure cases.
B The statement is NOT correct, but the reason is correct. Less variation exists in
C The statement is NOT correct, but the reason is correct. Less variation exists in
D The statement is NOT correct, but the reason is correct. Less variation exists in
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E The statement is NOT correct, but the reason is correct. Less variation exists in

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25. Palatal anesthesia usually involves anesthesia of the soft and hard tissue of the periodontium
of the palatal area such as the gingival tissue, periodontal ligament, and alveolar process.
Palatal anesthesia usually does NOT provide any pulpal anesthesia to the maxillary teeth or
associated facial or buccal gingival tissue.
ANS: A
Feedback
A Both statements are true. Palatal anesthesia usually involves anesthesia of the
soft and hard tissue of the periodontium of the palatal area such as the gingival
tissue, periodontal ligament, and alveolar process. Palatal anesthesia usually
does NOT provide any pulpal anesthesia to the maxillary teeth or associated
facial or buccal gingival tissue.
B Both statements are true. Palatal anesthesia usually involves anesthesia of the
C Both statements are true. Palatal anesthesia usually involves anesthesia of the
D Both statements are true. Palatal anesthesia usually involves anesthesia of the
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26. The dental professional MUST know the location of certain adjacent soft tissue structures,
such as major blood vessels and glandular tissue, so as to make sure to allow for injecting
these structures.
ANS: C
Feedback
A The statement is correct, but the reason is NOT. The dental professional MUST
know the location of certain adjacent soft tissue structures, such as major blood
vessels and glandular tissue, so as to make sure to avoid inadvertently injecting
these structures and causing complications.
B The statement is correct, but the reason is NOT. The dental professional MUST
C The statement is correct, but the reason is NOT. The dental professional MUST
D The statement is correct, but the reason is NOT. The dental professional MUST
E The statement is correct, but the reason is NOT. The dental professional MUST

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27. There is ONLY one type of local anesthetic injection used commonly in dentistry, the nerve
block. The type of injection used for a given dental procedure is determined by the type and
length of the procedure.
ANS: D
Feedback
A The first statement is false; the second is true. There are two types of local
anesthetic injections used commonly in dentistry: supraperiosteal injection and
nerve block. The type of injection used for a given dental procedure is
determined by the type and length of the procedure.
B The first statement is false; the second is true. There are two types of local
C The first statement is false; the second is true. There are two types of local
D The first statement is false; the second is true. There are two types of local

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28. Which of the following statements can be CORRECTLY used when discussing the “lingual
shock” some patients may experience when administering an inferior alveolar local
anesthetic block?
a. Occurs when the needle passes by the mylohyoid nerve
b. Patient may make involuntary movements
c. Reactions only include a slight opening of the eyes
d. Reactions made by the patient continue until anesthesia wears off
ANS: B
Feedback
A The “lingual shock” occurs when the needle passes by the lingual nerve and
NOT the mylohyoid nerve during administration of the inferior alveolar block.
B The “lingual shock” occurs when the needle passes by the lingual nerve during
administration of the inferior alveolar block. The patient may make an
involuntary movement, varying from a slight opening of the eyes to jumping in
the chair. This reaction is only momentary, and anesthesia will quickly occur.
C The patient may make an involuntary movement, such as a slight opening of the
eyes, but also may involve jumping in the chair. However, this reaction is only
momentary and will NOT continue, and anesthesia will quickly occur.
D The patient may make an involuntary movement, such as a slight opening of the
eyes, but also may involve jumping in the chair. However, this reaction is only
momentary and will NOT continue, and anesthesia will quickly occur.

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MULTIPLE RESPONSE
1. From the following list, select those that are anatomic factors involved in providing MORE
clinically effective maxillary arch anesthesia than mandibular arch anesthesia. (Select all
that apply.)
a. Thinner facial cortical plate over teeth
b. Less variation exists in anatomy
c. More variation exists in anatomy
d. Thicker facial cortical plate over teeth
ANS: A, B
Feedback
Correct MORE clinically effective maxillary arch anesthesia involves thinner
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facial cortical plate over teeth, and less variation exists in anatomy
making it MORE clinically effective than mandibular arch anesthesia.
Incorrect MORE clinically effective maxillary arch anesthesia involves thinner
facial cortical plate over teeth, and less variation exists in anatomy
making it MORE clinically effective than mandibular arch anesthesia.

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2. From the following list of complications involving the eyelid, nose, and upper lip, select the
MOST common ones associated with the infraorbital nerve block. (Select all that apply.)
a. Hematoma
b. Stimulation of the gag reflex
c. Tingling
d. Numbness
ANS: C, D
Feedback
Correct The most common complications noted with the infraorbital block are
tingling and numbness of the eyelid, nose, and upper lip; there is rarely
hematoma of the eyelid, nose, and upper lip.
Incorrect The most common complications noted with the infraorbital block are
tingling and numbness of the eyelid, nose, and upper lip; there is rarely
hematoma of the eyelid, nose, and upper lip.

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3. From the following list, select those statements that can be used CORRECTLY when
discussing paresthesia from the administration of local anesthesia and its progression over
time. (Select all that apply.)
a. Possibly abnormal area sensation
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b. Possible burning or prickling

c. Usually occurs with infections
d. Usually occurs with nonsurgical procedures
ANS: A, B, C
Feedback
Correct The following can be used to describe paresthesia and its progression:
possible abnormal area sensation, burning or prickling; it usually occurs
with infections as well as oral surgical procedures.
Incorrect Paresthesia does NOT usually occur with nonsurgical oral procedures
such as periodontal scaling but with oral surgical procedures such as the
removal of impacted mandibular third molars.

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4. From the following list of oral cavity landmarks, select those that need to be noted before
administering a clinically effective inferior alveolar nerve block. (Select all that apply.)
a. Occlusal plane
c. Pterygomandibular fold
d. Coronoid notch
e. Mandibular notch
ANS: A, C, D
Feedback
Correct The occlusal plane, pterygomandibular fold, and coronoid notch are ALL
landmarks for the administration of the inferior alveolar nerve block.
Incorrect The maxillary tuberosity is a landmark for the administration of the
posterior superior alveolar nerve block and NOT the inferior alveolar
nerve block. The mandibular notch is NOT a landmark for the
administration of the inferior alveolar nerve block.

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5. From the following list of oral cavity landmarks, select those that need to be noted before
administering a clinically effective posterior superior alveolar nerve block. (Select all that
apply.)
a. Mucobuccal fold
b. Coronoid notch
c. Maxillary first molar
d. Maxillary tuberosity
ANS: A, D
Feedback
Correct The height of the mucobuccal fold and the maxillary tuberosity are
landmarks for the administration of the posterior superior alveolar nerve
block.
Incorrect The coronoid notch is a landmark for the administration of the inferior
alveolar nerve block. The maxillary first molar is usually NOT a
landmark for any maxillary nerve anesthesia, but the maxillary second
molar is a landmark for the administration of the posterior superior
alveolar nerve block.

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6. Which of the following local anesthesia nerve blocks would benefit from using a topical
anesthetic-laced long cotton tip applicator to palpate the injection site as if it were the needle
and syringe? (Select all that apply.)
a. Posterior superior alveolar block
b. Inferior superior alveolar block
c. Greater palatine block
d. Nasopalatine block
ANS: A, B, C, D
The sometimes-complex orientation for ALL local anesthetic nerve blocks can be practiced
using a topical anesthetic-laced long cotton tip applicator to palpate the injection site as if it
were the needle and syringe.
DIF: Application REF: pp. 212, 223-224, 229 OBJ: 2

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Information
7. When troubleshooting incomplete anesthesia following an inferior alveolar local anesthetic

nerve block on a patient, the clinician notes a doubled mandibular canal on an intraoral
radiograph. What is present with this patient, and how can clinically effective anesthesia be
achieved? (Select all that apply.)
a. More superiorly placed second mandibular foramen exists.
b. More inferiorly placed second mandibular foramen exists.
c. The local anesthetic agent needs to be deposited more inferiorly to the usual
anatomic landmarks.
d. The local anesthetic agent needs to be deposited more superiorly to the usual
anatomic landmarks.
ANS: B, C
Feedback
Correct Incomplete anesthesia following an inferior alveolar block may be due to
a bifid inferior alveolar nerve, which can be detected by noting a doubled
mandibular canal on an intraoral radiograph. In many such cases a second
mandibular foramen, MORE inferiorly placed, exists. To correct this, the
local anesthetic agent is deposited MORE inferiorly to the usual anatomic
landmarks for the target area of the inferior alveolar block.
Incorrect Incomplete anesthesia following an inferior alveolar block may be due to
a bifid inferior alveolar nerve, which can be detected by noting a doubled
mandibular canal on an intraoral radiograph. In many such cases a second
mandibular foramen, more inferiorly placed and NOT superiorly placed,
exists. To correct this, the local anesthetic agent is deposited more
inferiorly and NOT superiorly to the usual anatomic landmarks for the
target area of the inferior alveolar block.

Information
NBDHE, Provision of Clinical Dental Hygiene Services, 2.0 Obtaining and Interpreting
Radiographs | NBDHE, Provision of Clinical Dental Hygiene Services, 3.0 Planning and
Managing Dental Hygiene Care | NBDHE, Provision of Clinical Dental Hygiene Services,
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8. Which of the following procedures may allow for LESS discomfort when anesthetizing the
palate of a patient with the anterior middle superior alveolar block? (Select all that apply.)
a. Topical anesthetic
b. Pressure anesthesia
c. Computer-controlled local anesthetic delivery device
d. Bidirectional rotation needle insertion technique
e. Prepuncture technique with needle bevel
ANS: A, B, C, D, E
To allow for less discomfort when anesthetizing the palate of a patient anterior middle
superior alveolar block, topical anesthetic, pressure anesthesia, computer-controlled local
anesthetic delivery device may be used. In addition, the techniques of bidirectional rotation
needle insertion and prepuncture with the needle may be also used.

Information
9. Which of the following are included in the linear relationship noted on the face that can
assist with the CORRECT administration of the infraorbital block? (Select all that apply.)
a. Ipsilateral supraorbital notch
b. Pupil of the eye looking forward
c. Midpoint of the infraorbital notch
d. Posterior superior alveolar foramina
e. Philtrum near the upper lip
ANS: A, B, C
Feedback
Correct There is also a linear relationship noted on the face that can assist with
the infraorbital block between the ipsilateral supraorbital notch, pupil of
the eye looking forward, midpoint of the infraorbital rim with its
zygomaticomaxillary suture, infraorbital foramen, and labial commissure.
Incorrect There is also a linear relationship noted on the face that can assist with
the infraorbital block between the ipsilateral supraorbital notch, pupil of
the eye looking forward, midpoint of the infraorbital rim with its
zygomaticomaxillary suture and NOT midline median palatine suture,
infraorbital foramen and NOT the posterior superior alveolar foramina,
and labial commissure and NOT the midline philtrum near the upper lip.

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Information
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Chapter 10: Lymphatic System

MULTIPLE CHOICE
1. Which of the following structures allows lymph to flow DIRECTLY into the surrounding
lymph nodes?
a. Afferent vessel
b. Efferent vessel
c. Lymphatic duct
d. Capillary
e. Venule
ANS: A
Feedback
A The afferent vessels are a type of lymphatic vessel in which lymph flows into
the lymph node.
B The efferent vessel is a type of lymphatic vessel in which lymph flows out of
the lymph node in the area of the node’s hilus.
C The lymphatic duct allows the lymph to converge before emptying into the
venous system.
D The capillary serves as blood supply for the tissue surrounding the lymphatic
system.
E The venule serves to drain the blood supply for the tissue surrounding the
lymphatic system. However, the lymphatics do drain into larger vessels of the
venous system of the blood in the chest area.

anatomy, physiology, and development
2. The lymphatics are a part of the immune system, and they help fight disease processes.
Another component of the lymphatic system is the thymus gland because it works within the
immune system.
ANS: C
Feedback
A The second statement is false. The thymus gland is NOT a component of the
lymphatic system even though it works within the immune system.
B The first statement is true. The lymphatics are a part of the immune system, and
they help fight disease processes.
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C The first statement is true. The lymphatics are a part of the immune system, and
they help fight disease processes. The second statement is false because the
thymus gland is NOT a component of the lymphatic system even though it
works within the immune system.
D The first statement is true. The lymphatics are a part of the immune system, and
they help fight disease processes. The second statement is false because the
thymus gland is NOT a component of the lymphatic system even though it
works within the immune system.

anatomy, physiology, and development | CDA: General Chairside, V. A. Oral Health
Information
Provision of Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene
Care
3. Which of the following is considered the MAIN role of the lymph nodes in relationship to
the lymph within lymphatic vessels?
a. Filtration
b. Liquefaction
c. Disassociation
d. Oxygenation
ANS: A
Feedback
A The lymph nodes are positioned along the lymphatic vessels to filter toxic
products from the lymph to prevent their entry into the vascular system.
B The lymph nodes do NOT liquefy toxic products.
C The lymph nodes do NOT disassociate themselves from toxic products.
D Lymph nodes do NOT oxygenate toxic products.

4. The lymphatics of the right side of the head and the neck converge by way of the right
jugular trunk. These lymphatics then join the lymphatics from the right arm and thorax to
form the thoracic duct.
ANS: C
Feedback
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A The second statement is false. The lymphatics on the right side of the head and
neck converge by way of the right jugular trunk to join the lymphatics from the
right arm and thorax to form the right lymphatic duct, which drains into the
venous system at the junction of the right subclavian and right internal jugular
veins. The lymphatic vessels of the left side of the head and neck converge into
the left jugular trunk, actually a short vessel, and then into the thoracic duct.
B The first statement is true. The lymphatics of the right side of the head and neck
converge by way of the right jugular trunk.
C The first statement is true. The lymphatics of the right side of the head and neck
converge by way of the right jugular trunk. The second statement is false. The
lymphatics on the right side of the head and neck converge by way of the right
jugular trunk to join the lymphatics from the right arm and thorax to form the
right lymphatic duct, which drains into the venous system at the junction of the
right subclavian and right internal jugular veins. The lymphatic vessels of the
left side of the head and neck converge into the left jugular trunk, actually a
short vessel, and then into the thoracic duct.
D The first statement is true. The lymphatics of the right side of the head and neck
converge by way of the right jugular trunk. The second statement is false. The
lymphatics on the right side of the head and neck converge by way of the right
jugular trunk to join the lymphatics from the right arm and thorax to form the
right lymphatic duct, which drains into the venous system at the junction of the
right subclavian and right internal jugular veins. The lymphatic vessels of the
left side of the head and neck converge into the left jugular trunk, actually a
short vessel, and then into the thoracic duct.

MSC: NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.1 Head and Neck
Anatomy
5. A dental professional needs to check carefully for any palpable nodes of the head and neck
during an extraoral examination BECAUSE the palpable lymph nodes may help determine
where a disease process is active.
ANS: A
Feedback
A The statement and the reason are correct and related. A dental professional
MUST examine any palpable nodes of the head and neck during an extraoral
examination. Palpable lymph nodes may help determine where a disease
process is active. The statement and reason are also related because they both
focus on palpable lymph nodes that can pinpoint disease and infection through
signs and symptoms.
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B The statement and the reason are correct, but they are also related. They both
focus on palpable lymph nodes that can help to pinpoint the progression of both
disease and infection.
C The reason is correct. Palpable lymph nodes may help determine where a
disease process is active.
D The statement is correct. A dental professional MUST examine any palpable
nodes of the head and neck during an extraoral examination.
E Both the statement and reason are correct. A dental professional MUST examine
any palpable nodes of the head and neck during an extraoral examination.
Palpable lymph nodes may help determine where a disease process is active.

Examination
Anatomy | NBDHE, Scientific Basis for Dental Hygiene Practice, 5.0 Pathology
6. Which of the teeth listed below, when infected, do NOT initially drain into the
submandibular lymph nodes but into another group of lymph nodes?
a. Maxillary anterior teeth
b. Maxillary first and second molars
c. Maxillary premolars
d. Maxillary third molars
ANS: D
Feedback
A The maxillary anterior teeth initially drain into the submandibular lymph nodes
and then into the superior deep cervical lymph nodes.
B The maxillary first and second molars initially drain into the submandibular
lymph nodes and then into the superior deep cervical lymph nodes.
C The maxillary premolars initially drain into the submandibular lymph nodes and
then into the superior deep cervical lymph nodes.
D The maxillary third molars initially drain into the superior deep cervical lymph
nodes and then into inferior deep cervical lymph nodes and do NOT drain into
the submandibular lymph nodes at any time.
DIF: Comprehension REF: pp. 250, 254 OBJ: 5

7. Which of the following lymph nodes are NOT considered to be superficial lymph nodes
located in the head?
a. Occipital lymph nodes
b. Retropharyngeal lymph nodes
c. Retroauricular lymph nodes
d. Facial lymph nodes
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ANS: B
Feedback
A The occipital lymph nodes are superficial lymph nodes located bilaterally on the
posterior base of the head in the occipital region, which drains this part of the
scalp.
B The retropharyngeal lymph nodes are NOT considered superficial lymph nodes
but instead deep lymph nodes of the head. These nodes are located near the
deep parotid nodes and at the level of the atlas and the first cervical vertebra.
C The retroauricular lymph nodes are superficial lymph nodes located posteriorly
to each ear, where the sternocleidomastoid muscle inserts on the mastoid
process.
D The facial lymph nodes are superficial lymph nodes located along the length of
the facial vein.

Anatomy
8. The occipital lymph nodes can be palpated during the extraoral examination by asking the
patient to tilt his or her head to the left and then to the right with the chin upward
BECAUSE the occipital lymph nodes empty into the inferior deep cervical nodes of the
neck.
ANS: D
Feedback
A The statement is NOT correct. The occipital lymph nodes can be palpated when
the patient leans his or her head forward because the occipital lymph nodes are
located bilaterally at the posterior base of the head.
B The statement is NOT correct. The occipital lymph nodes can be palpated when
located bilaterally at the posterior base of the head. In addition, the statement
and the reason are related. Both deal with location of the occipital lymph nodes.
C The reason is correct. The occipital lymph nodes empty into the inferior deep
cervical nodes of the neck.
D The statement is NOT correct. The occipital lymph nodes can be palpated when
located bilaterally at the posterior base of the head.
E The reason is correct. The occipital lymph nodes empty into the inferior deep
cervical nodes of the neck.
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Examination
Anatomy | NBDHE, Provision of Clinical Dental Hygiene Services, 1.2 Head and Neck
Examination
9. The retroauricular lymph nodes are also known by which of the following terms?
a. Mastoid lymph nodes
b. Facial lymph nodes
c. Deep parotid lymph nodes
d. Retropharyngeal lymph nodes
ANS: A
Feedback
A The retroauricular lymph nodes are also known as the mastoid lymph nodes.
They are located where the sternocleidomastoid muscle inserts on the mastoid
process, draining the tissue posterior to the ear.
B The facial lymph nodes are positioned along the length of the facial vein, with
each facial node subgroup draining the skin and mucous membranes where the
nodes are specifically located.
C The deep parotid lymph nodes are located deep in the parotid salivary gland and
drain the middle ear.
D The retropharyngeal lymph nodes are located near the deep parotid nodes and at
the level of the atlas at the first cervical vertebra, draining the pharynx, palate,
paranasal sinuses, and nasal cavity.

Anatomy
10. The submandibular lymph nodes are located at the inferior border of the mandibular ramus,
just superficial to the submandibular salivary gland and within the submandibular fascial
space. These nodes drain the cheeks, upper lip, body of the tongue, and anterior hard palate,
as well as the mandibular incisors and maxillary third molars.
ANS: C
Feedback
A The second statement is false. The submandibular lymph nodes drain the
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cheeks, upper lip, body of the tongue, anterior hard palate, and associated teeth,
except for the mandibular incisors and maxillary third molars.
B The first statement is true. The submandibular lymph nodes are located at the
inferior border of the mandibular ramus, just superficial to the submandibular
salivary gland and within the submandibular fascial space.
C The first statement is true. The submandibular lymph nodes are located at the
salivary gland and within the submandibular fascial space. The second
statement is false. The submandibular lymph nodes drain the cheeks, upper lip,
body of the tongue, anterior hard palate, and associated teeth, except for the
mandibular incisors and maxillary third molars.
D The first statement is true. The submandibular lymph nodes are located at the
salivary gland and within the submandibular fascial space. The second
statement is false. The submandibular lymph nodes drain the cheeks, upper lip,
body of the tongue, anterior hard palate, and associated teeth, except for the
mandibular incisors and maxillary third molars.

Anatomy
11. Which of the following lymph nodes can be effectively palpated during an extraoral
examination by having the patient turn his or her head to the side?
a. Superficial cervical lymph nodes
b. Anterior jugular lymph nodes
c. Inferior cervical lymph nodes
d. Occipital lymph nodes
ANS: B
Feedback
A The superficial cervical lymph nodes can be effectively palpated by having the
patient lower his or her chin. Then tissue in the area is pushed over the bony
edge of the mandible on each side, where it is grasped and rolled.
B The anterior jugular lymph nodes can be effectively palpated by having the
patient turn his or her head to the side.
C The inferior cervical lymph nodes can be effectively palpated by having the
patient turn his or her head to the side along with raising the shoulders upward
and forward.
D The occipital lymph nodes can be effectively palpated by having the patient tilt
his or her head forward.

Examination
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Anatomy | NBDHE, Provision of Clinical Dental Hygiene Services, 1.2 Head and Neck
Examination | NBDHE, Provision of Clinical Dental Hygiene Services, 3.0 Planning and
Managing Dental Hygiene Care
12. Tonsils are masses of lymphoid tissue located in the oral cavity and pharynx. Like lymph
nodes, tonsils are located along lymphatic vessels.
ANS: C
Feedback
A The second statement is false. Unlike lymph nodes, tonsils are NOT located
along lymphatic vessels.
B The first statement is true. Tonsils are masses of lymphoid tissue located in the
oral cavity and pharynx.
C The first statement is true. Tonsils are masses of lymphoid tissue located in the
oral cavity and pharynx. The second statement is false. Unlike lymph nodes,
tonsils are NOT located along lymphatic vessels.
D The first statement is true. Tonsils are masses of lymphoid tissue located in the
oral cavity and pharynx. The second statement is false. Unlike lymph nodes,
tonsils are NOT located along lymphatic vessels.

Anatomy
13. The palatine tonsil is located in the oral cavity between the posterior faucial pillar and which
of the following structures?
a. Posterior wall of the nasopharynx
b. Anterior faucial pillar
c. Uvula
d. Soft palate
e. Pterygomandibular fold
ANS: B
Feedback
A The palatine tonsil is located between the anterior faucial pillar and the
posterior faucial pillar or vice versa on each side of the fauces. In contrast, the
pharyngeal tonsil is located on the posterior wall of the nasopharynx.
B The palatine tonsil is located between the posterior faucial pillar and the
anterior faucial pillar or vice versa on each side of the fauces.
C The uvula is a muscular structure that hangs from the posterior margin of the
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soft palate.
D The soft palate is the posterior nonbony part of the palate.
E The pterygomandibular fold is a fold of tissue that extends from the junction of
hard and soft palates down to the mandible, just posterior to the most distal
mandibular molar.

Anatomy
14. Which of the following terms BEST describes the process in lymph nodes when a patient
has a disease process active in a region, such as cancer or infection, by increasing in size and
changing the consistency of the lymphoid tissue?
a. Lymphosarcoma
b. Lymphangitis
c. Lymphedema
d. Lymphadenopathy
ANS: D
Feedback
A Lymphosarcoma is a term used to describe a malignant tumor of the lymphatic
tissue.
B Lymphangitis is a term used to describe inflammation of the lymphatic vessels
that connect the lymph nodes.
C Lymphedema is a term used to describe when lymphatic fluid builds up in the
soft tissue of the body, usually in an arm or leg.
D Lymphadenopathy is a term that describes the process in lymph nodes when a
patient has a disease process active in a region, such as cancer or infection, by
increasing in size and changing the consistency of the lymphoid tissue.

Information | CDA: General Chairside, VI. A. 1. Identify medical conditions that can cause
medical emergencies in patients
Anatomy | NBDHE, Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE,
Care
15. What is the term used to denote the spread of cancer from the original or primary site of the
tumor to another secondary site?
a. Miosis
b. Metastasis
c. Mitosis
d. Mydriasis
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ANS: B
Feedback
A The term miosis denotes the contraction of the pupil of the eye.
B The term metastasis denotes the spread of cancer from the original or primary
site of the tumor to another secondary site.
C The term mitosis denotes cell division.
D The term mydriasis denotes prolonged abnormal dilation of the pupil.

Care
16. Which of the following signs or symptoms listed below CANNOT be used to describe a
lymph node involved in cancer?
a. Bony hard
b. Nonmotile
c. NOT tender
d. Mobile
ANS: D
Feedback
A Nodes involved in cancer can be bony hard, unlike those nodes involved with
acute infections, which are only firm.
B Nodes involved in cancer can become fixed to surrounding tissue and
structures, making them nonmotile, unlike those nodes involved with acute
infections, which are mobile.
C Nodes involved in cancer are usually NOT tender, unlike those nodes involved
with acute infections, which become tender due to enlargement and pressure
placed on surrounding nerves. However, they may be painful with perineural
infiltration such as that which can occur with parotid salivary gland cancer in
some cases.
D Nodes involved in cancer are NOT mobile; they can become fixed to
surrounding tissue and structures, unlike those nodes involved with acute
infections that are mobile.

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Care
17. MOST lymph from the head and neck ultimately drains through which group of lymph
nodes?
a. Superior deep cervical nodes
b. External jugular nodes
c. Inferior deep cervical nodes
d. Anterior cervical nodes
ANS: C
Feedback
A The superior deep cervical nodes may be secondary nodes for all other nodes of
the head and neck, except inferior deep cervical nodes.
B The external jugular nodes or superficial cervical nodes may be secondary
nodes for the occipital, retroauricular, anterior auricular, and superficial parotid
nodes. These nodes then empty into the deep cervical nodes.
C The inferior deep cervical nodes may be secondary nodes for the superficial
lymph nodes of the head and superior deep cervical nodes.
D The anterior jugular nodes or anterior cervical nodes empty into the deep
cervical nodes.

Care
18. What is another term for external jugular lymph nodes?

a. Superficial cervical nodes
b. Suprahyoid lymph nodes
c. Anterior cervical nodes
d. Mastoid glands
e. Occipital glands
ANS: A
Feedback
A The external jugular lymph nodes are also known as the superficial cervical
nodes.
B The suprahyoid lymph nodes are also known as the submental lymph nodes.
C The anterior cervical nodes are also known as the anterior jugular nodes.
D The mastoid glands are also known as the retroauricular lymph nodes.
E The occipital lymph nodes are located on the posterior base of the head in the
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occipital region and drain this part of the scalp.

Anatomy
19. Unlike capillaries, lymphatic vessels have valves similar to many veins. These valves ensure
a one-way flow of lymph through the lymphatic vessel.
ANS: A
Feedback
A Both the statement and the reason are correct and related. Unlike capillaries,
lymphatic vessels have valves similar to many veins. These valves ensure a
one-way flow of lymph through the lymphatic vessel.
B Both the statement and the reason are correct and related. Unlike capillaries,
C Both the statement and the reason are correct and related. Unlike capillaries,
D Both the statement and the reason are correct and related. Unlike capillaries,
E Both the statement and the reason are correct and related. Unlike capillaries,

20. In healthy patients, lymph nodes are usually small, soft, and free or mobile in the
surrounding tissue. Therefore lymph nodes can be easily visualized or palpable during an
extraoral examination of a healthy patient.
ANS: C
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Feedback
A The first statement is true; the second is false. In healthy patients, lymph nodes
are usually small, soft, and free or mobile in the surrounding tissue. Therefore
lymph nodes CANNOT be visualized or palpable during an extraoral
examination of a healthy patient.
B The first statement is true; the second is false. In healthy patients, lymph nodes
C The first statement is true; the second is false. In healthy patients, lymph nodes
D The first statement is true; the second is false. In healthy patients, lymph nodes

Examination | CDA: General Chairside, V. A. Oral Health Information | CDA: General
Chairside, VI. A. 1. Identify medical conditions that can cause medical emergencies in
patients
Provision of Clinical Dental Hygiene Services, 1.2 Head and Neck Examination
21. Lymph from a particular tissue region drains into a secondary node, regional node, or master
node. Secondary nodes, in turn, drain into a primary node or central node.
ANS: B
Feedback
A Both statements are false. Lymph from a particular tissue region drains into a
primary node, regional node, or master node. Primary nodes, in turn, drain into
a secondary node or central node.
B Both statements are false. Lymph from a particular tissue region drains into a
C Both statements are false. Lymph from a particular tissue region drains into a
D Both statements are false. Lymph from a particular tissue region drains into a
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Anatomy
22. The thoracic duct is MUCH smaller than the right lymphatic duct BECAUSE it drains the
lymph from the entire lower half of the body, both the right and left sides.
ANS: D
Feedback
A The statement is NOT correct, but the reason is correct. The thoracic duct is
much larger than the right lymphatic duct because it drains the lymph from the
entire lower half of the body, both the right and left sides.
B The statement is NOT correct, but the reason is correct. The thoracic duct is
C The statement is NOT correct, but the reason is correct. The thoracic duct is
D The statement is NOT correct, but the reason is correct. The thoracic duct is
E The statement is NOT correct, but the reason is correct. The thoracic duct is

23. The dental professional needs to remember that the lymph nodes NEVER drain other
structures of the head and neck but only the teeth and associated structures. A patient may
need a referral when lymph nodes are palpable due to a disease process.
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ANS: D
Feedback
A The first statement is false; the second is true. The dental professional needs to
remember that the lymph nodes drain NOT only intraoral dental structures such
as the teeth but also other structures of the head and neck. A patient may need a
referral when lymph nodes are palpable due to a disease process in these other
structures.
B The first statement is false; the second is true. The dental professional needs to
structures.
C The first statement is false; the second is true. The dental professional needs to
structures.
D The first statement is false; the second is true. The dental professional needs to
structures.

Chairside, VI. A. 1. Identify medical conditions that can cause medical emergencies in
patients
Anatomy | NBDHE, Scientific Basis for Dental Hygiene Practice, 1.1.2 Dental Anatomy |
NBDHE, Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision
of Clinical Dental Hygiene Services, 1.0 Assessing Patient Characteristics | NBDHE,
Care
24. The lymph nodes of the head are located in either a superficial or a deep position relative to
the surrounding tissue. All nodes of the head drain either the right or left tissue, structures,
or organs in each region.
ANS: A
Feedback
A Both statements are true. The lymph nodes of the head are located in either a
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superficial or a deep position relative to the surrounding tissue. All nodes of the
head drain either the right or left tissue, structures, or organs in each region.
B Both statements are true. The lymph nodes of the head are located in either a
C Both statements are true. The lymph nodes of the head are located in either a
D Both statements are true. The lymph nodes of the head are located in either a

Anatomy
25. The retroauricular, anterior auricular, and superficial parotid nodes drain the external ear,
lacrimal gland, and adjacent regions of the scalp and face. All of these nodes empty into the
submandibular lymph nodes.
ANS: C
Feedback
A The first statement is true; the second is false. The retroauricular, anterior
auricular, and superficial parotid nodes drain the external ear, lacrimal gland,
and adjacent regions of the scalp and face. All of these nodes empty into the
deep cervical lymph nodes. The submandibular nodes may be secondary nodes
for the submental nodes and facial regions. The lymphatic system from both the
sublingual and submandibular salivary glands also drains into these nodes. The
submandibular nodes then empty into the deep cervical nodes.
B The first statement is true; the second is false. The retroauricular, anterior
C The first statement is true; the second is false. The retroauricular, anterior
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D The first statement is true; the second is false. The retroauricular, anterior

Anatomy
MULTIPLE RESPONSE
1. From the following list of descriptions, select those that can CORRECTLY be used to
describe the lymphatic system or its components, including the vessels and the nodes.
a. Mainly parallels nervous system
b. Only superficial in location
c. No part visualized in healthy patients
d. Has valves for one-way flow
ANS: C, D
Feedback
Correct NO part of the lymphatic system, either lymph vessels or nodes, can be
visualized in healthy patients, and the lymphatic vessels do have valves
for one-way flow of lymph.
Incorrect Within the lymphatic system, the lymphatic vessels mainly parallel the
venous blood vessels and NOT the nervous system but are more
numerous. Its lymph nodes can be either superficial or deep in location
and NOT only superficial.

2. From the following list of lymph nodes, select those that are categorized as facial lymph
nodes. (Select all that apply.)
a. Malar lymph nodes
b. Buccal lymph nodes
c. Anterior auricular lymph nodes
d. Retroauricular lymph nodes
ANS: A, B
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Feedback
Correct Both malar and buccal lymph nodes are considered facial lymph nodes
since they are located along the length of the facial vein.
Incorrect Both the anterior auricular and retroauricular lymph nodes are NOT
considered facial lymph nodes since they are NOT located along the
length of the facial vein.

Anatomy
3. From the following list of lymph nodes, select those that are categorized as superficial
cervical lymph nodes. (Select all that apply.)
a. Retropharyngeal lymph nodes
b. Jugulodigastric lymph node
c. External jugular lymph nodes
d. Anterior jugular lymph nodes
ANS: C, D
Feedback
Correct Both the external and anterior jugular lymph nodes are considered
superficial cervical lymph nodes.
Incorrect Retropharyngeal lymph nodes are NOT considered superficial cervical
lymph nodes. The jugulodigastric lymph node is a superior deep cervical
lymph node.

Anatomy
4. From the following list of descriptions, select those that can be used to CORRECTLY
describe the jugulo-omohyoid lymph node. (Select all that apply.)
a. Superior deep cervical lymph node
b. Drains parts of tongue
c. Drains submental region
d. Inferior deep cervical lymph node
ANS: B, C, D
Feedback
Correct The jugulo-omohyoid lymph node drains parts of the tongue and
submental region and also is considered an inferior deep cervical lymph
node.
Incorrect The jugulo-omohyoid lymph node is considered an inferior deep cervical
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lymph node and is NOT considered a superior deep cervical lymph node.

Anatomy
describe tonsillar tissue. (Select all that apply.)
a. Located in pharynx
b. Drains into superior deep cervical lymph nodes
c. Masses of tissue in oral cavity
d. Found along lymphatic vessels
e. Drains into the jugulodigastric lymph node
ANS: A, B, C, E
Feedback
Correct Tonsils are masses of lymphoid tissue located in the pharynx as well as
the oral cavity. Tonsils drain into the superior deep cervical lymph nodes,
including draining DIRECTLY into the jugulodigastric lymph node.
Incorrect Tonsillar tissue is NOT found along lymphatic vessels, unlike lymph
nodes.

Anatomy
6. Which of the following statements are CORRECT when applied to the cervical lymph node
levels used by the medical community? (Select all that apply.)
a. Designated by Roman numerals for each area
b. Decrease in numbers as they become located nearer the chest
c. Classification based on imaging
d. Associated sublevels are included
ANS: A, C, D
Feedback
Correct An imaging-based classification used by the medical community divides
the deep cervical lymph nodes into six areas or cervical lymph node
levels. These levels, as well as associated sublevels, are designated by
Roman numerals for each area, increasing in numbers as they become
located nearer to the chest.
Incorrect The classification of cervical lymph node levels used by the medical
community would increase in numbers and would NOT decrease in
numbers as the levels become located nearer to the chest.
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Anatomy
describe cancer and its involvement with the lymph nodes. (Select all that apply.)
a. Nodes mainly aid in the spread of sarcomas
b. Spread of a cancer from primary site is considered metastasis
c. Nodes involved with cancer are softer than usual
d. Nodes involved with cancer may be fixed to their surroundings
e. Usually nodes with cancer are not as tender to palpation
ANS: B, D, E
Feedback
Correct The spread of a cancer from the original or primary site of the neoplasm
to another or secondary site is considered metastasis. When they are
involved with cancer, the lymph nodes can become possibly fixed to
surrounding tissue, structures, and organs. The cancerous nodes are
usually NOT as tender to palpation as those involved with infection.
Incorrect Nodes mainly aid in the spread of certain cancers, called carcinomas,
from epithelial tissue in the region they filter and NOT sarcomas, which
are involved instead with connective tissue. When they are involved with
cancer, the lymph nodes can become bony hard and NOT softer than
usual.

8. Which of the following need to be present for any lymph nodes to be considered palpable on
your patient with a history of hepatitis B? (Select all that apply.)
a. May have undergone fibrosis from the past infection
b. May be actively undergoing lymphadenopathy
c. Must each be approximately larger than 5 mm in diameter
d. Have increased number of lymphocytes
e. Have increased size of each lymphocyte
ANS: A, B, E
Feedback
Correct Changes in size and consistency with an active response to an infection
result in lymphadenopathy and allow the node to be palpated during the
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extraoral examination along the even firmer backdrop of underlying

bones and muscles or the clinician’s hands. Lymphadenopathy results
from an increase in both the size of each individual lymphocyte and the
overall cell count in the lymphoid tissue. The lymph nodes may stay
enlarged as a result of scar tissue after lymphadenopathy and thus are still
palpable, having a slightly firmer texture from the fibrosis process.
Incorrect In general, the lymph nodes must be larger than approximately 10 mm
and NOT larger than approximately 5 mm in diameter to be palpable or
even visualized.

Examination | CDA: General Chairside, V. A. Oral Health Information
MATCHING
Match the following cervical lymph nodes to their CORRECT cervical lymph node level as
used by the medical community.
a. Level I, Sublevel A
b. Level II, Sublevel B
c. Level II
d. Levels II to V
1. Jugulodigastric lymph node
2. Submandibular lymph nodes
3. Submental lymph nodes
4. Deep cervical lymph nodes
1. ANS: C DIF: Comprehension REF: p. 252

OBJ: 3
Anatomy
2. ANS: B DIF: Comprehension REF: p. 250
OBJ: 3
Anatomy
3. ANS: A DIF: Comprehension REF: p. 250
OBJ: 3
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Anatomy
4. ANS: D DIF: Comprehension REF: p. 252
OBJ: 3
Anatomy
OTHER
1. Place the following steps in the CORRECT order suggested that should be included in a
clinically effective extraoral examination of the facial lymph nodes.
a. Bilaterally palpate the angle of the mandible
b. Bilaterally palpate the infraorbital region
c. Bilaterally palpate the labial commissure
d. Bilaterally palpate the submandibular region
ANS:
B, C, A, D
Feedback
Correct During an extraoral examination, bilaterally palpate the facial nodes on
Order each side of the face, moving from the infraorbital region to the labial
commissure, and then to the surface of the angle of the mandible. Note
that the each facial node subgroup drains the skin and mucous
membranes where the nodes are located. The facial nodes also drain from
one to the other in a superior to inferior fashion and then finally drain
together into the deep cervical nodes by way of submandibular nodes.
Incorrec The submandibular region does NOT contain the facial lymph nodes.
t However, the facial nodes do finally drain together into the deep cervical
nodes by way of submandibular nodes.

Examination
Scientific Basis for Dental Hygiene Practice, 1.2 Head and Neck Examination
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Chapter 11: Fasciae and Spaces

MULTIPLE CHOICE
1. The fascia consists of layers of epithelial tissue. The fascia lies underneath the skin and also
surrounds the muscles, bones, vessels, nerves, organs, and other structures of the body.
ANS: D
Feedback
A The first statement is false. The fascia consists of layers of fibrous connective
tissue.
B The second statement is true. The fascia lies underneath the skin and also
surrounds the muscles, bones, vessels, nerves, organs, and other structures of the
body.
C The first statement is false. The fascia consists of layers of fibrous connective
tissue.
D The first statement is false. The fascia consists of layers of fibrous connective
tissue. The second statement is true. The fascia lies underneath the skin and also
surrounds the muscles, bones, vessels, nerves, organs, and other structures of the
body. NURSINGTB.COM
2. Superficial fasciae of the body, as well as superficial fasciae of the head and neck, contain
vessels, nerves, and muscles BECAUSE the superficial fasciae are located just deep to and
attached to skin.
a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
ANS: D
Feedback
A The statement is NOT correct. The superficial fasciae of the body do NOT
usually enclose muscles, except for the superficial fasciae of the head and neck.
The superficial fasciae contain muscles of facial expression.
B The statement is NOT correct. The superficial fasciae of the body do NOT
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The superficial fasciae contain muscles of facial expression. Also, the statement
and the reason are related.
C The statement is NOT correct. The superficial fasciae of the body do NOT
The superficial fasciae contain muscles of facial expression. The reason is
correct. Superficial fasciae are located just deep to and attached to the skin.
D The statement is NOT correct. The superficial fasciae of the body do NOT
The superficial fasciae contain muscles of facial expression.
E The reason is correct. Superficial fasciae are located just deep to and attached to
the skin.

3. Which fascia is NOT included in the layers of the deep fasciae of the face and jaws?
a. Brachial fascia
b. Temporal fascia
c. Masseteric-parotid fascia
d. Pterygoid fascia
ANS: A
A Brachial fascia is investing fascia in the arm and NOT in the face and jaws.
B Temporal fascia is a layer of the deep fasciae of the face and jaws. It covers the
temporal muscle down to the zygomatic arch.
C Masseteric-parotid fascia is a layer of the deep fasciae of the face and jaws. The
masseteric-parotid fascia is located inferior to the zygomatic arch and covers the
masseter muscle. It surrounds the parotid salivary gland.
D The pterygoid fascia is a layer of the deep fasciae of the face and jaws. The
pterygoid fascia is located on the medial surface of the medial pterygoid muscle.

4. Which of the following statements is the BEST description of investing fascia?

a. It is a tube of deep cervical fasciae, deep to the sternocleidomastoid muscle,
running inferiorly along each side of the neck from the base of the skull to the
thorax.
b. It is the most external layer of deep cervical fasciae that surrounds the neck,
continuing onto the masseteric-parotid fascia.
c. It is a single midline tube of deep cervical fasciae running inferiorly along the
neck, surrounding the airway and food way, including the trachea, esophagus, and
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thyroid gland.
d. It is the deepest layer of the deep cervical fasciae, which covers the vertebrae,
spinal column, and associated muscles.
ANS: B
Feedback
A This is the description of the carotid sheath. It is a tube of deep cervical fasciae,
deep to the sternocleidomastoid muscle, running inferiorly along each side of the
neck from the base of the skull to the thorax.
B Investing fascia is the most external layer of deep cervical fasciae that surrounds
the neck, continuing on to the masseteric-parotid fascia.
C This is the description of visceral fascia. It is a single midline tube of deep
cervical fasciae running inferiorly along the neck, surrounding the airway and
food way including the trachea, esophagus, and thyroid gland.
D This is the description of vertebral fascia. It is the deepest layer of the deep
cervical fasciae, which covers the vertebrae, spinal column, and associated
muscles.

5. Which of the following structures listed below is NOT found within the carotid sheath?
a. Internal carotid artery
b. Common carotid arteryNURSINGTB.COM
c. Eleventh cranial nerve or accessory nerve
d. Internal jugular vein
ANS: C
Feedback
A The internal carotid artery is within the carotid sheath.
B The common carotid artery is within the carotid sheath.
C The tenth cranial nerve or the vagus nerve is within the carotid sheath but NOT
the eleventh cranial nerve or accessory nerve. The eleventh cranial nerve or the
accessory nerve exits the skull through the jugular foramen, which is between
the occipital and temporal bones.
D The internal jugular vein is within the carotid sheath.

6. Which of the following fasciae surrounds the trachea, esophagus, and thyroid gland in the
neck?
a. Vertebral fascia
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b. Visceral fascia
c. Buccopharyngeal fascia
d. Prevertebral fascia
ANS: B
Feedback
A The vertebral fascia covers the vertebrae, spinal column, and associated muscles.
B The visceral fascia surrounds the airway and food way, including the trachea,
esophagus, and thyroid gland.
C The buccopharyngeal fascia encloses the entire superior part of the alimentary
canal and is continuous with the fascia on the surface of the buccinator muscle.
D The prevertebral fascia is also known as the vertebral fascia, which covers the
vertebrae, spinal column, and associated muscles.

7. Which of the following fasciae is also known as pretracheal fascia?

a. Visceral fascia
b. Prevertebral fascia
c. Buccopharyngeal fascia
d. Investing fascia
ANS: A NURSINGTB.COM
Feedback
A The visceral fascia is also known as pretracheal fascia.
B Prevertebral fascia is also known as vertebral fascia and NOT visceral fascia.
C Buccopharyngeal fascia is NOT known as visceral fascia.
D Investing fascia is NOT known as visceral fascia.

8. A dental professional MUST have knowledge of the anatomic aspects of the spaces of the
head and neck when examining a patient BECAUSE these spaces can be involved in
infections arising in dental tissue.
ANS: A
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Feedback
A The statement is correct. Dental professionals MUST know the anatomic aspects
of the spaces because this allows the dental professional to form a
three-dimensional view of the head and neck anatomy, and it also will permit the
dental professional to identify and understand possible infections occurring
within the head and neck. The reason is also correct because these spaces
communicate with each other directly, as well as through their blood and lymph
vessels. In addition, the statement and the reason are related. Both relate to the
spaces, the role of the spaces, and the importance of considering these spaces
during the patient examination.
B The statement and the reason are correct and they are related. Dental
professionals MUST know the anatomic aspects of the spaces because this
allows them to form a three-dimensional view of the head and neck anatomy and
permits them to identify and understand possible infections occurring within the
head and neck. Also, these spaces communicate with each other directly, as well
as through their blood and lymph vessels. Both relate to the spaces, the role of
the spaces, and the importance of considering these spaces during the patient
examination.
C The statement is correct. Dental professionals MUST know the anatomic aspects
of the spaces because this allows the dental professional to form a
three-dimensional view of the head and neck anatomy, and it also will permit the
dental professional to identify and understand possible infections occurring
within the head and neck. The reason is also correct. These spaces communicate
with each other directly, as well as through their blood and lymph vessels.
D The statement is correct.
NUDental
RSINprofessionals
GTB.COMMUST know the anatomic aspects
of the spaces because this allows them to form a three-dimensional view of the
head and neck anatomy, and it also will permit the dental professional to identify
and understand possible infections occurring within the head and neck.
E The statement and the reason are correct. Dental professionals MUST know the
anatomic aspects of the spaces because this allows the dental professional to
form a three-dimensional view of the head and neck anatomy, and it also permits
the dental professional to identify and understand possible infections occurring
within the head and neck. Also, these spaces communicate with each other
directly, as well as through their blood and lymph vessels.

anatomy, physiology, and development | CDA: General Chairside, I. B. Preliminary
Physical Examination | CDA: General Chairside, II. C. Describe how to perform and/or
assist with intraoral procedures | CDA: General Chairside, II. D. Patient Management |
CDA: General Chairside, V. A. Oral Health Information | CDA: General Chairside, VI. A.
4. Describe how to respond to and assist in the management of the signs and symptoms
related to specific medical conditions/emergencies likely to occur in the dental office
Scientific Basis for Dental Hygiene Practice, 5.0 Pathology | NBDHE, Provision of Clinical
Dental Hygiene Services, 1.0 Assessing Patient Characteristics | NBDHE, Provision of
Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care
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9. Where is the vestibular space of the mandible located?

a. Envelopes parotid salivary gland
b. Superior to upper lip
c. Between buccinator muscle and oral mucosa
d. Lateral to buccinator muscle
ANS: C
Feedback
A The parotid space envelopes the parotid salivary gland.
B The canine space is located superior to the upper lip.
C The vestibular space of the mandible is located between the buccinator muscle
and the oral mucosa.
D The buccal space is located lateral to the buccinator muscle.

10. Which space contains BOTH part of the mandible and the inferior alveolar nerve and
vessels?
a. Pterygomandibular space
b. Space within body of mandible
c. Submental space
d. Submandibular space NURSINGTB.COM
ANS: B
Feedback
A The pterygomandibular space contains ONLY a part of the inferior alveolar
nerve and vessels and NOT the mandible.
B The space within the body of the mandible contains both part of the mandible
and the inferior alveolar nerve and vessels.
C The submental space contains both the submental lymph nodes and anterior
jugular vein.
D The submandibular space contains submandibular lymph nodes, most of the
submandibular salivary gland, and parts of the facial artery.

11. The vestibular space of the maxilla is located medial to the buccinator muscle and inferior to
the attachment of this muscle along the alveolar process of the maxilla. This space
communicates with the maxillary anterior teeth and associated periodontium.
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ANS: C
Feedback
A The second statement is false. This space communicates with the maxillary
molar teeth and periodontium, NOT the maxillary anterior teeth and associated
periodontium.
B The first statement is true. The vestibular space of the maxilla is located medial
to the buccinator muscle and inferior to the attachment of this muscle along the
alveolar process of the maxilla.
C The first statement is true. The vestibular space of the maxilla is located medial
alveolar process of the maxilla. The second statement is false. This space
communicates with the maxillary molar teeth and associated periodontium, NOT
the maxillary anterior teeth and associated periodontium.
D The first statement is true. The vestibular space of the maxilla is located medial
alveolar process of the maxilla. The second statement is false. This space
communicates with the maxillary molar teeth and associated periodontium.

MSC: NBDHE, ScientificNBasis
URSfor
INDental
GTB.C OM Practice, 1.1 Anatomy
Hygiene
12. Which of the following spaces communicates with the canine space?
a. Buccal space
b. Temporal space
c. Masticator space
d. Vestibular space of the maxilla
ANS: A
Feedback
A The canine space communicates with the buccal space.
B The temporal space communicates with the infratemporal and submasseteric
spaces.
C All parts of the masticator space communicate with each other, as well as with
the submandibular space and a cervical fascial space, the parapharyngeal space.
D The vestibular space of the maxilla communicates with the maxillary teeth and
periodontium.

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13. Which of the following structures is/are NOT included within the masticator space?
a. Temporal and infratemporal space
b. Masseter muscle and ramus
c. Body of the mandible
d. Buccinator muscle
ANS: D
Feedback
A Both the temporal and infratemporal spaces are included within the masticator
space.
B The masseter muscle and the ramus of the mandible are included within the
masticator space.
C The body of the mandible is included within the masticator space.
D The buccinator muscle is a muscle of facial expression and NOT a muscle of
mastication and is NOT included within the masticator space.

14. What is the significance of pterygomandibular space to local anesthesia in the oral cavity?
a. Contains a part of the posterior superior alveolar nerve
b. Contains a part of inferior alveolar nerve
NUanterior
c. Contains part of both the RSINsuperior
GTB.Calveolar
OM and middle superior alveolar
nerves
d. Contains a part of the greater palatine nerve
ANS: B
Feedback
A The pterygomandibular space does NOT contain a part of the superior alveolar
nerve.
B The pterygomandibular space contains a part of the inferior alveolar nerve.
C The pterygomandibular space does NOT contain a part of either the anterior
superior alveolar or middle superior alveolar nerves.
D The pterygomandibular space does NOT contain a part of the greater palatine
nerve.

15. The submandibular space contains the submandibular lymph nodes, most of the
submandibular salivary gland, and parts of the facial artery. This space is usually involved if
an odontogenic infection spreads.
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ANS: A
Feedback
A The first statement is true. The submandibular space contains the submandibular
lymph nodes, most of the submandibular salivary gland, and parts of the facial
artery. The second statement is also true. This space is usually involved if an
odontogenic infection spreads.
B The first statement is true. The submandibular space contains the submandibular
C The second statement is true. This space is usually involved if an odontogenic
infection spreads.
D The first statement is true. The submandibular space contains the submandibular

Physical Examination | CDA: NUGeneral
RSINGChairside,
TB.COM II. C. Describe how to perform and/or
assist with intraoral procedures | CDA: General Chairside, II. D. Patient Management |
CDA: General Chairside, V. A. Oral Health Information | CDA: General Chairside, VI. A.
4. Describe how to respond to and assist in the management of the signs and symptoms
related to specific medical conditions/emergencies likely to occur in the dental office
16. To which cranial nerve, besides the eleventh and twelfth cranial nerves, is the
parapharyngeal space adjacent in the skull?
a. Third cranial nerve
b. Sixth cranial nerve
c. Seventh cranial nerve
d. Ninth cranial nerve
ANS: D
Feedback
A The third cranial nerve or oculomotor nerve lies in the lateral wall of the
cavernous sinus and exits the skull through the superior orbital fissure of the
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sphenoid bone on its way to the orbit.

B The sixth cranial nerve or abducens nerve exits the skull through the superior
orbital fissure of the sphenoid bone on its way to the orbit. This nerve runs
through the cavernous sinus close to the internal artery.
C The seventh cranial nerve or facial nerve leaves the cranial cavity by passing
through the internal acoustic meatus, which leads to the facial canal inside the
temporal bone. It exits the skull by way of the stylomastoid foramen of the
temporal bone.
D The ninth cranial nerve or glossopharyngeal nerve passes through the skull by
way of the jugular foramen between the occipital and temporal bones, which is
lateral to the visceral fascia around the pharynx.

17. What is the potential space between the buccopharyngeal fascia and the alar fascia that
extends posteriorly to the superior mediastinum termed?
a. Lateral pharyngeal space
b. Retrovisceral space
c. Parapharyngeal space
d. Previsceral space
ANS: B
A The parapharyngeal space or lateral pharyngeal space is a fascial space lateral to
the pharynx and medial to the medial pterygoid muscle, paralleling the carotid
sheath. The parapharyngeal space in its posterior part is adjacent to the carotid
sheath, which contains the internal and common carotid arteries and the internal
jugular vein, as well as the tenth cranial or vagus nerve.
B The retropharyngeal space or retrovisceral space is a fascial space located
immediately posterior to the pharynx, between the vertebral and visceral fasciae.
It extends from the base of the skull, where it is posterior to the superior
pharyngeal constrictor muscle, inferiorly to the thorax. Some anatomists
distinguish a separate layer of the vertebral fascia, called the alar fascia, which
runs from the skull base to connect with the visceral fascia inferiorly in the neck.
C The parapharyngeal space or lateral pharyngeal space is a fascial space lateral to
the pharynx and medial to the medial pterygoid muscle, paralleling the carotid
sheath. The parapharyngeal space in its posterior part is adjacent to the carotid
sheath, which contains the internal and common carotid arteries and the internal
jugular vein, as well as the tenth cranial or vagus nerve.
D The previsceral space is located between the visceral and investing fasciae,
anterior to the trachea.

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18. The buccal space is the fascial space formed between the buccinator muscle and masseter
muscle. Therefore the buccal space is superior to the zygomatic arch.
ANS: C
Feedback
A The first statement is true; the second is false. The buccal space is the fascial
space formed between the buccinator muscle and masseter muscle. Therefore the
buccal space is superior to the zygomatic arch.
B The first statement is true; the second is false. The buccal space is the fascial
C The first statement is true; the second is false. The buccal space is the fascial
D The first statement is true; the second is false. The buccal space is the fascial

NURSI.IA.
TOP: CDA: General Chairside, NGDemonstrate
TB.COM understanding of basic oral and dental
19. Which of the following muscles creates a division between the submandibular and
sublingual spaces?
a. Mylohyoid muscle
b. Intrinsic muscles of the tongue
d. Platysma muscle
ANS: A
Feedback
A The mylohyoid muscle creates a division between the submandibular and
sublingual space.
B The tongue and its intrinsic muscles form the medial border of the sublingual
space.
C The carotid sheath is a tube of deep cervical fasciae deep to both the investing
fascia and sternocleidomastoid muscle on both sides of the neck.
D The superficial cervical fasciae of the neck do contain the platysma muscle,
which covers most of the anterior cervical triangle.
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20. What is a general term for a fascial space located in the face and jaws?
a. Parapharyngeal space
b. Fascial plane
c. Median plane
d. Vestibular space
ANS: B
Feedback
A The parapharyngeal space is a cervical fascial space lateral to the pharynx and
medial to the medial pterygoid muscle.
B A potential space is created between the layers of fasciae of the body because of
the sheetlike nature of the fasciae. They are termed a fascial space or fascial
plane.
C The median plane is created by an imaginary line dividing the body into equal
right and left halves.
D The space of the upper jaw, the vestibular space of the maxilla, is located medial
alveolar process of the maxilla. The vestibular space of the mandible is located
between the buccinator muscle and overlying oral mucosa.
DIF: Recall REF:NUp.R264

SINGTB.C OM 3
OBJ:
21. Which of the following structures is NOT contained even in part within the parotid space?
a. Seventh cranial nerve
b. External carotid artery
c. Retromandibular vein
d. Internal carotid artery
ANS: D
Feedback
A The seventh cranial nerve or facial nerve is contained in part within the parotid
space.
B The external carotid artery is contained in part within the parotid space.
C The retromandibular vein is contained in part within the parotid space.
D The internal carotid artery is NOT contained within the parotid space but instead
within the carotid sheath.

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22. The buccopharyngeal fascia is continuous with the fascia covering the buccinator muscle,
where that muscle and the superior pharyngeal constrictor muscle come together at the
a. lateral pterygoid plate.
b. mandibular symphysis.
c. pterygomandibular raphe.
d. hyoid bone.
ANS: C
Feedback
A The infratemporal space is bordered anteriorly by the lateral pterygoid plate.
B The submental space is located in the midline between the mandibular
symphysis and hyoid bone.
C The buccopharyngeal fascia is continuous with the fascia covering the
buccinator muscle, where that muscle and the superior pharyngeal constrictor
muscle come together at the pterygomandibular raphe.
D The hyoid bone creates the medial apex of the submandibular space.

NURisSNOT
23. Which of the following spaces INGpart
TB.C OMmasticator space?
of the
a. Infratemporal space
b. Temporal space
c. Pterygomandibular space
d. Space of the body of the mandible
ANS: D
Feedback
A The infratemporal space is part of the masticator space.
B The temporal space is part of the masticator space.
C The pterygomandibular space is a part of the infratemporal space, which is part
of the masticator space.
D The space of the body of the mandible is NOT part of the masticator space but
formed instead by the periosteum, anterior to the body of the mandible from its
symphysis to the anterior borders of the masseter and medial pterygoid muscles.

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24. Which space of the face and jaws has NO border inferiorly and posteriorly and is continuous
with the cervical fascial space and the parapharyngeal space?
a. Submental space
b. Infratemporal space
c. Submandibular space
d. Retropharyngeal space
ANS: B
Feedback
A The floor of the submental space is the superficial cervical fascia covering the
suprahyoid muscles. The roof is the mylohyoid muscle, covered by the investing
fascia. Forming the lateral boundaries of this space of the face and jaws are the
diverging anterior bellies of the digastric muscles.
B The infratemporal space is a space of the face and jaws that has NO border
inferiorly and posteriorly. The space is continuous with the cervical fascial space
and the parapharyngeal space.
C The mylohyoid line of the mandible is the superior border of the submandibular
space, a space of the face and jaws. The mylohyoid muscle forms the medial
border of the space, and the hyoid bone creates its medial apex.
D The retropharyngeal space is a cervical space that is located immediately
posterior to the pharynx, between the vertebral and visceral fasciae and extends
from the base of the skull, where it is posterior to the superior pharyngeal
constrictor muscle and inferior to the thorax.

NURSI.IA.
TOP: CDA: General Chairside, NGDemonstrate
TB.COM understanding of basic oral and dental
25. Which of the following fasciae is considered deep cervical fasciae?

a. Pterygoid fasciae
b. Anterior cervical triangle
c. Muscles of facial expression
d. Investing fasciae
ANS: D
Feedback
A The pterygoid fasciae are a part of the deep fasciae of the face and jaws and are
located on the medial surface of the medial pterygoid muscle.
B The superficial cervical fasciae of the neck contain the platysma muscle, which
covers most of the anterior cervical triangle.
C The superficial fasciae of the face enclose the muscles of facial expression.
D The deep cervical fasciae are composed of layers that include investing fasciae,
carotid sheath, visceral fasciae, and vertebral fasciae.

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26. Which of the following spaces has important landmarks for administering either the inferior
alveolar block or Vazirani-Akinosi mandibular block?
a. Submasseteric space
b. Submandibular space
c. Pterygomandibular space
d. Parapharyngeal space
ANS: C
Feedback
Correct The pterygomandibular space is important to dental professionals because
it contains the inferior alveolar and lingual nerves and associated blood
vessels. Thus the space in itself is a landmark for the inferior alveolar
block as well as the Vazirani-Akinosi mandibular block, since it contains
the target for both of these blocks.
Incorrect The submasseteric space, submandibular space, and parapharyngeal space
do NOT contain landmarks for the either the inferior alveolar block or
Vazirani-Akinosi mandibular block NOR are they each a landmark in
themselves like the pterygomandibular space. Note that even though the
submasseteric space is part of the masticator space that includes the
pterygomandibular space as well, it is the submasseteric space located
between the masseter muscle and the external surface of the vertical
mandibular ramus and NOT the medial surface of the mandibular ramus
that is important for both injections.
NURSINGTB.COM
Physical Examination | CDA: General Chairside, II. D. Patient Management
MULTIPLE RESPONSE
1. From the following list of descriptions, select those that CORRECTLY describe the location
of the sublingual space. (Select all that apply.)
a. Oral mucosa is the roof
b. Palatal tonsils form medial border
c. Mandible forms lateral wall
d. Floor is hard palate
ANS: A, C
Feedback
Correct The oral mucosa is the roof, and the mandible forms the lateral wall for
the sublingual space.
Incorrect The tongue (NOT the tonsils) forms the medial border; the floor is the
mylohyoid muscle for the sublingual space and NOT the hard palate.
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2. From the list of fascial spaces, select those that are considered spaces of the face and jaws.
a. Canine space
b. Parotid space
c. Carotid sheath
d. Parapharyngeal space
e. Previsceral space
ANS: A, B
Feedback
Correct The canine space and parotid space are considered fascial spaces of the
face and jaws.
Incorrect The carotid sheath is a tube of deep fascia along the side of neck. The
parapharyngeal and previsceral spaces are considered cervical fascial
spaces and NOT spaces of the face and jaws.

MSC: NBDHE, ScientificNBasis
URSfor
INDental
GTB.C OM Practice, 1.1 Anatomy
Hygiene
3. From the following list of structures, select which are contained within the sublingual space.
a. Submandibular duct
b. Facial artery and hypoglossal nerve
c. Submental lymph nodes
d. Lingual nerve and lingual artery
e. Mandible
ANS: A, D
Feedback
Correct The contents of the sublingual space include the submandibular duct and
also the lingual nerve and lingual artery, as well as the hypoglossal nerve.
Incorrect The facial artery is located within the submandibular space, and the
submental lymph nodes are located within the submental space. The
mandible is located within the space of the body of the mandible.

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4. From the following list of fascial spaces, select those that communicate with the
submandibular space. (Select all that apply.)
a. Space of the body of the mandible
b. Infratemporal space
c. Submental space
d. Sublingual space
e. Buccal space
ANS: A, B, C, D
Feedback
Correct The submandibular space communicates with the space of the body of the
mandible, infratemporal space, submental space, and sublingual space, as
well as the parapharyngeal space.
Incorrect The buccal space communicates with the canine space, pterygomandibular
space, and the space of the body of the mandible and NOT the
submandibular space.

5. From the following list of structures, select those located within the carotid sheath. (Select
all that apply.)
a. Hypoglossal nerve
b. Internal carotid artery NURSINGTB.COM
c. Internal jugular vein
d. Common carotid artery
e. Vagus nerve
ANS: B, C, D, E
Feedback
Correct The internal jugular vein and both the common and internal carotid
arteries, as well as the vagus nerve, are located within the carotid sheath.
Incorrect The hypoglossal nerve is NOT located within the carotid sheath.

6. Which of the following descriptions are CORRECT when discussing the cervical
compartments of the neck? (Select all that apply.)
a. Neck is divided into three major cervical compartments
b. Useful when deciding on the anatomic borders of the cancer
c. Neck is divided into four major cervical compartments
d. Useful when defining the anatomic borders of cancer treatment
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ANS: B, C, D
Feedback
Correct The neck can be divided into four major cervical compartments. The
defining of these cervical compartments is useful when deciding on the
anatomic borders of the cancer and subsequent cancer treatment.
Incorrect The neck can be divided into four major cervical compartments and NOT
three cervical compartments.

7. A patient (when updating their medical history) states that they had thyroid gland cancer but
that it was contained within the visceral compartment of the neck. Which of the following is
CORRECT when discussing this compartment of the neck? (Select all that apply.)
a. Also considered the posterior compartment of the neck
b. Contains the spinal cord and cervical vertebrae, as well as associated muscles
c. Within the surrounding vertebral fascia
d. Continuation of the gastrointestinal and respiratory systems
e. More movable in comparison to other compartments
ANS: D, E
Feedback
Correct The visceral compartment
NURSINisGTa B.C continuation
O M of the gastrointestinal and
respiratory systems. This compartment is more movable in comparison to
the other compartments.
Incorrect The visceral compartment is the anterior compartment and NOT the
posterior compartment. The compartment contains the thyroid, thymus,
and parathyroid glands, as well as the hyoid bone, larynx, trachea,
esophagus and pharynx, but does NOT contain the spinal cord or cervical
vertebrae, as well as associated muscles. The visceral compartment is
within the surrounding visceral fascia and NOT the vertebral fascia.

Dental Hygiene Services, 1.1 Medical and Dental History | NBDHE, Provision of Clinical
8. When discussing odontogenic infections, what can be noted about what is known by dental
professionals as the “danger space” of the neck? (Select all that apply.)
a. Located immediately anterior to the pharynx
b. Located between the vertebral and visceral fasciae
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c. Communicates directly with the submental space

d. Communicates directly with the parapharyngeal spaces
ANS: B, D
Feedback
Correct The retropharyngeal space or “danger space” of the neck as known by
dental professionals is located between the vertebral and visceral fasciae
and communicates directly with the parapharyngeal spaces.
Incorrect The retropharyngeal space or “danger space” of the neck as known by
dental professionals is located immediately posterior and NOT
immediately anterior to the pharynx. The retropharyngeal space does NOT
communicate with the submental space but directly with the
parapharyngeal spaces.

Physical Examination | CDA: General Chairside, II. C. Describe how to perform and/or
assist with intraoral procedures | CDA: General Chairside, II. D. Patient Management
9. What are the CORRECT borders of the triangular-shaped submandibular space? (Select all
that apply.) NURSINGTB.COM
a. Mylohyoid line of mandible is its superior border
b. Masseter muscle forms its medial border
c. Mandible forms its medial border
d. Alveolar process of mandible is its superior border
ANS: B, D
Feedback
Correct The mylohyoid line of the mandible is the superior border of the
Incorrect The mylohyoid line of the mandible is the superior border of the
submandibular space and NOT the alveolar process of the mandible. The
mylohyoid muscle then forms its medial border and NOT the masseter
muscle or mandible; the hyoid bone also creates its medial apex.

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Chapter 12: Spread of Infection

MULTIPLE CHOICE
1. Which of the following terms is BEST used to describe an infection with suppuration
resulting from the entrapment of pathogens in a contained space?
a. Cellulitis
b. Abscess
c. Fistula
d. Embolus
ANS: B
Feedback
A Cellulitis is a diffuse inflammation of soft tissue.
B An abscess is an infection with suppuration resulting from the entrapment of
pathogens in a contained space.
C A fistula is a passageway in the skin, mucosa, or even bone that allows drainage
of an abscess at the surface.
D An embolus is foreign material or a thrombus traveling in the blood that can
block the vessel.

Information | CDA: General Chairside, VI. B. 1. Recognize the signs and symptoms related
to specific dental conditions/emergencies likely to occur in the office
Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care | NBDHE,
Provision of Clinical Dental Hygiene Services, 4.1 Etiology and pathogenesis of periodontal
diseases
2. Which of the following terms BEST describes the infectious process created by indigenous
regional microorganisms because the body’s defenses are compromised?
a. Resident microbiota
b. Suppuration
c. Opportunistic infection
d. Perforation
ANS: C
Feedback
A Resident microbiota is defined as indigenous regional microorganisms that
usually do NOT cause infections.
B Suppuration is pus containing pathogenic bacteria, white blood cells, tissue
fluid, and debris.
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C An opportunistic infection is an infectious process created by resident

microbiota when the body’s defenses are compromised.
D A perforation is an abnormal hole in a hollow organ such as in the wall of a
sinus.

3. Which of the following infections initially and DIRECTLY involves teeth and associated
tissue?
a. Odontogenic infection
b. Lymphadenitis
c. Endophthalmitis
d. Otitis media
ANS: A
Feedback
A An odontogenic infection is a dental infection involving the teeth and associated
tissue.
B Lymphadenitis is an infection of the lymph nodes.
C Endophthalmitis is an infection within the ocular cavity usually involving the
internal structures of the eye.
D Otitis media is an infection of the middle ear, usually involving the eardrum.

diseases
4. A dental professional SHOULD understand the infectious process that allows

microorganisms to create disease. Certain nonresident microorganisms can invade and
initiate an infection.
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ANS: A
Feedback
A Both the first and second statements are true. A dental professional SHOULD
understand the infectious process that allows microorganisms to create disease.
Certain nonresident microorganisms can invade and initiate an infection.
B Both the first and second statements are true. A dental professional SHOULD
understand the infectious process that allows microorganisms to create disease.
Certain nonresident microorganisms can invade and initiate an infection.
C The second statement is true. Certain nonresident microorganisms can invade
and initiate an infection.
D The first statement is true. A dental professional SHOULD understand the
infectious process that allows microorganisms to create disease.

Chairside, VI. B. 1. Recognize the signs and symptoms related to specific dental
Clinical Dental Hygiene Services, 3.0 Planning and Managing Dental Hygiene Care |
NBDHE, Provision of Clinical Dental Hygiene Services, 4.1 Etiology and pathogenesis of
periodontal diseases
5. Upon intraoral examination of a patient’s palate, you notice the presence of an abscess.
Which teeth can be involved with the clinical presentation of this abscess?
a. Maxillary molars: buccal surface and buccal roots
b. Maxillary lateral incisors: lingual surfaces and roots; maxillary premolars: lingual
surfaces and roots; and maxillary molars: lingual surfaces and roots
c. Maxillary anterior teeth: all surfaces and roots; maxillary posterior teeth: buccal
surfaces and roots
d. Maxillary molars: buccal surfaces and buccal roots; mandibular first and second
molars: buccal surfaces and buccal roots
ANS: B
Feedback
A The maxillary molars, buccal surface and buccal roots, are involved when an
abscess or fistula perforates into the maxillary sinuses.
B The maxillary lateral incisors: lingual surfaces and roots; maxillary premolars:
lingual surfaces and roots; and maxillary molars: lingual surfaces and roots are
involved when an abscess or fistula is clinically present on the palate.
C The maxillary anterior teeth (all surfaces and roots) and maxillary posterior
teeth (buccal surfaces and roots) are involved when an abscess or fistula is
clinically present in the maxillary vestibule.
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D The maxillary molars (buccal surfaces and buccal roots) and mandibular first
and second molars (buccal surfaces and buccal roots) are involved when an
abscess or fistula is clinically present on the buccal skin surface.

6. Which of the following disease states can DIRECTLY cause a periapical abscess?
a. Periodontal disease
b. Chronic gingivitis
c. Progressive caries
d. Dentigerous cyst formation
ANS: C
Feedback
A Acute periodontal disease can cause a periodontal abscess to occur along with
apical migration of the gingival tissue and alveolar bone.
B Chronic gingivitis can cause the marginal and interdental gingival tissue to
become enlarged and inflamed.
C A periapical abscess can result from progressive caries. This occurs from an
infection of the pulp causing the pulp to become necrotic due to invasion of
microorganisms into the sterile pulp from the progressive caries. The infection
will usually spread apically.
D A dentigerous cyst is a developmental odontogenic cyst that forms around the
crown of a developing impacted tooth.

diseases
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7. Early detection of an abscess is imperative in order to avoid destruction of dental tissue.

Early detection of an abscess is BEST accomplished with the use of dental radiographs.
ANS: C
Feedback
A The second statement is false. Abscess formation may NOT be detectable on
radiographs during the early stages. This is because the infection process may
NOT have destroyed alveolar bone, thereby decreasing the density of the bone
that can be seen radiographically as a radiolucent image.
B The first statement is true. Early detection of abscess is imperative in order to
avoid destruction of dental tissue.
C The first statement is true. Early detection of abscess is imperative in order to
avoid destruction of dental tissue. The second statement is false. Abscess
formation may NOT be detectable on radiographs during the early stages. This
is because the infection process may NOT have destroyed alveolar bone,
thereby decreasing the density of the bone that can be seen radiographically as a
radiolucent image.
D The first statement is true. Early detection of abscess is imperative in order to
avoid destruction of dental tissue. The second statement is false. Abscess
formation may NOT be detectable on radiographs during the early stages. This
is because the infection process may NOT have destroyed alveolar bone,
thereby decreasing the density of the bone that can be seen on radiographs as a
radiolucent image.

diseases
8. Which of the following signs OR symptoms CANNOT be used to describe cellulitis of the
face and neck?
a. Pain
b. Tenderness
c. Redness
d. Systemic infection
ANS: D
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Feedback
A Pain is often associated with infection and inflammation such as that which
occurs with cellulitis, a diffuse inflammation of soft tissue spaces.
B Tenderness is often associated with infection due to the swelling and pressure
placed on surrounding nerves such as that which occurs with cellulitis, a diffuse
inflammation of soft tissue spaces.
C Redness or inflammation is often associated with infection such as that which
occurs with cellulitis, a diffuse inflammation of soft tissue spaces.
D Even though infection is associated with cellulitis, a diffuse inflammation of
soft tissue spaces, the infection usually remains localized and is NOT systemic.

diseases
9. Which of the following disease states may be involved in an odontogenic infection that has
an inflammation of the bone marrow?
a. Osteomyelitis
b. Paresthesia
c. Cellulitis
d. Meningitis
ANS: A
Feedback
A Osteomyelitis is an inflammation of the bone marrow.
B Paresthesia is an abnormal sensation in an area such as burning or prickling.
C Cellulitis is a diffuse inflammation of soft tissue spaces.
D Meningitis is an inflammation of the meninges of the brain or spinal cord.

diseases
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10. Osteomyelitis MOST often occurs in the mandible BECAUSE of the mandible’s thicker
cortical plates and reduced vascularization.
ANS: A
Feedback
A Both the statement and the reason are correct and related. Osteomyelitis MOST
often occurs in the mandible due to the mandible’s thicker cortical plates and
reduced vascularization. They are also related because the statement refers to
osteomyelitis, which is an inflammation within the bone, and the reason
discusses why this inflammation occurs in a bone such as the mandible.
B Both the statement and the reason are correct and related. Osteomyelitis MOST
often occurs in the mandible due to the mandible’s thicker cortical plates and
reduced vascularization. The statement and reason are also related because the
statement refers to osteomyelitis, which is an inflammation within the bone, and
the reason discusses why this inflammation occurs in a bone such as the
mandible.
C The reason is correct. The fact that the mandible has thicker cortical plates and
reduced vascularization allows osteomyelitis to occur MORE readily.
D The statement is correct. Osteomyelitis MOST often occurs in the mandible.
E The statement and the reason are correct. Osteomyelitis MOST often occurs in
the mandible due to the mandible’s thicker cortical plates and reduced
vascularization.

diseases
11. When a patient complains of burning and prickling in the mandible, more than likely he or
she has a condition known as Ludwig angina BECAUSE an infection from the entrapment
of pathogens or resident microbiota with suppuration has become encased in that area.
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ANS: E
Feedback
A The statement is NOT correct. When a patient complains of burning and
prickling in the mandible, more than likely he or she has a condition known as
paresthesia, NOT Ludwig angina. The reason is NOT correct. An infection from
the entrapment of pathogens with suppuration describes an abscess, and resident
microbiota are indigenous regional microorganisms that usually do NOT cause
an infection. The statement and the reason are NOT related.
B The statement is NOT correct. When a patient complains of burning and
an infection.
C The statement is NOT correct. When a patient complains of burning and
paresthesia, NOT Ludwig angina.
D The reason is NOT correct. An infection from the entrapment of pathogens with
suppuration describes an abscess, and resident microbiota are indigenous
regional microorganisms that usually do NOT cause an infection.
E The statement is NOT correct. When a patient complains of burning and
an infection.

12. Which of the following symptoms is NOT related to an infection of the paranasal sinuses
that resulted from a direct spread of infection from the teeth and associated oral tissue?
a. Headache
b. Pharyngeal discharge
c. Hypothermia
d. Tenderness
ANS: C
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Feedback
A Sinus pressure from enlarged, inflamed sinus tissue will often result in a
headache in the area of the maxillary sinuses.
B A pharyngeal discharge occurs due to infectious, puslike fluids building up in
the sinus cavity due to paranasal sinus infections. It can be foul smelling and
can also involve nasal discharge.
C Fever or increased body temperature is often associated with infection.
However, hypothermia is a decrease in body temperature.
D Tenderness due to tissue enlargement in the area of the infection presses on
nerves in the surrounding area, causing tenderness that can occur with paranasal
sinus infections.

diseases
13. Which of the following disease states can DIRECTLY cause the spread of odontogenic
infections by way of the vascular system?
a. Fistula
b. Bacteremia
c. Pustule
d. Abscess
ANS: B
Feedback
A A fistula is a passageway in the skin, mucosa, or even bone that allows drainage
of an abscess at the surface.
B Bacteremia is bacteria traveling within the blood system, thus allowing a spread
of odontogenic infection by way of the vascular system.
C A pustule is a small, elevated, circumscribed suppuration-containing lesion of
either the skin or oral mucosa.
D An abscess is a type of infection from an entrapment of pathogens with
suppuration in a contained space.
DIF: Comprehension REF: p. 294 OBJ: 2 | 3

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diseases
14. An infected thrombus can dislodge from the inner blood vessel wall and travel as an
embolus. Emboli can travel in the veins, draining the oral cavity into areas such as the dural
venous sinuses within the oral cavity.
ANS: A
Feedback
A Both statements are true. An infected intravascular clot or thrombus can
dislodge from the inner blood vessel wall and travel as an embolus. Emboli can
travel in the veins, draining the oral cavity into areas such as the dural venous
sinuses within the oral cavity.
B Both statements are true. An infected intravascular clot or thrombus can
dislodge from the inner blood vessel wall and travel as an embolus. Emboli can
travel in the veins, draining the oral cavity into areas such as the dural venous
sinuses within the oral cavity.
C The second statement is true. Emboli can travel in the veins, draining the oral
cavity into areas such as the dural venous sinuses within the oral cavity.
D The first statement is true. An infected intravascular clot or thrombus can
dislodge from the inner blood vessel wall and travel as an embolus.

diseases
15. Which of the following signs and symptoms CANNOT be used to describe cavernous sinus
thrombosis?
a. Fever
b. Drowsiness
c. Bradycardia
d. Rapid pulse
ANS: C
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Feedback
A Fever is a common symptom of an infection such as cavernous sinus
thrombosis.
B Drowsiness is a common symptom of cavernous sinus thrombosis.
C Bradycardia is a decreased heart rate or pulse rate. However, an increase in the
pulse rate or rapid pulse is a common sign or symptom of cavernous sinus
thrombosis.
D A rapid pulse is a sign or symptom of cavernous sinus thrombosis.

16. The loss of which of the following is noted during an examination of a patient with
abducens nerve paralysis?
a. Hearing
b. Smelling sensation
c. Eyeball movement
d. Tongue movement
ANS: C
Feedback
A Abducens nerve paralysis does NOT affect the seventh cranial nerve, which
serves as an afferent nerve for hearing and balance.
B Abducens nerve paralysis does NOT affect the first cranial nerve, which
transmits smell from the nasal mucosa to the brain.
C Abducens nerve paralysis does affect the sixth cranial nerve, which is an
efferent nerve to one of the muscles that moves the eyeball.
D Abducens nerve paralysis does NOT affect the twelfth cranial nerve XII, which
is an efferent nerve for the intrinsic and extrinsic muscles of the tongue.

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17. From what case histories do MOST odontogenic infections in patients result from?
a. Dermatologic infections
b. Upper respiratory infection
c. Dental biofilm (dental plaque)
d. Sinusitis
ANS: C
Feedback
A Only some odontogenic infections are secondary infections incited by an
infection from the tissue surrounding the oral cavity such as the skin, tonsils,
ears, or sinuses.
B Only some odontogenic infections are secondary infections incited by an
ears, or sinuses.
C MOST odontogenic infections result initially from the formation of dental
biofilm (dental plaque) from the surrounding area.
D Only some odontogenic infections are secondary infections incited by an
ears, or sinuses.

18. Which of the following complications can result from untreated cellulitis?
a. Bell palsy
b. Ludwig angina
c. Trigeminal neuralgia
d. Transient facial paralysis
ANS: B
Feedback
A Bell palsy involves unilateral facial paralysis with NO known cause, except that
there is a loss of excitability of the involved facial nerve.
B Cellulitis can possibly spread due to perforation of the surrounding bone,
causing serious complications such as Ludwig angina, which is cellulitis of the
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C Trigeminal neuralgia or tic douloureux has NO known etiology but involves the
afferent nerves of the fifth cranial or trigeminal nerve.
D Transient facial paralysis can occur due to injection into the gland during an
incorrectly administered inferior alveolar block.

19. Which of the following is KEY to preventing complications with odontogenic infections in
patients?
a. Sterilizing instruments
b. Covering hard operatory surfaces
c. Using mouthwashes
d. Early diagnosis and treatment
ANS: D
Feedback
A Early diagnosis and treatment of odontogenic infections MUST occur in all
patients.
B Early diagnosis and treatment of odontogenic infections MUST occur in all
patients.
C Early diagnosis and treatment of odontogenic infections MUST occur in all
patients.
D Early diagnosis and treatment of odontogenic infections MUST occur in all
patients.

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20. Evaluation of lymph node involvement can BEST determine which of the following?
a. Healing level of patient
b. Etiology of infection
c. Age of the patient
d. Regional involvement
ANS: D
Feedback
A Evaluation of the involved nodes can determine the degree of regional
involvement in the infection process, which is instrumental in the diagnosis and
management of the infection.
B Evaluation of the involved nodes can determine the degree of regional
C Evaluation of the involved nodes can determine the degree of regional
D Evaluation of the involved nodes can determine the degree of regional

21. Which of the following factors is important in the spread of odontogenic infections from
their involvement with gram-negative anaerobic bacteria?
a. Adaption to wet environment
b. Increased metabolism
c. Beta-lactamase enzyme
d. Thicker cell walls
ANS: C
Feedback
A More than half of the gram-negative anaerobic bacteria are capable of
producing the beta-lactamase enzyme, which is responsible for the initial
etiology of head and neck infections, as well as treatment failures in
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odontogenic infections.
B More than half of the gram-negative anaerobic bacteria are capable of
C More than half of the gram-negative anaerobic bacteria are capable of
D The pathogenic capability of gram-negative bacteria is often associated with
certain components of gram-negative cell walls, in particular, the
lipopolysaccharide, also known as LPS or endotoxin layer.

22. What recent procedure performed in the community has increased the cases of Ludwig
angina?
a. Tongue piercing
b. Tooth jewelry
c. Ear piercing
d. Laser hair removal
ANS: A
Feedback
A With the recent popularity of the piercing of oral sites such as the tongue, there
has been an increase in infections of these sites that can become more serious
such as with Ludwig angina.
B With the advent of earlier care of abscessed teeth and more routine antibiotic
treatment, Ludwig angina has become an uncommon dental emergency in
healthy patients.
C With the advent of earlier care of abscessed teeth and more routine antibiotic
healthy patients.
D With the advent of earlier care of abscessed teeth and more routine antibiotic
healthy patients.
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23. A thorough medical history with periodic updates will allow the dental professional to
perform effective treatment of medically compromised patients and avoid serious
complications due to dental diseases. These patients may require antibiotic premedication
before dental treatment or other changes in the dental treatment plan so as to prevent serious
sequelae.
ANS: A
Feedback
A Both statements are true: a thorough medical history with periodic updates will
allow the dental professional to perform safe treatment of medically
compromised patients and avoid serious complications due to dental diseases.
These patients may require antibiotic premedication before dental treatment or
other changes in the dental treatment plan so as to prevent serious sequelae.
B Both statements are true: a thorough medical history with periodic updates will
C Both statements are true: a thorough medical history with periodic updates will
D Both statements are true: a thorough medical history with periodic updates will

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24. Using an antiseptic oral rinse before treatment, a rubber dam, or an antimicrobial-laced
external water supply during treatment when ultrasonics or irrigators are used may be of
help in preventing the spread of infection.
ANS: A
Feedback
A Both the statement and the reason are correct and related. MOST odontogenic
infections result initially from the formation of dental biofilm (dental plaque)
from the surrounding area. There must also be strict adherence to standard
precautions of infection control during other types of dental treatment so as to
prevent the spread of infection.
B Both the statement and the reason are correct and related. MOST odontogenic
C Both the statement and the reason are correct and related. MOST odontogenic
D Both the statement and the reason are correct and related. MOST odontogenic
E Both the statement and the reason are correct and related. MOST odontogenic
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25. Since the apices of the mandibular second and third molars are inferior to the mylohyoid
muscle, an infection here will MOST likely spread directly to the sublingual space.
ANS: D
Feedback
A The statement is NOT correct, but the reason is correct. Since the apices of the
mandibular second and third molars are inferior to the mylohyoid muscle, an
infection here will directly spread to the submandibular space.
B The statement is NOT correct, but the reason is correct. Since the apices of the
C The statement is NOT correct, but the reason is correct. Since the apices of the
D The statement is NOT correct, but the reason is correct. The apex of the
mandibular first molar is superior to the mylohyoid muscle, so involvement of
this tooth or teeth anterior to this will first involve the sublingual space. Since
the apices of the mandibular second and third molars are inferior to the
mylohyoid muscle, an infection here will directly spread to the submandibular
space.
E The statement is NOT correct, but the reason is correct. Since the apices of the

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26. From the following list, select those that describe components that may be involved as
infection resistance factors in the oral cavity.
a. Gram-positive aerobic bacteria
b. Beta-lactamase enzyme production
c. Penicillin-susceptible pathogens
d. Lipase enzyme production
ANS: B
Feedback
Correct Beta-lactamase enzyme production can be involved as an infection
resistance factor, as well as gram-negative anaerobic bacteria and
penicillin-resistance pathogens, in the oral cavity.
Incorrec Gram-positive aerobic bacteria, penicillin-susceptible pathogens, and
t lipase enzyme production are NOT infection resistance factors noted in
the oral cavity.

27. From the following list, select which are the imaging modalities of choice in the evaluation
of the patient with a deep tissue cervical infection.
a. Ultrasound imaging
b. Full mouth radiographs
c. Panoramic radiograph
d. Contrast-enhanced computed tomography scan
ANS: D
Feedback
A Ultrasound imaging, full mouth radiographs, or panoramic radiograph are NOT
the imaging modalities of choice in the evaluation of the patient with a deep
tissue cervical infection.
B Ultrasound imaging, full mouth radiographs, or panoramic radiograph are NOT
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C Ultrasound imaging, full mouth radiographs, or panoramic radiograph are NOT
D Contrast-enhanced computed tomography scan has become the imaging
modality of choice in the evaluation of the patient with a deep tissue cervical
infection.

28. Why does abducens nerve paralysis possibly become fatal in a dental patient?
a. Damage only to the sixth cranial nerve
b. Edema of the larynx occurs
c. May lead to meningitis
d. Only because diplopia occurs
ANS: C
Feedback
A There may also be damage to the other cranial nerves with abducens nerve
paralysis, with cavernous sinus thrombosis involving abducens nerve paralysis
such as the oculomotor nerve (third) and trochlear nerve (fourth), as well as to
the ophthalmic and maxillary divisions of the trigeminal nerve (fifth).
B Only Ludwig angina can involve edema of the larynx.
C Abducens nerve paralysis can be fatal because it may lead to meningitis,
inflammation of the meninges in the brain or spinal cord, which requires
immediate hospitalization with intravenous antibiotics and anticoagulants.
D The patient with abducens nerve paralysis usually has double vision (diplopia)
due to restricted movement of one eye, as well as edema of the eyelids and
conjunctivae, tearing (lacrimation), and extruded eyeballs (exophthalmus),
depending on the course of the infection.

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MULTIPLE RESPONSE
1. From the following list of fascial spaces, select those that can be DIRECTLY involved in the
spread of infection concerning Ludwig angina. (Select all that apply.)
a. Infratemporal space
b. Retropharyngeal space
c. Parapharyngeal space
d. Submandibular space
ANS: A, B, C, D
The infratemporal space, retropharyngeal space, and parapharyngeal space can ALL be
directly involved in Ludwig angina since they ALL communicate with the submandibular
space and, most importantly, infection in any of these spaces can spread in this manner from
space to space.

2. From the following list of case histories of dental patients, select those that have a high risk
of opportunistic infections. (Select all that apply.)
a. Human immunodeficiency virus infection
b. Uncontrolled diabetes
c. Cancer therapy
d. Transplant therapy
ANS: A, B, C, D
Case histories involving human immunodeficiency virus infection and uncontrolled
diabetes, as well as cancer and transplant therapy, ALL have a high risk of opportunistic
infections.
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3. From the following list of factors, select those that involve bacteremia and its complications.
a. Lodging of bacteria in compromised tissue
b. Need for psychologic premedication
c. Low risk of infective endocarditis
d. High risk of serious heart infection
ANS: A, D
Feedback
Correct Bacteremia and its complications can involve lodging of bacteria in
compromised tissue as well as a high risk for serious heart infection.
Incorrect Bacteremia and its complications can involve a high risk of infective
endocarditis and thus the possible need for antibiotic premedication.

4. From the following list, select those that can be involved in the spread of odontogenic
infections. (Select all that apply.)
a. Vascular system
b. Paranasal sinuses
c. Fascial spaces
d. Lymphatics
ANS: A, B, C, D
Odontogenic infections can spread by the vascular system, paranasal sinuses, fascial spaces,
and lymphatics.
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5. From the following list of dental setting procedures, select those that might serve as
precautions when undertaken to prevent the spread of an odontogenic infection in a patient.
a. Adhering to standard infection control measures
b. Removing heavy dental biofilm (dental plaque)
c. Avoiding contamination of oral surgery sites
d. Using antimicrobial rinse or rubber dam
ANS: A, B, C, D
Odontogenic infections can be prevented from spreading by adhering to standard infection
control measures, removing heavy dental biofilm (dental plaque), avoiding contamination of
oral surgery sites, and using antimicrobial rinse or rubber dam.

6. From the following list, select which treatments are usually administered with the acute
medical emergency of Ludwig angina. (Select all that apply.)
a. Removal of tonsils
b. Cricothyrotomy
c. Puncture of tympanic membrane
d. Immediate hospitalization
ANS: B, D
Feedback
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Correct Ludwig angina is an acute medical emergency requiring immediate

hospitalization and may necessitate an emergency cricothyrotomy. During
this emergency airway puncture, an incision is made through the skin and
cricothyroid membrane (the larger part of the laryngeal membrane) to
quickly create a patent airway due to it being compromised.
Incorrect Both the removal of tonsils and puncture of tympanic membrane do NOT
usually occur with the acute medical emergency of Ludwig angina.

OTHER
1. Place the following in the CORRECT order of occurrence when untreated Ludwig angina
becomes involved with edema of the larynx.
a. Asphyxiation
c. Complete respiratory obstruction
d. Death
ANS:
C, A, D
Feedback
Correct When Ludwig angina becomes involved with edema of the larynx there
Order can be (in this order) complete respiratory obstruction, asphyxiation, and
death.
Incorrec Ludwig angina is an acute medical emergency requiring immediate
t hospitalization and may necessitate the treatment of an emergency
cricothyrotomy. During this emergency airway puncture, an incision is
made through the skin and cricothyroid membrane (the larger part of the
laryngeal membrane) to quickly create a patent airway due to it being
compromised.

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Test Bank For Illustrated Anatomy of The Head and Neck 5th Edition by Fehrenbach

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Test Bank For Illustrated Anatomy of The Head and Neck 5th Edition by Fehrenbach

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Chapter 01: Introduction to Head and Neck Anatomy

DIF: Comprehension REF: p. 3 OBJ: 2

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 3 OBJ: 2

DIF: Comprehension REF: p. 3 OBJ: 2

5. What is the anatomic relationship of the muscles to the skin?

DIF: Comprehension REF: p. 3 OBJ: 2

6. What is the anatomic relationship of the shoulders to the hips?

DIF: Comprehension REF: p. 3 OBJ: 2

7. Which of the following is meant by the term “ventral”?

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 2 OBJ: 2

DIF: Comprehension REF: p. 3 OBJ: 2

DIF: Comprehension REF: p. 3 OBJ: 2

DIF: Recall REF: p. 3 OBJ: 1

12. What is another term for a transverse section?

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 3 OBJ: 1

DIF: Comprehension REF: p. 3 OBJ: 3

b. Both statements are false.

DIF: Recall REF: p. 3 OBJ: 2

DIF: Recall REF: p. 3 OBJ: 2

18. What is another term for coronal plane?

DIF: Recall REF: p. 3 OBJ: 1

an individual can vary in size, location, and even presence.

DIF: Comprehension REF: p. 3 OBJ: 3

20. What is another term for midsagittal plane?

DIF: Recall REF: p. 3 OBJ: 1

B A frontal plane or coronal plane is created by an imaginary line dividing the

DIF: Recall REF: p. 3 OBJ: 2

DIF: Recall REF: p. 3 OBJ: 2

23. The transverse section is a division through a _____ plane.

A The transverse section or horizontal section is a division through a horizontal

DIF: Recall REF: p. 3 OBJ: 1

DIF: Comprehension REF: p. 3 OBJ: 2

DIF: Comprehension REF: p. 3 OBJ: 2

in relationship to the planes, so they are NOT DIRECTLY associated with

DIF: Recall REF: p. 4, Figure 1-4 OBJ: 1

DIF: Recall REF: p.N

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 3 OBJ: 1

DIF: Recall REF: p. 3 OBJ: 1

DIF: Comprehension REF: p. 2 OBJ: 2

DIF: Recall REF: p. 3 OBJ: 1

1. ANS: B DIF: Recall REF: p. 3 OBJ: 1

physiology, and development

DIF: Application REF: p. 3 OBJ: 2

Chapter 02: Surface Anatomy

DIF: Comprehension REF: p. 11 OBJ: 2

2. Which of the following is the CORRECT definition of the term labial?

B This is the definition of the term facial.

DIF: Recall REF: p. 15 OBJ: 1

DIF: Recall REF: p. 14 OBJ: 3

DIF: Recall REF: p. 13 OBJ: 3

DIF: Comprehension REF: p. 14 OBJ: 3

DIF: Application REF: p. 15 OBJ: 3

DIF: Comprehension REF: p. 15 OBJ: 3

DIF: Comprehension REF: p. 15 OBJ: 3